Neurocognitive Disorders Flashcards
1
Q
Neurocognitive Disorders
A
These are disorders in which a clinically significant deficit in cognition or memory exists, representing a significant change from a previous level of functioning
2
Q
what is age risk for dementia
A
middle age and beyond
3
Q
what is delirium
A
A disturbance in level of awareness and change in cognition
4
Q
How quick does Delirium develop
A
rapidly over a short period
5
Q
what are the symptoms of delirium
A
- Difficulty sustaining and shifting attention
- extreme distractibilty
- disorganized thinking
- speech that is rambling, irrelevant, pressured
- Impaired reasoning ability and goal-directed behavior
- disorientation to time and place
6
Q
what are the symptoms of delirium
A
- impairment of recent memory
- misperceptions about the environment, including illusions and hallucinations
- disturbance in level of consciousness, interruption of wake and sleep cycle
- fluctuates between agitation and restlessness and vegetative state
- emotional instability
7
Q
Delirium autonomic Symptoms
A
tachycardia sweating flushed face dilated pupils elevated blood pressure
8
Q
delirium duration
A
usually brief and subsides completely on recovery from underlying determinant
9
Q
Substance-induced delirium
A
maybe cause by intoxication or withdrawal from certain substance
- Anticholinergics, antihypertensives, corticosteroids
- alcohol, amphetamines, cannabis, cocaine, hallucinogens
- toxins, solvents, fuels, lead, mercury, arsenic, carbon monoxide
10
Q
Neurocognitive disorder
A
impairment in the cognitive functions of thinking, reasoning, memory, learning, and speaking
11
Q
Two classes of NCD depending on serverity
A
- Mild NCD also known as mild cognitive impairment
- Major NCD constitutes what was previously described in the DSM as dementia
12
Q
Primary NCDs
A
disorder itself is the major sign of some organic brain disease not directly related to any other organic illness(Alzheimer disease)
13
Q
Secondary NCDs
A
are caused by or related to another disease or condition (HIV DISEASE, CEREBRAL TRAUMA)
14
Q
NCDs symptoms
A
- Abstract thinking, judgement, and impulse control
- conventional rules of social conduct are disregarded
- Personal appearance and hygiene are neglected
- Personality change is common
15
Q
Reversible NCD (temporary dementia) is caused by ?
A
Stoke depression side effects of medications Nutritional deficiencies metabolic disorders
16
Q
NCD symptoms
A
Aphasia- cannot speak at all
Apraxia- inability to carry out motor activities
Irritability and moodiness, sudden outburst
Inability to care for personal needs independently
Wandering away from home
Incontinence
17
Q
Alzheimer’s disease (AD)
A
Accounts for 50 to 60% of all cases of NCD
18
Q
Alzheimer’s disease Stage 1
A
No apparent symptoms
19
Q
Alzheimer’s stage 2
A
Forgetfulness
loose things/forget names of people
20
Q
Alzheimer’s stage 3
A
Mild cognitive decline
Inference with work performance that is noticeable
get lost when driving car
decline ability to plan or organize
21
Q
Alzheimer’s stage 4
A
Mild to moderate cognitive decline
-shopping/ personal finances
-forget major events in history-childs birthday
Confabulation- creating imaginary events to fill the memory gaps
22
Q
Alzheimer’s stage 5
A
Moderate cognitive decline
- forget addresses, phone numbers, place and time
- loose ability to perform ADL
23
Q
Alzheimer’s stage 6
A
Moderate to severe cognitive decline -forget name of spouse -forgot day, season, year sundowning can't remember major life events
24
Q
Alzheimer’s stage 7
A
Severe cognitive decline
-end stages
unable to recognize family ,members
immobility, contractures
25
Onset of Alzheimer's (AD)
- Onset is slow and insidious
| - course is generally progressive and deteriorating
26
NCD due to Alzheimer's Disease AD
The enzyme used to produce acetylcholine alterations is drastically reduced
27
Etiologies of AD
Over abundance in the brain of plague and tangles
plaques: are protein (amyloid beta)
Tangles: are formed from a special protein tau protein whose function provide stability
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risk of AD
History of head trauma makes them a higher risk
29
Alzheimer's genetic factors
40% have a family history
30
Vascular NCD
NCD occurs as a result of significant cerebrovascular disease
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Vascular NCD onset
More abrupt onset than is seen in association with AD, and the course is more variable
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Vascular NCD
Impairment may occur in a large vessels or in microvascular networks
33
vascular NCD
Second most common form of NCD
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Vascular NCD progression
- Progression of symptoms occur in steps
| - symptoms seem to clear up to just start again
35
Vascular NCD etiologies
Hypertension-most significant factor
cerebral emboli
cerebral thrombosis
36
Frontotemporal NCD occurs?
Occurs as a result of shrinking of the frontal and temporal anterior lobes of the brain
37
Frontotempal NCD
Previously called Pick's disease
38
Frontotempal NCD cause?
Genetics appear to be a factor
39
Frontotempal NCD clinical patterns
1. behavioral and personality changes
-inappropriate actions- lack of judgement- repetitive
compulsive behavior
2.speech and language problems
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NCD due to traumatic brain injury
Amnesia is the most common neurobehavioral symptom following head trauma
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dementia pugilistica
repeated head trauma
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dementia pugilistica symptoms
emotional liability- rapid exaggerated mood changes
dysarthria- unclear speech/disruption to muscles
ataxia- impaired balance
impulsivity- emotional or behavioral self control
43
Traumatic brain injury causes
confusion/ changes in speech
vision and personality
could subside or be permanent
44
Lewy body disease
Similar to AD, but progresses more rapidly
45
appearance of lewy bodies is found
in the cerebral cortex and brain stem
46
lewy body is
progressive and irreversible
| depression and delusions
47
earlier appearance of lewy body
visual hallucinations and parkinsoian features
48
NCD due to HIV infection
Caused by brain infections with opportunistic organisms or by the HIV-1 virus directly
49
HIV infection symptoms
symptoms range from barley perceptible changes to acute delirium to profound cognitive impairment.
confusion-changes in behavior-sometimes psychoses in later stages
50
parkinson's disease
loss of nerve cells located in the substantia nigra, domamine diminished resulting in
- involuntary muscle movements
- slowness
- rigidity
- tremor=upper extremities
51
Substance-induced NCD occurs?
as a result of reactions to, or overuse or abuse of substances such as
- alcohol
- inhalants
- sedatives, hypnotics, and anxiolytics
- medications that cause anticholinergic side effects
- toxins, such as lead and mercury
52
Huntington's disease is transmitted
as a mendelian dominant gene
53
Huntington's disease damages
the areas of the basal ganglia and the cerebral cortex
54
Huntington's disease usually declines
into a profound state of dementia and ataxia
55
Average course of Huntington's disease
is based on age at onset
| juvenile-onset and late-onset having the shortest durations
56
Prion disease
| (Creutzfeldt-jakob disease or bovine spongiform encephalopathy) onset
onset of system typically occurs between ages 40 and 60 years
57
Prion disease life span
course is extremely rapid, with progression from diagnosis to death is LESS THAN 2 YEARS
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Prion disease genetic factor
15% have a genetic component
59
NCD due to other medical conditions
```
HypoTHROIDISM
hyperparaTHROIDISM
pituitary insuffiency
uremia
brain tumor
pernicious anemia
pellagra
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60
Nursing process/assessment
The client history
Areas of concern to be addressed
- Type, frequency,and severity of mood swings
- personality and behavioral changes
- catastrophic emotional reactions
- cognitive changes
- language difficulties
61
Nursing process/assessment
the client history
areas of concern
- orientation to person,place,time,and situation
- appropriateness of social behavior
- current and past use of medications, drugs, and alcohol
- client and family history of specific illness
62
Nursing process/assessment
Physical assessment
Assessment for disease of various organ systems that can induce confusion, loss of memory, and behavioral changes
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Nursing process/assessment
physical assessment
Neurological examination to assess mental status, alertness, muscle strength, reflexes, sensory perception, language skills, and coordination
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What does blood and urine test for
- various infections
- hepatic and renal dysfunctions
- diabetes or hypoglycemia
- metabolic and endocrine disorders
- presence of toxic substance
65
Other diagnostic evaluations may include
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electroencephalogram
computed tomography scan
positron emission tomography
magnetic resonance imaging
lumbar puncture to examine cerebrospinal fluid
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66
Nursing diagnosis/outcome identification
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Risk for trauma
disturbed sensory perception
Risk for other-directed violence
Impaired verbal communication
self-care deficit
situational low self-esteem
grieving
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67
Outcome criteria
The Client
- has not experienced physical injury
- has not harmed self or others
- has maintained reality orientation to the best of his or capability
- discusses positive aspects about self and life
- participates in activities of daily living assistance
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Planning and Implementation
Risk for trauma
GOALS
- Client will not experience physical injury
| - client will maintain a calm demeanor, with minimal agitated behavior
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Planning and Implementation
Risk for trauma
Interventions
Arrange furniture and other items in the room to accommodate clients disabilities
Store frequently used items within easy access
70
Client and family/education
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Possible causes
what to expect
symptoms
ways to ensure safety
how to maintain reality
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71
Client family/education
| Support services
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Finanical services
legal assistance
caregiver support groups
respite care
home health care
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72
Delirium medical treatment
+Determination and correction of the underlying causes
+staff to remain with client at all times to monitor behavior and provide reorientation and assurance
73
Delirium medical treatment
+room with low stimulus level
+low-dose antipsychotic agents to relieve agitation and aggression
+Benzodiazepines commonly used when etiology is substance withdrawal
74
Pharmaceutical agents for cognitive impairment
- Physostgmine (antilirium)
- Tacrine (Cogex)
- Donepezil (Aricept)
- Rivastigmine (Exelon)
- Galantamine (Razadyne)
- Memantine (Namenda)
75
Pharmaceutical agents for cognitive impairment
- Pharmaceutical agents for agitation, aggression, hallucinations, thought disturbances, and wandering
- risperidone (risperdal)
- olanzapine (seroquel)
- ziprasidone(geodon)
76
Black box warning
| on antipsychotics
all atypical antipsychotics are associated with an increased risk of death in elderly patients with dementia
77
Pharmaceutical agents for depression
* Selective serotonin reuptake inhibitors
- often considered first line
* Tricyclic antidepressants
- often avoided due to anticholinergic and cardiac side effects
* Trazodone (desyrel)
- good choice for clients with insomnia
* Dopaminergic agents
- helpful in treatment of severe apathy
78
Medicine for anxiety
| should not be used routinely for prolonged periods
* Chlordiazepoxide (librium)
* Alprazolam (xanax)
* Lorazepam (Ativan)
* Oxazepam (Serax)
* Diazepam (Valium)
79
Medicine for sleep disturbances
| for short term therapy only
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Flurazepam (dalmane)
Temazepam (Restoril)
Triazolam (Halcion)
Zolpidem (Ambien)
Zaleplon (Sonata)
Ramelteon (Rozerem)
Eszopiclone (lunesta)
Trazodone (Desyrel)
Mirtazapine (Remeron)
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