Neurocog d/o w3 Flashcards
Delirium – ACUTE cognitive impairment with rapid onset, caused by medical condition
Dementia – CHRONIC cognitive impairment, differentiated by cause not symptoms
Sundowning – mood deteriorates and agitation increases later in the day, with the fading light or at night
Agnosia – loss of ability to recognize objects
Confabulation – unconscious creation of stories/answers in place of actual memories (not done intentionally, maintains self esteem)
Preservation – persistent repetition of a word, phrase, or gesture
Hyperorality – tendency to put things in mouth to taste or chew
Aphasia – loss of language
Expressive aphasia (broca’s area) – cant find words to express ideas
Receptive aphasia (wernicke’s) – cant interpret what is said
Apraxia – loss of purposeful movement
NCD: Medications
Acetyl/cholinesterase inhibitors (AChEI)
- Donepezil
- Rivastigmine – PO and transdermal
- Galantamine
NMDA antagonists
- Memantine
_________
ACUTE cognitive impairment with rapid onset, caused by medical condition or direct physiological cause
Causes:
- Meds
- Infections
- F&E imbalances
- Hypoxia/ischemia
- Brain alterations
- Surgery
delirium
________: Clinical picture
- Attention and awareness disturbance
- Acute onset (hours to days) change from baseline, fluctuates with periods of lucidity over course of a 24 hour period
- Memory deficit
- Disorientation
- Language changes
- Visuospatial ability
- Delusions and hallucinations (visual)
- Sleep wake pattern disturbance
delirium
4 cardinal features of _________
- Acute onset and fluctuation course
- Reduced ability to direct, focus, shift and sustain attention
- Disorganized thinking
- Disturbance of consciousness
cognitive and perceptual disturbances
- Illusions
- Hallucinations
delirium
Non-pharm nursing interventions: delirium
orientation
- Encourage to express fears and discomforts
- Comfort measures to instill trust
- Verbal orientation
- Frequent brief interactions
- Consistency in staff
- Tv during day with daily news
- Non-verbal music
- Approach pt slowly, from front, use name
environment
- Adequate lighting
- Calendars and clocks
- Noise level, decrease stimulation at night
- Sleep hygiene
- Provide safety
- Symptomatic and supportive care
Pharm nursing interventions: delirium
- Medicate with small doses of antipsychotics
- Benzodiazepines – lorazepam
- Sleep aids – mirtazapine
- Pain control
- Drug drug interactions
- Treat underlying cause
___________ - Degenerative progressive neuropsychiatric disorder that results in cognitive impairment, emotional, and behavioral changes, physical and functional decline, and ultimately death
- CHRONIC cognitive impairment
- differentiated by cause not symptoms
Dementia
____________ disorders
- Progressive deterioration of cognitive functioning and global impairment of intellect
- No change in consciousness
- Acquired condition, not developmental
- Difficulty with memory, problem solving, complex attention
- Affects orientation, attention, memory, vocabulary, calculation ability, abstract thinking
- (major d/o) interferes with daily functioning and independence
- (Mild d/o) – does not interfere with ADLs, does not progress
ex (major):
- Alzheimers
- Dementia
- TBI
- HIV infection
- Parkinsons, huntingtons, prion disease
Neurocognitive disorders
delirium or dementia?
s/s
- Disturbance in executive functioning
- Aphasia – loss of language
- Apraxia
- Agnosia
- MMSE – cant name things
- Sundowning
- Memory impairment – confabulation
- Preservation
- Hyperorality
- Hoarding
Alzheimers: Most common dementia
Risk factors: delirium or dementia?
- Age, family hx
- CV disease
- Social engagement
- Diet
- TBI
- HTN and dyslipidemia
- Neuronal degeneration
- Genetics
Alzheimers: Most common dementia
Etiology of AD
- Tau proteins and beta amyloid plaques (sticky clumps between nerve cells) create neurofibrillary tangles (abnormal collections of protein threads inside nerve cells)
- Oxidative stress and free radicals
- Inflammation
- Brain atrophy
Neurotransmitters in AD
- Less Acetylcholine produced (med- cholinesterase inhibitors keep enzyme from breaking down acetylcholine)
- Excessive glutamate (med – NMDA antagonists reduce excess calcium by blocking some NMDA receptors)
Stages AD
Mild – priority care is delay cognitive decline
- Forgetful
- Misplaces things
- Decreased recall
- Social withdrawal
- Frustrated with self
- Changes may not be apparent to others
Moderate - priority care is safety
- Decreased self care, way finding
- Disoriented to time and place
- Wandering, pacing
- Hallucinations or delusions
- Decreased visual perception
- Required supervision
- Emotional lability
- Symptoms noticeable
Severe - priority care is physical needs
- Cant care for self
- Loss of language
- Minimal long term memory
- Constant complete care
AD meds
1st line
Class = acetylcholinesterase inhibitors (AChEI)
Drugs = donepezil, rivastigmine, galantamine
- Indication = mild to moderate AD
- Delays cognitive decline
- s/e = n/v
- peaks in 3 mos, then continues to decline
- rivastigmine route – PO and patch
2nd line or combo
Class = NMDA antagonists
Drug = memantine
- restore function of damaged nerve cells and reduce abnormal excitatory signals of glutamate
- s/e = dizzy, confusion, h/a, constipation
