M11 Cognition Flashcards
Haldol does not work for
Elderly with dementia
Has opposite effect
Med good for hyperactive delirium
Haldol
Beers list
Meds contraindicated in elderly
Also has alternatives
Delirium assessment
Confusion assessment model tool
CAM
Can be done without an order
Mini COG assessment
Alzheimer
Can be done without orders
MMSE
Mini Mental State Examination
Assesses cognitive performance in elderly
Cognition in elderly may be affected by
Sensory impairment Physiologic health Environment Sleep Psychosocial influence
Fluid intelligence and age
Declines
usually due to circulatory or nervous disorders
Crystalized intelligence and age
Remains intact
Delirium
Acute confused state
Delirium can lead to
Changes in level of consciousness
Irreversible brain damage
Death
Delirium symptoms
Stupor - hypoactive
Excessive activity - hyperactive
Disorganized thinking
Short attention
Hallucinations, delusion, fear, anxiety, paranoia
Dementia symptoms are
where as delirium symptoms are
long term onset
acute onset
Because of unknown underlying causes, delirium is considered a
Medical Emergency
Delirium prevention
Reorienting Early Mobilization Pain control Good sleep Enhance communication methods (hearing aids, glasses) O2 levels Hydration
Delirium treatment
Fall prevention
Discontinue none essential meds
Monitor Nutrition and Fluids
Familiar environment ques like fam interaction
Dementia is
most common dementia
General decline in higher brain function
AD
Alzheimer Disease
AD
6th leading cause of death in
progressive degenerative neurologic disease
AD occurs in people over
65y/o
Patho of AD
Neurofibrillary tangles - nonfunctional neurons
Neurotic plagues - deposits of amyloid protein in the brain
What neurotransmitter is particularly affected by AD
Acetylcholine
Stages of AD
Preclinical - minor forgetfulness, small difficulties
Mild Cognitive - Noticeable mild changes that can be measured
Dementia due to Alzheimer’s - Significant impairment of thinking, behavior and functioning independently
Reality orientation
With AD
Who and where a person is in a time continuum
Will only WORSER mental state of AD patient due to increased anxiety
Diagnosis of AD
True diagnosis only after death
CBC CT MRI MMSE to rule out other possibilities
Meds for AD
Cholinesterase inhibitors
Donepezil
Rivastigmine
WILL NOT CURE
Nurses roles in AD
Supporting Cognitive Function
Calm predictable routine
Simple explanations
Memory aids
Physical and verbal stimulation
Clock/calendar display
Nursing roles in AD
Promoting physical safety
Rails, lighting, secure doors leading outside,
Nursing roles in AD
Promotion of independence
Make short organized achievable goals to promote autonomy
Nursing roles in AD
Anxiety reduction
Keep environment constant and calm
Delaying activity until patient is calm is appropriate
Nursing roles in AD
Improve Communication
Provide Socialization
use clear and concise messages, reduce noise
support visits, letters, phone calls, hobbies etc.
Nursing roles in AD
Nutrition
Activity and rest
cueing to encourage adequate nutrition and hydration. Small pieces, not too hot.
Music, warm milk or other que for sleep
Encourage exercise during day
Nursing roles in AD
Neglect/abuse
Report all suspected abuse
Nurses job is to report, not to prove
In AD damage is caused by a substance called
Amyloid
3 parts of AD brain tissue damage
Neurofibrillary tangles
Neurotic plaque
Granulovacuolar degeneration
AD Risk factors
Aging Low education Down Syndrome Smoking Fam hist Insulin resistance Dyslipidemia
With AD Depression is present in _ stages
Early
Early AD symptom
Impaired sense of smell
Diagnosing AD is done by exclusion, meaning
Tests are performed to rule other things out
Diagnostics for AD
Electroencephalography
Neuropsychological tests
AD PTs should avoid what consumable
Coffee-containing foods
Coffee tea cola chocolate
Meds that help preserve memory
Memantin
Ginkgo Biloba
Cholinesterase inhibiters interact with which drug
NSAIDs
