Neurocognitive Disorders Flashcards
What is Delirium?
-Disturbance in attention that develops over a SHORT period of time.
-Additional disturbance in cognition
-Symptoms CAN be reversed
Delirium S&S
-Sudden onset of confusion and change in cognitive mental status
-Irritability
-Confusion
-Changes in LOC
-Hyperactivity
-Trembling
-Tachycardia
-Sweating
-Tremors
-N/V
-Impaired consciousness
-Seizures
-Hallucinations
-Delirium tremens (DTs): RAPID onset of irritability, confusion, tremors, N/V, seizures caused by withdrawal from substances → fatal if untreated
-Usually occur when a client consumed a large amount of a substance (alc) over long period of time and withdraws abruptly
-Hypoactive delirium: empty gaze, reduced responsiveness, lessened motor activity
-Associated with sleep-wake cycle disturbances, rapid and unpredictable emotional disturbances
Cause of Delirium?
-Substance intoxication: when a client uses a substance for a prolonged time and then withdraws from the substance → delirium
Alcohol
Cannabis
Phencyclidine
Hallucinogens
Inhalants
Opioids
Sedatives/hypnotics/anxiolytics
Amphetamines
Cocaine
-Hepatic encephalopathy
-Hepatic failure
-Older clients who are dehydrated or have a UTI
-Infection
-Malnutrition
-Metabolic disorders
Thyroid disorders
-Neurological disorders
Head trauma
-Tumors
-Vitamin B-12 deficiency
-Physical stressors
Pain
Sleep deprivation
-Drugs
Lithium
Levodopa
Tricyclic antidepressants
Benzos
CNS depressants
Digitalis
Steroids
Medication for delirium?
1 Med tx: Cholinesterase inhibitors (donepezil, rivastigmine, galantamine)
#2: Memantine
IV e- solution
Infection → antibiotic
Withdrawl → benzo (dizepam or chlordiazepoxide) to prevent seizures and delirium tremens
Antipsychotic or neuroleptic meds if pt has agitation, sleep disturbances, or hallucination
Nonmed treatment for delirium
-Early mobility, families in care, restricting the use of analgesics or sedatives
-Monitoring proper hydration and nutrition, daily exercise, well lit enviornment
-When fluid & e- are balanced → return to regular cognitive fx
-Infection is resolved → return to regular cognitive fx
-the plan of care: reestablish electrolyte or vitamin imbalances, improve blood sugar levels, restore the client’s temperature, adjust medications, or withdraw the client successfully from alcohol or other substances.
-Mediterranean diet (fish, veg, plant oils)
-Exercise
-DASH diet
-Omega 3 fatty acids
Malnutrition: Restore fluid, electrolyte, protein, and other nutritional deficits via IV, oral, or other parenteral interventions.
Infection: Initial administration of broad-spectrum antibiotics
Medication-Induced: Discontinue suspicious medications and prepare to manage unstable body systems.
Hypoglycemia: Monitor and restore blood glucose, in severe cases, consider glucagon.
What is Dementia
Significant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, function, learning, memory, language, motor, social)
Deficits interfere with independence in everyday activities
S&S of Dementia
-Starting with mild cognitive deficits which progress to major deficits
Forgetfulness → needing round the clock supervision
-Flat affect
Cause of Dementia
-Progressive deterioration of neurons
-History of chronic oxygenation issues to the brain is a risk factor for developing dementia
-Primary intervention: communicate with the client and fam about the disease and comfort them as dementia progresses
-Use distraction and anticipate the client’s needs are important to communicate empathy to the client
-Reminiscence therapy → client will not feel the loss as deeply
-Reinforce reality and orient clients to person, place, location
-Nurses introduce themselves frequently
-Use short simple phrases
-Limit choices to alleviate stress of decision making
Meds to treat Dementia
1 Med tx: Cholinesterase inhibitors stops breakdown of acetylcholine –> increases acetylcholine
Donepezil, rivastigmine, galantamine
-Does not cure alz!
Nonmed treatment for Dementia
-Mediterranean diet (fish, veg, plant oils)
-Exercise
-DASH diet
-Omega 3 fatty acids
-MUSIC - improving appetite
-MASSAGE THERAPY
-FACE-RECOGNITION
-PET THERAPY
Stage 1 of dementia
No functional change, normal adult
Stage 2 of dementia
Trouble with words and locations but able to live independently, normal aging
Stage 3 of dementia
In stressful settings deficits occur. Client returns to baseline when stress decreases. May need assistance/monitoring. Designate financial or medical power of attorney.
Alzheimer’s disease possible, incipient
Stage 4 of dementia
Requires assistance with organizing and planning. May abandon previous hobbies, mild Alz
Stage 5 of dementia
Needs prompting and assistance for hygeine and dressing. Inappropriate or misplaced emotions. Medical and financial attorney should be in place by now. Moderate Alz
