elderly Flashcards
Identify the three common cognitive disorders among the elderly. (3D)
i. Delirium (Acute Confusional State)
ii. Dementia
iii. Depression
Describe the clinical presentations of delirium (3 disturbances + 2 other stuff)
- Acute onset AND Fluctuating consciousness
- impaired attention
- perceptual disturbance
- sleep-wake cycle disturbance (wake up at odd hours)
- psychomotor disturbance
can also test using The Confusion Assessment
Method (CAM) Diagnostic
Algorithm
Feature 1: Acute onset and fluctuating course
Feature 2: Inattention
Feature 3: Disorganized thinking
Feature 4: Altered level of consciousness
* present/abnormal rating for features 1 AND 2 and also for either feature 3 OR 4.
Describe the BPSD of dementia +10 warning signs
BEHAVIORAL
Aggression
Wandering
Sleep disturbances
Inappropriate eating
behavior
Constant questioning
Shadowing
Negativism
PSYCHOLOGICAL
Hallucinations
Delusions
Depression
Apathy
Anxiety
Misidentifications
10 warning signs of dementia
1. Recent memory loss that affects job skills
2. Misplacing things
3. Problems with language
4. Poor or decreased judgment
5. Problems with abstract thinking
6. Difficulty performing familiar tasks
7. Disorientation with time and place
8. Changes in mood or behavior
9. Changes in personality
10. Loss of initiative
Describe the clinical presentations of depression
Atypical presentation:
- difficulty with concentration
* Pseudodementia (‘like dementia’)
- worries about health
- Preoccupation with health concerns or multiple vague physical complaints
- Signal or cry for help
Discuss the management of delirium
Admission
Diagnostic tests (Identify treatable and reversible causes)
Appropriate specific treatment
Good supportive care (hydration, nutrition, avoidance of restrainers & bedsore prevention, bladder & bowel care &
speedier recovery)
Quiet environment with good lighting & warm, friendly &
reassuring staff
Sedatives to be used with caution
Discuss the management of dementia
- Identify any reversible causes of dementia
- Exclude delirium and unmet needs
- Identify and quantify common psychiatric
syndromes - Identify target symptoms
- Assess need for treatment
- Non-pharmacological strategies:
Cognitive retraining
Reminiscence therapy
Life review
Art therapy
Music therapy
Aromatherapy
Pet therapy
Physiotherapy (physical
exercise) - Pharmacological treatments:
Disease modifying agents - Acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine)
*Common side effects: nausea, vomiting, agitation,
giddiness, bradycardia - NMDA antagonist (memantine)
*Common side effects: giddiness, nausea, vomiting
Other psychotropic medications
1. Antipsychotics (risperidone, quetiapine, olanzapine,
haloperidol)
*common side-effects: anticholinergic effects,
extrapyramidal side-effects
2. Antidepressants (fluvoxamine, escitalopram, mirtazapine)
*Common side-effects: anticholinergic effects,
hypotension
3. Mood stabilizers (sodium valporate)
*Thrombocytopenia, bleeding tendencies
4. Benzodiazepines (lorazepam, clonazepam)
*Hypotension, sedation
Discuss the management of depression
Antidepressants
- Newer generations (SSRIs) used as first line * safer if overdosed
* fewer anticholinergic side effects
* E.g. fluoxetin, fluoxamine, escitalopram, sertraline
-Tricyclic antidepressants
*E.g. imipramine, amitriptyline, nortriptyline
- MAO inhibitors
- E.g. phenelzine, trancylopramine
- Response ~80%
Other psychotropic agents
- Benzodiazepines
E.g. lorazepam, clonazepam
- Antipsychotics
E.g. risperidone, quetiapine, olanzepine
- mood stabilizers
E.g. sodium valproate, lithium
Psychotherapy (Talk therapy/Counseling)
- Dealing with relationship difficulties
- Problem solving
- Change negative thinking
- Acceptance
ECT
- Severely suicidal
- Refusal to eat or drink
- Unable to tolerate side-effects of medications
The nurse is talking with a woman who is worried that her mother has
Alzheimer disease. The nurse knows that the first sign of dementia is
a. disorientation to person, place, or time.
b. memory loss that is more than ordinary forgetfulness.
c. inability to perform self-care tasks without assistance.
d. variable with different people.
b
The nurse has been teaching a caregiver about donepezil (Aricept). The
nurse knows that teaching has been effective when the caregiver makes
which statement?
a. “Let’s hope this medication will stop the Alzheimer disease from
progressing any further.”
b. “It is important to take this medication on an empty stomach.”
c. “I’ll be eager to see if this medication makes any improvement in
concentration.”
d. “This medication will slow the progress of Alzheimer disease
temporarily.”
d
When teaching a client about memantine (Namenda), the nurse will include which information?
a. Lab tests to monitor the client’s liver function are needed.
b. Namenda can cause elevated blood pressure.
c. Taking Namenda will improve the client’s cognitive functioning.
d. The most common side effect of Namenda is gastrointestinal
bleeding.
b
Which statement by the caregiver of a client newly diagnosed with
dementia requires further intervention by the nurse?
a. “I will remind Mother of things she has forgotten.”
b. “I will keep Mother busy with favorite activities as long as she can participate.”
c. “I will try to find new and different things to do every day.”
d. “I will encourage Mother to talk about her friends and family.”
c
A client with delirium is attempting to remove the IV tubing from his
arm, saying to the nurse, “Get off me! Go away!” What is the client
experiencing?
a. Delusions
b. Hallucinations
c. Illusions
d. Disorientation
b
Which statement indicates the caregiver’s accurate knowledge about the needs of a parent at the onset of the moderate stage of dementia?
a. “I need to give my parent a bath at the same time every day.”
b. “I need to postpone any vacations for 5 years.”
c. “I need to spend time with my parent doing things we both enjoy.”
d. “I need to stay with my parent 24 hours a day for supervision.”
c
Which of the following interventions is most appropriate in helping a client with early-stage dementia complete ADLs?
a. Allow enough time for the client to complete ADLs as independently as possible.
b. Provide the client with a written list of all the steps needed to
complete ADLs.
c. Plan to provide step-by-step prompting to complete the ADLs.
d. Tell the client to finish ADLs before breakfast or the nursing
assistant will do them.
a
A client with late moderate-stage dementia has been admitted to a
long-term care facility. Which nursing intervention will help the client maintain optimal cognitive function?
a. Discuss pictures of children and grandchildren with the client.
b. Do word games or crossword puzzles with the client.
c. Provide the client with a written list of daily activities.
d. Watch and discuss the evening news with the client.
a
