Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHTY2230 > L30: Managing Confusion and Dementia > Flashcards

L30: Managing Confusion and Dementia Flashcards

1
Q

What is the definition for dementia?

A

Loss of diminishments of mental power due to pathological changes in the brain

  • Avascular
  • Neurological disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is confusion?

A

A state of being mixed up, disorientated or bewildered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are 3 causes that can lead to delirum from confusion?

A
  1. Infection
  2. Hypoxia
  3. Underlying condition –> dementia –> delirium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is delirium?

A

Rapid onset (usually hours/days) of variable and fluctuating changes in mental status (consciousness, attention, cognition and perception)

  • Is a medical emergency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Is delirium treatable or untreatable?

A

treatable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 2 presentations of confusion?

A
  1. Acute
  2. Chronic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are 7 causes whihc present as delirum?

A
  1. Infection
    • Eg, UTI, sepsis
  2. Injury/pain
    • High levels of uncontrolled pain
  3. Blood loss
    • Trauma or surgery
  4. Hypoxia
    • Trauma or surgery
  5. Low blood glucose
    • Uncontrolled diabetes
  6. Electrolytes imbalance
    • Usually low K+ levels
  7. Drug/alcohol
    • Polypharmacy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are 6 characteristics of confusion/delirium?

A
  1. Disorientation in new environment
    • Eg. older people with cognitive impairment –> who are taken out of their home (unfamilar environment) –> into hospital or aged care facility
  2. Inability to understand instruction (deaf, blind, aphasic)
  3. Language difference/problem
  4. Thyroid dysfunction
    • Hypothyroidism
  5. Post-epileptic fit
  6. Fear, anxiety, depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 2 types of aphasia which occur after a brain injury (inability to formulate language)?

A
  1. Broca’s –> frontal lobe injury
  2. Werkines –> temporal lobe injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can the state of confusion be reversed (How long will it take to return to normal mental function?) which are implications for the physiotherapist.

A

Heart surgery –> severe blood loss –> confused state

  • Need to get blood transfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are 2 severities of confusion determines degree of patient compliance and cooperation?

A
  1. Can’t remember instructions, interpret instructions
    • Unable to give informed content
  2. Can’t assist with goal-setting/shared decision making
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Is the confusion reversible?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If confusion is irreversible, what would confusion/delirium be? What are 4 characteristics?

A

Dementia Progressive Element

  1. Strategies for assisting carer to cope
  2. Improve QoL for carer
  3. Improve QoL for patient
  4. Improve quality of care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If confusion is reversible, what would confusion/delirium be? What are 4 implications for management?

A

Implications for Management

  1. Strategies for assisting carer to cope
  2. Improve QoL for carer
  3. Improve QoL for patient
  4. Improve quality of care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 8 reversible causes of delirium which follow the DELIRIUM acronym?

A
  1. Drugs, including any new medications, increased dosages, drug interactions, over-the-counter drugs, alcohol, etc.
  2. Electrolyte disturbances (K+ deficiency), especially dehydration, and thyroid problems
  3. Lack of drugs, such as when long-term sedatives (including alcohol and sleeping pills) are stopped, or when pain drugs are not being given adequately
    • Conditions uncontrolled
  4. Infection, commonly urinary or respiratory tract infection
  5. Reduced sensory input, which happens when vision or hearing are poor
    • Problems with visual spacio perception
  6. Intracranial (referring to processes within the skull) such as a brain infection, haemorrhage, stroke, or tumour (rare)
  7. Urinary or intestinal problems (e.g. inability to urinate, constipation)
    • Brain damage
  8. Myocardial (heart) and lungs, e.g. heart attack, cardiac arrhythmias, worsening of chronic obstructive lung disease- Systemic problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are 8 ways to treat confused patients?

A
  1. Ask simple questions
    • Avoid open answered questions
  2. Speak slowly and clearly
  3. Do NOT shout –> not hard of hearing; just can’t understand
  4. Wait for a reply.. As central processing is often very slow
  5. Give simple, one stahe commands 6. Reduce the number of NOISE and PEOPLE distractions in the environment- Eg. take them somewhere else
  6. Change focus of attention if patient becomes too agitated through inability to understand or comply
    • Can be quite aggressive
    • Do something else = okay
  7. Assessment and treatment short and relevant (eg. Rx primary problem)
    • Short attention span = go for primary problem that is most concerned
  8. No options–> command, don’t ask (Do you want to go for a walk” “We will go for a walk”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the 5 types of dementia?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 2/5 common dementia types?

A
  1. Alzheimers
  2. PD with lewy bodies
  3. Abnormal deposits of protein in nerve cells that regulate cognition..etc

Can have lewy body dementia + PD = can have both; can be hard to differentiate between them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are 6 other causes of dementia?

A
  1. Multiple Sclerosis
  2. Huntington’s disease
    • Genetic neurodegenerative disease
  3. Creutzfeldt-Jakob (Mad cow disease)
    • Infectious disease which slowly destroys spinal cord and brain (contaminated human tissue, equipement or ingesting contaminated beef)
  4. Alcohol damage (Korsakoff’s)
  5. Neurosyphilis
    • Bacteria causing infection of brain and spinal cord
  6. AIDS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is Huntington’s disease?

A

Genetic neurodegenerative disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is Mad cow disease?

A

Infectious disease which slowly destroys spinal cord and brain (contaminated human tissue, equipement or ingesting contaminated beef)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is neurosyphilis?

A

Bacteria causing infection of brain and spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are 9 dementia presentations?

A
  1. Memory loss
  2. Confused
  3. Misunderstanding and not using words properly
  4. Difficulty corrdinating thought and actions
  5. Altered perception
  6. Walking and wandering
  7. Delusions, hallucinations (visual and auditiory), misidentification, confabulations, paranoia
  8. Mood and personality change
  9. Emotional lability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is “memory loss” as a presentation of dementia?

A
  • Early short-term memory is lost
  • Later lose long-term memory As the disease progresses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is “confused” as a presentation of dementia?

A
  • Mixing up people, recognising familiar person
  • Confusing place, time & objects, orientation
  • E.g. thinks daughter is mother and was present at a significant life event
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is “misunderstanding and not using words properly” as a presentation of dementia?

A

Ask patient a question and responses with inappropriate and unrelated answer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is “difficulty coordinating thoughts and action” as a presentation of dementia?

A

E.g. Gets into wrong bed (hospital, RACF)

Disorientated in environment

28
Q

What is “altered perception” as a presentation of dementia?

A
  • Visual (Acuity, depth perception and contrast sensitivity)
  • Verbal
  • Touch (Can be highly sensitive (can perceive as pain- allodynia)
29
Q

What is “walking and wandering” as a presentation of dementia?

A

May be a sign of agitation due to noxious stimulus

30
Q

What is “delusion, hallucinations (visual and auditory), misidentification, confabulation, paranoia” as a presentation of dementia?

A

Fabricate an event that might have happened in the past

31
Q

What is “mood and personality change” as a presentation of dementia?

A

a

32
Q

What is “emotional lability” as a presentation of dementia?

A

E.g. Rage and tears

Quite extreme swings in emotions (eg, anger –> happy)

33
Q

What are 3 characteristics of visual altered perception?

A
34
Q

What are 4 characteristics of verbal altered perception?

A
35
Q

What are the 2 types of somatosensory of altered perception?

A
  1. Touch perceived as painful
  2. For personal care use
36
Q

What are 2 examples of “touch perceived as painful” for somatosensory in altered perception?

A
  1. Jet of water from shower
  2. Water temperature
37
Q

What are 3 examples for “personal care use” for somatosensory in altered perception?

A
  1. More dispersing shower head
  2. Water at skin temperature (~34°C)
  3. Consider a bath
38
Q

What are 4 ways that dementia affect mobility?

A
  1. Forgets where they are going, what they are doing, and what they will do next
  2. Distracted from task of going from A to B by anything that takes their attention → forgets what they were doing
  3. Takes no notice of obstacles in path
  4. Lacks desire to move
39
Q

What are gait and balance impairments in older people with dementia?

A
40
Q

What are the psychological risk factors for falls in older people with dementia?

A
41
Q

What are 6 reasons why people with dementia fall?

A
  1. Can’t share attention between two tasks
  2. Difficulty judging distances
  3. Finds it hard to choose between a number of options
    • E.g. which chair to sit on
  4. Difficulty ‘seeing’ chair if not a contrast to background colour
  5. Has difficulty in deciding what to do next
  6. Unable to understand instructions of directions
    • E.g. backwards or sideways
42
Q

What are 5 strategies for reducing the risk of falls in dementia patients?

A
  1. Examples of “trip hazards”
  2. Clear hallways and tracks from bed to bathroom (or where patients like to walk) of low objects
  3. People with severe dementia can’t read signs
  4. Low position of ‘wet floor’ signs → trip hazards (in addition to the slippery floor itself)
  5. Position people with their feet up on leg rests or in wheelchairs so that the footrests do notstick out into paths where others want to walk
43
Q

What are 2 non verbal cues to get movement for dementia patients for going to bed

A
  1. Invade personal space –“move over”
  2. ‘Pat’ the bed to make a sound and draw attention to it and say “lie here”
44
Q

What is the problem with non-verbal cues to get movement when going to be (invade personal space- move over)?

A

Person with dementia is sitting too close to foot of the bed to lie down with their head on the pillow

45
Q

What is the strategy with non- verbal cues to get movement with management considerations for dementia?

A
  • Sit close to them and gently suggest ‘move up’ as you ease your bottom sideways into their space
  • Move in sync with patient –> they mimic your movements
46
Q

What is the problem with non-verbal cues to get movement when going to be (“pat: the bed to make a sound and draw attention to it and say “lie here”)?

A

Difficulties getting the person with dementia to lie down in bed

47
Q

What is the strategy with non-verbal cues to get movement when going to be (“pat: the bed to make a sound and draw attention to it and say “lie here”)?

A

Try patting the pillow while saying “lie here”

48
Q

What is the problem with non-verbal cues to get movement when going to be (“Helping move from sitting on edge of bed to standing”)?

A

Lack of desire to initiate movement to stand up from sitting position

49
Q

What is the strategy with non-verbal cues to get movement when going to be (“Helping move from sitting on edge of bed to standing”)?

A
  • Sit beside patient, and lean forwards with patient as coming to standing
  • Hold hand and place on your knee to allow them to push up to standing
50
Q

What is the problem with non-verbal cues to get movement when going to be (“Adopting an upright sitting position from lying”)?

A

Patient doesn’t sit straight when getting up from lying on bed

51
Q

What is the strategy with non-verbal cues to get movement when going to be (“Adopting an upright sitting position from lying”)?

A

• Place shoes in the position on the floor to put feet into shoes • Patient will straighten up when they put their feet into shoes

52
Q

What is the problem with non-verbal cues to get movement when going to be (“Approaching a chair and sitting down”)?

A

Patient unable to “see” target, choose seat, and is easily distracted

53
Q

What is the strategy with non-verbal cues to get movement when going to be (“Approaching a chair and sitting down”)?

A
  • When assisting mobilizing, approach a seat from the diagonal so that the patient can see where you are heading
  • When close to the chairpat the chair seat and say “sit here”
54
Q

How can you overcome fear of standing up in dementia patients?

A

Place the back of a dining chair in front of patient, but not too close that he/she might pull up on it

55
Q

What are 4 characteristics of supervising walking in dementia patients?

A
  1. Walk in step with your resident
  2. ‘Stops walking to talk’.
    • Try not to talk to the person you are supervising to walk. Patient unable to dual-task
  3. To guide direction of walking gently hold hand and you moving in the desired direction will cause the patient to follow
  4. Help to ‘see’ a step by walking slightly ahead and stepping up or down before the patient so they can ‘feel’ what you do and copy the action automatically
56
Q

What are 4 characteristics of of supervising walking in patients who cannot “see”/blind?

A
  1. Walk in front of patient with them holding both your hands.
  2. Steer them past objects safely and keep them safely mobile
  3. Frequent & purposeful (to toilet, meals or outside in garden)
  4. May help to reduce agitation; repetitive calling out; trying to walk alone; falls
57
Q

What is the optimal handgrip for guiding activity (physio) for dementia patient?

A

Prevention of painfully squeezed hand when walking / transferring

58
Q

How can you get the grip released (physio) for dementia patients?

A
  • Gently bend the wrist forwards
  • Fingers loosen, allowing you to slip your hand out of the grip
  • Get patient to hold around thumb –> fingers are more free
59
Q

What are 11 characteristics of early dementia?

A
  1. Appears more apathetic
  2. Loss of interest in hobbies/activities
  3. Unwilling to try new things
  4. Poor judgment and makes poor decisions
  5. Shows earliest signs of confusion
  6. Can still perform concrete manual and functional tasks independently
  7. Unwilling to try new things / unable to adapt to change
  8. Slower to grasp complex ideas and takes longer with routine jobs
  9. More forgetful of recent events
  10. More likely to repeat themselves or lose thread of conversation
  11. Becomes more irritable or upset if they fail at something

Make exercise a little easier/not too complex = confidence booster

Positive comments (“Keep standing up” don’t say: Don’t sit down)

60
Q

What are the 3 stages of dementia?

A
  1. Early
  2. Moderate
  3. Advanced
61
Q

What is the key concept for early dementia?

A

Can still be involved in directed activities

62
Q

What are 11 characteristics of moderate dementia?

A
  1. More forgetful of recent events
  2. Confusion regarding time and place
  3. Lost if away from familiar surroundings
  4. Forgets names of family/friends
  5. Wandering –streets at night, becoming lost
  6. Inappropriate behaviour (going outdoor in nightwear)
  7. Visual / auditory hallucinations
  8. Thinking is disorganised
  9. Can only follow a one step very familiar action
  10. Neglectful of hygiene or eating
  11. Becomes angry, upset or distressed through frustration
63
Q

What are 12 characteristics of advanced dementia?

A
  1. Unable to remember occurrences for even a few minutes
  2. Loss of ability to understand or use speech
  3. Incontinent
  4. No recognition of friends or family
  5. Requires assistance eating, washing, toileting, dressing
  6. Unable to recognise everyday objects
  7. Disturbed at night
  8. Restless (e.g. looking for long-dead relatives)
  9. Aggression when feeling threatened or closed in
  10. Difficultly walking → confined to wheelchair
  11. Uncontrolled movement
  12. Immobility → bedridden
64
Q

What is the key concept for moderate dementia?

A

Manage by keeping a predictable routine

65
Q

What are 6 management considerations for dementia?

A
  1. Maintain mobility in a safe environment
  2. Prevent joint contractures / pressure areas
  3. Validation -helping the family & patient to accept that their problems are real
    • Help family understand that this is something real, a real problem for the patient
  4. Work with carers to set goals: respite if needed
  5. ‘Time-out’ when catastrophic reaction occurs
  6. One word instructions for profoundly impaired
66
Q

What are the 3 passive movement of the prevention of musculoskeletal complications at end stage dementia?

A
  1. Slow, full range with gentle prolonged pressure at end of range, sustained for 3-5 seconds
  2. Maintains, and can often ↑, joint range of motion
  3. Applied daily –can be performed in bath
    • Combination with heat therapy
67
Q

What are the 3 providing education characteristics of the prevention of musculoskeletal complications at end stage dementia?

A
  1. Overzealous nursing staff handling →soft tissue tears & #
  2. Movement in non-anatomical planes →soft tissue tears & #

PHTY2230 (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions