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Nursing 232 Post Midterm > Dementia / Delerium / Depression > Flashcards

Dementia / Delerium / Depression Flashcards

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1
Q

Dementia:

  1. Onset
  2. Course
  3. Progression
  4. Duration
A
  1. Insidious
  2. Slowly progressive
  3. Slowly Progressive
  4. months to years
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2
Q

Delerium:

  1. onset
  2. course
  3. progression
  4. duration
A
  1. acute
  2. fluctuates
  3. fluctuates
  4. days to weeks
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3
Q

Depression:

  1. onset
  2. course
  3. progression
  4. duration
A
  1. variable
  2. diurnal variation (worse in the morning)
  3. variable
  4. variable
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4
Q

What is dementia?

A

Loss of ordered neural function (loss of cognition, memory, language)

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5
Q

Dementia can be:

  1. Static or Fixed
  2. Slowly Progressive
  3. Rapidly Progressive

What would this be due to?

A
  1. trauma
  2. Different forms such as alzheimers disease, vascular dementia, dementia with lewy bodies
  3. Different forms such as alzheimers disease, vascular dementia, dementia with lewy bodies
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6
Q

What is the most common form of dementia?
What is the second most common?

Can there be a mix between these two forms?

A

Alzheimers
Vascular

Yes there can be a mix

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7
Q

What are some of the symptoms of dementia? (10)

A
  1. Memory loss
  2. Inability to learn new info
  3. Personality changes
  4. Incontience
  5. Inability to reason
  6. Aggression
  7. Inapproproiate behaviour
  8. paranoia
  9. agitation
  10. Difficulty communicatin
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8
Q

Define:

  1. Receptive aphasia:

2. Expressive aphasia:

A
  1. Inability to understand speech

2. Inability to express themselves verbally

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9
Q

Who is at risk for dementia?

  1. Unmodifiable:
  2. Modifiable:
A
  1. Age, family history, female
  2. HTN, hyperlipiedmia, High LDL Cholesterol, Type 2 Diabetese, Atherosclerosis, increased homocystiene levels (d/t eating meat), smoking, protect yo dang head!
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10
Q

Is dementia a normal proccess of aging?

A

NO!

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11
Q

How can Dementia be identified / diagnosed? (7)

A
  1. Medical history / physical exam
  2. Labs & diagnostis to rule out treatable causes
  3. Neurological Evaluation
  4. CT Scan
  5. MRI
  6. Neuropyschological Tests
  7. Cognitive Assessment for positive Diagnosis
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12
Q

What does the neurological evaluation include? (3)

A
  1. Glasgow coma scale
  2. PERLA
  3. Cranial nerves
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13
Q

What is a CT Scan / MRI scan looking for?

A

Brain tumor, stroke, cortex atrophy

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14
Q

Is there a defenitive diagnosis to see the placques and tangles in alzherimers disease?

A

Yes… autopsy

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15
Q

What are the two cognitive assessment tools that are used for Diagnosis / monitoring of progression of Dementia?

A
  1. MIni Mental Status Exam (MMSE)

2. Montreal Cognitive Assessment (MOCA)

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16
Q

What is MMSE testing for?

A

Tests memory, orientation, arithmetic.

17
Q

What is MOCA testing for? Is it less or more sensitive than MMSE?

A

More sensitive

18
Q

What can be done for a patient with dementia?

A
  1. Referal to Gerontology

2. Interdisciplinary Team Approach (involves OT, PT, dietician, liason)

19
Q

What is the role of:

  1. The Ot:
  2. The PT:
  3. Dietician
  4. Liasion
A
  1. Assess ADLS
  2. Assess mobility
  3. Assess nutrition status / preferances
  4. discussion between hospital and the location where they are awaiting placement
20
Q

What does the pharmacology include for Dementia? What is an example of what this is called?

A

Acetylcholinesterase Inhibitors

Aricept

21
Q

What do Acetylcholinesterase Inhibitors do?

A

Block the degradation of ACH (already low in a patient with Alzheimers disease, therefore if less is being degraded you have more left), this means there is an increase of ACH

22
Q

What is Acetylcholine? What is it responsible for?

A

Neurotransmitter. Responsible for learning and memory

23
Q
  1. Is Acetylcholineresterase inhibitor effective at eradicating demtnia?
  2. Does this work for severe cases?
  3. Are the effects good?
  4. What is the maximum way of having this medication work?
A
  1. No, you can not eradicate it
  2. It works on mild- moderate cases to slow the progression
  3. The effects are modest at best
  4. Works best with early detection of the disease
24
Q

What are other ways that patient with dementia could be helped outside of pharmacologic treatment?

A

Bio-Psycho-Socio-Spritual Approach:

Consider that the patient has their glasses, hearing aids, dentures, monitor for nutrition, rest, activity, bowel/bladder management.

Keep the social routine consistent and simple, pet and music therapy are useful, reinforce communcation with others (do not isolate the patient), minimize environmental distraction

25
Q

How should you talk to a pateint with demetnia?

How should you relate to their spiritual needs?

A

Slowly and clearly, use a lot of expression and smiles to promote that you are a safe environment for them to talk to, distract the patient from their hallucinations

Support their conection

26
Q

The patients who survive delerium will have a poor prognosis in what?

A
  • Poor functional outcomes, higher institutionalization rates, increased risk of cognitive decline, higher mortality rates within following year
27
Q

Define Delerium:

Is this preventable? Is this treatable?

A

An acute confusional state

Often preventable. Usually treatable

28
Q

Presentations of delerium can inclue hyperactive hyperalert and hypoactive hypoalert, or a mixture of both. Explain what each of these means?

A

Hyperactive-hyperalert: restless, agitated, aggressive, psychotic (delusions, hallucinations)

Hypoactive-hypoalert: lethargic, drowsy, sluggish, quiet and confused

29
Q

Who is at risk for Delerium?

A

Advanced age, male, cognitivie impairment, polypharmacy, vision and or hearing impairments, limited activity levels

30
Q

What are some of the common causes of delerium?

A

Alochol, Opioids, Pneumonia, UTI, Stroke, CHI

31
Q

Some medications are more high risk to cause delerium. What does this mean?

A

Nurse should be aware if the patient is on one of the meds that they are at higher risk of becoming delerious

32
Q

The Mnemonic for precipitating factors of Delerium:

D
E
L
I
R
I
U
M
A 
Drugs
Enviornment/eyes/ears
Low Oxygen
Infection
Retention
Irritation
Underhydrated/ nourished
Metabolic
Stroke/shock/subdural
33
Q

How can you identify delerium?

Would you expect to see the sings fluctuating?

A

Acute onset in disturbance of consciousness (reduced clarity or awareness of the enviornment)
Acute change in cognition (memory deficit, disorientation, language disturbance)

Yes, you would expect to see the patient fluctating

34
Q

The Assessment for Delerium is the Confussion Assessment Model. A patient is considered for positive delerium if they have both features A and B pesent (acute onset/fluctuating courrse and inanttention) AND one of either c or d.

If a patient has this, are they + for delerium?

A

Yes

35
Q

What can be done for a patient who is delerious?

A
  1. Discontinue inappropriate meds
  2. Detect early
  3. Early mobilization
  4. Ensure hydrating
  5. Ensure adequate nutrition
  6. Minimize use of restraints
  7. Regulate bowel/bladder function
  8. Reorientation activies
  9. Use of sensory aids (glasses, hearing aids)
  10. Ensuring normal sleep patterns
  11. Pain control

Nursing 232 Post Midterm (10 decks)

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