Exam 2 Flashcards
What is Delirium
-rapid onset (within 24 hours)
-reversible
-altered level of consciousness
- could be a medical emergency
What could cause delirium?
-Coexisting factors
-Side effects for medication
-Circulatory disturbances
-dehydration
-Malnutrition
-Hyper/hypo tension
-Hyper/hypo glycemia
-Infection
-Surgery
-Stress
-Alcohol/drugs
What are some things that can happen with delirium?
-Short term memory loss
-Long term memory loss
-Inattentive
-Disoriented
-Confused
-Distorted thinking
-Incoherent speech
How do you treat delirium
-treatment depends on what is causing delirium. It is important to understand what the underlying causes and treat that.
-interventions to take during the acute stage include
-Consistency
-Minimize stimulation
-establish medical stability
-Prevent harm to self and others
-Provide support
-Set realistic expectations
What is Dementia?
-permanent
-progressive disorder
-chronic
-impaired cognitive function
What are some things that can happen with dementia ?
-memory loss
-disoriented
-altered reasoning
-lack of attention
-language
-problem solving
What are causes of dementia
Damage or injury to brain, could have several different causes.
Several types of diseases that fall under dementia.
-degenerative disease
-circulatory problems
-lack of oxygen
-infection
-trauma
-hydrocephalus
-tumor
-alcoholism
How to treat dementia?
Medication to help treat symptoms
Nursing interventions of Dementia
-consistent and structured environment
-Items that trigger memory
-Controlled environment
-be aware of wandering behavior risk
-Prevent abuse from caregivers
-Note that there are problems related to poor judgment and misperceptions
-Promote therapy and activity (occupational and expressive therapy, ferry and reality, orientation, touch, modified communication techniques)
-Physical care (monitor, eating, drinking invading, consider in ability to)
-promote respect (individuality, independence, freedom, dignity, connection)
What is the most common form of dementia?
Alzheimer’s disease
What is the main medication used for alzheimers disease?
Aricept
What is happening in the brain in Alzheimer’s?
 Characterized by two changes in the brain
1) presence of neuritic plaques *found in Alzheimer’s and Down syndrome
2) neurofibrillary tangles in cortex
-there is also a loss of degeneration of neurons and synapses and a change in neurotransmitter system.
What are causes of Alzheimer’s?
-genetics
-Environment (crop spray, minors)
-Chromosomal abnormalities (autism)
-Free radical (radiation, mercury)
-Slow acting viruses (Covid)
How does Alzheimer’s present itself in different people?
-Develop gradually and progress at different rates among different people
What are the Staging Mechanisms used for Alzheimer’s?
Staging via GDS/FAST
-GDS = condition global deterioration scale
-FAST= function assessments staging
What stage of Alzheimer’s is the suicidal rate the highest?
The beginning stage where the individual is still wear these changes are happening and they can’t stop it
Vascular Dementia
-small cerebral infractions
-cause: stroke
-rapid w/ quick progression
Frontotemporal Dementia
-neuronal atrophy affecting front lobes
-blows to the head
-wrestlers, football players, etc
Lewy Body dementia
-Subcortical pathology with Lewy body substance in cerebral cortex
-caused by protein deposits in nerve cells
-robin Williams
Creutzfeldt Jakob disease
-Rare
-death within 1 year of diagnosis
-deconstruction of neurons in cerebral cortex and overgrowth if glia
Wernickle encephalopathy
degenerative brain disorder caused by the lack of vitamin B1. It may result from: Alcohol abuse. Dietary deficiencies, Prolonged vomiting, chemo or eating disorders
-Bruce Willis
Parkinson’s disease
-unintended or uncontrollable movements
-causes: genetics, toxins, Lewy bodies
-S/S: shaking, stiffness, bradykinesia, speech problems
-Muhammad Ali, ozzy, michal J fox
AIDS
-could lead to dementia
-trauma / toxins
-Ab Lincoln, Nixon
What is a CAM therapies used to treat dementia
CAM = complementary and alternative therapies
Vitamins: B6, B12, C, E, folic acid, zinc selenium
Minerals
Herbs (ginkgo Biloba)
Theraoeutic: Thai chi
Safe environment practices for Alzheimer’s?
-bed rails
-remove tripping haze adds
-close to nurses station
-good lighting
-memory items
-monitor eating / drinking
-monitor social needs
Therapeutic communication with client who is in denial of substance abuse
They must acknowledge they have a problem
What happens to caloric needs as people age
They’re caloric needs decrease, meaning they need less calories
Dysphasia
Difficulty swallowing
Transfer dysphasia
Difficulty moving (transferring) food from the mouth to the esophagus
Transport dysphasia
Difficulty with food going down (transporting) the esophagus
Delivery dysphasia
Problems with getting food from the esophagus to the stomach (being delivered)
Understand how nutritional supplements play a role in healthcare
It is important to use caution regarding vitamins, minerals, herbs, particularly in high doses… They can produce adverse effects and interact with current medication
What can too much vitamin D cause?
Calcium deposits in the kidneys and arteries
What can too much vitamin K (potassium) lead to?
Blood clots, Arrhythmias, cardiac arrest
What can too much Folic acid lead to?
Masking of vitamin B 12 deficiency, which causes dementia
What can too much calcium lead to?
-Renal calculi (kidney stones) and increased risk of cancer, as well as, imparted ability to absorb other minerals
*no more than 500mg of calcium supplements should be taken at a time.
*minimum of 1500 mg of calcium in daily diet for men and women (not taking estrogen -only 1000 for women taking estrogen)
Why is constipation More common in older adults?
-Due to slower peristalsis (constriction and relaxation of muscles in intestine)
-inactivity
-side effects of medications
-less fiber and fluid in diet
What to do FIRST when transferring client from bed to chair
Make sure they can bear weight
Anorexia Nervosa: bone density?
Much lower due to malnutrition
What is BUN level used for?
Assessing dehydration.
BUN = blood Uria nitrogen
Normal BUN level = 6-24;
BUN levels increase with dehydration = 35
What to do first when transferring a client from the bed to wheelchair
Make sure wheelchair and bed are locked
What question do you need to ask with insomnia
Do you fall asleep while driving?
What is insomnia?
Inability to fall asleep, stay asleep, or has premature waking
What is nocturnal myoclonus ?
Condition characterized by at least 5 leg jerks or movements PER HOUR during sleep
Associated with the use of tricyclic antidepressants and chronic renal failure
What is restless leg syndrome?
Neurological disorder characterized by an uncontrollable urge to move legs when one lies down
Let’s can be: uncomfortable, electrical, itching, pins and needle, pulling, creepy crawling, painful
What is sleep apnea?
A disorder in which at least 5 episodes of cessation of breathing lasting at least 10 seconds occur per hour of sleep
Accompanied by daytime sleepiness
What is sleep latency
A delay in the onset of sleep
What is the correlation between calcium and people with emphysema or difficult mobility?
The calcium in the body will increase
Breakdown of bone tissue, so extra calcium goes into the body
Why do elderly people sleep less soundly?
They spend more time in stage 1 & 2. Decline in proportion of time spent in the deeper stages 3 & 4
What are causes of insomnia?
Physical or mental illness
Environmental factors
Substance abuse
Medication
*alcohol does NOT help (no wine)
Causes for restless leg syndrome
-iron deficiency anemia
-Uremia
-Parkinson’s disease
-rheumatoid arthritis
-Diabetes
-Neurological lesions
Alterations and dopamine an iron metabolism 
-anti-depressants anti-histamines, antipsychotics alcohol and hypoglycemia can also contribute
Some ways to relive restless leg syndrome
-moving legs
-Drinking water
-Massage
-Applying heat or cold 
What are causes of sleep apnea?
-Defect in the central nervous system that affects the diaphragm
-A blockage in the upper airway that interferes with normal airflow (obstruction sleep apnea)
-Combination of both
What health conditions can affect to sleep?
Chronic conditions can interfere with sleep by producing symptoms such as nocturia, incontinence, pain, orthopnea, apnea, muscle cramps, and tremors
Cardiovascular conditions can produce nocturnal cardiac ischemia which interfere with sleep due to Dyspnea and transient angina
Diabetes due to blood glucose levels
Gastric pain and reflux
Conditions that cause someone to cough and have difficulty breathing
Muscle skeleton conditions can cause pain
Dementia has minimal stage 2 sleep or REM and no longer stage 4.
What types of medications affect sleep
-anticholinergics
-Antidepressants
-Antihypertensive
-Benzodizaoines
-beta blockers
-diuretics
-leovdopa
-steroids
-theophylline
-thyroid preparations
Hypnotics interfere with Ren and deep sleep stages and can cause daytime drowsiness

What specific drug examples affect sleep?
-Diphenhydramine HCI (Benadryl capsules)
-Nocotine (NicoDerm nicotine transdermal system)
-Fluoxetine HCI (Prozac)
-Theophylline (Theo-x Extended Release tablets)
-alprazolam (Xanax)
***many have diphenhydramine (Benadryl) as a primary ingredient
What do you do if a patient starts to fall?
Slide them down your leg and assist them to the floor