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NRSG 126: Mental Health > [Exam 3] Chapter 24 - Cognitive Disorders > Flashcards

[Exam 3] Chapter 24 - Cognitive Disorders Flashcards

1
Q

What is cognition?

A

Ability to process, retain, and use information. Cognitive abilities include reasoning, judgement, perception, attention, and memory

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2
Q

What is a cognitive disorder?

A

Disruption or impairment in these higher level functions of the brain. Can have effects on ability to function in daily life. People forget names, and cannot perform tasks

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3
Q

Cognitive disorders were previously categorized as what?

A

dementia, delirium and amnesic disorders. Now are just called neurocognitive disorders.

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4
Q

Delirium: What is this?

A

Syndrome that involves disturbance of consciousness accompanied by a change in cognition. Usually develops over short period.

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5
Q

Delirium: What will this person struggle with?

A

Difficulty paying attention, are easily distracted and disoriented, and may have sensory disturbances such as illusions, misinterpretations or hallucinations

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6
Q

Delirium: How will they mistake electrical cord or banging of a laundry cart?

A

Appear as a snake and may mistake it for gunshot

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7
Q

Delirium: Most common group for this?

A

Elderly patients. 14-24% of those admitted to hospital are delirious.

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8
Q

Delirium: Percentage of those with general surgery, open heart surgery, and fractured hip surgery?

A

10-15%

30%

50%

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9
Q

Delirium: Often times, teh causes of delirium are due to multiple stressors such as?

A

Trauma to CNS , drug toxicity or withdrawal, and metabolic disturbances

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10
Q

Delirium: Risk factors for it?

A

severity of physical illness, older age, hearing impairment, decreased food and fluid intake, medications, and baseline cognitive impairments

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11
Q

Delirium & Etiology: Almost always results from what?

A

identifable physiological, metabolic, or cerebral disturbance or disease or from dug intoxication or withdrawal

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12
Q

Delirium & Etiology: Physiological or metabolic causes of this?

A

hypoxemia, electrolyte imbalance, renal failure, hypoglycemia, dehydration, sleep depirivation, thiamine or vitamin b12 deficiency

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13
Q

Delirium & Etiology: systemic infection causes?

A

sepsis, uti, pneumonia

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14
Q

Delirium & Etiology: cerebral infection causes?

A

meningitis, encephalitis, HIV syphilis

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15
Q

Delirium & Etiology: intoxication causes of this?

A

anticholinergics, lithium, alcohol, sedatives, and hyponotics

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16
Q

Delirium & Etiology: withdrawal causes of this?

A

alcohol, sedatives and hyponotics

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17
Q

Delirium & Treatment/Prognosis: Primary tx for this is what?

A

To identify and treat any casual or contributing medical condition. Always a transient condition that clears with successful tx of underlying cause

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18
Q

Delirium & Psychopharmacology: Tx for client with quiet, hypoactive delirium?

A

Need no specific pharmacologic tx aside from that indicated from the causative condition

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19
Q

Delirium & Psychopharmacology: What may be used for someone to prevent inadvertent self-injury?

A

Sedation

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20
Q

Delirium & Psychopharmacology: What medication will be used to decrease agitation and psychotic symptoms?

A

Antipsychotic med such as haloperidol (Haldol), in doses of 0.5 to 1 mg.

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21
Q

Delirium & Psychopharmacology: Information about Benzodiazepines like Lorzepam (Ativan)?

A

They’ve been used but may worsen delirium, especially in elderly.

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22
Q

Delirium & Psychopharmacology: When should benzodiazepines be used?

A

Resesrved for tx of sedative-hyponotic withdrawal.

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23
Q

Delirium & Psychopharmacology: What may person with impaired liver or kidney struggle with?

A

Could have difficulty metabolizing or excreting sedatives

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24
Q

Delirium & Psychopharmacology: How is delirium induced by alcohol treated?

A

Benzodiazepines

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25
Q

Delirium & Other Medical Tx: What other supporitve physical measures are needed?

A

Adequate nutritious food and fluid intake speed recovery. IV fluids or PRN may be necessary.

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26
Q

Delirium & History: What does nurse obtain from patient?

A

Alcohol and other drugs are obtained. Need to know OTC medications.

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27
Q

Delirium & General Appearance and Motor: How do they act motor wise?

A

Restless and hyperactive, frequently picking at bed clothes or making sudden uncontrolled attempts to get out of bed.

May also have slowed motor behavior, appearing sluggish and lethargic

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28
Q

What is acute confusion?

A

Abrupt onset of reversible disturbances of consciousness, attention, cognition, and perception that develop over shrot period of time

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29
Q

Delirium & General Appearance and Motor: How is speech?

A

Becomes less coherent and more difficult to understand. Client may perservate on single topic or detail, may be rambling and difficult to follow, or may have pressured speech that is rapid

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30
Q

Delirium & Mood/Affect: Mood here?

A

Have rapid and unpredictable mood shifts. Wide range of emotional responses like anxiety, fear, irritability, anger, euphoria, and apathy

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31
Q

Delirium & Thought Process/Content: How is it here?

A

Content in delirium unrelated to siutation and difficult to understand. Disorganized and makes no sense. Make experience delusions

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32
Q

Delirium & Sensorium / Intellectual Proceses: Initial signs of delirium is usually what?

A

Altered level of consciousness that is seldom stable and usually fluctuates throughout day.

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33
Q

Delirium & Sensorium / Intellectual Proceses: Orientation here?

A

Oriented to people but not time or place.

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34
Q

Delirium & Sensorium / Intellectual Proceses: Clients cannot focus on what?

A

Cannot focus, sustain, or shift attention effectivelly and there is impaired recent aand immediate memory.

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35
Q

Delirium & Sensorium / Intellectual Proceses: Examples of reactions to misperceptions they may experience?

A

May hear door slam and think its gunshot or see nurse reach for IV bag and believe nurse is about to strike them.

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36
Q

Delirium & Sensorium / Intellectual Proceses: What are some common illusions?

A

Include client believing that IV tubing or an electrical cord is a snake and mistaking the nurse for a family member.

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37
Q

Delirium & Judgement/Insight: How is judgement impaired here?

A

Cannot perceive potentially harmful siutations or act in their own best interests. May try to repeatdly pull out IV tubing

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38
Q

Delirium & Judgement/Insight: How is insight?

A

THose with severe delirium may have no insight. Mild delirium may recognize they are confused.

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39
Q

Delirium & Roles/Reltationships: Roles here?

A

Unlikely to fulfill their roles during the course of delirium

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40
Q

Delirium & Self-Concept: How do they feel?

A

Delirium has no effect on self-concept, but they often feel frightened or feel threatened

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41
Q

Delirium & Physiological/Self-Care: What changes occucr here?

A

Experience disturbed sleep-wake cycles that include difficulty falling asleep, daytime sleepiness, nighttime agitation. May also ignore internal body cues

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42
Q

Delirium & Intervention - Promoting Safety: What to know about medicines?

A

Should be used sparingly because it may worsen confusion and increase rf falls

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43
Q

Delirium & Intervention - Promoting Safety: What does the nurse teach patient?

A

To request assistance for activites such as getting out of bed.

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44
Q

Delirium & Intervention - Promoting Safety: When would restraints be used?

A

If the client is agitated or pulling at IV lines or catheters

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45
Q

Delirium & Intervention - Promoting Safety: What do you teach client and family?

A

Monitor chronic conditions

Visit physician regularly

Include all medications

Avoid alcohol/recreational drugs

Get adequate sleep

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46
Q

Delirium & Intervention - Managing Client’s Confusion: Voice here?

A

Client speaks calmly and speaks in a clear low voice

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47
Q

Delirium & Intervention - Managing Client’s Confusion: Example of what nurse should say?

A

I know things are upsetting and confusing right now, but your confusion should clear as you get better

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48
Q

Delirium & Intervention - Managing Client’s Confusion: How to phrase questions?

A

Use short, simple sentences allowing adequate time for clients to grasp the content or respond to a question

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49
Q

Delirium & Intervention - Promoting Sleep/Nutrition: What does nurse monitor here?

A

Client’s sleep and elimination patterns and food and fluid intake.

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50
Q

Delirium & Intervention - Promoting Sleep/Nutrition: Overall things to monitor here?

A

Monitor sleep/elimination

Monitor food and fluid intake

Provide periodic assitance to bathroom

Discourage daytime napping to help sleep

Encourage some exercise during day

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51
Q

Delirium & Intervention - Controlling environment to reduce sensory: Overall things to monitor here?

A

Keep environment noise to minimum

Monitor clients response to visitors

Validate clients anxiety and fears

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52
Q

Delirium & Intervention - Managing client confusions: Overall things to do here?

A

Speak in calm manner

Allow adequate time for client to comprehend

Allow client to make decisions

Provide orienting verbal cues

Use supportive touch

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53
Q

Delirium & Intervention - Promoting client’s safety: Overall things to do here?

A

Teach the clients to request assistance

Provide close supervision to ensure safety during these activities

Promptly respond to clients call for assistance

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54
Q

Delirium & Evaluation: Successul tx of underlying causes of delirium causes what to happen to patient?

A

Return to their previous levels of functioning.

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55
Q

Delirium & Evaluation: Family must understand what health care practices are necessary to avoid recurrence including what?

A

Monitoring a chronic health condition, using meds carefully, or abstaining from alcohol or other drugs

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56
Q

Dementia: What is this?

A

Refers to disease process marked by progressive cognitive impairment with no change in level of consciousness

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57
Q

Dementia: Involves multiple cognitive impairments including what?

A

Memory impairment, with further cognitive disturbances my be seen

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58
Q

Dementia: What cognitive disturbances may be caused?

A

Aphasia
Apraxia
Agnosia
Disturbance in Executive Functioning

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59
Q

Dementia: What is Aphasia?

A

Deterioration of language function

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60
Q

Dementia: What is Apraxia?

A

Which is impaired ability to execute motor function despite intact motor abilities

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61
Q

Dementia: What is Agnosia?

A

Inability to recognize or name objects despite intact sensory abilities

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62
Q

Dementia: What are some disturbance sin executive functioning?

A

Ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior

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63
Q

Dementia: What does mild NCD refer to?

A

A mild cognitive decline, and a modest impairment of performance that doesn’t prevent independent living but may require some accommodation or assitance

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64
Q

Dementia: What does major NCD refer to?

A

A significant cognitive decline and a substantial impairment in performance that interferes with ADLs

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65
Q

Dementia: What happens if dementia and delirium coexist?

A

Symptoms of dementia remain even when the delirium has cleared.

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66
Q

Dementia: Is deliriumm or dementia onset faster?

A

DElirium

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67
Q

Dementia: LOC here?

A

Not affected

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68
Q

Dementia: Speech here?

A

Normal in early stage, progressive aphasia in later stage

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69
Q

Dementia: Thought process here?

A

Impaired thinking, eventual loss of thinking abilitites

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70
Q

Dementia: Perception here?

A

Often absent, but can have paranoia, hallucinations, illusions

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71
Q

Dementia: Mood here?

A

Depressed and angry in early stage

Labile mood, restless pacing, angry outbursts in later stages

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72
Q

Dementia: Prominent early sign of this>?

A

Memory impairment . Have difficulty learning new material and forget previously learned material

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73
Q

Dementia: Aphasia usually begins with what?

A

Inability to name familar objects or people and then progresses to speech that becomes vague or empty with excessive use of terms such as it or things

74
Q

Dementia: Clients may experience echolalia and palilalia which is what?

A

Echolalia - Echoing what is heard

Palilalia - Repeatings words or sounds over and over

75
Q

Dementia: Apraxia may cause clients to lose ability to do what?

A

Perform self-care activites sucha s dressing or cooking

76
Q

Dementia: Why is Agnosia frustrating?

A

May look at table and chair but are unable to name the

77
Q

Dementia & Onset/Clinical: What are the stages of this?

A

Mild

Moderate

Severe

78
Q

Dementia & Onset/Clinical: What happens in mild?

A

Forgetfulness if hallmark of beginning. Exceeds normal occasional forgetfulness. Cannot find words frequently loses objects, adn experiences anxiety about these losses. Avoid Social settings

79
Q

Dementia & Onset/Clinical: What happens in moderate stage?

A

Progressive memory loss. Cannot perform complex tasks but remains oriented. Still recognizes familiar people

80
Q

Dementia & Onset/Clinical: What happens toward the end of the moderate stage?

A

Person loses ability to live independently and requires assistance because of disorientation to time and loss of information . Remain in community if caregiver support available

81
Q

Dementia & Onset/Clinical: What happens in severe stage

A

Personality and emotional changes. May be delusional, wandere at night, forget names, and require assitance with ADL. Live in nursing facilitites at this stage

82
Q

Dementia & Etiology: Metabolic activity here?

A

Decreased in brains of clients with dementia. Not known whether dementia causes decreased metabolic activity or if decreased metabolic activity results in dementia

83
Q

Dementia & Etiology: Genetic compoent has been identifeid for some, such as what?

A

Huntington Disease

ABnormal APOE gene linked with Alzheimers.

HIV or Creutzfeldt-Jakob didsease

84
Q

Dementia & Etiology: What are some common types of dementia?

A 
Alzheimer Disease
NCD with Lewy Bodies
Vasculat Dementia
Frontotemporal Lobar Degeneration
Prion Disease
HIV Infection
Parkinson Disease
Huntington Disease
85
Q

Dementia & Etiology - Alzheimer Disease: What is this?

A

Progressive brain disorder that has gradual onset but causes increase decline in functioning, including loss of speech/motor function, and profoudn personality changes including paranoid, delusions, hallucinations and inattention to hygiene

86
Q

Dementia & Etiology - Alzheimer Disease: What is this evidenced by?

A

atrophy of cerebral neurons, senile plaque deposits and enlargement of 3rd and 4th ventricles of brain

87
Q

Dementia & Etiology - Alzheimer Disease: RF this increases with what?

88
Q

Dementia & Etiology - Alzheimer Disease: average duration from onset of symptoms to death is what?

A

8-10 years

89
Q

Dementia & Etiology - Lewy Body Dementia: What is this?

A

Involves progressive cognitive impairment and extensive neuropsychiatric symtoms as well as motor symptoms

90
Q

Dementia & Etiology - Lewy Body Dementia: What is common here?

A

Delusions adn visual hallucinations

91
Q

Dementia & Etiology - Lewy Body Dementia: What is more pronounced that cognitive deficits?

A

Functional impairments

92
Q

Dementia & Etiology - Lewy Body Dementia: How is this passed?

A

Several risk genes have been identified, but can occur in families though that is less common with no family hx

93
Q

Dementia & Etiology - Vascular Dementia: What is this?

A

Symptoms similar to those of Alzheimer. Onset typically abrupt, followed by rapid changes in function, a plateau, more abrupt changes, and then another leveling off and so on

94
Q

Dementia & Etiology - Vascular Dementia: What does CT/MRI show?

A

Multiple vascular lesions of the cerebral cortex and subcortical structures resulting from decreased blood supply

95
Q

Dementia & Etiology - Frontotemporal Lobar Degeneration: What is this?

A

degenerative brain disease that affects frontal and temporal lobes and results in signs close to alzheimer disease

96
Q

Dementia & Etiology - Frontotemporal Lobar Degeneration: Early signs of this?

A

personality changes, loss of social skills, and inhibitions ,emotional blunting, and language abnormalities

97
Q

Dementia & Etiology - Frontotemporal Lobar Degeneration: Onset and how long to die?

A

Onset is 50-60 years old

Deah ocurs in 2-5 years

98
Q

Dementia & Etiology - Frontotemporal Lobar Degeneration: How is this passed?

A

Strong genetic ocmponent, and tends to run in families

99
Q

Dementia & Etiology - Prion Diseases: What is this?

A

Caused by prion that can trigger normal proteins in the brain to fold abnormally. CJD is most common priod disease affecting humans

100
Q

Dementia & Etiology - Prion Diseases: Onset age?

A

40-60 years

101
Q

Dementia & Etiology - Prion Diseases: Signs?

A

Altered vision, loss of coordination or abnormal movements, and dementia that usually progresses rapidly.

102
Q

Dementia & Etiology - Prion Diseases: Causes of encephalopathy?

A

Infectious particle rsistant to boiling, some disinfectants and some UV radiation

103
Q

Dementia & Etiology - Prion Diseases: What are some other prion diseases?

A

mad cow disease and kuru

104
Q

Dementia & Etiology - HIV: This type of demetia can result in what symptoms?

A

those ranging from mild sensory impairemnt to gross memory and cognitive deficits to severe muscle dysfunction

105
Q

Dementia & Etiology - Parkinson Disease: What is this?

A

slowly progressive neurologic condition characerized by tremor, rigidity, bradykinesi and postural instability .

106
Q

Dementia & Etiology - Parkinson Disease: signs of this?

A

cognitive and motor slowly, impaired memory, and impaired exectutive functioning

107
Q

Dementia & Etiology - Huntington Disease: What is this?

A

Inherited, dominant gene disease that primarily involves cerebral atrophy, demyelination and enlargement of the brain ventricles.

108
Q

Dementia & Etiology - Huntington Disease: Signs?

A

Initially choreiform movements and invovle facial contortions, twisitng, turning, adn tongue movements.

109
Q

Dementia & Etiology - Huntington Disease: Age for htis?

A

30-40 and may last 10-20 years before death

110
Q

Dementia & Related Disorders: Long term use of alcohol that results in dementia is known as?

A

Koraskoff syndrome or dementia

111
Q

Dementia & Related Disorders: Mild or major CND due to another medical condition is cause dby waht?

A

diseases such as brain tumor, brain metastasis, subdural hematoma, arteritis, renal failure.

112
Q

Dementia & Related Disorders: Unsppecified NCD characterize dby what?

A

neurocognitive symptoms that cause person distress or impairment but do not meet criteria for another other

113
Q

Dementia & Related Disorders: What were previously classified as amnestic disorders?

A

Neurocognitive deficitis due to storoke, head injuries, carbon m onoxide poisoning, or brain damage

114
Q

Dementia & Related Disorders: How many poeple have this?

115
Q

Dementia & Related Disorders: Most common type inn north america?

116
Q

Dementia & Cultural Considerations: Why should you be aware fo this?

A

Because people from other countires may not be able to tell you who the US presient is

117
Q

Dementia & Tx and Prognosis: How can vascular dementia be treeated?

A

Appropriate tx of underlying vascular condition (changes in diet, exercise, control of hypertension).

118
Q

Dementia & Tx and Prognosis: What neurons are decreased here?

A

Acetylcholine, Dopamine, Norepinephrine and Serotonin.

119
Q

Dementia & Tx and Prognosis: What medications have shown modest therapeutic therapeutic effects and slow progress of dementia?

A

Donepezil (Aricept)

Rivastigmine (Exelon)

Galantamine (Reminyl, Razadyne, Nivalin)

These are cholinesterase inhibitors

120
Q

Dementia & Tx and Prognosis: What does Tacrine (Cognex) do?

A

Cholinesterase Inhibitor. Elevates liver enzymes in about 50% of clients using it.

121
Q

Dementia & Tx and Prognosis: What is Memantine (Namenda)

A

NMDA receptor antagonist that can slow progression of Alzheimers.

122
Q

Dementia & Tx and Prognosis: Donepezil (Atricept) dosage

A

5-10 mg orally

123
Q

Dementia & Tx and Prognosis: Donepezil (Aricept) nursing consideratiosn

A

nausea, diarrhea, and insomnia. Test stools periodically for GI bleeding

124
Q

Dementia & Tx and Prognosis: Rivastigmine (Exelon) dosage

A

3-12 mg orally divided into two doses

125
Q

Dementia & Tx and Prognosis: Rivastigmine (Exelon) nursing considerations

A

monitor for nausea, vomiting, abdominal pain, los of appetite

126
Q

Dementia & Tx and Prognosis: Memantine (Namenda) dosage

A

10-20 mg divided into two doses

127
Q

Dementia & Tx and Prognosis: Memantine (Namenda) nursing considerations

A

monitor for hypertension, pain, headache, vomiting, constipation and fatigue

128
Q

Dementia & Tx and Prognosis: What to do about antidepressants?

A

Are effective for significant depressive symptoms but can cause delirium

129
Q

Dementia & Tx and Prognosis: SSRI used because

A

they have fewer side effects

130
Q

Dementia & Tx and Prognosis: Why would antipsychotics be used?

A

Manage psychotic symptoms of delusions, hallucinations or paanoia and other behaviors sucha s agitation or aggression

131
Q

Dementia & Tx and Prognosis: What antipsychotics have been used

A

Haloperidol (Haldol0

Olanzapine (Zyprexa)

Risperidone (Risperdal)

Quetiapine (Seroqual)

132
Q

Dementia & Tx and Prognosis: Why would lithium carbonate, carbamazepine (Tegretol) and valporic acid (Depakote) be used?

A

help stabilize affective lability and diminish aggressive outbursts

133
Q

Dementia & Tx and Prognosis: Bebnzodiazepines used cautiously because why

A

they may cause delirium and can worsen already compromised cognitive abilities

134
Q

Dementia & Tx and Prognosis: What has been approved to tx delusiosn and hallucinations that some experience with parkinson disease?

A

Pimavanserin (Nuplazid). One 34 mg capsule per day is recommended.

135
Q

Dementia & Assessment: How to approach client during meeting?

A

Take frequent breaks so they don’t become confused or tire out. Ask simple questions.

136
Q

Dementia & History: How will you get your information?

A

From family, friends, or caregivers

137
Q

Dementia & Appearance/Motor: Speech here?

A

Aphasia, conversation becomes repetitive and speech may evantually become slurred, followed by total loss of language

138
Q

Dementia & Appearance/Motor: Motor ability?

A

Loss of ability to perform familar tasks (apraxia). Cannot imitate task when others demonstrate it. ALso have uninhibited beavior include making inappropriate jokes.

139
Q

Dementia & Mood/Affect: Mood at first?

A

Show anxiety and fear over beginning losses of memory and cognitive function. Mood becomes more labile over time. EMotional outbursts common.

140
Q

Dementia & Mood/Affect: Start to demonstrate catastrophic emotional reactions that include what?

A

Verbal or physical aggression, wandering at night, agitation, or other behaviors that seem to indicate loss of personal control

141
Q

Dementia & Thought Process/Content: Ability to think here?

A

Is impaired resulting in loss of ability to plan, sequence, monitor, initiate or stop complex behavior . Cannot solve problems

142
Q

Dementia & Thought Process/Content: DElusions here?

A

As dementia progresses, this occurs. May accuse others of stealing objects he or she has lost

143
Q

Dementia & Sensorium/Intellectual PRocesses: What does client lose?

A

Intellectual function, which means loss of their abilities.

144
Q

Dementia & Sensorium/Intellectual PRocesses: Confabulation occurs. What is this?

A

When they make up answers to fill in memory gaps.

145
Q

Dementia & Sensorium/Intellectual PRocesses: Agnosia occurs. What is this?

A

Clients lose spatial relationships, which is often evidenced by deterioration of ability to write or draw simple objects

146
Q

Dementia & Judgement/Insight: How is judgement a problem?

A

They underestimate risks and unrealistically appraise their abilities, which result in a high risk for injury. Cannot evluate siutations for risks or danger

147
Q

Dementia & Judgement/Insight: Insight here?

A

Limited. May be aware of problems with memory and cognition and may worry that they are losing their mind. These concerns about ability to function diminish and they have no awareness of this.

148
Q

Dementia & Self-Concept: How is this?

A

May be angry or frustrated initially. Soon, lose that awareness of self and cannot recognize themselves in the mirror

149
Q

Dementia & Physiological/Self-Care Considerations: What do they often experience here?

A

Disturbed sleep-wake cycles. Nap during the day and wander at night. May also ignore internal cues such as hunger or thirst.

150
Q

Dementia & Outcome Identification: Outcomes must focus on what?

A

Client’s medical condition or deficits.

151
Q

Dementia & Outcome Identification: What does psychosocial care involve?

A

Maintaining the client’s independence as long as possible, validating the client’s feelings and keeping the client involved in the environment.

152
Q

Dementia & Outcome Identification: Some treatment outcomes may include what?

A

Client will remain injury free.

Maintain adequate balance of activity and rest

Client will function as independetly as possible

Client will feel respected and supported

Client will remain involved in their surroundings

153
Q

Dementia & Intervention: Interventions are rooted in belief of what?

A

That clients with dementia have personal stregnths. Focus on demonstrating caring, keeping clients involved by relating to environment, and validating feelings and dignity of clients.

154
Q

Dementia & Intervention - Promoting Client Safety: Safety considerations involve what?

A

protecting against injury, meeting physiolgoical needs, and managing risks posed by environment, including internal stimuli.

155
Q

Dementia & Intervention - Promoting Client Safety: Example of how client living at home does not exercise normal caution?

A

Client may forget food cooking on stove and client living in residental care may leave for a wlak in cold weater without coat and gloves

156
Q

Dementia & Intervention - Promoting Client Safety: Assistance or supervision that is unobstrusive as possible does what for client?

A

from injury while preserving their dignity

157
Q

Dementia & Intervention - Structing Environment/Routine: What must nurse know?

A

Whether client prefers a tub bath or shower and washes at night or in the morning and include those preferences in the clients care.

158
Q

Dementia & Intervention - Structing Environment/Routine: What to know about tolerance?

A

They can tolerate less stimulation when they are fatigued, hungry, or stressed. As dementia prpogresses, tolerance for environmental stimuli decreases

159
Q

Dementia & Intervention - Providing Emotional Support: This relationsbip involves empathic caring, which is what?

A

Includes being kind, respectful, calm, and reassuring and paying attention to the client.

160
Q

Dementia & Intervention - Providing Emotional Support: How can nurse convey reassurance?

A

By approaching the client in a calm, supportive manner as if nurse and client are a team. A “we can do it together” approach

161
Q

Dementia & Intervention - Providing Emotional Support: If client is confused about getting dressed, what could nurse say?

A

I’ll be glad to help you with that shirt. i’ll hold it for you while you put your arms in the sleeves

162
Q

Dementia & Intervention - Providing Emotional Support: Why is supportive touch effective?

A

Can provide reassurance and convey caring when words may not be understood

163
Q

Dementia & Intervention - Promoting Interaction and Involvement: What occurs in the psychosocial model of dementia care?

A

Nurse or caregiver plans activites that reinforce the client’s identity and keep him or her engaged and involved in business of living

164
Q

Dementia & Intervention - Promoting Interaction and Involvement: Example of nurse using psychosocial model of dementia care?

A

Client with an interest in history may enjoy documentary programs on televisions

165
Q

Dementia & Intervention - Promoting Interaction and Involvement: What is reminiscence therapy?

A

Thinking about or relaitng personally significant past experiences

166
Q

Dementia & Intervention - Promoting Interaction and Involvement: Why is reminiscence therapy effective?

A

Effective for clients with dementia. Therapy encourages family and caregivers to also eminisce with the client. Promote clients use of memory

167
Q

Dementia & Intervention - Promoting Interaction and Involvement: Example of why nurse must listen carefully?

A

As dementia progreses, they may have trouble speaking. Listen to try to determine meaning behind what is being said

168
Q

Dementia & Intervention - Promoting Interaction and Involvement: What should nurse do when they cannot understand the meaning?

A

“Can you show me what yoou mean or where you wwant to go?

169
Q

Dementia & Intervention - Promoting Interaction and Involvement: Interacting with clients with dementia often means what?

A

Dealing with thoughts and feelings that are not based in reality but arise from clients suspicion or chronic ocnfusion

170
Q

Dementia & Intervention - Promoting Interaction and Involvement: What does distraction involve?

A

Shifting the client’s attention and energy to a more neutral topic.

171
Q

Dementia & Intervention - Promoting Interaction and Involvement: Example of distraction technique?

A

Client may display catatrophic reaction to current siutation suhc as thinking food tastes like poison. Nurse would interevene and try to find something to eat that nurse wants.

172
Q

Dementia & Intervention - Promoting Interaction and Involvement: What is timy away?

A

Involves leaving clients for short period and then returning to them to reengage in interaction. Leaves fro 5-10 mins and then returns

173
Q

Dementia & Intervention - Promoting Interaction and Involvement: What is going along?

A

Providing emotional reassurance to clients without corecting their misperception or delusion. Does not engage with them. Would just go along with it.

174
Q

Dementia & Community-Based Care: Adult day care centers provide what?

A

supervision, meals, support, adn recreational activites in group settings. Client’s may attention for few hours a week or full-time.

175
Q

Dementia & Community-Based Care: Residental facilities are available for who?

A

Clients who do not have in-home caregivers or whose needs have progressed beyond the care that could be provided at home.

176
Q

Dementia & Mental Health Promotion: People with what are at increased risk for dementia?

A

Elevated levels of plasma homo cysteine

177
Q

Dementia & Role of Caregiver: Who is this most often?

A

2/3 caring for family members are women and over 1/3 are adult daughters

178
Q

Dementia & Role of Caregiver: When is role strain identified?

A

When demands of providing care threaten to overwhelm a caregiver. This includes constant fatigue that is unrelieved by rest, increased use of alcohol and social isolation

179
Q

Primary goals of nursing care for clients with delirium are what

A

protection from injury, management of confusion, and meeting physiological and psychological needs

180
Q

Psychosocial model for probiding care for people with dementia addresses needs for what

A

safety, structure, support, interpersonal involvement and socil interaction

181
Q

Areas for teahcing for caregivers includes what?

A

Monitoring the client’s health, avoiding alcohol and recreational drugs, ensuring adequate nutrition, schedulign regular checkps, getting adequate rest, promoting actiity and socialization and helping the client maintain independence

NRSG 126: Mental Health (24 decks)

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