NUR 144 - WEEK 3 "MH" - Neurocognitive Disorders Flashcards
Delirium vs. Dementia
Delirium:
- Short term, sudden onset
- Episodic
“Find out what the underlying cause is”
Dementia:
- Cognitive decline (slow)
- Several types
- Symptoms are similar, but very different diagnoses
Delirium:
What is it?
Causes
Medical emergency-priority treatment
What is it:
- A disturbance in attention that develops over a short period of time, with an additional disturbance in cognition
“out of one’s furrow”
Causes:
- UTI (esp in elderly patients)
- Medications & med complication
Delirium:
s&s / Characteristics
- Rapid acute onset
- Secondary to physical insult’
Think: “Patient seems drunk”
- Impaired short-term memory
- Fluctuating level of consciousness
- Slurred speech
- Hallucination
Delirium:
Manifestations to assess
- Hyperactivity
- trembling, tremors
- tachycardia
- sweating
- Nausea, vomiting
- LOC
- seizures, hallucinations
Delirium:
Describe the three types
Hyperactive - restless and agitated, hallucinations and delusions
Hypoactive - Often missed as it mimics depression, lethargy, fatigue, quickly falling back asleep
Mixed type - Symptoms of both hyperactive and hypoactive
Delirium:
Etiology / Causes
Intoxication / withdrawal:
- Alcohol, cannabis
- Opioids, sedative, hypnotics
- Stress
- Sleep withdrawal
- Emotional Disturbances
Delirium:
Comorbidities
- Dehydration
- Electrolyte imbalance
- Infection
- Hepatic Encephalopathy
- Metabolic Disorders
- Tumors
Dementia:
What is it?
s/s?
Cause
What is it:
- “Significant cognitive decline from previous level of performance in one or more cognitive domains (attention, executive function, learning & memory)
- “Out of one’s mind”
s/s:
- Slow development
- Wernicke encephalopathy
- Korsakoff psychosis
- Impaired short term memory
- Long term memory slowly fades
- LOC unchanged
- Thought content initially normal, later confused
- Affect alterations
Dementia:
Assessment
Slide 25
Wernicke Encephalopathy & Korsakoff Psychosis:
What are they?
Treatment?
Neuro problems found in alcoholic patients
Treatment: Can be reversed by
- treating Vitamin B1 deficiency
- Treating malnutrition
What is the most common/prevalent dementia?
Alzheimer’s disease
What is the strongest risk factor for Alzheimer’s
Age
- Highest in age 85 or older
Vascular Disease Dementia:
What is it
Causes
Deficits with blood vessels
- HTN
- Reduced blood flow to the brain
- Cerebrovascular “events”
- Risk increase exponentially after age 65
Describe Lewy Body Dementia
Lewy bodies are present in the brain
s/s:
- Memory loss
- Sleep issues
- Autonomic dysfunction
- Parkinson’s disease-like signs
Dementia:
Etiologie
- Alzheimers
- Vascular disease
- Lewy Body
- Injury to the brain
- HIV
- Substance Use
- Prion
- Huntington’s
- Parkinson’s
Dementia:
Which domains are effected?
Executive function - planning
Complex attention - Processing speed
Learning/Memory - Short term
Perceptual/Motor - Everyday tasks
Social Cognition - Insensitive to standards
Delirium / Dementia:
Nursing Management
- Advocate for least restrictive environment
Communication:
- Calm tone
- Short simple phrases
Delirium / Dementia:
Safety Implications
- Minimize mirrors
- Ensure patients have access to hearing aids, eyeglasses
- Ensure units are well-lit
- Minimize use of restraints
Dementia:
Nursing interventions
- Clothes should be easy to put on and take off
- Use finger foods (appetite may diminish)
- Weight weekly
- Support independence with ADLs
Delirium:
Treatment
Treat cause
Alzheimer’s:
Treatment
- ## Treat symptoms
How are mild and major neurocognitive disorders differentiated?
Mild:
- MODEST decline in one or more cognitive domains
- DOES NOT interfere with independence
Major:
- SIGNIFICANt decline in one or more domains
- DOES interfere with independence
- Mild/Major can have the same initial condition (alzheimer’s, lewy body, TBI, etc) just depends how severe condition becomes
Neologism
Making up words
Perseveration
Saying or doing something repeatedly
