Cognitive Disorders: Exam 3

Question 1

the brains ability to process, retain, and use information.

Answer 1

cognition

Question 2

a disruption or impairment in these higher-level functions of the brain

Answer 2

cognitive disorder

Question 3

previously categorized in DSM-5 as adult cognitive disorders that include: dementia, delirium, and amnestic disorders.

Answer 3

Neurocognitive disorders (NCDS)

Question 4

Reconceptualized in the DSM-5 as:

Answer 4

Delirium
Major NCD
Minor NCD
Subtype: dementia

Question 5

A consciousness disturbance with changes in cognition that develops over a short period of time. Once the medication wears off the client will begin to remember what happen and will question about what they have done. They may have sensory problems, the cause is usually treatable or self limiting. It can be something that is induced and or inhaled. (paint fumes, gas smell)

Answer 5

Delirium

Question 6

Predisposing factors include serious

Answer 6

medical, surgical, or neurological conditions

Question 7

Other etiological implications for delirium

Answer 7

Substance intoxication and withdrawal
Medication-induced delirium

Question 8

Progressive cognitive impairment. Multiple cognitive deficits.

Answer 8

Dementia

Question 9

Dementia: Initially memory, later the following may be seen:

Answer 9

Aphasia: deterioration of language function
Apraxia: impaired motor function despite intact mobile abilities
Agnosia: inability to recognize or name objects despite intact sensory ability
Disturbance in executive function: client loses the ability to think abstract. pain, initiate, sequence and monitor and stop complex behavior.

Question 10

What are the stages of dementia?

Answer 10

Mild
Moderate
Severe

Question 11

forgetfulness is the hallmark. It exceeds the normal, occasional forgetfulness experienced with aging

Answer 11

mild onset of dementia

Question 12

Confusion is apparent, along with progressive memory loss. The person can no longer perform tasks but remains oriented to person and place.

Answer 12

moderate dementia

Question 13

personality and emotional changes occur. The person may be delusional, wander at night, forget names of spouse and children, and requires assistance with ADLs

Answer 13

severe dementia

Question 14

What is the etiology of dementia?

Answer 14

Causes vary and at times no definitive diagnosis can be made until a postmortem exam is completed

Metabolic activity is decreased in the brains of clients with dementia

A genetic component has been identified in some: Huntingdon disease and Alzheimer disease (abnormal APOE gene)

Infections
-HIV
-Creutzfeldt-Jacob disease

Question 15

inherited disease dominate gene, primary involves cerebral atrophy (demyelination, enlargement of brain ventricles, facial contortions, twisting, turning, and tongue movement.

Answer 15

Huntingdon disease

Question 16

What are the common types of dementia?

Answer 16

Alzheimer disease
Lewy body dementia
Vascular dementia
Pick disease
Prion disease (Creutzfeldt-Jacob disease)
Dementia related to HIV infection
Parkinson disease

Question 17

What causes dementia?

Answer 17

Dementia due to traumatic brain injury & Huntington disease

Question 18

What are related disorders of dementia?

Answer 18

Substance or medication induced mild or major neurocognitive disorder

Korsakoff syndrome: long term alcohol use that results in dementia.

Previously known as amnestic disorder since amnesia and confabulation (make up stuff to fill in the gaps in their memory) are common

Question 19

Delirium vs. Dementia

Answer 19

Delirium:
Acute and fluctuating
Usually resolved by treating the underlying medical condition
Prognosis involves complete resolution of the impairments

Dementia:
Progressive
No treatments found to reverse, current therapies only temporarily slow the progress
Progressive deterioration until death

Question 20

What is the nursing process?

Answer 20

Assessment
Diagnosis
Planning
Implementation
Evaluation

Question 21

What is the assessment for Delirium?

Answer 21

History: obtain information related to:
Medical illness
Alcohol
Other drugs (prescribed, over-the-counter, illicit drugs)

General appearance and motor behavior:
Disturbed psychomotor behavior
Possible speech problems

Mood and affect
Rapid, unpredictable shifts

Thought process and content
May be fragmented

Sensorium and intellectual processes
Decreased awareness of environment

Judgment and insight
Impaired judgment

Roles and relationships
Inability to fulfill roles

Self-concept
Fear
Feel threatened

Physiological and self-care
Sleep problems
Fail to perceive internal body cues

Question 22

What is the nursing diagnosis for delirium?

Answer 22

Risk for injury (PRIORITY)
Altered thought process

Outcomes
The client will:
Be free from injury
Demonstrate increased orientation, reality contact
Return to optimal level of functioning

Question 23

What are the interventions for delirium?

Answer 23

Promote client safety

Manage confusion:
Face client while speaking
Phrase questions and directions in short simple sentences
Orienting cues
-Call client by name
-Refer to time of day
-Refer to expected activity

Promote sleep, proper nutrition

Provide supervision, the nurse should check clients at intervals, use frequent verbal orientations (help with the frightening experiences related to delirium) Make sure the information board is updated!

Question 24

What is the assessment for Dementia?

Answer 24

Mental status examination

History:
Clients may be unable to provide accurate and thorough history
Interviews with family, friends, or caregivers may be necessary; bc the patient may not be able to give history themselves

General appearance and motor behavior:
Aphasia
Apraxia
Uninhibited behavior: ex: sexually inappropriate behavior

Mood and affect:
Increasingly labile mood
Emotional outburst

Thought process and content
Impaired abstract thinking
Delusions of persecution: they feel like you as the nurse are torturing them

Sensorium and intellectual processes:
Loss of intellectual function
Memory deficits: recent memory is lost first, may not remember the days of the week, but can remember back to things when they were younger.
confabulation

Judgment and insight:
Poor judgment
Unrealistically appraise abilities: increases risk of falls

Self-concept:
Sadness: a lot of times dementia is mistaken as depression
Loss of self-awareness

Roles and relationships:
Profoundly affected

Physiological and self-care:
Disturbed sleep
Incontinence
Hygiene deficit

Question 25

What is the nursing diagnosis for dementia?

Answer 25

Risk for injury
Impaired memory
Disturbed sleep pattern

Outcomes
The client will:
Be free from injury
Respond positively to memory cues
Maintain an adequate balance of activity and rest

Deuteriation until they become decerebrate, complete deuteriation starting with their memory. Goal of treatment is to meet their needs at that current moment. Overall arching goal, you will have to learn how to meet their needs when they need their needs met.

Question 26

What are the interventions for dementia?

Answer 26

Safety
Protect against injury
Meet physiological needs
Managing risk posed by
Delusions
hallucinations

Sleep, proper nutrition, hygiene, activity
Help meet basic physiological needs
Monitor food and fluid intake
Monitor elimination patterns
Provide mild physical activity

At night when the sun goes down they become more agitated, keep them active during the day to wear them out, so they will sleep once nighttime hits. If you see one of these patients sleeping during the day u want to wake them up bc they get angry at night and you want them awake up all day so they will sleep once night hits.

Environmental
Encourage client to follow their usual routine
Monitor response to daily routines and adjust as necessary
Monitor and manage tolerance of stimulation

Emotional support
Provide empathetic caring
Convey reassurance
Use supportive touch (evaluate each client’s response)

There is no cure for dementia, these meds don’t treat dementia, but they slow down the aggressive decline. The meds wont make it better, you wont see improvement, but you will see there is a slow down the disease. May want to use finger foods, because the client may be at the point they cannot use utensils. What they may be able to do this week, they may not be able to do next week due to the decline. Create that bridge to reality, it cannot be created, it will cause the dementia patient to become agitated with you for doing that.

Interaction and involvement
Provide a wide variety of activities such as
Music
Dancing
Pet therapy

Plan activities that
Reinforce the client’s identity
Engages them in the business of living

Tailor activities to the client’s interests and abilities
Avoid routine group activities

Clients often need the involvement of another person to:
Sustain attention in the activity
Enjoy it more fully

Question 27

What are the risk factors for dementia?

Answer 27

elevated levels of plasma homocysteine

Question 28

Measures to decrease risk for Alzheimer disease

Answer 28

Folate, vitamin B12 and betaine reduce plasma homocysteine
Regular participation in brain-stimulating activities
Leisure-time physical activity
Large social network

Question 29

Meeting the Needs of the Caregiver

Answer 29

Role of caregiver
Mostly women
Adult daughters
Wives

Needs of caregiver
Education about dementia
Assistance in dealing with own feelings of loss
Respite to care for own needs
Support groups
Assistance from agencies
Support to maintain personal life

Question 30

What are the common signs for care-giving burnout?

Answer 30

easily flustered or frustrated
extremely tired
Uninterested in things they use to enjoy
forgetful or foggy
quick to anger
anxious or depressed
hopeless or helpless