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NUR 325 > E2 Delirium & Dementia > Flashcards

E2 Delirium & Dementia Flashcards

1
Q

Delirium also called

A

acute confusional state

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2
Q

Delirium

A

-Transient disorder of cognitive function, consciousness, or perception
-Can be sudden or gradual onset
-Hyperactive confusional state & Hypoactive confusional state

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3
Q

Hyperactive delirium

A

-Acute disturbance in attention or awareness
-Typically develops over 2-3 days
-Usually seen in ICUs, post-surgery, withdrawal, hospitalized elderly

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4
Q

Hyperactive delirium Risk Factors

A

-Medications
-Acute infection/ sepsis
-Surgery
-Hypoxia
-Electrolyte or metabolic disfunction
-Insomnia

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5
Q

Manifestations of hyperactive delirium

A

-Restlessness
-Irritability
-Difficulty concentrating
-Insomnia
-Tremulousness
-Poor appetite

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6
Q

Fully developed hyperactive delirium symptoms

A

-Hallucinations
-Person completely inattentive
-Grossly altered perception

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7
Q

Physical symptoms of hyperactive delirium

A

dilated pupils, increased HR, diaphoretic, increased temp

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8
Q

Fully developed hyperactive delirium can lead to

A

excited delirium syndrome (ExDS) can cause death
-More common in pts with mental illness or intoxication

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9
Q

Symptoms of excited delirium syndrome

A

combative, aggressive, cause pain, rapid breathing

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10
Q

Treatment of hyperactive delirium

A

-Remove risk factors
-Usually self-resolves in 2-3 days but can persist for weeks
-Try to help them sleep
-Try not to give meds that can alter perception
-Get them home ASAP

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11
Q

Hypoactive delirium is associated with

A

-Right-sided frontal basal-ganglion disruption (part of brain associated w/ coordinated movements & alertness)

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12
Q

Hypoactive delirium is most common in those with

A

Metabolic disorders
-Liver or kidney failure

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13
Q

Manifestations of hypoactive delirium

A

-Decreased alertness & attention span
-Decreased ability to perception and interpretation of the environment
-Forgetful
-Apathetic
-Slow speech
-Frequently falls asleep

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14
Q

What is the goal of the treating delirium?

A

Identify cause and remove causative agents, modify risk factors when possible

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15
Q

Individuals who have ____ at baseline have a MUCH higher risk of delirium

A

Dementia
But there are differences

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16
Q

Delirium can be _____

A

prevented

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17
Q

Define Dementia

A

-Acquired deterioration and progressive failure of cerebral functioning
-Umbrella term for Cognitive impairment
-Impaired intellectual processes: memory, language, judgement, decision making, orientation
-Some genetic-predisposition

18
Q

Some one may not be aware of dementia onset and may present as

A

agitated, wandering, aggression

19
Q

Pathophysiology of dementia

A

-Neuron degeneration
-Compression of brain tissue
-Atherosclerosis of cerebral vessels
-Brain trauma
-Infection
-Neuro-inflammation

20
Q

____ and ____ can cause dementia like qualities

A

HIV & Creutzfield-Jacob disease

21
Q

Onset of dementia

A

Generally slow, and symptoms are usually irreversible

22
Q

Treatment of Dementia

A

-No cure
-Treatment directed at restoring and optimizing functional capacity and accommodating with lost abilities

23
Q

________ is the leading cause of severe cognitive dysfunction in the elderly

A

Alzheimer’s Disease

24
Q

How many Americans have it and who is most likely to get it

A

6 million Americans
2/3 Women

25
Q

Cause of Alzheimers

A

Exact is unknown
-Genetic associations more common in early onset
-Sporadic late-onset AD is most common and does not have specific genetic association

26
Q

How is Alzheimers diagnosed

A

-Ruling out other conditions
-like vascular brain tumor or anything like that

27
Q

Risk factors for AD

A

-Being older than 65
-Family history
-Inheriting genes for the disease
-Existing mild cognitive impairment
-Down syndrome
-Unhealthy Lifestyle (drinking/smoking)
-Previous head trauma
-Isolation

28
Q

Pathophysiology of AD

A

Accumulation of neuritic plaques and intraneuronal neurofibrillary tangles of tau preotein
-Plaques disrupt nerve impulse transmission and kill neurons
-Loss of synapses and Acetylcholine
-Brain atrophy from loss of neurons

29
Q

What part of the brain does AD usually effect

A

Cerebral cortex and hippocampus

30
Q

When do pathophysiological changes of AD occur

A

Decades prior to symptoms
-Starts as mild short-term memory loss to total loss of cognitive and executive function

31
Q

Vascular Dementia

A

-2nd most common type of dementia
-related to cerebrovascular disease
-R/T large artery disease, cardioembolism, small vessel diesease, stroke
-Risk factors: DM, HPL, HTN, Smoking
-Treat: prevent risk factors

32
Q

Frontotemporal Dementia

A

-Rare
-AKA Picks Disease
-Familial association with age of onset less than 60
-R/T gene mutations of encoding tau protein
-No Treatment

33
Q

3 distinct clinical syndromes of Frontotemporal Dementia

A
  1. Behavioral Variant (change in personality & judgement
  2. Progressive non-fluent behavior (Prob with language & writing)
  3. Semantic dementia (problem forming words & sentences)
34
Q

MOA of Donepezil

A

Works centrally in the brain to increase levels of acetylcholine by inhibiting acetylcholinesterase

Mild to moderate AD

35
Q

Adverse Effects of Donepezil

A

Normally none to mild, resolve on own
-GI upset
-drowsy/dizzy
-Insomnia
-Muscle Cramping
-Bradycardia
-Reflex tachycardia
-Syncope

36
Q

When is Donepezil given?

A

PO at bedtime, best with food to minimize GI effects

Avoid NSAIDs to avoid GI upset

37
Q

MOA of memantine

A

Blocks the stimulation of NMDA receptors believed to be associated with AD

Moderate to severe AD

38
Q

Adverse effects of memantine

A

Uncommon
-Confusion
-Hypotension
-Headache
-Dizziness
-Constipation (take fiber)

39
Q

Memantine helps prevent neuronal damage bc it ______ in brain

A

decreases level of Ca2+

40
Q

Memantine is often given in conjunction with

A

Colon esterase

NUR 325 (21 decks)

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