NUR 114 Delirium and Dementia 2020 - EXAM II

Question 1

involves a change in cognition in which there is an abrupt onset of confusional state involving:

• disturbances of consciousness
• change in cognition
• develops over a short period of time
• fluctuates during the day
• always secondary to another condition
• complete recovery can occur

Answer 1

Delirium acute confusion

Question 2

disorientation worse at night and early morning

Answer 2

sundowning

Question 3

errors in perception and interpretation of real sensory stimuli

Answer 3

illusions

Question 4

both visual and tactile false sensory stimuli

Answer 4

hallucinations

Question 5

• labile mood swings
• agitation and/or mood swings
• hypervigilance (constantly alert or scanning room)
• increase pulse, increase BP, flushed, sweating and dilated pupils

Answer 5

symptoms of delirium

Question 6

a common tool utilized to assess acute onset confusion. an assessment tool that is specific for delirium. The assessment takes less than 5 minutes. very helpful in noting change in cognition. a delay in treatment can have serious consequences

Answer 6

Confusion Assessment Method (requires feature 1 and 2 and either 3 or 4)
Feature 1 acute onset and fluctuating course
Feature 2 inattention
Feature 3 disorganized thinking
Feature 4 altered level of consciousness

Question 7

directed toward and identifying and treating any underlying cause

Answer 7

medical management

Question 8

direct towards patient safety

Answer 8

nursing implementations

Question 9

communicate in simple and concrete phases.

• use reality-oriented aid (clocks, calendars)
• maintain the same staff, if possible
• encourage family members to be supportive

Answer 9

planning and implementing in regards to delirium

Question 10

• progressive loss of cognitive function
• impairment in memory w/o impairment in consciousness
• difficulty w/ memory, thinking and comprehension
• majority are irreversible
• most common cause is Alzheimer’s disease (Alzheimer’s is a subtype of dementia)

Answer 10

Dementia (Chronic Confusion)

Question 11

stage of alzheimer’s disease that is characterized by forgetfulness and possible depression. can be easily passed off and not easily recognized. some lost of energy, more difficult time learning new things. simple tasks become more difficult.

Answer 11

stage 1 (mild)

Question 12

stage of alzheimer’s disease that is characterized by confusion, disorientation is evident, memory gaps, self care gaps, apraxia, and labile mood. Client’s confusion about recent event grow, and memory gaps become more noticeable. loved ones become aware of the problem during this stage. There may be changes in personality as well, client becomes more irritable, agitated, more aggressive, and there will be gaps in self-care. They may deny that anything is wrong and thus have behavioral issues.

Answer 12

stage 2 (moderate)

Question 13

stage of alzheimer’s disease that is considered severe and is the point in which the client can’t identify familiar objects or people. advanced agnosia and apraxia.

Answer 13

stage 3 (severe)

Question 14

trouble remembering words

Answer 14

anomia

Question 15

trouble with language

Answer 15

aphasia

Question 16

loss of purposeful movement

Answer 16

Apraxia

Question 17

does not recognize objects

Answer 17

agnosia

Question 18

there is no definitive test for Alzheimer’s other than an autopsy but a history of _____ is what is used to diagnose someone

Answer 18

symptoms

Question 19

cholinesterase inhibitors that increase acetylcholine levels to slow down progression of AD. acetylocholine aids in memory. used to treat mild to moderate Alzheimer’s. can stabilize the client for about 6-12 months.
side effects: headaches, dizziness, diarrhea, loss of appetite

Answer 19

donepezil
rivastigime
galantamine

Question 20

Drug intoxications/withdrawals
Infections
Metabolic disorders—fluid & 
     electrolyte imbalances, hypoxia,
      hypo/hyperglycemia
Drugs—CNS depressants, digitalis,
     lithium, steroids, benzodiazepines
Neurological diseases—head trauma, seizures
Cancer—primary or metastatic lesions
Psychosocial stressors—sensory deprivation/overload, relocation, pain, immobility, sleep deprivation

Answer 20

causes of delirium

Question 21

errors in perception and interpretation of real sensory stimuli

Answer 21

illusions

Question 22

(visual and tactile): false sensory stimuli

Answer 22

hallucinations

Question 23

delirious patients require what kind of environment ?

Answer 23

a very simple environment (safe and reduce stimulus environment)

Question 24

type of dementia that is irreversible, progressive, and not secondary to any other disease.

Answer 24

Primary Dementia

Question 25

type of dementia that is a result of another pathologic process. (ex: AIDS related dementia)

Answer 25

Secondary Dementia

Question 26

Advancing age
Gender
Ethnicity
Family history 
Vascular issues
Head injury/repeated trauma

Answer 26

Risk factors for Alzheimer’s Diease

Question 27

end stage Alzheimer’s. The client is total care and experience hyperorality (obsessing with chewing on things), hypermetamorphosis, and agraphia (inability to write and understand written information).

Answer 27

Stage 4 (late) of Alzheimer’s

Question 28

makes up stories to preserve own self esteem

Answer 28

confabulation

Question 29

giving the same answer regardless of the question

Answer 29

preservation

Question 30

N-methyl-D-aspartate receptor antagonist blocks the uptake of glutamtate.
side effects: dizziness, constipation and headache.

Answer 30

memantine (protoype)