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delirium and dementia Flashcards

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1
Q

8 aspects of cognition

A

-Attention
-Orientation
-Memory (short & long-term)
-Language
-Judgment
-Interpersonal relationships (social cognition, reading situation))
-Performing actions
-Problem solving

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2
Q

An acute (sudden onset) disturbance of cognition, manifested by short-term confusion, excitement, disorientation, and clouded consciousness. Reversible

A

delirium

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3
Q

what is hallucinations and delusions common in? Delirium or Dementia?

A

delirium

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4
Q

Progressive, irreversible decline in cognitive ability in the presence of clear consciousness

A

dementia

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5
Q

delirium diagnostic criteria

A

-a disturbance in attention or awareness
-Develops over a short period of time (hours to days) and fluctuates in severity over the course of the day
-An additional disturbance in cognition (memory deficit, disorientation, language, visuospatial ability or perception

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6
Q

direct consequence of anther medical condition (withdrawal, exposure to toxin)

A

delirium

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7
Q

delirium onset- head injury, seizure

A

rapid- hours

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8
Q

delirium onset- metabolic, systemic illness

A

slow- hours to days

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9
Q

Delirium assessment mnemonic: delirium

A

-Drugs
-Electrolyte imbalance
-Low O2 sats
-Infection
-Reduced sensory input
-Intracranial
-Urinary or renal retention
-Myocardial

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10
Q

delirium clinical findings

A

-Distractible, needing continual re-focusing
-Disorganized in thinking, reflected by alterations in speech
-Impaired reasoning and goal-directed behavior
-Disorientation to time and place
-Impairment of recent memory

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11
Q

delirium predisposing factors

A

-Low activity level
-Hx of falls
-visual/hearing impairment
-Dehydration
-Polypharmacy
-ETOH/drug abuse
-Hx of delirium
-Co-existing dementia/cognitive impairment

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12
Q

delirium precipitating factors

A

-Infections
-Hypoxia
-Fever or hypothermia
-Anemia
-Malnutrition
-Head trauma

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13
Q

delirium medical treatment

A

-Identify and treat underlying cause(s)
-Remain with pt for monitoring
-Treat psychosis with agitation and aggression with low dose antipsychotic (SGA). FGA associated with prolonged QT interval
-Treat substance induced delirium with benzodiazepine
-Treat sleep disturbances with melatonin or Rozerem (ramelteon)

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14
Q

delirium treatment goals

A

-Prevention (most common complication of all hospitalized patients!)
Monitoring
-Rapid assessment and identification
-Early intervention
-Injury prevention

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15
Q

diagnostic criteria: -Evidence of significant cognitive decline from a previous level performance in one or more cognitive domains: complex attention, executive function, learning, memory, language, perceptual-motor, or social cognition, based on:
-Concern that there has been significant decline in cognitive functions
-Substantial impairment in cognitive performance

A

neurocognitive disorder

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16
Q

neurocognitive disorder: mild or major?

-Modest cognitive decline
-Concern about the decline
-Impairment does not interfere with independence
-Do not occur in the context of a delirium
-Not better explained by MDD or schizophrenia

A

mild

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17
Q

neurocognitive disorder: mild or major?

-Significant cognitive decline
-Concern about the decline
-Deficits interfere with independence with daily activities
-Do not occur in the context of a delirium
-Not better explained by -MDD or schizophrenia

A

major

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18
Q

primary neurocognitive disorder

A

-alzheimers diseae
-Major sign of an organic brain disease, not directly related to any other organic illness

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19
Q

secondary neurocognitive disorder

A

Created by or related to another disease or condition such as HIV or a brain tumor

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20
Q

neurocognitive disorder clinical findings

A

-Impairment in abstract thinking, judgment, impulse control
-Behavior may be uninhibited and inappropriate
-Very rarely reversible
-Irritable, moody, outbursts
-Apraxia (inability to carry out motor functions)

21
Q

late signs of neurocognitive disorder

A

Chair or bed-bound
Very active hands, repetitive movements
Grunting
Depressed immune system functioning
Death caused by infection, sepsis, or aspiration

22
Q

most common neurocognitive disorder

A

alzheimers disease

23
Q

Alzheimers disease onset speed

A

slow, insidious

24
Q

alzheimers disease course

A

progressive and deteriorating

25
Q

alzheimers disease clinical findings: CT or MRI

A

Degenerative changes:
-Atrophy
-Widened cortical sulci
-Enlarged ventricles

26
Q

alzheimers disease clinical findings: microscopic examination

A

Neurofibrillary tau protein tangles
Amyloid beta plaques

27
Q

Alzheimer’s etiology: amyloid beta plaques

A

Plaques are formed when the amyloid beta peptides clump together and mix with other cellular matter

28
Q

alzheimer’s etiology: Tau protein tangles

A

Tangles are formed from a special kind of cellular protein called tau proteins
In alzheimer’s disease, the tau protein is chemically altered; the strands of protein become tangled together and interfere with neuronal transport

29
Q

-Secondary to Cardiovascular disease
-Fluctuating pattern of progression
-Related to interruption of vascular flow

A

vascular neurocognitive disorder

30
Q

onset of vascular neurocognitive disorder

A

more abrupt

31
Q

pattern of decline in vascular neurocognitive disorder

A

irregular

32
Q

Dementia accompanied by delirium, visual hallucinations, and parkinsonism

A

Lewy body dementia

33
Q

symptoms of Lewy body dementia

A

-Syncope
-Falls
-Sleep disorders
-Depression

34
Q

second most common form of dementia

A

Lewy body dementia

35
Q

Lewy body dementia progression speed

A

rapid

36
Q

is Lewy body dementia reversible?

A

yes

37
Q

Lewy body dementia: changes in daily routine

A

-Self-care
-Job responsibilities
-Work habits
-Managing finances

38
Q

Lewy body dementia: function assessment

A

-attention
-concentration

39
Q

Lewy body dementia physical assessment

A

-Neuro exam
-Diseases of other organ systems that may result in mental changes
-Muscle strength, reflexes
-Signs of abuse or neglect
-Screening for visual or hearing impairment
-MSE
-Gait

40
Q

Lewy body dementia testing

A

-CT
-MRI
-labs
-PET scan
-EEG
-vision & hearing evaluation

41
Q

labs for Lewy body dementia

A

-UA
-CMP
-LFTs
-serum creatinine
-TSH
-Folate
-B12

42
Q

neurocognitive disorder nursing diagnoses

A

-risk for trauma
-disturbed thought process
-impaired memory

43
Q

Neurocognitive Disorder: Medications

A

- aricept (donepezil)
-Namenda (Memantine)
-antipsychotics
-benzodiazepines

44
Q

what class is Aricept (donepezil)

A

cholinesterase inhibitor

45
Q

that class is Namenda (Memantine)

A

N-Methyl-D-Aspartate (NMDA) receptor antagonist

46
Q

what medication is given for all the dementias (early onset)

A

Aricept (Donezepil)

47
Q

what medication is given for moderate to severe impairment

A

nameda (Memantine)

48
Q

interventions

A

-Safe environment (well lit/free of glares)
-Wandering
-Prevent escalation of anger
-Simple activities
-Reorientation

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