neurocognitive disorders

Question 1

cognition

Answer 1

system of interrelated abilities such as perception, reasoning, judgement, intuition, and memory. Allows one to be aware of oneself in relation to others

Question 2

memory

Answer 2

facet of cognition, retaining and recalling past experiences

Question 3

delirium

Answer 3

ACUTE cognitive impairment with rapid onset caused by medical condition
cognitive impairment, emotional and behavioral changes, physical and functional decline, and untimely death

Question 4

dementia

Answer 4

CHRONIC cognitive impairment; differentiated by cause not symptoms

Question 5

sundowning

Answer 5

the tendency for an individuals mood to deteriorate and agitation increase in the later part of the day, with the fading of light, or at night

Question 6

aphasia

Answer 6

loss of language

Question 7

expressive aphasia

Answer 7

cannot find the words to express ideas (Broca’s area)

Question 8

receptive aphasia

Answer 8

cannot interpret what is said ( Wernicke’s)

Question 9

apraxia

Answer 9

loss of purposeful movement

Question 10

agnosia

Answer 10

loss of ability to recognize objects

Question 11

confabulation

Answer 11

unconscious creating of stories or answers in place of actual memories (maintains self-esteem)

Question 12

perservation

Answer 12

persistent repetition of a work, phrase, or gesture

Question 13

hyperorality

Answer 13

tendency to put everything in the mouth and to taste and chew

Question 14

common identified causes of delirium

Answer 14

meds
infections
fluid and electrolyte imbalances
hypoxia/ischemia
brain alterations
**medical emergency

Question 15

clinical picture of delirium

Answer 15

disturbance in attention and awareness
acute onset (hours to a few days) change from baseline; fluctuates over coarse of 24 hours
may also experience: memory deficit, disorientation, language changes, visuospatial ability ( think provider is daughter), delusions and hallucinations (usually visual), disturbances in sleep-wake pattern, direct physiological cause

Question 16

four cardinal features of delirium

Answer 16

acute onset and fluctuating coarse
reduced ability to direct, focus, shift, and sustain attention
disorganized thinking
disturbances of consciousness

Question 17

cognitive and perceptual disturbances of delirium

Answer 17

illusions
hallucinations

Question 18

orientation - non-pharmacological for delirium

Answer 18

encouraged to express fears and discomforts
comfort measures to instill trust
frequent verbal orientation
frequent brief interaction
consistency
allow television during the day with daily news
play non verbal music
approach patient slowly and from the front and address patients by name

Question 19

environment- non-pharmacological for delirium

Answer 19

adequate lighting
easy to read calendars and clocks
reasonable noise level
sleep hygiene
safety
symptomatic and supportive care

Question 20

pharmacological interventions for delirium

Answer 20

very small doses of antipsychotics
benzo’s ( lorazepam, watch for irritation, for hepatic dysfunction use this instead of antipsychotics)
sleep aid: mirtazapine
pain control: assess objectivity; consider intermittent narcotics
identify all possible drug-drug interaction
must treat underlying cause

Question 21

nursing care summary for delirium

Answer 21

provide safety
medication management
provide symptomatic and supportive care
basic human needs
build trust

Question 22

communication with delirium

Answer 22

use short, simple sentences
speak slowly and clearly, pitching voice low, do not act rushed or shout
identify self by name
repeat questions, allowing adequate time for response
tell client what you want done not what to do
encourage to express fears and discomfort
frequent, brief, verbal orientation

Question 23

neurocognitive disorders

Answer 23

progressive deterioration
no change in consciousness
condition is acquired
difficulty with memory, problem solving, and complex attention
affects orientation, attention, memory, vocabulary, calculation ability, and abstract thinking

Question 24

mild neurocognitive disorders

Answer 24

does not interfere with ADL’s, does not necessarily progress

Question 25

major neurocognitive disorders

Answer 25

interferes with daily functioning and independence

Question 26

causes of major neurocognitive disorders

Answer 26

Alzheimer's frontotemporal dementia dementia with Lewy bodies vascular dementia TBI substance induced dementia HIV infection Prion disease Parkinson's disease huntingtins disease

Question 27

Alzheimers

Answer 27

disturbances in executive functioning including aphasia, apraxia, agnosia, MMSE, sun downing, confabulation, preservation (persistent repetition of a work, phrase, or gesture), hyperorality

Question 28

risk factors of Alzheimers

Answer 28

age and family history, cardiovascular disease, social engagement, head injury and TBI, HTN and dyslipidemia

Question 29

hallmarks of Alzheimers

Answer 29

Tau proteins and beta-amyloid plaques create neurofibrillary tangles oxidative stress and free radicals, inflammation, brain atrophy

Question 30

amyloid plaques

Answer 30

sticky clumps between nerve cells

Question 31

neurofibrillary tangles

Answer 31

abnormal collections of protein threads inside nerve cells

Question 32

neurotransmitters implicated in alzheimers

Answer 32

acetylcholine and glutamate

Question 33

acetylcholine

Answer 33

learning, memory, and mood. brain produces less acetylcholine cholinesterase inhibitors keep the acetylcholinesterase enzyme from breaking down acetylcholine

Question 34

glutamate

Answer 34

involved with cell signaling, learning, and memory. excess glutamate NMDA antagonists help reduce excess calcium by blocking some NMDA receptors

Question 35

mild alzheimers

Answer 35

forgetfulness, misplace articles, decreased recall, social withdraw, frustrated with self, changes may not be apparent to others

Question 36

moderate alzheimers

Answer 36

decreased ability for self care, way finding, disoriented to time and place; wandering, pacing, possible hallucinations or delusions begin, decreased visual perception leading to accidents; needs supervision; emotional lability-big swings, symptoms noticable

Question 37

severe alzheimers

Answer 37

cannot care for self, loss use of language, minimal long term memory, constant complete care

Question 38

cognitive assessment tools

Answer 38

Mini-mental state exam (MMSE) dementia severity rating scale geriatric depression scale memory impairment screen mini-cog functional assessment staging tool (FAST)

Question 39

interventions for confusion/agitation

Answer 39

speak clearly, slowly, directly don't approach from behind face patient use of para-verbal and nonverbal communication techniques walk or walk/talk with patient if they are restless picture albums of pets, wildlife, scenery music- that the person likes patience!!!

Question 40

alzheimers meds-acetylcholinesterase inhibitors (AChEl)

Answer 40

donepezil rivastigmine P.O. transdermal patch galantamine indicated for mild to moderate Alzheimer's used to delay not decrease cognitive decline most common side effects nausea, vomting peaks in 3 months but continues to delay decline

Question 41

alzheimers meds- NMDA antagonists

Answer 41

memantine modulation of N-methyl-D-asperate (NMDA) restore the function of damaged nerve cells and reduce abnormal excitary signasl of the NT glutamate mild side effects of dizziness, confusion, headaches, and constipation