Dementia / Delerium / Depression

Question 1

Dementia:

1. Onset
2. Course
3. Progression
4. Duration

Answer 1

1. Insidious
2. Slowly progressive
3. Slowly Progressive
4. months to years

Question 2

Delerium:

1. onset
2. course
3. progression
4. duration

Answer 2

1. acute
2. fluctuates
3. fluctuates
4. days to weeks

Question 3

Depression:

1. onset
2. course
3. progression
4. duration

Answer 3

1. variable
2. diurnal variation (worse in the morning)
3. variable
4. variable

Question 4

What is dementia?

Answer 4

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

Question 5

Dementia can be:

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

What would this be due to?

Answer 5

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

Question 6

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

Can there be a mix between these two forms?

Answer 6

Alzheimers
Vascular

Yes there can be a mix

Question 7

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

Answer 7

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

Question 8

Define:

1. Receptive aphasia:

2. Expressive aphasia:

Answer 8

1. Inability to understand speech

2. Inability to express themselves verbally

Question 9

Who is at risk for dementia?

1. Unmodifiable:
2. Modifiable:

Answer 9

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!

Question 10

Is dementia a normal proccess of aging?

Answer 10

NO!

Question 11

How can Dementia be identified / diagnosed? (7)

Answer 11

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

Question 12

What does the neurological evaluation include? (3)

Answer 12

1. Glasgow coma scale
2. PERLA
3. Cranial nerves

Question 13

What is a CT Scan / MRI scan looking for?

Answer 13

Brain tumor, stroke, cortex atrophy

Question 14

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

Answer 14

Yes… autopsy

Question 15

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

Answer 15

1. MIni Mental Status Exam (MMSE)

2. Montreal Cognitive Assessment (MOCA)

Question 16

What is MMSE testing for?

Answer 16

Tests memory, orientation, arithmetic.

Question 17

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

Answer 17

More sensitive

Question 18

What can be done for a patient with dementia?

Answer 18

1. Referal to Gerontology

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

Question 19

What is the role of:

1. The Ot:
2. The PT:
3. Dietician
4. Liasion

Answer 19

1. Assess ADLS
2. Assess mobility
3. Assess nutrition status / preferances
4. discussion between hospital and the location where they are awaiting placement

Question 20

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

Answer 20

Acetylcholinesterase Inhibitors

Aricept

Question 21

What do Acetylcholinesterase Inhibitors do?

Answer 21

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

Question 22

What is Acetylcholine? What is it responsible for?

Answer 22

Neurotransmitter. Responsible for learning and memory

Question 23

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?

Answer 23

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

Question 24

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

Answer 24

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

Question 25

How should you talk to a pateint with demetnia? How should you relate to their spiritual needs?

Answer 25

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

Question 26

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

Answer 26

- Poor functional outcomes, higher institutionalization rates, increased risk of cognitive decline, higher mortality rates within following year

Question 27

# Define Delerium: Is this preventable? Is this treatable?

Answer 27

An acute confusional state Often preventable. Usually treatable

Question 28

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

Answer 28

Hyperactive-hyperalert: restless, agitated, aggressive, psychotic (delusions, hallucinations) Hypoactive-hypoalert: lethargic, drowsy, sluggish, quiet and confused

Question 29

Who is at risk for Delerium?

Answer 29

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

Question 30

What are some of the common causes of delerium?

Answer 30

Alochol, Opioids, Pneumonia, UTI, Stroke, CHI

Question 31

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

Answer 31

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

Question 32

The Mnemonic for precipitating factors of Delerium: ``` D E L I R I U M ```

Answer 32

``` Drugs Enviornment/eyes/ears Low Oxygen Infection Retention Irritation Underhydrated/ nourished Metabolic Stroke/shock/subdural ```

Question 33

How can you identify delerium? Would you expect to see the sings fluctuating?

Answer 33

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

Question 34

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?

Answer 34

Yes

Question 35

What can be done for a patient who is delerious?

Answer 35

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