Module 11: Neurocognitive Disorders

Question 1

What is delirium?

Answer 1

Disturbance in consciousness and a change in cognition developing over a short period of time

• reversible (if treated quickly)

Question 2

How is delirium characterized?

Answer 2

impaired consciousness

• less aware of environment; loss of ability to focus
• problems in memory, orientation, language
  (different from dementia)

Question 3

Describe hyperactive delirium.

Answer 3

• agitation
• psychomotor restlessness

Question 4

Describe hypoactive delirium.

Answer 4

• somnolence
• psychomotor slowing (retardation)

Question 5

Is delirium hyperactive or hypoactive?

Answer 5

both

Question 6

What are risk factors of delirium?

Answer 6

• age and comorrbid cognitive impairment are biggest risk
• infection (COVID, pneumonia, urinary tract)
• medications (anticholinergic side effects)
• changes in vital signs (including hypotension and hyper- or hypothermia)
• electrolyte or metabolic imbalance (dehydration, renal failure, hyponatremia)
• pain
• stress
• substance withdrawal

Question 7

Treatments for delirium?

Answer 7

• Identify and treat the underlying cause
• Ensure a safe environment
• Stop drugs that worsen symptoms
• Monitor and manage symptoms
• Therapy and mobility
• Pharmacological (antipsychotics)

Question 8

What do interventions for delirium focus on?

Answer 8

• identifying and correcting underlying cause
• symptomatic and supportive measures

Question 9

What do interventions for delirium include?

Answer 9

• Stopping all suspected medicines
  
  • Anticholinergics
  • Sedatives
  • Anti-inflammatories
  • Many others!
• Vital sign monitoring (At least every 2 hours)
• Close observation of vitals, behavior and mental status changes

Question 10

What is Alzheimer Disease?

Answer 10

Degenerative, progressive neuropsychiatric disorder

Question 11

How is Alzheimer Disease characterized?

Answer 11

• Cognitive impairment
• Emotional and behavioral changes
• Physical and functional decline

Question 12

What medications are used for Alzheimer Disease?

Answer 12

• Cholinesterase inhibitors
  
  • Donepezil (Aricept)
  • Galantamine (Razadyne)
• NMDA Antagonist
  
  • Memantine (Namenda)
• Combinations
  
  • Memantine ER + Donepezil (Namzaric)

Question 13

How to evaluate effectiveness of medication?

Answer 13

• Cognitive assessments
• Behavioral and functional assessments
• Caregiver/Family feedback
• Tracking symptoms
• Monitor side effects
• Longitudinal evaluation

Question 14

What are nursing considerations for Alzheimer Disease?

Answer 14

• Confirm diagnosis
• Establish baseline levels in functional sphere
• Establish therapeutic relationship with patient and family
• Focus of treatment efforts
  
  • Manage cognitive symptoms
  • Delay cognitive decline
  • Treat non-cognitive symptoms: psychosis, mood symptoms, and agitation
  • support caregivers
• Needs vary throughout disease