Exam 3 Flashcards
Delirium (causes)
Acute, rapid, reversible
Metabolic or UTI can take longer to treat
Delirium s/sx
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
Delirium risk factors
General medical condition - head trauma, seizures
Metabolic disorder
Substance induced - drugs/toxins
Alzheimer’s stages
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
Predisposing factors for dementia/AD
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
Types of NCD (neurocognitive disorder)
Vascular
Frontotemporal
TBI
Lewy body disease
Parkinson’s
HIV infection
Huntington’s disease
Vascular NCD
Stroke patients, result of death of nerve cells, confusion, risk of injury, abrupt onset, smoking increases risk
Frontotemporal NCD
Shrinking of frontal and temporal lobes, cause is unknown
- genetics may play a role, behavioral and personality changes, speech/language difficulty
TBI NCD
Amnesia is common, repeated head trauma - dementia pugilistica, emotional lability, ataxia, impulsivity
Lewy body disease
Similar to Alzheimer’s, progresses more rapidly, early appearance of visual hallucinations and Parkinsonian features, progressive, irreversible, 25% of all NCD
Parkinson’s disease
Caused by loss of nerve cells in substantia nigra and decrease in dopamine activity
tx: Levodopa
HIV infection
Caused by brain infection or HIV virus, early stages not noticeable, progresses to cognitive decline
Huntington’s disease
Genetic, dx in adulthood, damage in basal ganglia and cerebral cortex, profound dementia and ataxia
Nursing dx for NCD
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
Cholinesterase inhibitors (examples and MOA)
Aricept (donepezil), Namenda (memantine)
- delays destruction of acetylcholine, can delay progression in early stages