Final - Neurocogntivie Flashcards
What is delirium?
It is an organic mental disorder characterized by a cluster of cognitive impairments with an acute onset and identification of a specific precipitating stressor
What are the characteristics of delirium?
- A disturbance in attention and awareness
- Develops over a short period of time and tends to fluctuate in severity during the course of a day
- An additional disturbance in cognition (memory deficit, disorientation, language, visuospatial ability, perception)
- Disturbances in 1 and 3 are not better explained by another neurocognitive disorder
- Direct result of:
- Medical condition
- Substance intoxication or withdrawal
- Exposure to a toxin
- Multiple etiologies
What classifies someone as having substance intoxication delirium?
When symptoms in Criteria A and C predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention
Describe the realtionship between age and gender and delirium?
- Risk is greater for women
- Most prevalent in children and those over 60 years of age
- Children may be more prone than adults
- Medication
- Febrile response
- Anxiety
What is the prognosis for a patient with delirum?
- Medical emergency!!!
- Reversible if diagnosed and treated early
- May remit spontaneously
- May progress to dementia and other chronic problems
- With treatment- 1 to several weeks
- 10% of clients progress to coma and death
What would you use to assess a patient for possible delirium?
- Mental status exam
- Mini-mental status exam
- Assess memory, thought processes, attention, and concentration
- Involve family members and significant others as historians
- Behavioral rating scales
- Assessment of medication combinations
What are some nursing interventions for delirum?
- Individualized, based on cause
- Prioritize patient safety
- Use alternatives to physical restraints , use least restrictive methods first!!
- Reality based treatment –> music, flowers to smell,
- Avoid escalating anxiety –> reduce noise, coordinate the lighiting,
- Pharmacological interventions
- benzodiazepines (would wnat to use adavan & serax because of short halflife)
- anxiolytic (BuSpar)
- antipsychotics
- dexmedetomidine
- Delirium assessment
- Pain management
- Early mobilization
- Elimination of unnecessary medication
- Interdisciplinary team management
What are some outcomes for patients with delirium?
- No injuries
- Return to baseline functioning
- Ability to communicate thoughts and feelings
- Ability to understand others
What is the criteria to be diagnosed with major neurocognitive disorder?
- Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains:
- Attention
- Executive function
- Learning
- Memory
- Language
- Perceptual-motor
- The cognitive deficits:
- Interfere with independence in everyday activities
- Do not occur exclusively in the context of a delirium
- Are not better explained by another mental disorder
What is the critqeria to be diagnosed with mild NCD?
- Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains:
- Attention
- Executive function
- Learning
- Memory
- Language
- Perceptual-motor
- The cognitive deficits:
- Do not interfere with independence in everyday activities
- Do not occur exclusively in the context of a delirium
- Are not better explained by another mental disorder
What are the characteristics of major or mild NCC due to Alzheimer’s?
What are some characteristics of Alzheimer’s?
- More common in women than men
- Number 1 mental health problem in elderly
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What are some risk factors for Alzheimer’s?
- Advancing age
- Family history
- APOE- ɛ4
- Mild Cognitive Impairment (MCI)
- Cardiovascular disease risk factors
- Social engagement and diet
- Traumatic Brain Injury (TBI)
How can alzheimer’s be diagnosed?
What are some biological theories for the cause of Alheimer’s?
- Amyloid cascading hypothesis
- Cholinergic theories
- Genetic theories
What are some nursing interventions for a patient with Alzheimer’s?
- Safety
- Breaking down tasks
- Encouragement
- Orientation –> calendar’s, newspapers, clocks,
- Frequent assessment
- Safe places to wander
- Remotivation therapy–>
- Medication management
What is sundowning?
Confusion and agitation with the conset of evening?
What is confabulation?
What are the pharmacological interventions for alzheimer’s?
Cholinesterase inhibitor therapy
- tacrine (Cognex)
- donepezil (Aricept)
- galantamine (Reminyl, Razadyne)
- rivastigmine (Exelon)
Antipsychotic therapy
- haloperidol (Haldol)
- risperidone (Risperdal)
Benzodiazepines
Hypnotics
Antidepressants
How are patients with Major or Mild Vascular NCD diagnosed? Describe the pathophysiology
- Small emboli or strokes
- Computed tomography (CT) and magnetic resonance imaging (MRI)
- Multiple lesions of the cerebral cortex and the sub-cortical structures of the brain
- EEG may reveal focal lesions
- Diagnosis based on:
- history of CAD
- reported episodic decline in function
- physical examination of neurological abnormalities
What is the prognosis for patients with mild or major vascular NCD?
- May be preventable
- Aggressive treatment may reduce incidence and severity
- Early indicators/Risk factors
- Risk for CAD
- Declining scores on mental status exams
What are some nursing interventions for dementia (neurocognitive declines)?
- Medication management
- Nootropics - “smart drugs”
- Family support and education
- Manage therapeutic environment
- Physical assessment
- Monitoring and maintenance
- vital signs
- fluid and nutritional intake
- sleep-wake cycle
- skin care
What are some Interventions for Patients With NCD:
Chronic Confusion
- Use simple concise language with a low pitched voice
- Use concrete rather than abstract language –> give them options
- Eliminate distracting background stimuli
- Arrange the unit with a reality orientation board
- Place cherished familiar objects in room
- Don’t agree or disagree, redirect the patient, talk about the patient’s feelings.
- Refrain from confronting or arguing
- Refrain from agreeing or disagreeing with delusions
Interventions for Patients With NCD:
Social Interaction, Impaired
Self-Care Deficits
- Ensure patients have dentures, glasses, and hearing aids when needed
- Adhere to routine care
- Engage clients in short, routine social interactions
- Assess client’s ability to perform once familiar motor tasks and offer assistance when necessary
What are some issues of caregiving with patients with dementia?
- Disruption in family dynamics
- Caregiver fatigue
- Depression
- Financial
- Cultural
- Spiritual
What are some family interventions for patients with dementia?
- Refer to support groups in community
- Provide other information about support systems in community
- Refer family members for a physical examination
- Provide health promotion education
- Teach stress management skills
- Teach about medications
- Explain patient may use confabulation in social situations and give rationale
- Inform family that client responds better to reminiscences about the past rather than to “here and now.”
