Cognitive Process Flashcards
“the systematic way a person thinks, reasons, and uses language”
cognition
What does cognition require?
- consciousness
- thought
- memory
- learning
- language
What part of brain coordinates cognition?
Cerebral Cortex
3 things required for perception to occur?
- functioning sensory system
- neurotransmission
- processing
what is neurotransmission?
when receive stimuli and sensory receptors receive it, neural impulse is sent to brain to be interpreted
What are 3 types of sensory receptors?
extero, proprio, intero (receptors)
3 things about exteroreceptors?
- external
- vision, hearing, pain, and somatic receptors
- anything that responses to stimuli from external environment
3 things about proprioreceptors?
- position
- inner ear, muscles, tendons, joints
- relates to bodiesphysical state, position, sensation of movement
3 things about interoreceptors?
- internal
- viscera and deep tissue-reflex level (unaware- BP,O2)
- relates to change in internal environment
“state of awareness, responsiveness”
consciousness
“insight process of reasoning- take a stimuli and determine its meaning”
judgement
“ability to store and recall”
memory
“ones ability to understand”
comprehension
Language is based on ____ data
subjective
Newborn/infants do not have______developed and interpret through _________
Sensorimotor- speech not developed, interpreting through 5 senses and expressive through behavior
which age develops object permanence?
toddler-preschooler
which age is egocentric, develops concrete thinking and can say 200/understand 300 words?
toddler/preschooler
which age develops abstract thinking?
school age to adolescent
Are cognitive impairments considered normal part of aging?
nope
Factors affecting cognitive fxn?
Oxygenation**- most important Circulation Nutrition Fluid and Electrolyte Balance Medications Medical Environment
brain requires ___% of oxygen for functioning
20
What comes first in CPR?
CAB- circulation!
What mineral is needed for hemoglobin?
Iron
Low iron increases risk for what?
oxygen deficiency, anemia
____% of glucose is used by the brain
25
Which electrolyte has the biggest influence on water? why?
Na, can pass thru BBB Freely
most important electrolyte for changes in mental status?
Na
-low/high sodium = confusion
Which metabolic by-product affects cognition?
high ammonia
Metabolic by-products
-kidney or liver impairment
med to lower ammonia?
lactalose
Meds that effect cognition?
- Act directly on CNS- anti seizure, opioids, hypnotics
- Side Effect
- Toxicity- too much med/not clearing med properly
define delirium
ACUTE change in mentation, consciousness, or the ability to maintain attention.
is delirium preventable?
yep
2 things delirium increases
- mortality risk
- length of hospital stay
Can delirium cause long term cognitive impairment?
yep
Where does delirium most commonly occur?
icu
3 tyoes of delirium
- hyperactive
- hypoactive
- mixed
what is hyperactive delirium, how is it manifested?
patient is disruptive, jumping out of bed, inattention, calling out frequently
**easiest to assess
how is hypoactive delirium manifested?
most common, patient lying in bed sleepy/lethargic/uneasy to rouse
**Highest risk of mortality , most common, least diagnosed
which delirium is most common and has highest mortality risk?
hyoactive
What is mixed delirium?
hyperactivity + very sleepy, wax on/wax off
delirium risk factors
Medications (benzo)
Anesthesia
ICU on Ventilator
Stroke
Dementia
Respiratory Failure
Sepsis
Drug Abuse
Alcohol Abuse
Isolation
2 steps for assessing delirium?
- patients cognitive baseline must be determined
- Confusion Assessment MEdthod (CAM)
CAM assesses for:
onset, inattention, disorganized thinking, altered level of consciousness
is this acute change from baseline?
did patient experience inattention in conversation?
was patient disorganized in thinking?
Was patient anything other than alert?
Nursing Management of Delirium
Early ambulation
Limit restraint use
Promote adequate sleep
Frequent reorientation
Enhance sensory stimuli
do meds prevent delirium?
heck no
define dementia
Progressive impairment of intellectual function and memory.
Gradual Decline- not acute
Permanent
causes of dementia
trauma, circulation, genes, alteration in neurotransmitters, infection agents
dementia: Cerebral atrophy or shrinking of cortex =
Alzheimer Dementia
dementia: Inadequate blood flow due to plaques or arterial brain lesions =
Vascular dementia
which patients are at high risk for vascular dementia?
patients with strokes are at higher risk
dementia: Nerve cell loss and impairment of frontal and anterior temporal lobes
Frontotemporal Dementia
dementia: Clumps of protein causing neurodegeneration=
Lewy Body Dementia
parkinson’s dementia diagnosis?
If dementia occurs greater than 1 yr after Parkinson’s
symptoms of depression in elderly
Forgetfulness
Fatigue
Changes in behavior or mood
which of the 3 D’s does not have treatment?
Dementia
Which of 3 D’s has acute onset?
Delirium
What is Dysarthria?
-Impaired speech related to motor control, weakness, paralysis, or incoordination of the oral musculature
-Hearing not impacted
-Can write or select words appropriately
→ damage to peripheral or central nervous system might be cause
is hearing impacted with dysarthria?
nope
Primary cause of aphasia?
stroke
what is aphasia?
Complete or partial loss of language abilities.
what is expressive aphasia?
limited, unable to find right words they want to express
Anomia→ problems with word retrieval
which kind of aphasia has anomia?
expressive aphasia
what is anomia?
problem with word retrieval
what is receptive aphasia?
speech is articulated but they are having a hard time understanding what you are saying or what is written in front of them
what is global aphasia?
severe and extensive damage - can’t speak, read, write
expressive aphasia effects what part of brain?
broca or motor
Receptive aphasia effects what part of brain?
wernicke or sensory
What can the nurse use to assess alterations in cognitive function?
Mini-Mental Status Exam or Pfeiffer
Pfeiffer
10 questions
A correct response gets a 1
Score of 7 or less indicates cognitive impairment
on the Pfieiffer exam a score less then what indicates cognitive impairment?
7
First neurological signs of reduced oxygen?
confusion, lethargy, altered mental status
Electrolytes linked to cognitive impairment?
sodium, calcium
What would a problem with kidneys or liver show?
confusion, ammonia/urea build up, jaundice
What do you do if someone has trouble speaking or understanding and it is acute?
- mini mental status exam
- check O2
What do you do if someone has trouble speaking or understanding? (chronic)
- creating structure to day
- familiarity
- allowing time for rest breaks for self and patient
- gestures, communication board
What can you use to help orient the patient back to reality?
whiteboard, open blinds, who you are,
What would you NOT want to do with confused patient?
argue
What may help make a hospital less unfamiliar to a patient?
-decorate, personal items, continuity of care
Recommendations for individuals with progressive cognitive impairment
- family support
- day and respite care
- Socialization therapies
- Long term care
