Exam 3 Flashcards

1
Q

Delirium (causes)

A

Acute, rapid, reversible
Metabolic or UTI can take longer to treat

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2
Q

Delirium s/sx

A

Difficulty sustaining attention, distractibility, disorganized thinking, rambling, incoherent speech, disoriented to time and place, recent memory impairment, agitation/restlessness, emotional instability, tachycardia, sweating, dilated pupils, flushed face

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3
Q

Delirium risk factors

A

General medical condition - head trauma, seizures
Metabolic disorder
Substance induced - drugs/toxins

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4
Q

Alzheimer’s stages

A

Stage 1: No symptoms
Stage 2: Forgetfulness
Stage 3: Mild cognitive decline; gets lost, difficulty concentrating, planning, organizing, pt will try to hide symptoms
Stage 4: Mild to moderate cognitive decline; trouble with finances, traveling alone, trouble remembering recent events, denial of symptoms, withdrawal from family and friends
Stage 5: Moderate cognitive decline; trouble with address/phone number, time of day, forgetting major events, assistance needed for daily activities
Schedules and structure to orient pt
Stage 6: Moderate to severe cognitive decline; extensive assistance, forgetting family members, incontinence, sensory alterations
Stage 7: Severe cognitive decline; don’t recognize family members, inability to speak, serious decline in ADL’s and movement, loss of motor skills/walking

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5
Q

Predisposing factors for dementia/AD

A

Hypothyroidism, hyperparathyroidism, pituitary insufficiency, uremia, encephalitis, brain tumor, pernicious anemia, thiamine deficiency, MS, pellagra, uncontrolled epilepsy, cardiopulmonary insufficiency, fluid and electrolyte imbalances, CNS and systemic infections, systemic lupus erythematosus

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6
Q

Types of NCD (neurocognitive disorder)

A

Vascular
Frontotemporal
TBI
Lewy body disease
Parkinson’s
HIV infection
Huntington’s disease

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7
Q

Vascular NCD

A

Stroke patients, result of death of nerve cells, confusion, risk of injury, abrupt onset, smoking increases risk

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8
Q

Frontotemporal NCD

A

Shrinking of frontal and temporal lobes, cause is unknown
- genetics may play a role, behavioral and personality changes, speech/language difficulty

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9
Q

TBI NCD

A

Amnesia is common, repeated head trauma - dementia pugilistica, emotional lability, ataxia, impulsivity

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10
Q

Lewy body disease

A

Similar to Alzheimer’s, progresses more rapidly, early appearance of visual hallucinations and Parkinsonian features, progressive, irreversible, 25% of all NCD

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11
Q

Parkinson’s disease

A

Caused by loss of nerve cells in substantia nigra and decrease in dopamine activity
tx: Levodopa

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12
Q

HIV infection

A

Caused by brain infection or HIV virus, early stages not noticeable, progresses to cognitive decline

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13
Q

Huntington’s disease

A

Genetic, dx in adulthood, damage in basal ganglia and cerebral cortex, profound dementia and ataxia

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14
Q

Nursing dx for NCD

A

Risk for trauma
Impaired verbal communication
Disturbed sensory perception
Risk for other-directed violence
Impaired memory
Self-care deficit
Compromised or disabled family coping
Disturbed thought processes

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15
Q

Cholinesterase inhibitors (examples and MOA)

A

Aricept (donepezil), Namenda (memantine)
- delays destruction of acetylcholine, can delay progression in early stages

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16
Q

Antipsychotic examples

A

Risperdal (risperidone), Seroquel (quetiapine), Zyprexa (olanzapine), Geodon (ziprasidone), Abilify (aripiprazole)

17
Q

Antidepressant examples

A

Zoloft (sertraline), Paxil (paroxetine)
SSRIs: first line, few side effects
Trazodone (Desyrel): Used for insomnia in low doses and depression in higher doses
Dopaminergic agents: Tx for severe apathy

18
Q

Tricyclic antidepressants

A

Avoided due to anticholinergic and cardiac side effects

19
Q

Antianxiety med examples

A

Ativan (lorazepam), Valium (diazepam)

20
Q

TNPAP

A

TnPAP strives to assist those nurses who are struggling with drug addiction and/or mental health issues obtain an accurate diagnosis, quality treatment if recommended, and then ongoing monitoring once the nurse has achieved a stable recovery to assist them in long term maintenance of their sobriety

21
Q

Intoxication s/sx

A

Disinhibition, sexual/aggressive impulses, mood lability (mood swings), impaired judgment, slurred speech, unsteady gait, nystagmus, flushed face

22
Q

Withdrawal s/sx

A

Coarse tremors, N/V, malaise, tachycardia, sweating, elevated BP, anxiety, depressed mood, irritability

23
Q

Withdrawal tx

A

Tx: Benzodiazepines, anticonvulsants, multivitamin therapy, thiamine

24
Q

Delirium tremens

A

Due to alcohol withdrawal
Hallucinations, shaking, confusion, sweating, tachycardia

25
Q

Medications used in recovery phase for ETOH and other addictions

A

disulfiram (Antabuse): drinking deterrent - induces N/V with drinking
naltrexone (ReVia): blocks pleasure of drinking
nalmefene (Revex): reduces alcohol consumption and prevents opioid overdose
SSRIs
acamprosate (Campral): reduces desire to drink

26
Q

Positive symptoms of schizophrenia

A

Delusions, alterations in speech, hallucinations

27
Q

Negative symptoms of schizophrenia

A

Affect (diminished, blunted)
Alogia (short answers)
Anergia (lack of energy)
Anhedonia (lack of interest/pleasure)
Avolition (apathy)
Asociality (reduced social interaction)

28
Q

Nursing dx for schizophrenia and nursing considerations

A

Disturbed sensory perception: observe for signs of hallucinations, distract from hallucinations
Disturbed thought process: do not argue, focus on reality
Social isolation
Risk for violence: self-directed or other-directed
Impaired verbal communication: facilitate trust and understanding, orient to reality
Self care deficit
Disabled family coping
Ineffective health maintenance
Impaired home maintenance

29
Q

Atypical antipsychotics MOA

A

Serotonin and dopamine antagonist

30
Q

Atypical antipsychotics side effects

A

Weight gain, increased risk for diabetes, cardiovascular disease, and hypertension

31
Q

Anticholinergic side effects

A

Nausea, skin rash, sedation, orthostatic hypotension, photosensitivity, hormonal effects, ECG changes, hypersalivation, weight gain, hyperglycemia, diabetes, increased mortality risk in elderly with dementia, reduction in seizure threshold, agranulocytosis, extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome

32
Q

Extrapyramidal side effects

A

Pseudoparkinsonism: Drug induced parkinson’s symptoms, shuffled gait, muscle stiffness
Akinesia: Loss of voluntary muscle movement
Akathisia: Inability to stay still
Dystonia: Muscle twitching
Oculogyric crisis: Eye deviates upwards
Tardive dyskinesia: Tongue movements

33
Q

Extrapyramidal tx

A

Anticholinergic drugs

34
Q

Neuroleptic malignant syndrome cause

A

Antipsychotics
Occurs from dopamine blockage

35
Q

Neuroleptic malignant syndrome
s/sx

A

MEDICAL EMERGENCY
Decreased LOC, increased muscle tone, high fever, hypertension, sweating, tachycardia, drooling

36
Q

Neuroleptic malignant syndrome
tx

A

D/C antipsychotic drug
Tx: Dopaminergic medications - bromocriptine (Parlodel) and dantrolene (Dantrium)

37
Q

Serotonin syndrome symptoms

A

Agitation, anxiety, restlessness, disorientation, diaphoresis, hyperthermia, tachycardia, nausea, vomiting, tremor, muscle rigidity, hyperreflexia, myoclonus, dilated pupils, ocular clonus, dry mucous membranes, flushed skin, increased bowel sounds, and a bilateral Babinski sign