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ADN 213 > Neurocognitive Disorders > Flashcards

Neurocognitive Disorders Flashcards

1
Q

Delirium

A

Characterized by a disturbance in attention and awareness and a change in cognition that develop rapidly over a short period

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2
Q

Delirium s/s

A
  • difficulty sustaining/shifting attention
  • distractiblity
  • disorganized thinking
  • speech that is rambling, irrelevant, pressured, incoherent and that unpredictably switches from subject-to-subject
  • impairment in reasoning ability and goal-directed behavior
  • illusions/hallucinations
  • disturbances in sleep/wake cycle
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3
Q

Delirium predisposing factors

A
  • serious medical, surgical, or neurological conditions
  • age > 65
  • dementia, depression, falls and elder abuse
  • substance w/d and intoxication
  • meds
  • fam hx
  • hypoxia
  • nutritional deficiencies
  • metabolic disturbances
  • endocrine issues
  • CVD
  • infection
  • chemical exposures
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4
Q

Who usually picks up on delirium in a pt first?

A

Nurses or family

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5
Q

Delerium objective assessments

A
  • VS
  • CNS exam
  • labs
  • check for infection – urine, blood
  • check for hypoglycemia
  • CMP
  • drugs/ETOH
  • EEG, CT, MRI, PET
  • mental status exams
  • MMSE
  • nursing Delirium Screening Scale (NU DESC)
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6
Q

Goals in management of delirium

A
  • fix underlying cause
  • keep pt safe
  • manage ADLs
  • manage grief/depression/self-esteem
  • care plan
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7
Q

Medical management of delirium

A
  • dx and management of underlying causes
  • treat symptoms
  • low-dose antipsychotics
  • Haloperidol (Haldol)
  • Benzodiazepines if delirium d/t substance abuse w/d
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8
Q

Delirium

Nursing care: environmental aspects

A
  • safety (furniture, low-stimulation, well-lit)

- reality orientation (controversy)

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9
Q

Delirium

Nursing care: communication

A
  • keep it simple and factual
  • use of distraction
  • assure glasses, hearing aides
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10
Q

Delirium

Nursing care: pt needs

A
  • assist with ADLs as needed
  • ensure/assist with nutrition needs
  • assist family/caregivers
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11
Q

Delirium

Evaluation

A
  • safety
  • orientation
  • confusion
  • agitation
  • family needs met?
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12
Q

Neurocognitive disorder (NCD)

A

Classified as either mild or major

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13
Q

Mild NCD

A
  • known as mild cognitive impairment

- early intervention could prevent or slow progression of the disorder

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14
Q

Major NCD

A

Previously known as DEMENTIA

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15
Q

NCD manifestations

A
  • impairment in abstract thinking, judgement and impulse control
  • uninhibited/inappropriate behavior
  • vague language, aphasia
  • personality, social conduct changes
  • apraxia
  • irritability/moodiness
  • wandering
  • profound memory deficits
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16
Q

NCD predisposing factors

A
  • alzheimers disease
  • vascular neurocognitive disorder
  • frontotemporal neurocognitive disorder
  • TBI
  • Lewy body dementia
  • Perkinson’s disease
  • HIV infection
  • substance abuse
  • Huntington’s disease
  • prion disease
  • family hx
17
Q

NCD subjective assessment

A
  • client or family hx of progression of symptoms/level of severity
  • cognitive decline
  • how long
  • how severe
  • what domains affected?
  • affect on ADLs
  • behavioral/psychotic symptoms
  • mood disturbances
  • agitation/apathy
  • stages of decline
18
Q

NCD objective assessment

A

Same as delirium

19
Q

Alzheimer’s Disease (AD)

A
  • progressive mental deterioration that can occur in middle or old age, due to generalized degeneration of the brain
  • the most common cause of premature senility
20
Q

AD stages of progression of symptoms

A

1) no apparent symptoms
2) forgetfullness
3) mild cognitive decline
4) mild-to-moderate cognitive decline
5) moderate cognitive decline
6) moderate-to-severe cognitive decline
7) severe cognitive decline

21
Q

AD etiology

A
  • neurotransmitter alterations
  • plaques and tangles
  • head trauma
  • genetic factors
22
Q

A client with dementia and chronic confusion is suspected to have Alzheimer disease. Which imaging technique is specific for Alzheimer disease?

A

Magnetic resonance spectroscopy

23
Q

Planning and interventions for NCD

A
  • maslow

- SAFETY!!

24
Q

NCD meds for treatment of cognitive impairment

A
  • Donepezil (Aricept)
  • Rivastigmine (Exelon)
  • Galantamine (Razadyne)
  • Memantine (Namenda)
25
Q

NCD meds for treatment of moderate-to-severe alzheimer’s type dementia

A

Memantine, extended release + donepezil (Namzaric)

26
Q

NCD meds for treatment of agitation, aggression, hallucinations, thought disturbances, wandering

A
  • Risperidone (Risperdal)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Haloperidol (Haldol)
27
Q

NCD meds for treatment of depression

A
  • Sertraline (Zoloft)
  • Parozetine (Paxil)
  • Nortiptyline (Pamelor)
28
Q

NCD meds for treatment of anxiety

A
  • Lorazepam (Ativan)

- Oxazepam (Serax)

29
Q

NCD meds for treatment of insomnia

A
  • Temazepam (Restoril)
  • Zolpidem (Ambien)
  • Zaleplon (Sonata)
  • Eszopiclone (Lunesta)
  • Ramelteon (Rozerem)
30
Q

NCD meds for treatment of depression and insomnia

A
  • Trazodone

- Mirtazapine (Remeron)

31
Q

An older adult with dementia has recently started to make mistakes regarding the time, place, and person. Which action of the nurse would be appropriate in this situation?

  • Minimize environmental stress to reduce confusion
  • Let the client continue to think in his or her own way
  • Prompt the client to recognize the correct date and time
  • Ask the client to recall the past to understand the present situation
A

Let the client continue to think in his or her own way

32
Q

A nurse is caring for an older adult with dementia who has been admitted in the special ward for further treatment. Which situation should the nurse address to meet the safety and security needs of the client according to Maslow’s hierarchy of needs?

  • “Since my teeth hurt when I eat, I drink fruit juices and prefer a liquid diet.“
  • “I do not want to talk to any stranger as I fear that they might take away my things.”
  • “My blood pressure level keeps on fluctuating, although I take medications regularly.”
  • “Ever since my family members came to know about my problem they are trying to avoid me.”
A

“I do not want to talk to any stranger as I fear that they might take away my things.”

33
Q

The home healthcare nurse visits an elderly couple living independently. The wife cares for the husband who has dementia. Which interventions should the nurse implement for them? Select all that apply.

  • Assess the wife for caregiver burden.
  • Arrange hospice care for the husband.
  • Make healthcare decisions for the couple
  • Assess the husband for signs of physical abuse.
  • Identify social support within the community.
A
  • Assess the wife for caregiver burden.
  • Assess the husband for signs of physical abuse.
  • Identify social support within the community.

ADN 213 (14 decks)

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