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NSG 470 > Neurocognitive lecture > Flashcards

Neurocognitive lecture Flashcards

1
Q

What is a neurocognitive disorder

A

Disturbances in
* Orientation
* Perception
* Memory
* Intellect
* Judgement
* Affect
Resulting in brain dysfunction

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2
Q

What are some effects of Neurocognitive disorders

A
  • Cannot understand facts
  • Cannot connect appropriate feelings to events
  • Results in inability to meet challenges of living (ADL)
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3
Q

Three main categories of neurocognitive disorders

A
  • Delirium
  • Dementia
  • Mild neurocognitive disorder
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4
Q

Normal aging

A
  • Some mild degree of forgetfulness is normal
  • Mild cognitive impairment does not always progress to severe cognitive impairments
  • Does not interfere with a person’s social or occupational behavior
  • Memory complaints are more related to depression vs normal aging
  • Intellectual function, capacity for change and productive engagement remain stable
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5
Q

Pseudodementia

A

Treatable disorders, that mimic dementia, usually depression

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6
Q

Possible causes of delirium

A
  • Restraints
  • HAC (Alcohol induced)
  • Falls
  • Sleep deprivation
  • Aspiration
  • Pneumonia
  • Pressure ulcers
  • Insufficent food intake
  • Drugs
  • Hypoglycemia
  • Fever
    *

Pt with delirium from drug withdrawl are at increased risk for seizures

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7
Q

Morbidity of delirium

A

Some fail to recover, can worsen over time to a stupor, dementia, coma, death

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8
Q

Complications of delirium

A

Increase risk for complications
* Falls
* Malnutrition
* decubiti
* Aspiration pneumonia
* Prolonged hospitalization

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9
Q

Decubiti

A

Pressure ulcers

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10
Q

S+S Delirium

A
  • Disorientation and confusion that fluctuates (Also sundowning)
  • Decreased LOC, looks scared
    *Acute onset
  • Last hours to weeks
  • Reversible if diagnosed and treated (Can lead to further exasperation if not)
  • Disruption of sleep wake cycle (Sundowning)
  • Disturbed psychomotor behavior (Agitation, purposeless movement to catatonic stupor)
  • Disorientation, incoherent memory disturbances
  • Altered perception in forms of illusions, hallucinations and delusions
  • Alterations in thinking, disorganized, irrational, delusions
  • Hypervigilant, to stupor or semi coma
  • Autonomic instability (Tachycardia, sweating, flushed face, dilated pupils, elevated BP)
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11
Q

Is delirium a primary or secondary medical condition

A

it’s always secondary to a medical condition

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12
Q

Causes of delirium: D

A

Drugs

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13
Q

Causes of delirium: E

A

Electrolyte imbalances (Dehydration)

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14
Q

Causes of delirium: L

A

Lack of drugs
* Withdrawal, pain

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15
Q

Causes of delirium: I

A

Infection
* Uti or pneumonia
* Syphilis
* Meningitis

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16
Q

Causes of delirium: R

A

Reduced sensory input
* Hearing or vision deficits

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17
Q

Causes of delirium: I

A

Intracranial
* CVA
* Subdural hemorrhage

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18
Q

Causes of delirium: U

A
  • Urinary retention/fecal impaction
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19
Q

Causes of delirium: M

A

Myocardial/pulmonary

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20
Q

Lab analysis for delirium

A
  • Urine analysis (UTI)
  • Liver enzymes
  • Glucose test
  • Electrolytes
  • Thyroid test
  • Vitamin B12
  • Drug and alc test
  • Rapid plasma reagin for syphilis
  • HIV testing
  • CT and MRI (CVA)
  • Lumbar puncture (Meningitis)
  • PET scan
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21
Q

Population most affected by delerium

A

Older adults

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22
Q

How long does delirium last

A

1 week to one month

Depending on underlying cause and age

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23
Q

Does delirium have permanent damage

A

Yes if left untreated, however if the underlying condition is treated then a complete recovery should occur

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24
Q

Delirium safety assessment

A
  • Pt wants to pull out IV, and cath
  • Falling out of bed
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25
Q

Delirium comfort assessment

A

Sensory input is impaired, need to assess for pain, cold and positioning

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26
Q

Autonomic S+S of delirium

A
  • INcreased vitals
  • Tachycardia
  • Sweating
  • Flushed face
  • Dilated pupils
  • elevated BP
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27
Q

Delirium Assessment: Physical

A
  • Safety
  • Comfort
  • Vitals
  • Drug reactions or interactions
  • Electrolyte disturbances
  • Sleep wake disturbances
  • Infection (Done by provider)
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28
Q

Gold standard treatment for delirium

A

Prevention and early mgmt

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29
Q

Nursing interventions for delirium

A
  • Early mgmt and prevention
  • Neuro checks regularly
  • Safety
  • Fall prevention/ prevent injury
  • Determine underlying cause
  • Electrolyte balance
  • Hydration and nutrition
  • Turn and position Q2hr
  • Therapeutic milieu environment
  • Introduce self and call pt by name (Reorientated)
  • Hallucinations: enforce reality
  • One piece of info at a time, short concrete sentences
  • make sure pt wears glasses and hearing aids
  • Reorientated (Clocks, calendars, well lit room, family pictures)
  • Educate and include family
30
Q

Dementia etiology

A
  • Interaction between genes, lifestyle and environment
  • Not a specific disease but a group a symptoms that can be caused by many different diseases
  • Different categories of dementia have different etiologies but a similar clinical picture
  • This is beyond the normal effects of aging
31
Q

Dementia onset

A

Over months, not sudden

32
Q

Dementia causes

A
  • Alzheimer’s
  • Vascular disease
  • HIV
  • Alcoholism
33
Q

Dementia alterations in consciousness

A

None

34
Q

Dementia mood/affect

A

Flat and or delusional

35
Q

Dementia speech

A

Incoherent, slow speech

36
Q

Is dementia reversible

A

No

37
Q

Dementia memory

A

Impaired memory and judgment

38
Q

Delirium Onset

A

Sudden: Hours to days

39
Q

Delirium consciousness

A

Altered level of consciousness

40
Q

Delirium mood/ affect

A

Labile mood, swinging

41
Q

Delirium: Speech

A

Incoherent RAPID speech

42
Q

Delirium memory

A

Impaired memory or judgment

43
Q

Alzheimer’s disease

A
  • Most common cause of dementia
  • Mixed pathologies ( Can occur with other forms of dementia (Lewy- body or CVD))
  • Early clinical symptoms
  • Late clinical symptoms
44
Q

Alzheimer’s disease: Early symptoms

A
  • Memory impairment
  • Apathy
  • Depression
45
Q

Alzheimer’s disease: Late symptoms

A
  • Impaired communication
  • Poor judgment
  • Physical impairment
46
Q

Vascular dementia

A
  • Occurs from cerebral blood vessel dmg (Stroke)
  • Ischemic or hemorrhagic processes
  • More common as mixed pathology (Not the only one)
    *** Cognitive and motor function impairment **
47
Q

Initial symptom of vascular dementia

A
  • Impaired executive functioning (Task management and higher level thinking)
48
Q

Lewy body dementia

A
  • Abnormal aggregations of proteins
  • Develops in the cortex
  • similar S+S to alzheimer’s
  • Visuospatial impairment
  • Occurs with parkinson’s disease
49
Q

What protein is abnormal in lewy body dementia

A

Alpha-synuclein

50
Q

Early S+S lewy body dementia

A

Sleep disturbances

51
Q

Frontotemporal lobar degeneration (FTLD)

A
  • Early symptoms
  • Memory is typically spared in early changes
  • Atrophy of frontal and temporal lobes
  • Abnormal protein inclusions
  • Earlier age of onset
52
Q

Early symptoms of Frontotemporal lobar degeneration (FTLD)

A

Behavioral changes

53
Q

TBI related dementia

A
  • Occurs secondary to a tbi, from brain rattling around
  • Depending on severity of TBI symptoms may eventually subside or may be perm
54
Q

dementia pugilistica-syndrome

A

TBI based dementia, caused by repeated injury
Characterized by
* Emotional instability
* Dysarthria
* Ataxia
* Impulsivity

Chronic traumatic encephalopathy
Injury to frontal lobe and poor impulse control

55
Q

Nursing assessment dementia

A
  • Safety (Home environment, general)
  • PLan with family how mgmt labile moods, aggressive behavior, nocturnal delirium catastrophic reactions
  • Eval for suicide or aggression
  • Review meds including over the counter
  • Asses for evidence of abuse or neglect
56
Q

Agraphia

A

S+S dementia
Inability to read or write

57
Q

Hyperorality

A

S+S of dementia
Need to taste, chew and place objects in one’s mouth

58
Q

Hypermetamorphosis

A

S+S dementia
Touching everything that one can see

59
Q

Hallucinations and delusions interventions

A
  • Minimize focus on delusional thinking
  • Reassure them they ar esafe
  • Never argue
  • DO not ignore reports of hallucinations: what they perceive is real to them and they can be disturbed by them (May need anti psych meds)
  • Assess for med side effects
  • Ensure hearing aids and glasses are available and working
  • Distraction techniques
  • Assess if hallucinations are problematic for pt
60
Q

Risk for injury: Dementia

A
  • Pt wants to pull out iV, foley, feeds
  • Wandering
  • Falling
  • Pressure injuries (From immobility)
  • Skin integrity
61
Q

Pt care: Dementia

A
  • Food and fluid intake monitoring
  • Monitor electrolytes
  • Vitals
  • Assistive devices
  • Weigh pt weekly
  • Offer finger foods
  • Ensure safety of solid foods (Avoid hard candy, popcorn nuts)
  • Dysphagia can occur try pureed foods or ensure or decision about tube feeding
62
Q

Non pharm interventions: Dementia

A
  • Reduce physical and chemical restraints
  • mgmt of pain
  • provide sensory stimulation activities and socialization
  • improve communication
  • Hearing aids and glasses
  • Regular toileting
  • relaxation strategies, massage
  • outdoor opportunities
63
Q

Non pharm interventions: Dementia, memory enhancement

A
  • Reinforce short and long term memory
  • Remind pt what they had for breakfast and what activities recently occured
  • Fill in blanks casually when memory falters
  • Encourage story telling of earlier years
64
Q

Pharm interventions for dementia: Cholinesterase inhibitors

A
  • FDA approved for alzheimer’s (AD)
  • Lessens impairment in cognition, behavior and function in ADL as disease process advances
  • Makes more Acetylcholine available by inhibiting breakdown, stimulates nicotinic receptors to make more Ach
  • Mild to moderate AD
  • Some efficacy in lewy body dementia
65
Q

Cholinesterase inhibitor: drug names

A

Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne)

66
Q

Cholinesterase inhibitor: Side effects

A
  • Effects are time limited
  • GI disturbances (N+V+D, increased gastric upset=risk for ulcers)
  • Take with food to minimize GI upset
  • Sedation and weight gain are Unusual
  • Rare effects is it worsening asthma
  • Lethal in overdose
67
Q

Memantine (Namenda)

A

“Artificial magnesium” , known as a cognitive enhancer
* NMDA- glutamatergic ion channel antagonist
* Blocks over secretion of glutamate

  • FDA approved for use during MODERATE to SEVERE stages of AD
  • Does not stop or reverse effect of disease, just slows progression
68
Q

Memantine (Namenda): SE

A
  • Dizziness, HA, constipation
69
Q

Antidepressants in Dementia

A
  • Well tolerated in older pt (used in much lower doses)
  • Treats depression symptoms and anxiety
  • Need to avoid meds with anticholinergic side effects (Like TCA)
  • Older pt are at higher risk of anticholinergic tox
70
Q

Trazodone

A

Antidepressant used to treat insomnia

71
Q

Atypical antipsychotics in dementia

A
  • NOT indicated for used in dementia
  • Increased risk of for stroke in elderly dementia pt
  • Black box warnings associated with increased risk of death in elderly pt who display psych behaviors (Cardio relate)
  • Limited use only
  • Behavioral interventions preferred

NSG 470 (26 decks)

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