Cognitive Disorders: Exam 3 Flashcards

1
Q

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

A

cognition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

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

A

cognitive disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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

A

Neurocognitive disorders (NCDS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Reconceptualized in the DSM-5 as:

A

Delirium
Major NCD
Minor NCD
Subtype: dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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)

A

Delirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Predisposing factors include serious

A

medical, surgical, or neurological conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Other etiological implications for delirium

A

Substance intoxication and withdrawal
Medication-induced delirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Progressive cognitive impairment. Multiple cognitive deficits.

A

Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

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

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the stages of dementia?

A

Mild
Moderate
Severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

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

A

mild onset of dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

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

A

moderate dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

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

A

severe dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the etiology of dementia?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

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

A

Huntingdon disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the common types of dementia?

A

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

17
Q

What causes dementia?

A

Dementia due to traumatic brain injury & Huntington disease

18
Q

What are related disorders of dementia?

A

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

19
Q

Delirium vs. Dementia

A

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

20
Q

What is the nursing process?

A

Assessment
Diagnosis
Planning
Implementation
Evaluation

21
Q

What is the assessment for Delirium?

A

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

22
Q

What is the nursing diagnosis for delirium?

A

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

23
Q

What are the interventions for delirium?

A

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!

24
Q

What is the assessment for Dementia?

A

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

25
What is the nursing diagnosis for dementia?
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.*
26
What are the interventions for dementia?
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
27
What are the risk factors for dementia?
elevated levels of plasma homocysteine
28
Measures to decrease risk for Alzheimer disease
Folate, vitamin B12 and betaine reduce plasma homocysteine Regular participation in brain-stimulating activities Leisure-time physical activity Large social network
29
Meeting the Needs of the Caregiver
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
30
What are the common signs for care-giving burnout?
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