Neurocognitive Disorders Flashcards
Delirium
Disturbance in attention and awareness
- acute onset (h-d)
- change in baseline fluctuating with lucidity over 24h-d
Symptoms of delirium
May have poor memory, disorientation (often only oriented to self), long term memory, visuospatial ability, delusions and hallucination (often visual), often sus and persecutory prob, sleep/wake (reversed, no sleep)
Physio changes of delirium
- meds (BDZs)
- infx
- F&E chx
- hypoxia/ischemia
- surgery
- brain chx—dec cerebral fun or brain metab, inc plasma cortisol, NT imbalance, damage enzymes sys, BBB, cell membranes
- kids—often meds or fever
Cardinal features of delirium
- acute onset and fluc course
- Dec ability to direct, focus, shift, sustain attn
- disorg thinking
- disturbance of consciousness
Assessment of delirium
- cardinal features
- cog and perceptual disturbance—illusion, hallucination
- physical needs—help with ADLs
Nursing outcomes of delirium
- safety
- orientation
- visual cues in enviro to orient
- free from falls
- pt/fam understand illness cause
- continuity of care providers
Non-pharm tx for delirium
- express fears and discomfort
- comfort measures for trust
- freq verbal orientation
- freq brief interactions
- consistent nursing staff
- tv in day, off in night
- nonverbal music
- slowly approach pt and call name
- good lighting
- easy to read clock/calendar
- Dec stim at night
- Dec sleep disruptions, lower lights
- provide physical safety
- sx and supportive care (hydrate, nut, pain control, reassurance)
Pharm tx for delirium
- very small dose of antipsychotics PRN
- BDZs—watch for opp fx of agitation; better if hepatic probs
- sleep—-mirtazapine
- objective pain control; consider intermittent narcotics
- ID drug-drug interactions
- tx underlying causes
Communication with delirious pts
- short simple sentences
- speak low
- ID self AAT and explain process
- repeat questions if needed and leave time for response
- educate pt when not conf and fam
- call by name
- repeat PRN
- tell what to do, not what NOT to do
- express fears
- brief freq verbal orientation
dementia
degen, prog neuropsych dx resulting in cog, emo, bx, phys and dec fxn then death
Neurocog dx
Umbrella term including dementia
- prog dec of cog fxn and global impairment of intellect
- no LOC change
- acquired; not dev
- prob with memory, prob solving, complex attn, orientation, vocab, math, thinking abstractly
Mild neurocog dx
No interference with ADLs
Major neurocog dx
Interfere with daily fxn and ind
- examples Alz, vascular dementia, TBI, Parkinson’s, HIV, Hunt’s
Alzheimer’s
- most common dementia
- type of dementia that disturbs executive functions and is irreversible and progressive
- often dx with r/o
Symptoms of Alz
- aphasia—lose lang (receptive and expressive)
- apraxia—lose purposeful mvt
- agnosia—lose ability to recognize object/ppl - can’t remember family (measure with MMSE)
- sundown in
- confabulation—make things up to inc self-esteem
- perseveration—repetition of words, phases, gestures
- hyperorality—put things in mouth to taste and chew
