M3 day 1 Flashcards
cognition, memory, delirium, dementia definitions
Cognition
- System of interrelated abilities, such as perception, reasoning, judgment, intuition, and memory
- Allows one to be aware of oneself
Memory
- Facet of cognition, retaining and recalling past experiences
Delirium
- Acute cognitive impairment caused by medical condition (ex: infection), substance use, or multiple etiologies
Dementia
- Chronic, cognitive impairment
- Differentiated by cause, not symptoms
delirium
diagnostic cirteria, associated behaviours, hyper vs hypo delirium
Key diagnostic criteria: Impairment in cognition
- Disturbance in consciousness and a change in cognition
- Develops over a short period of time
- Usually reversible if underlying cause identified
- Serious, should be treated as an emergency (25% of patients do not survive)
Associated behavioural/physical findings:
- Attention wandering
- Perseveration
- Easily distracted
- day sleepiness
- Night-time agitation
- Restlessness
- Hyperkinetic delirium: psychomotor hyperactivity, excitability, hallucinations
- Hypokinetic delirium: lethargic, somnolent, apathetic
Delirium – Nursing Interventions
safety, maintaining, pharmacological, environmental
Safety
- Low beds, guard rails, and careful supervision
Maintaining:
- fluid and electrolyte balance
- Adequate nutrition
Pharmacological (based on symptoms)
- Benzodiazepines when the delirium is related to alcohol withdrawal.
environmental
- Adequate lighting
- Easy-to-read calendars and clocks
- Reasonable noise level
- Devices available — eye glasses and hearing aids
dementia manifestations
initial, intermediate, advanced
Initial:
- loss of memory–> alteration of short term memory
- Loss of initiative and interest
- Geographical disorientation
Intermediate:
- Difficulties recognizing loved ones
- Behavioural changes (wandering, agitation, etc.)
- Loss of long term memory and loss of procedural memory
- Confusion and insomnia
- Aphasia (knowing what to say, not finding words to say it)
- Apraxia (Inability to execute movement)
- Agnosia (inability to identify objects)
- Hallucination, delusions & illusions
Advanced:
- Incapacity to assimilate new information
- Incomprehension of words
- Dysphagia
- Immobility
- Incontinence
- Echolalia
- Dependant for ADLs
Dementia: Alzheimer’s type - Etiology
Beta-amyloid P, Neurofibrillary tangles, neurotransmission, Genetis
Beta-amyloid plaques
- Deposits destroy cholinergic neurons
Neurofibrillary tangles
- In limbic system
- contribute to memory disturbances and psychiatric symptoms
Cell death and neurotransmission
- Neurotransmission is reduced, neurons are lost
Genetic factors
- Roles of chromosome 1, 14, and 21
dementia pharm managment
pharmacological interventions
Acetylcholinesterase inhibitors (AChEI) for Alzheimer’s type (Donepezil /Aricept)
- Used to delay cognitive decline
Antipsychotics (symptom management)
Antidepressants and mood stabilizers (symptom management)
Antianxiety medications — used with caution (can cause paradoxical reactions)
Avoid medications with anticholinergic side effects (codeine for example).
delirium vs dementia
delirium
- Sudden onset
- Fluctuating course
- ↓ Consciousness
- ↓ Attention
- ↓ Cognition
- Hallucinations
- Incoherent speech
Dementia:
- Insidious onset
- Stable course
- Clear consciousness
- Clear attention
- ↓ Cognition
- Hallucinations may be present
- Normal speech
dementia nursing interventions for cognitive and mood alterations
Interventions for cognitive impairment
- Validation therapy - focuses on the emotions and subjective reality of the patient (help restore self-worth, reduction in stress…)
- Memory enhancement - concerted effort to reinforce short and long-term memory (reminding patients what they had for breakfast…)
- Orientation (avoid confrontation if the patient contradicts your attempts to remind him or her of time, place and person).
- Maintenance of language functions
- Supporting visuospatial functioning (ike dressing)
- Use distraction or reassurance.
- do not force activities, but encourage them
mood:
- manage anxiety
- manage depression
- Wandering behaviour: identify pattern. Determine level of confusion; walk with patient, then re-direct.
- Use antipsychotics for frightening hallucinations
ADHD and ASD
neurodevelopmental disorders
Attention deficit and hyperactivity disorder
- Inattention, Hyperactivity and impulsivity
- Symptoms present in at least 2 settings (school/home/friends)
Autism spectrum disorder
- Impairment in communication & imagination creativity
- Impairment in social interactions
- Restriction in behaviours and interests
- Range: mild, moderate & severe
Disruptive, Impulse Control, and Conduct Disorders
Oppositional defiant disoder, conduct disoder
Oppositional Defiant Disorder
- Negative, disobedient, hostile and defiant behaviour toward authority
- Does Not violate basic rights of others
- Severity related to number of settings where behaviours are observed
Conduct Disorder
- Pattern of antisocial behaviour
- Violates basic rights of others and disregard for social norms
- Poor self-esteem
- Transition to adulthood: Antisocial personality disorder /delinquency /criminality
Types:
(1) aggression
(2) property destruction
(3) theft
(4) rule violation
Anxiety Disorders
seperation Anxiety Disorder, generalized anxiety disorder
Separation anxiety disorder
- Significant stress that alters social, academic and/or occupational functioning when separated from parental figures
- Develops often following a significant stress (loss, illness, move)
- S/S: Fear of being/sleeping alone, fear parental figures will be harmed, somatic symptoms of anxiety, etc.
Generalized anxiety disorder
- Same as adult – omnipresent feeling of worry
- ++ need of reassurance about all performances
Nsg interventions for
Disorders of Children and Adolescents
- Family therapy: stabilize the environment
- Group therapy: adapted to developmental stage
- Play therapy: games, books, drawing, etc. (goal: consolidate emotions & behaviours)
- Behavioural therapy: Token/Reward Systems
- Pharmacotherapy: last resort
What is a personaity disorder and common features
Personality Disorder
- An enduring (long lasting) pattern of deviant inner experiences and behaviours
- Pervasive, inflexible, and stable
- Leads to distress or impairment that alters our ability to ‘function’ = criteria necessary for the diagnosis of a personality disorder
COMMON FEATURES
Cognitive Alterations:
- caused by maladaptive coping strategies
Altered emotional stability
- decreases one’s ability to accurately perceive one’s environment, affect one’s ability to learn to adapt to their environment, etc.
Altered interpersonal functioning/self-identity
Altered control of impulses = destructive behaviour
- Often the reason why people with personality disorders come into contact with the health care system.
- Inability to consider the consequences of their actions.
Types of Personality Disorders
cluster A (3), cluster b (4), cluster c (3)
Cluster A – ‘odd, eccentric’
- Paranoid personality disorder
- Schizoid personality disorder
- Schizotypal personality disorder
Cluster B – ‘dramatic, emotional, erratic’
- Borderline personality disorder
- Antisocial personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder
Cluster C – ‘anxious, fearful’
- Avoidant personality disorder
- Dependent personality disorder
- Obsessive-compulsive personality disorder
Cluster A
Paranoid Personality Disorder
features, Tx, interventions
Features
- Mistrustful, avoid relationships that they cannot control
- prefers solitude, avoids intimacy, secretive
- Incidents are often misinterpreted as having sinister or hidden meaning.
- These people tend to lack insight into their behaviours and may be hypercritical and project.
Treatment
- Psychotherapy focussed on developing trust in relationships
Cluster A
Schizoid Personality Disorder
features, Tx, interventions
Features
- Expressively impassive –> Blunted or flat affect –> . (unable to experience the pleasurable aspects of life)
- Introverted, reclusive and heightened anxiety when engaging in social activities.
- Rejection of intimacy –> (e.g., imaginary friends)
- Depersonalization and detachment – life observers, not participants
Treatment
- Psychotherapy (individual & group) = interpersonal relationships
- Pharmacotherapy: antidepressants (impassivity); antipsychotics (expressiveness)
nsg interventions
- Do not encourage social interactions; instead work on discussing topics related to anxiety and coping.
- Realistic outcomes may be as simple as increasing the patient’s satisfaction with solitary activities
- Milieu therapy: Protect the patient against being ridiculed/intimidated
Cluster A
Schizotypal Personality Disorder
features, Tx, interventions, difference w schizophrenia
Features
- Eccentric (unconventional & “slightly strange”)
- Pattern of social and interpersonal deficits, no close friends – seeks solitude.
- Cognitive and perceptual distortions, magical thinking, ideas of reference, illusions, bizarre communication – paranoia (people out to get them)
- Constricted and inadequate affect.
- Difference with schizophrenia = these people can be made aware of their perceptual disturbances.
Tx
- Psychotherapy (individual & group) = interpersonal relationships
- Pharmacotherapy = low dose antipsychotic (help with positive symptoms and improve day-to-day function)
Interventions
- respect for beliefs and symptoms
difference between Schizoid/schizotypical and schizophrenia
Schizoid and schizotypal personality disorders
- tend to be stable throughout the person’s life (including childhood).
Schizophrenia
- is dynamic (appears in early adult life). It evolves with time leaving place to negative symptoms and a decline in cognitive function.
- This decline isn’t present in cluster A personality disorders.
Level of behaviour ‘oddness’ = schizoid – schizotypal – schizophrenia
