Neurocognitive Disorders Flashcards
1
Q
Delirium
A
Disturbance in attention and awareness
- acute onset (h-d)
- change in baseline fluctuating with lucidity over 24h-d
2
Q
Symptoms of delirium
A
May have poor long-term memory, disorientation (often only oriented to self), visuospatial ability, delusions and hallucination (often visual), often sus and persecutory prob, sleep/wake (reversed, no sleep)
3
Q
Physio causes of delirium
A
- 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
4
Q
Cardinal features of delirium
A
- acute onset and fluc course
- Dec ability to direct, focus, shift, sustain attn
- disorg thinking
- disturbance of consciousness
5
Q
Assessment of delirium
A
- cardinal features
- cog and perceptual disturbance—illusion, hallucination
- physical needs—help with ADLs
6
Q
Nursing outcomes of delirium
A
- safety
- orientation
- visual cues in enviro to orient
- free from falls
- pt/fam understand illness cause
- continuity of care providers
7
Q
Non-pharm tx for delirium
A
- 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)
8
Q
Pharm tx for delirium
A
- 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
9
Q
Communication with delirious pts
A
- 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
10
Q
dementia
A
degen, prog neuropsych dx resulting in cog, emo, bx, phys and dec fxn then death
11
Q
Neurocog dx
A
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
12
Q
Mild neurocog dx
A
No interference with ADLs
13
Q
Major neurocog dx
A
Interfere with daily fxn and ind
- examples Alz, vascular dementia, TBI, Parkinson’s, HIV, Hunt’s
14
Q
Alzheimer’s
A
- most common dementia
- type of dementia that disturbs executive functions and is irreversible and progressive
- often dx with r/o
15
Q
Symptoms of Alz
A
- 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
16
Q
Epidemiology of Alz
A
- age 65+ and family
- CVD
- social engagement
- diet
- TBI
- head injury
- HTN and dyslipidemia
17
Q
Bio rf for Alz
A
Oxidative stress and free radicals precedes plaques
- inflammation after stroke (use of NSAIDs may Dec)
18
Q
Patho of Alz
A
- Extracellular sticky beta-amyloid plaques (block synapses that are normally protected by tau proteins so nutrition can’t get into the cells and cells starve)
- Intracellular neurofibrillary tangles—abnormal collections of tau proteins
- brain atrophy and increase ventricle size
- oxidative stress and free radicals
- inflammation
19
Q
NTs in Alz
A
- ACh (parasymp)—learn, memory, mood; prod decreases as disease progresses
- Glutamate—cell signaling, learning, memory; inc in Alz (NMDA antags dec Ca by blocking NMDAr)
20
Q
Priorities for Alz tx
A
- initial delay cog decline
- moderate - protect pt from hurting self
- late - phys needs become the focus of care
21
Q
Mild Alz sx
A
- forgetful, misplaced stuff, Dec recall, social w/d, self-frustration
- change might not be apparent except to spouse
22
Q
Mod Alz sx
A
- Dec self-care, disoriented to time/place, wander, pace, delusions, hallucinations, Dec visual perception
- accidents, need supervision, emotional mood swing
- sx noticeable
23
Q
Severe Alz sx
A
- often LTC
- emotional self-care, long-term memory loss, lose language
- incontinence, gait probs, mute, sz, can’t feed self
- physical needs important
24
Q
Dementia assessment
A
- biological—phys and ROS
- phys fxn—sleep-wake, self-care, pain, nut, activity
- psych—confab, perseveration, agraphia, hyperorality, aphasia, apraxia, agnosia, sundowning, sus, delus/halluc, illusions, anx, mood chx, catastrophic rxn
- defense mechs—denial, confab, perseveration, avoidance
- social—fxn, social sys, spiritual, QoL, primary caregiver, legal status
- bx
25
Behavioral s/s dementia
- apathy and w/d
- restless, agitate, agg
- aberrant motor bx
- disinhibition
- hypersexuality
- signs stress/anx
26
Dementia dx
- r/o metabolic dx
- CT, PET, med, psych hx
- MMSE
- often only known in autopsy
- review recent sx, meds, nut
27
Interventions for confusion/agitation
- speak clear, slow, direct
- approach from front
- face pt
- 1 task at a time
- patience!
- nutrition—watch wt, intake, hydrate, watch for swallow prob
- bowel/bladder fxn
- para and nonverbal comm
- walk if pt restless
- pictures of pets, fam, wildlife
- music they like (when young)
- self-care but allow ind
- sleep intx
- balance activity with sleep
- relax techniques
- pain measures—don’t rely on verbalizing pain
28
Acetylcholinesterase inhibitors
- Galantamine for mild-mod
- Donepezil and rivastigmine or transdermal patch (all stages)
- used to delay not dec cog decline (stabilize memory, lang, orientation)
- peak in 3M but continues to delay decline
- minimal benefit after 1 year
29
Benefit of the patch
Fewer GI prob
30
Most common side effects of AChEI
N/V
- CNS dizzy, HA
- GI
- insomnia
- brady and syncope
31
NMDAr anatgonist
Memantine
- restore fxn of damaged nerve cells and dec abnormal excitatory signals of the NT glut
- slow decline, slight inc in cog fxn
- used in all stages Alz and vasc dementia (mod-severe)
- block glut from NMDAr--prevent Ca from going into cells (NMDA normally binds and causes Ca to go into cell--dec abnormal signal of glut)
32
NMDA antag SE
dizzy, confusion, HA, constipation
33
Order of Alz meds
- 1st ACh
- 2nd NMDAr antag
- can give both at once
34
Off label meds for Alz
Start very low dose
- antipsychotics (may inc mort; be cautious)
- antidepressants
- antianx
- anticonvulsants
