Module 2: Lesson 4: Cognition and Productive Aging Flashcards
The following cognitive interventions below have what type of evidence support:
- Multifaceted transition care intervention
Moderate evidence
The following cognitive intervention has what type of evidence support?
- Home based OT services targeting IADL
Strong evidence
The following cognitive intervention has what type of evidence support?
- Chronic disease self-management programs based on the Stanford Model of Chronic Disease Self Management
Moderate evidence
True or false: There is weak evidence to support the OT cognitive interventions targeting community dwelling older adults IADL performance?
False - strong evidence
What outcomes were noted with an OT facilitated 10 wk functional task exercise group (IADLs w/ focus on cognitive components)?
Pts demonstrated significant improvement with:
- General cognitive functions
- Memory
- EF
- Functional status
- Everyday problem solving
What are the most critical cognitive issues to be addressed in acute care?
- Consciousness
- Attention
- Working memory
- Safety judgement
What capacities are easily observed in acute care settings?
- Memory
- Attention deficits
- Overt problem solving
What term describes this LOC?
- Awake and participates in therapy with no efforts to increase arousal
Alert
What term describes this LOC?
- Drowsy, requires loud verbal stimulation to arouse, responds slowly
- May need to be sitting to maintain arousal, but will be able to participate minimally (follow occasional 1 step directions)
Lethargic
What term describes this LOC?
- Requires constant tactile or motor stimulation to obtain and maintain arousal
- May need to be sitting to maintain arousal
- When awake, the pt is confused and not able to productively participate in therapy
Obtunded
What term describes this LOC?
- Minimally arousable only with noxious stimuli such as sternal rub, calling the pt loudly, pinching arm or leg, deep nail bed pressure, shaking shoulders or bed
- Will not actively participate in therapy and has minimal awareness of self
Stupor
What term describes this LOC?
- Not arousable with any type of stimulus, including noxious
- The pt may exhibit physiological reflexive responses that are abnormal or normal
Coma
What is the primary skill required for memory and judgement?
Attention
In acute care, what four separate steps of memory are important to focus on?
- Encoding
- Consolidation
- Storage
- Retrieval
Name some common ICU medications that can impact cognition
Sedatives/hypnotics
- Lorazepam (Ativan)
- Midazolam (Versed)
- Dexmedetomidine HCL (Precedex)
- Propofol tirated (Diprivan)
What term is described below:
- Acute cognitive changes
- Fluctuating arousal
- Altered motor activity (hypo or hyper)
- Sleep disruption
Delirium
Describe delirium
- Acute cognitive changes
- Fluctuating arousal
- Altered motor activity (hypo or hyper)
- Sleep disruption
What is the incidence of delirium in the ICU
16-89%
What is ICU delirium linked to?
- Increased LOS
- Increased mortality
- Increased long term functional issues
- Increased cognitive deficits
- Increased time on mechanical ventilation
- Increased self extubation
What are some risk factors for delirium?
- Pre existing dementia
- History of hypertension
- History of alcoholism
- High severity of illness on admission
What are assessments used with cognition, disorders of consciousness and delirium in the ICU?
- Glasgow coma scale
- JFK Coman Recovery scale
- Richmond Agitation Sedation Scale (RASS)
- Confusion Assessment Method for the ICU
- Intensive Care Delirium Screening checklist
What are some issues that OT addresses with delirium?
- Sleep disturbances
- Immobility
- Cognitive deficits
- Visual deficits
- Lack of natural light exposure during the day
What cognitive scale is described below:
- 15 pt rapid assessment of consciousness and brain injury assessing eye opening and verbal and motor ability
Glasgow Coma Scale
Describe the scores of the GCS
- > or equal to 13 mild brain injury
- 9 to 12 moderate injury
- < or equal to 8 severe injury
What cognitive assessment is described below:
- Used w/ DOC
- Assists in differential diagnosis
- Quantifies emergence from a minimally conscious state
- Provides prognostic assessment and treatment planning
- Assesses the following functions: Auditory, visual, motor, oromotor, communication and arousal
The JFK Recovery Scale - Revised (CRS-R)
Describe the scores of the JFK Coma Recovery Scale - Revised
Scores range from 0 (deep coma_ to 23 (able to follow commands and use objects purposefully)
Describe the cognitive assessment listed below:
- 10 level scale (Scores range from +4 combative to 0 alert and calm to -5 unarousable)
The Richmond Agitation-Sedation Scale (RASS)
Describe the scoring/interventions of the RASS scores
-3 and -2: Appropriate for PROM and sitting EOB
`-1, 0, +1: As tolerated, progress toward ambulation and ADL
What cognitive assessment is described below:
Four feature assessment:
- AMS
- Inattention
- Altered consciousness (RASS score other than 0)
- Disorganized thinking
the Confusion Assessment Method for the ICU (CAM-ICU)
Describe the results of the Confusion Assessment Method for the ICE (CAM-ICU)
Positive for the presence of delirium if both features 1 and 2 are present, with at least one of features 3 or 4
What cognitive assessment is described below:
8 item check list assessing:
- LOC
- Inattention
- Disorientation
- Hallucinations or delusions
- Psychomotor agitation or retardation
- Inappropriate speech or mood
- Sleep wake cycel disturbances
- Symptom fluccuation
The Intensive Care Delirium Screening Checklist
Describe the scoring of the Intensive Care Delirium Screening Checklist
A score of > or equal to 4 within an 8 to 24 hour period is positive for delirium
Name some evidence based interventions that target prevention of delirium
- Establishing a daily schedule that promotes participation in daily activities
- Early mobilization
- Emotional regulation techniques
- Scheduled rest
- Establishing premorbid sleep wake cycles
- Frequent reorientation
- Assessing for pain and agitation during sessions when communicating findings to the team
- Coordinating with team for treatment while sedation is lifted