Neurocognitive Disorders Flashcards
Exam 4 (Final)
Cognition
Brain’s ability to process, retain, use information
Cognitive Processes
Processes: reasoning, judgment, perception, attention, comprehension, memory
Neurocognitive disorders
disruption or impairment in higher level brain functions
Delirium
Syndrome involving disturbance of consciousness with change in memory, orientation and language
How long is delirium?
Short period
Etiology of Delirium
infections, fluid and electrolyte imbalances, metabolic disturbance, hypoxia (COPD, emphysema, pneumonia), medications (Table 39.2), drug intoxication or withdrawal
Treatment for Delirium
Treat cause of delirium
Assessment of Delirium: History
medical history, medications
Assessment of Delirium: General appearance and motor behavior
disturbed psychomotor behavior (hypo or hyper), possible speech problems
Assessment of Delirium: Mood and affect
unpredictable shifts (agitated to lethargic)
Assessment of Delirium: Thought process and content
thoughts may be fragmented, severely impaired memory especially most recent.
Assessment of Delirium: Sensorium and intellectual processes
decreased awareness of environment
Assessment of Delirium: Judgment and insight
impaired
Assessment of Delirium: Roles and Relationships
inability to fulfill roles
Assessment of Delirium: Self concept
fear, feel threatened
Assessment of Delirium: Physiological and self care
sleep problems, ignore or fail to perceive internal body cues
Delirium: outcome identification
Freedom from injury *
Increased orientation, reality contact
Balance of activity and rest
Adequate nutrition and fluid balance
Return to optimal level of functioning
Delirium: Intervention
Promoting client safety
Managing client’s confusion: orienting cues; speaking in low, clear voice; avoiding sensory overload
Promoting sleep, proper nutrition
Delirium: Treatment
No specific medications
Supportive measures and treatment of precipitating factors are most effective & preferred
Dementia/ Alzheimer’s Disease
Progressive cognitive impairment*; language impairment
Issues involving Dementia/ Alzheimer’s Disease
Executive function
Aphasia
Apraxia
Agnosia
Executive function
(difficulty w/ ability
to think abstract, plan, initiate, sequence
Aphasia
(difficulty with speech)
Apraxia
(difficulty with movements on command)
Agnosia
(loss of ability to identify things or objects)
Stages of Dementia/ Alzheimer’s Disease - How many and what are they
- Mild
- Moderate
- Severe
Dementia/ Alzheimer’s Disease : Mild Stage
Loss of memory (forgetting recent conversations, events)
Language difficulties
Mood difficulties
Personality changes
Diminished judgement
Dementia/ Alzheimer’s Disease : Moderate Stage
Inability to retain new information
Behavioral, personality changes
Increasing long term memory loss
Wandering, agitation, aggression, confusion
Requires assistance with ADLS
Dementia/ Alzheimer’s Disease : Severe Stage
Gait and motor disturbances
Bedridden
Unable to perform ADLs
Incontinence
Requires long term care placement
Etiology of Dementia/ Alzheimer’s Disease: There are multiple factors involved in the development and progression of this disorder:
There are multiple factors involved in the development and progression of this disorder
Genetic factors APOE-e4 gene
Prior risk for head injury*
Metabolic syndrome associated w/ microvascular changes
B-amyloid protein accumulation
Reduced neurotransmission which affects acetylcholine, norepinephrine, and serotonin
Dementia Assessment: History
client may be unable to provide accurate history.
Dementia Assessment: General appearance and motor behavior
aphasia; apraxia; uninhibited behavior
Dementia Assessment: Mood and affect
depression prevalent in early stages*;
Dementia Assessment: Thought process and content
impaired abstract thinking; delusions, visual hallucinations
Common Delusional Beliefs
Belief that their partner is engaging in marital infidelity
Belief that other patients or staff members are impersonators
Belief that people are stealing their belongings
Belief that strangers are living in their home
Belief that people on television are real and not actors
Most common type of hallucinations
Visual hallucinations are the most common
Example of a common visual hallucination
Frequent complaint that children, adults, or strange creatures are entering the house or the patient’s room
Dementia Assessment: Sensorium and intellectual processes
memory deficits; confabulation*
Dementia Assessment: Judgment and insight
: poor judgment
Dementia assessment: self concept
sadness; eventual loss of self-awareness
Dementia assessment: Roles and relationships
profoundly affected
Dementia assessment: Physiological and self care
disturbed sleep; incontinence; hygiene deficits
Dementia interventions
Safety
Sleep, proper nutrition, hygiene, activity
Environmental, routine structure
Emotional support
Interaction and involvement
Mental Health promotion: Measures to decrease risk of Alzheimer’s disease
Regular participation in brain-stimulating activities
Leisure-time physical activity during midlife
Large social network
Role of the caregiver: Needs of caregivers
Education about dementia, required client care
Assistance in dealing with own feelings of loss
Respite to care for own needs*, role strain
Support groups
Assistance from agencies
Support to maintain personal life
Self-Awareness Issues
Teaching clients with dementia can be frustrating.
Discuss frustrations with a mentor or supervisor.
May be difficult to deal with feelings about people who will never “get better and go home”
Importance of dignity for client and family
Medications for Alzheimer’s/Dementia
No cure exists, but medications and management strategies may temporarily improve symptoms
What does Alzheimer’s do to levels of chemical messengers?
Alzheimer’s disease decreases levels of a chemical messenger (acetylcholine) which is needed for alertness, memory, thought and judgment
Cholinesterase inhibitors
Cholinesterase inhibitors boost the amount of acetylcholine available to nerve cells by preventing its breakdown in the brain.
What do Cholinesterase inhibitors NOT do?
Cholinesterase inhibitors can not reverse Alzheimer’s disease or stop the destruction of nerve cells.
Why do cholinesterase inhibitors eventually lose effectiveness?
Eventually these medications lose effectiveness because dwindling brain cells produce less acetylcholine as the disease progresses.
Example drugs for Alzheimer’s/Dementia:
Galantamine (Razadyne)
Rivastigmine (Exelon)
Memantine (Namenda)
Donepezil and Memantine (Namzaric)
Donepezil (Aricept)
Galantamine (Razadyne): what does it treat and
treats mild to moderate Alzheimer’s.
Galantamine (Razadyne): how is it taken
It’s taken as a pill once a day or as an extended release capsule twice a day
Rivastigmine (Exelon)
treats mild to moderate Alzheimer’s disease.
Rivastigmine (Exelon): How is it taken?
It’s taken as a pill.
A skin patch is available that can also be used to treat severe Alzheimer’s disease.
Memantine (Namenda)
treats moderate to severe Alzheimer’s Disease.
Donepezil and Memantine (Namzaric)
) treats moderate to severe
Donepezil (Aricept)
treats All stages of the disease. It’s taken once a day as a pill.
Medication Most Common Side effects
Headache, dizziness, nausea and diarrhea.
How to mitigate medication side effects
Mitigation Strategies; Start at a low dose with slow titration up. Take with food. Over time side effects will dissipate
