neurocognitive disorders Flashcards
cognition
system of interrelated abilities such as perception, reasoning, judgement, intuition, and memory. Allows one to be aware of oneself in relation to others
memory
facet of cognition, retaining and recalling past experiences
delirium
ACUTE cognitive impairment with rapid onset caused by medical condition
cognitive impairment, emotional and behavioral changes, physical and functional decline, and untimely death
dementia
CHRONIC cognitive impairment; differentiated by cause not symptoms
sundowning
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
aphasia
loss of language
expressive aphasia
cannot find the words to express ideas (Broca’s area)
receptive aphasia
cannot interpret what is said ( Wernicke’s)
apraxia
loss of purposeful movement
agnosia
loss of ability to recognize objects
confabulation
unconscious creating of stories or answers in place of actual memories (maintains self-esteem)
perservation
persistent repetition of a work, phrase, or gesture
hyperorality
tendency to put everything in the mouth and to taste and chew
common identified causes of delirium
meds
infections
fluid and electrolyte imbalances
hypoxia/ischemia
brain alterations
**medical emergency
clinical picture of delirium
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
four cardinal features of delirium
acute onset and fluctuating coarse
reduced ability to direct, focus, shift, and sustain attention
disorganized thinking
disturbances of consciousness
cognitive and perceptual disturbances of delirium
illusions
hallucinations
orientation - non-pharmacological for delirium
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
environment- non-pharmacological for delirium
adequate lighting
easy to read calendars and clocks
reasonable noise level
sleep hygiene
safety
symptomatic and supportive care
pharmacological interventions for delirium
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
nursing care summary for delirium
provide safety
medication management
provide symptomatic and supportive care
basic human needs
build trust
communication with delirium
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
neurocognitive disorders
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
mild neurocognitive disorders
does not interfere with ADL’s, does not necessarily progress
major neurocognitive disorders
interferes with daily functioning and independence
causes of major neurocognitive disorders
Alzheimer’s
frontotemporal dementia
dementia with Lewy bodies
vascular dementia
TBI
substance induced dementia
HIV infection
Prion disease
Parkinson’s disease
huntingtins disease
Alzheimers
disturbances in executive functioning including aphasia, apraxia, agnosia, MMSE, sun downing, confabulation, preservation (persistent repetition of a work, phrase, or gesture), hyperorality
risk factors of Alzheimers
age and family history, cardiovascular disease, social engagement, head injury and TBI, HTN and dyslipidemia
hallmarks of Alzheimers
Tau proteins and beta-amyloid plaques create neurofibrillary tangles
oxidative stress and free radicals, inflammation, brain atrophy
amyloid plaques
sticky clumps between nerve cells
neurofibrillary tangles
abnormal collections of protein threads inside nerve cells
neurotransmitters implicated in alzheimers
acetylcholine and glutamate
acetylcholine
learning, memory, and mood. brain produces less acetylcholine
cholinesterase inhibitors keep the acetylcholinesterase enzyme from breaking down acetylcholine
glutamate
involved with cell signaling, learning, and memory.
excess glutamate
NMDA antagonists help reduce excess calcium by blocking some NMDA receptors
mild alzheimers
forgetfulness, misplace articles, decreased recall, social withdraw, frustrated with self, changes may not be apparent to others
moderate alzheimers
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
severe alzheimers
cannot care for self, loss use of language, minimal long term memory, constant complete care
cognitive assessment tools
Mini-mental state exam (MMSE)
dementia severity rating scale
geriatric depression scale
memory impairment screen
mini-cog
functional assessment staging tool (FAST)
interventions for confusion/agitation
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!!!
alzheimers meds-acetylcholinesterase inhibitors (AChEl)
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
alzheimers meds- NMDA antagonists
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
