Exam 3 Study guide: Ch 13 Flashcards
Is Delerium an acute or chronic disturbance or cognition?
Acute disturbance of cognition
“Manifested by short-term confusion, excitement, disorientation, and clouding of consciousness.”
a.) AD
b.) Schizophrenia
c.) Dementia
d.) Delerium
d.) Delerium is SHORT-TERM confusion, excitement, disorientation and clouding.
Hallucinations in Delerium are “X”, normally lasting 1 “blank” but no longer than “blank.”
Hallucinations in delirium are brief, normally lasting one week, but no longer than one month.
What is the usual period of time in which delirium symptoms diminish?
3-7 days
There are 4 other etiologies of delirium. What are they?
- Substance intoxication delirium
- Substance withdrawal delirium
- Medication induced delirium
- Other medical condition delerium
A patient is very distractible and has difficulty providing attention. They are Experiencing disorganized thinking, rambling speech, and have difficulty with goal directed behavior. The patient is also experiencing hallucinations with emotional instability. The patient has no history of drug abuse, and these symptoms have presented in the past several hours.
What is the patient most likely experiencing?
Delerium
most likely due to an underlying health condition or medication reaction
Hypervigilance, stupor, and “semi coma” are awareness level ranges of what neurological disease?
Delerium
What age group is considered a high-risk group for developing delirium?
elderly, ages 65+
For people over the age of 65 what other 3 factors contribute to delirium?
Depression, falls, and elderly abuse
Put the stages of AD in order:
-moderate cognitive decline
-mild cognitive decline
-severe cognitive decline
-very severe cognitive decline
-moderately severe cognitive decline
-no apparent symptoms
-very mild change
Its really obvious
In the first stage of Alzheimer’s there is no apparent decline in memory despite changes that are beginning to occur in the brain. What is the scan that can be used to detect these changes?
A PET scan
During stage two, the very mild change stage, the individual begins to lose things or forget names of people.
Is the patient aware of their intellectual decline?
Does this stage affect their ADL?
What is a care method for treatment of Stage 2 patients?
Patients Are aware of their mental decline
Stage two does not affect patient ADL
Maintaining organization with lists and a structured routine are good methods of care.
During stage three, mild cognitive decline, behavior becomes noticeable to family and friends.
Does this effect ADL? How?
Yes it effects the ability to plan and organize.
What might an individual in stage three of Alzheimer’s experience while driving?
They might get lost on a route they have been down thousands of times
Getting lost while driving is a consequence of which stage of Alzheimer’s development?
Stage 3
In stage four of Alzheimer’s disease a individual may forget major events in their personal history, such as their own “blank”.
ADL is also greatly affected. What ADL activities would be affected during this stage?
Childs birthday
ADL difficulties would manifest in shopping, cooking, and managing personal finances.
During stage four of Alzheimer’s disease confabulation develops. What is confabulation?
Confabulation is creating imaginary events to fill in memory gaps.
“X” and “Y” withdrawal are common in stage “Z”.
Depression and Social withdrawal are common in stage 4
“Individuals lose the ability to perform ADL’s independently including hygiene, dressing, and grooming, and require some assistance to manage these tasks on an ongoing basis.”
What Alzheimer’s stage is this?
Stage 5
During the stage individuals forget addresses, phone numbers, and names of close relatives. They become disoriented about place and time but maintain knowledge about themselves.
What AD stage is this?
Stage 5
At this stage individuals cannot recall the name of their spouse or misidentify their child as their spouse. The person is unable to manage ADL’s without assistance.
What stage is this?
Stage 6
Urinary and fecal incontinence are common in which Alzheimer’s stage?
Stage 6
Which Alzheimer’s stage sees the phenomenon of sundowning?
Stage 6
What is sundowning?
Sun Downing is when Alzheimer’s symptoms become worse in the late afternoon and evening.
Psychomotor symptoms including wandering, Obsessiveness, agitation, and aggression are manifested in which Alzheimer’s stage?
Stage 6
Communication becomes more difficult with increasing loss of language skills. Institutional care is usually required at the stage.
Which stage of AD is this?
Stage 6
During this stage a patient is unable to recognize family members. Most commonly bed fast and aphasic. Problems of immobility, such as decubiti and contractures may occur. Patient may show disinterest in food and difficulty swallowing.
What stage is this?
Stage 7
Decubiti and contractors occur during what Alzheimer’s stage?
Stage 7
Alzheimers disease is identified by 3 specific biomarkers rather than by the progression of cognitive symptoms. What are these three biomarkers?
-Amyloid beta plaques
-Tau neurofibrillary tangles
-Neuronal damage
What neurotransmitter is dramatically reduced in Alzheimer’s patients?
Acetylcholine
An overabundance of structures called “blank” and “blank” appear in the brain of individuals with AD.
Plaques and tangles.
Progressive decline in cognitive ability in the presence of clear consciousness
a.) Delerium
b.) Schizophrenia
c.) Dementia
d.) AD
c.) Dementia
Alzheimer’s CAUSES dementia
Should barbiturates be used in elderly clients?
What is their drug category?
No
Sedative/Hypnotic
Which of these drug classes are avoided in elderly NCD patients because of their cardiac and anticholinergic side effects:
a.) SSRI’s
b.) Acetylcholics
c.) Tricyclics
d.) Antidepressants
c.) Tricyclics are avoided for the elderly because of their cardiac and anticholinergic side effects
What drug types are considered by many to be first line drug treatment for depression in the elderly because of their favorable side effect profile?
SSRI’s
Many antipsychotic, antidepressant, and antihistamine medications are not used in elderly people with neuro cognitive disorders. Why?
Because of their anticholinergic side effects.
Confusion, blurred vision, constipation, dry mouth, dizziness, and difficulty urinating are all adverse reactions of what drug classes that are not used in the elderly?
They are all anticholinergic side effects of Antipsychotic, antidepressant, and antihistamine medications.
An example of a reversible form of NCD is one that is caused by which of the following? (Select all that apply)
a. Multiple sclerosis
b. Multiple small brain infarcts
c. Electrolyte imbalances
d. HIV disease
e. Folate deficiency
b.
c.
e.
Mrs G has been diagnosed with NCD due to Alzheimer’s disease. This disorder is associated with the presence of which of the following?
a. Multiple small brain infarcts
b. Lewy bodies
c. Cerebral abscesses
d. Amyloid beta plaques and neurofibrillary tangles
d.) Amyloid beta plaques and neurofibrillary tangles
Mrs. G has been diagnosed with NCD due to Alzheimer’s disease. The primary nursing intervention in working with Mrs. G is which of the following?
a. Ensuring that she receives food she likes to prevent hunger
b. Ensuring that the environment is safe to prevent injury
c. Ensuring that she meets the other patients to prevent social isolation
d. Ensuring that she takes care of her own ADL’s to prevent dependence.
b. Ensuring that the environment is safe to prevent injury
Which of the following medications have been indicated for improvement in cognitive functioning in mild to moderate Alzheimer’s disease? (Select all that apply.)
a. Donepezil (Aricept)
b. Rivastigmine (Exelon)
c. Risperidone (Risperdal)
d. Sertraline (Zoloft)
e. Galantamine (Razadyne)
a Aricept
b Exelon
e Razadyne
Mrs. G who has NCD due to Alzheimer’s disease, says to the nurse, “I have a date tonight, I always have a date on Christmas.” Which of the following is the most appropriate response?
a. )Don’t be silly. It’s not Christmas
b.) Today is Tuesday, October 21st, Mrs G. We will have supper soon, and then your daughter will come to visit.
c.) Who is your date with Mrs. G?
d.) I think you need some more medication, Mrs. G. I’ll bring it to you now
b.) Redirect the conversation
In addition to disturbances in cognition and orientation, individuals with Alzheimer’s disease may also show changes to which of the following? (Select all that apply.)
a. Personality
b. Vision
c. speech
d. hearing
e. Mobility
a. Personality
c. speech
e. mobility
Mrs. G, who has NCD due to Alzheimer’s disease, has trouble sleeping and wanders around at night. The following nursing actions would be best to promote sleep in Mrs. G?
a. Ask the doctor to prescribe flurazepam.
b. Ensure that Mrs. G gets an afternoon nap so she will not be overtired at bedtime
c. Make Mrs. G a cup of tea with honey before bedtime
d. Ensure that Mrs. G gets regular physical exercise during the day
d. Ensure that Mrs. G gets regular physical exercise during the day
The night nurse finds Mrs G, a client with Alzheimer’s disease, wandering the hallway at 4:00 AM and trying to open the door to the side yard. Which statement by the nurse reflects the most patient centered approach to the situation?
a. That door leads out to the patio, Mrs. G. Its Nighttime. You Don’t want to go outside now.
b. You look confused. Is something bothering you?
c. This is the patio door, are you looking for the bathroom?
d. Are you lonely? If you’d like to go back to your room we can talk for a while.
c. This is the patio door, are you looking for the bathroom?
Redirection instead of denying the patient’s reality.
Which of the following factors is not associated with increased incidence of NCD due to Alzheimer’s disease?
a. Multiple small strokes
b. Family history of Alzheimer’s
c. head trauma
d. advanced age
d. Advanced age
Mr Stone is a patient in hospital with a diagnosis of vascular NCD. Explaining this disorder to Mr Stone’s family, which of the following statements by the nurse is correct?
a. He will probably live longer than if his disorder was of the Alzheimer’s type.
b. Vascular NCD shows stepwise progression. This is why he sometimes seems OK.
c. Vascular NCD is caused by plaques and tangles that form in the brain
d. The cause of Vascular NCD is unknown
b. Vascular NCD shows stepwise progression. This is why he sometimes seems okay.
Which of the following interventions is most appropriate in helping a patient with Alzheimer’s disease with her Adl’s? (Select all that apply.)
a. Perform ADLS for her while she is in the hospital
b. Provide her with a written list of activities she is expected to perform
c. Assist her with step-by-step instructions
d. Tell her that if her morning care is not completed by 9:00 AM, it will be performed for her by the nurses aide.
e. encourage her and give her plenty of time to perform as many of her ad L’s as possible independently
b.
c.
e.
