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Mental health chapter 13 > Neurocognitive Disorders > Flashcards

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

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2
Q

what is age risk for dementia

A

middle age and beyond

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3
Q

what is delirium

A

A disturbance in level of awareness and change in cognition

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4
Q

How quick does Delirium develop

A

rapidly over a short period

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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
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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
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7
Q

Delirium autonomic Symptoms

A 
tachycardia
sweating
flushed face
dilated pupils
elevated blood pressure
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8
Q

delirium duration

A

usually brief and subsides completely on recovery from underlying determinant

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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
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10
Q

Neurocognitive disorder

A

impairment in the cognitive functions of thinking, reasoning, memory, learning, and speaking

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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

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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)

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13
Q

Secondary NCDs

A

are caused by or related to another disease or condition (HIV DISEASE, CEREBRAL TRAUMA)

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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
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15
Q

Reversible NCD (temporary dementia) is caused by ?

A 
Stoke
depression
side effects of medications 
Nutritional deficiencies
metabolic disorders
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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

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17
Q

Alzheimer’s disease (AD)

A

Accounts for 50 to 60% of all cases of NCD

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18
Q

Alzheimer’s disease Stage 1

A

No apparent symptoms

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19
Q

Alzheimer’s stage 2

A

Forgetfulness

loose things/forget names of people

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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

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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

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22
Q

Alzheimer’s stage 5

A

Moderate cognitive decline

  • forget addresses, phone numbers, place and time
  • loose ability to perform ADL
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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
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24
Q

Alzheimer’s stage 7

A

Severe cognitive decline
-end stages
unable to recognize family ,members
immobility, contractures

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25
Q

Onset of Alzheimer’s (AD)

A
  • Onset is slow and insidious

- course is generally progressive and deteriorating

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26
Q

NCD due to Alzheimer’s Disease AD

A

The enzyme used to produce acetylcholine alterations is drastically reduced

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27
Q

Etiologies of AD

A

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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28
Q

risk of AD

A

History of head trauma makes them a higher risk

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29
Q

Alzheimer’s genetic factors

A

40% have a family history

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30
Q

Vascular NCD

A

NCD occurs as a result of significant cerebrovascular disease

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31
Q

Vascular NCD onset

A

More abrupt onset than is seen in association with AD, and the course is more variable

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32
Q

Vascular NCD

A

Impairment may occur in a large vessels or in microvascular networks

33
Q

vascular NCD

A

Second most common form of NCD

34
Q

Vascular NCD progression

A
  • Progression of symptoms occur in steps

- symptoms seem to clear up to just start again

35
Q

Vascular NCD etiologies

A

Hypertension-most significant factor
cerebral emboli
cerebral thrombosis

36
Q

Frontotemporal NCD occurs?

A

Occurs as a result of shrinking of the frontal and temporal anterior lobes of the brain

37
Q

Frontotempal NCD

A

Previously called Pick’s disease

38
Q

Frontotempal NCD cause?

A

Genetics appear to be a factor

39
Q

Frontotempal NCD clinical patterns

A
  1. behavioral and personality changes
    -inappropriate actions- lack of judgement- repetitive
    compulsive behavior
    2.speech and language problems
40
Q

NCD due to traumatic brain injury

A

Amnesia is the most common neurobehavioral symptom following head trauma

41
Q

dementia pugilistica

A

repeated head trauma

42
Q

dementia pugilistica symptoms

A

emotional liability- rapid exaggerated mood changes
dysarthria- unclear speech/disruption to muscles
ataxia- impaired balance
impulsivity- emotional or behavioral self control

43
Q

Traumatic brain injury causes

A

confusion/ changes in speech
vision and personality
could subside or be permanent

44
Q

Lewy body disease

A

Similar to AD, but progresses more rapidly

45
Q

appearance of lewy bodies is found

A

in the cerebral cortex and brain stem

46
Q

lewy body is

A

progressive and irreversible

depression and delusions

47
Q

earlier appearance of lewy body

A

visual hallucinations and parkinsoian features

48
Q

NCD due to HIV infection

A

Caused by brain infections with opportunistic organisms or by the HIV-1 virus directly

49
Q

HIV infection symptoms

A

symptoms range from barley perceptible changes to acute delirium to profound cognitive impairment.
confusion-changes in behavior-sometimes psychoses in later stages

50
Q

parkinson’s disease

A

loss of nerve cells located in the substantia nigra, domamine diminished resulting in

  • involuntary muscle movements
  • slowness
  • rigidity
  • tremor=upper extremities
51
Q

Substance-induced NCD occurs?

A

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
Q

Huntington’s disease is transmitted

A

as a mendelian dominant gene

53
Q

Huntington’s disease damages

A

the areas of the basal ganglia and the cerebral cortex

54
Q

Huntington’s disease usually declines

A

into a profound state of dementia and ataxia

55
Q

Average course of Huntington’s disease

A

is based on age at onset

juvenile-onset and late-onset having the shortest durations

56
Q

Prion disease

(Creutzfeldt-jakob disease or bovine spongiform encephalopathy) onset

A

onset of system typically occurs between ages 40 and 60 years

57
Q

Prion disease life span

A

course is extremely rapid, with progression from diagnosis to death is LESS THAN 2 YEARS

58
Q

Prion disease genetic factor

A

15% have a genetic component

59
Q

NCD due to other medical conditions

A 
HypoTHROIDISM
hyperparaTHROIDISM
pituitary insuffiency
uremia
brain tumor
pernicious anemia
pellagra
60
Q

Nursing process/assessment

                         The client history 
         Areas of concern to be addressed
A
  • Type, frequency,and severity of mood swings
  • personality and behavioral changes
  • catastrophic emotional reactions
  • cognitive changes
  • language difficulties
61
Q

Nursing process/assessment

                    the client history 
                areas of concern
A
  • 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
Q

Nursing process/assessment

                Physical assessment
A

Assessment for disease of various organ systems that can induce confusion, loss of memory, and behavioral changes

63
Q

Nursing process/assessment

            physical assessment
A

Neurological examination to assess mental status, alertness, muscle strength, reflexes, sensory perception, language skills, and coordination

64
Q

What does blood and urine test for

A
  • various infections
  • hepatic and renal dysfunctions
  • diabetes or hypoglycemia
  • metabolic and endocrine disorders
  • presence of toxic substance
65
Q

Other diagnostic evaluations may include

A 
electroencephalogram 
computed tomography scan
positron emission tomography
magnetic resonance imaging
lumbar puncture to examine cerebrospinal fluid
66
Q

Nursing diagnosis/outcome identification

A 
Risk for trauma 
disturbed sensory perception
Risk for other-directed violence
Impaired verbal communication
self-care deficit
situational low self-esteem
grieving
67
Q

Outcome criteria

                  The Client
A
  • 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
68
Q

Planning and Implementation

         Risk for trauma
              GOALS
A
  • Client will not experience physical injury

- client will maintain a calm demeanor, with minimal agitated behavior

69
Q

Planning and Implementation

         Risk for trauma
          Interventions
A

Arrange furniture and other items in the room to accommodate clients disabilities

Store frequently used items within easy access

70
Q

Client and family/education

A 
Possible causes
what to expect
symptoms
ways to ensure safety 
how to maintain reality
71
Q

Client family/education

Support services

A 
Finanical services
legal assistance
caregiver support groups 
respite care
home health care
72
Q

Delirium medical treatment

A

+Determination and correction of the underlying causes

+staff to remain with client at all times to monitor behavior and provide reorientation and assurance

73
Q

Delirium medical treatment

A

+room with low stimulus level
+low-dose antipsychotic agents to relieve agitation and aggression
+Benzodiazepines commonly used when etiology is substance withdrawal

74
Q

Pharmaceutical agents for cognitive impairment

A
  • Physostgmine (antilirium)
  • Tacrine (Cogex)
  • Donepezil (Aricept)
  • Rivastigmine (Exelon)
  • Galantamine (Razadyne)
  • Memantine (Namenda)
75
Q

Pharmaceutical agents for cognitive impairment

A
  • Pharmaceutical agents for agitation, aggression, hallucinations, thought disturbances, and wandering
  • risperidone (risperdal)
  • olanzapine (seroquel)
  • ziprasidone(geodon)
76
Q

Black box warning

on antipsychotics

A

all atypical antipsychotics are associated with an increased risk of death in elderly patients with dementia

77
Q

Pharmaceutical agents for depression

A
  • 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
Q

Medicine for anxiety

should not be used routinely for prolonged periods

A
  • Chlordiazepoxide (librium)
  • Alprazolam (xanax)
  • Lorazepam (Ativan)
  • Oxazepam (Serax)
  • Diazepam (Valium)
79
Q

Medicine for sleep disturbances

for short term therapy only

A 
Flurazepam (dalmane)
Temazepam (Restoril)
Triazolam (Halcion)
Zolpidem (Ambien)
Zaleplon (Sonata)
Ramelteon (Rozerem)
Eszopiclone (lunesta)
Trazodone (Desyrel)
Mirtazapine (Remeron)

Mental health chapter 13 (1 decks)

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