MEDSURG 2 EXAM #2 Flashcards
Week 3 & 4
- Define dementia and delirium.
Dementia: *
___________________
Delirium:* acutely disturbed state of mind
— S/Sx: restlessness, illusions, and incoherence, hyper/hypoactive activities
Dementia differences
Using mnemonic “OCDCAMPS”
Onset — insidious (over months to years)
Course — progressively gets worse
Duration — irreversible (months to years)
Consciousness — often normal
Attention — often normal (associated mostly to memory loss)
Memory — immediate recall often normal
Psychomotor changes — not usually present
Sleep-wake cycle — often normal
Delirium differences
Using mnemonic “OCDCAMPS”
Onset — rapid (hrs to days)
Course — fluctuating (“sundowning” towards the evening)
Duration — reversible (days to weeks; can cause liver failure)
Consciousness — altered due to something (infection, imbalances, etc)
Attention — significant inattention/lack of concentration)
Memory — immediate recall = impaired
Psychomotor changes — HYPER/HYPOactive
Sleep-wake cycle — often reverse of cycle
Depression differences using mnemonic “OCDCAMPS”
Onset — often coincides w/ life changes; often abrupt
Course — variable, rapid to slow, but may be uneven
Duration — several months to years, especially if not treated
Consciousness — feels sense of hopelessness (may not want to live)
Attention — may be indecisive
Memory — intact, but w/ apathy & fatigue
Psychomotor — often withdrawn and hypoactive
Sleep-wake cycle — disturbed, often w/ early AM awakening; can sleep all the time, or not at all
What is delirium + example?
Acutely disturbed state of mind, a cognitive impairment due to something
— e.g. fever, intoxication, d/o’s, UTI/infections
What is an illusion + example?
Perceiving something differently than what actually exists
— e.g. fearing a shadow is an attacker
Reasons for short-term illness in older adults with delirium?
— Lung/heart disease
— Infection
— Poor nutrition
— Drug interaction
Patients who experience delirium are at an increased risk for?
— Longer hospitalizations
— Further functional decline
— Institutionalization
The 3 most common cognitive problems in adults are?
- Delirium (acute confusion)
- Dementia
- Depression
NOTE: problems often occur together
What is a delusion + example?
Believing things that are contradicted by what is generally accepted as relation or rational argument
— e.g. fearing that people are trying to harm you
- Classify the different etiologies of dementia.
— Can occur following a relatively minor insult in a vulnerable patient
— e.g. Patient w/ underlying health problems (like HF, sensory limitations) may develop delirium in response to a minor change (e.g. use of a sleeping medication)
—Nonvulnerable patients may take a combination of factors to precipitate delirium
— e.g. Anesthesia, major surgery, infection
- Explain the pathophysiology for different types of dementia.
Precipitating Factors for delirium
— Demographic characteristics
— Cognitive status
— Environmental
— Functional status
— Sensory
— Decreased oral intake
— Drugs
— Surgery
— Coexisting medical conditions
Mnemonic for causes of delirium
D — dementia, dehydration
E — electrolyte imbalance, emotional stress
L — lung, liver, heart, kidney, brain
I — infxn, ICU
R — Rx drugs
I — injury, immobility
U — untreated pain, unfamiliar environment
M — metabolic d/o’s
- Discuss the clinical manifestations of mild cognitive impairment.
— Manifestations are sometimes confused with dementia and depression
— Usually develops over a 2-3 day period (or w/in hrs)
S/Sx: hypoactive, lethargic, hyperactive, agitated, hallucinating
— acute delirium lasts 1-7 days
Early manifestations of delirium
Inability to concentrate
Irritability
Insomnia
Loss of appetite
Restlessness
Confusion
Later manifestations of delirium
Agitation
Misperception
Misinterpretation
Hallucinations
Vascular dementia cause
also known as multiinfarct dementia
— Loss of cognitive function due to ischemic or hemorrhagic brain lesions caused by CV disease.
Creutzfeldt-Jakob Disease (CJD)
A degenerative brain disorder that leads to dementia and, ultimately, death
S/Sx of Creutzfeldt-Jakob Disease (CJD)
Can resemble those of other dementia-like brain disorders, such as Alzheimer’s. But Creutzfeldt-Jakob disease usually progresses much more rapidly.
- Describe the clinical manifestations, diagnostic studies, and nursing and interprofessional care for a patient with dementia.
Dx — focused on determining the cause through medical, neurological, psychological hx, and mental status testing
— only performed to RULE OUT other conditions
— MRI + CT can ID cognitive loss + vascular brain lesions
Dementia with Lewy bodies disease (LBD)
abnormal deposits of protein in the brainstem and cortex with manifestations similar to Alzheimer’s (cognitive impairment and hallucinations) and Parkinson’s (bradykinesia, rigidity, and postural instability but not always a tremor).
What is Alzheimer’s Disease (AD)?
Chronic, progressive, degenerative disease of the brain. It is the most common form of dementia, accounting for 60% to 80% of all cases of dementia. Exact cause is unknown. Likely a combination of genetic and environmental factors.
Causes of dementia
Types of dementias
— Neurodegenerative disorders
— Vascular diseases
Immunologic diseases or infections
—Medications
— Systemic diseases
— Trauma
— Tumors
— Ventricular disorders
Causes of dementia: neurodegenerative disorders
- AD
- Amyotrophic lateral sclerosis (ALS)
- Dementia with Lewy bodies (DLB)
- Down syndrome
- Frontotemporal lobar degeneration (FTLD)
- Huntington’s disease
- Parkinson’s disease
Causes of dementia: vascular disease
- Chronic subdural hematoma∗
- Subarachnoid hemorrhage∗
- Vascular (multiinfarct) dementia
Causes of dementia: immunologic disease or infections
- Multiple sclerosis
- Systemic exertion intolerance disease
- Infections (e.g., Creutzfeldt-Jakob disease)
- Acquired immunodeficiency syndrome (AIDS)
- Meningitis∗
- Encephalitis∗
- Neurosyphilis∗
- Systemic lupus erythematosus∗
Causes of dementia: medications
- Anticholinergics
- Antiparkinsonian drugs
- Cardiac drugs: digoxin, methyldopa
- Cocaine
- Heroin
- Hypnotics
- Opioids
- phenytoin (Dilantin)
- Tranquilizers
Causes of dementia: metabolic or nutritional diseases
- Alcohol use disorder
- Cobalamin (vitamin B12) deficiency∗
- Folate deficiency∗
- Hyperthyroidism∗
- Hypothyroidism∗
- Thiamine (vitamin B1) deficiency∗
Causes of dementia: systemic diseases
- Dialysis dementia∗
- Hepatic encephalopathy∗
- Uremic encephalopathy∗
- Wilson’s disease
Causes of dementia: trauma
- Head injury (potentially reversible)
Causes of dementia: tumors
- Brain tumors (primary)∗
- Metastatic tumors (potentially reversible)
Causes of dementia: ventricular disorders
- Hydrocephalus (potentially reversible)
Delirium Diagnostic Studies
Medical history
Psychologic history
Physical examination
Careful attention to medications
Cognitive measures
Confusion Assessment: Method (CAM)
Dx Studies in Delirium
To explore the cause:
— Serum electrolytes
— Blood urea nitrogen level
— Creatinine level
— Complete blood count (CBC)
— Drug and alcohol levels
— Electrocardiogram (ECG)
— Urine analysis
— Liver & Thyroid function tests
— O2 saturation levels
— Lumbar puncture
What is the role of the RN for a patient with delirium?
— Prevention
— Early recognition
— Treatment
— Focus on eliminating precipitating factors
— Protect patient from harm
— Encourage family members to stay at bedside
— If delirium is 2ndary to infxn, ABX therapy is next
- Discuss the clinical manifestations, diagnostic studies, and nursing and interprofessional care for a patient with Alzheimer disease.
- Explain the etiology, pathophysiology, clinical manifestations, diagnostic studies, and nursing and interprofessional care for a patient with delirium.
RN Mgmt for Delirium
Reorientation and behavioral interventions—used in all patients with delirium
Create a safe and quiet environment.
Provide reassurance.
Pay attention to environmental stimuli.
Clocks, calendars, noise, and light levels
Patient experiencing delirium is also at risk for
Immobility
Skin breakdown.
Nurse should also focus on supporting the family and caregivers.
Drug therapy for Delirium
— Dexmedetomidine (Precedex) for sedation
— Neuroleptics (antipsychotics, major tranquilizers)
— Haloperidol (Haldol)
— Risperidone (Risperdal)
— Olanzapine (Zyprexa)
— Quetiapine (Seroquel)
— Short-acting benzodiazepines (e.g. Lorazepam (Ativan))
- Outline the classification of spinal cord injuries and associated clinical manifestations.
Decipher the different mechanisms of injury
Differences in C4, C6, T6, & L1 spinal cord injuries
C4 (cervical) — tetraplegia (below the neck)
C6 (thoracic) — partial paralysis of hands and arms and lower body
T6 (lumbar) — paraplegia below chest
L1 (sacral) — paraplegia below the waist
NOTE: “C3, 4, & 5, keeps the diaphragm alive!”
What is Trigeminal Neuralgia?
trigeminal nerve CN V
— Characterized by sudden, usually unilateral, severe, brief, stabbing, recurrent episodes of pain in the distribution of the trigeminal nerve
— Both motor and sensory branches and usually affects sensory (mainly maxillary and mandibular branches)
— * Most cases result from vascular compression of the trigeminal nerve root by an abnormal loop of the superior cerebellar artery.
— Abnormal loop of the superior cerebella’s artery, which compresses the nerve as it exits the brainstem. This leads to chronic injury, causing flattening and atrophy of the nerve and damage to the myelin sheath
— Underlying pathology (MS, shingles, masses in cerebellum/brainstem)
Clinical manifestation for Bell’s Palsy
— Acute onset of unilateral lower motor facial weakness
— Pain around/behind ear/neck (50-60%)
— Drooping eyelid and corner of mouth
— Drooling
— Facial twitching
— Dryness of eyes/mouth
— Facial numbness
— Altered taste
— Hearing loss
— Excessive tearing in 1 eye
NOTE: most S/Sx will begin suddenly and reach their peak w/in 48-72 hrs
RF for Guillain-Barré Syndrome
S/Sx of Botulism
Treatments for Tetanus symptoms
