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life span > Nurb Test 1: Delirium and Dementia > Flashcards

Nurb Test 1: Delirium and Dementia Flashcards

0
Q

-progressive loss of consciousness

A
  1. Dementia
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1
Q

Cognitive Problems

Three most common in adults

A

dementia
delirium
depression

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2
Q
  • Often associated with dementia and delirium
A
  1. Depression
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3
Q

—acute confusion, rapid, can be reversed

A
  1. Delirium
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4
Q
  • State of temporary but acute mental confusion, always secondary to another condition
  • Highest in hospitalized older adults, 40% in icu
  • sudden cognitive impairment, disorientation, sensory
A

Delirium

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5
Q

: Lung, Heart, Infection, Poor nutrition, Drug interactions

A

delirium Co morbidities

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6
Q

: Longer hospitalization, frequent high misdiagnosis leading to high death rate, further functional decline, Institutionalization

A

delirium Risk for

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7
Q

misunderstood Rarely caused by a single factor

	- Chronic stress, Cholinergic deficiency, Excesses relief of dopamine 
	- Often caused by an underlying factor usually precipitating event happens
A

delirium Contributors:

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8
Q

A. Demographics: 65 or older, male
B. Cognitive status: dementia, cognitive impairment, and hx of delirium
C. Environmental: admit to icu, use of physical restraints, pain= become aggressive, emotional stress, sleep deprivation
D. Functional: immobility, hx of falls
E. Sensory: overload, deprivation
F. Decreased oral intake: dehydration, malnutrition
G. Drugs- 4 or more, sedatives, opiates, drug interactions, alcohol, drug withdraw
H. Surgery
I. Co-existing medical conditions: acute or terminal illness, hx of stroke, infection or sepsis, or any neurological disease

A

Delirium Precipitating Factors

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9
Q
  • two to three days, rapid
A

Delirium Clinical Manifestations

Onset

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10
Q
  • can last 1-7 days, can be discharged with
A

delirium Duration

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11
Q
  • after two to three days, agitation, misperception, hallucinations
A

Later sx delirium

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12
Q

-Irritability, restless, confused, can’t concentrate

A

early sx delirium

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13
Q
  1. Medical history: family can provide
  2. Physical exam
  3. Psychological history
  4. Medications: new ones put on
  5. Cognitive measures: mmse: mini mental state examination= what cows drink
  6. Laboratory tests: electrolytes, bun, creatinine,
  7. Any preexisting: drug and alcohol levels, liver analysis
A

Delirium Diagnostic Studies

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14
Q
  1. When did the confusion begin?
  2. Does the condition change over a 24-hour period?
  3. Is there a change in the person’s sleep patterns?
  4. What specific thought problems have been noticed?
  5. Is there a history of mental illness or similar thought disturbance?
  6. Has there been a sudden decline in physical function or a new onset of falls?
A

Delirium Critical Questions to ask the patient

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15
Q

prevent , early recognition, treatment as necessary

  • Focus on eliminating precipitating factors: protect from harm no falls, encourage family to stay at bedside and be involved
  • If secondary to infection, antibiotic therapy is started
  • Reorientation and behavioral interventions—used in all patients: create safe enviro, don’t overstimulate, reassure the patient and family, pay attention to noise level
  • Safety is number one!
A

Delirium Nursing Management

Nurse’s role:

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16
Q

Delirium Drug Therapy- Reserved for those patients with severe agitation

A

low dose antipsychotics

short acting benzodiazepine

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17
Q

B. Short-acting benzodiazepines

A
  1. lorazepam [Ativan]
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18
Q

A. Treated with low-dose antipsychotics

A
  1. Haloperidol (Haldol) 2. Risperidone (Risperdal) 3. Olanzapine (Zyprexa) 4. Quetiapine (Seroquel)
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19
Q
  • irreversible, not caused by any other disorder
  • Vascular dementia (VD) 20% (multiinfarct)
  • Alzheimer’s disease (AD) 60%
A

A. Primary dementia

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20
Q

due to another condition can reverse if find the cause, if they keep being exposed (prolonged) to these it can make it irreversible
Ex: AIDS dementia complex, Korsakoff’s syndrome=vit B deficiency associated with heavy alcohol consumption, infection

A

B. Secondary dementia

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21
Q
  • Onset of depends on cause
  • gradual and progressive
  • abrupt step by step pattern
  • Etiology of difficult to distinguish based on symptoms alone
A

Dementia Assessment Clinical Manifestations
Neurological
Vascular

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22
Q 
function normal, can do adls, do have memory loss, mild disorientation, words become difficult to find, difficulty with numbers, lose interest in hobbies 
-still with it enough can compensate, hard to diagnose, ongoing eval
A

mild dementia

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23
Q

start to lose recognition of family and friends, agitated, pace, wonder get lost more frequently, loss of ability to do skills, argue easily, hallucinations occur

A

moderate dementia

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24
Q

little memory left, don’t recognize self in the mirror, cant process new info, cant process words, eating and swallowing is difficult, repeat words, can’t perform and adls, become immobile and incontinent

A

severe dementia

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25
Q
  • Try to find cause to see if it is irreversible
  • Thoroughly evaluate patient history-anything can treat
  • Physical examination to rule out other medical conditions
  • Screening
  • Mental status testing (MMSE)
  • Functional Screening
  • Depression screening because it happens with dementia a lot : look at if fatigued, how active are they, appear to be very sad, difficulty concentrating or thinking
  • Do an ongoing assessment, find pt is at risk= monitor closely do mri and ct to see changes
A

dementia dx studies

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26
Q

A. =basic adls, bathing dressing, toileting, eating,

A

katz

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27
Q

=more complex adls: grocery shopping, cleaning house, cooking, paying bills

A

lawtons

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28
Q

scores the functions of eating dressing, habit changes

A

C. Blessed Dementia rating scale:

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29
Q

-Exact is unknown what triggers
-Similar to other forms of dementia, hard to distinguish
-Age is most important risk factor
Early onset= less than 60 years old

A

Alzheimer’s Disease Etiology

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30
Q

: in genes, earlier onset, more rapid

A

Familial Alzheimer’s disease

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31
Q

Not in genes

A

-Sporadic Alzheimer’s:

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32
Q

-Pathologic changes precede clinical manifestations by 5 to 20 years, brain is changing but no signs and symptoms

-Changes in brain structure and function
A. Amyloid plaques: plaques dev as we age, more than norm in hippocampus= short term memories are
B. Neurofibrillary tangles: twisted proteins in the nerves
C. Loss of connections between cells and cell death: parts of your brain

A

Alzheimer’s Disease Pathophysiology

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33
Q
  • Diagnosis of exclusion
    -No single clinical test
    -Made once all other possible conditions causing cognitive impairment have been ruled out
    -Comprehensive patient evaluation: Complete health history, Physical examination, Neurologic assessment, Mental status assessment, Laboratory tests
    -Brain imaging tests
    CT – Computed Tomography
    MRI – Magnetic Resonance Imaging
    PET – Positron Emission Tomography- active cells are yellow
    *Allow monitoring in early stages and treatment response
A

Alzheimer’s Disease Diagnostic Studies

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34
Q

: No cure
-Collaborative management aimed at improving or controlling decline in cognition, Controlling undesirable behavioral manifestations

A

Alzheimer’s Disease Collaborative Care

35
Q
  • Used to treat mild and moderate dementia
  • Block enzyme responsible for breaking down acetylcholine
  • Improves or stabilizes cognitive decline but does not cure or reverse
A

Cholinesterase inhibitors

36
Q

gastric=nausea, vomiting, diarrhea, weight loss, tired drowsy, bleeding, seizures and chest pain
Ex: Meds used to treat mild to moderate: aricept, exelon, cognex

A

side effects

cholinesterase inhibitiors

37
Q

cholinesterase inhibitors

A

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

38
Q

Manage acute episodes of agitation, Aggressive behavior, Psychosis
-Side effects: extra pyramidial=tremors

A

Conventional antipsychotic drugs-

39
Q

conventional antipsychotic drugs

A

haldol

40
Q
  • More commonly used= less side effects

- Side effects and uncertain benefits

A
  1. Atypical antipsychotic drug
41
Q

atypical antipsychotic drugs

A

Risperdaol, Zyprexa ,

Seroqual

42
Q

Alzheimer’s Disease Drug Therapy Depression

A

ssri

antiseizure

43
Q

1–help to sleep

A

. selective serotonin reuptake inhibitors

44
Q

ssri

A

prozac, selexa

45
Q

2-Manage behavioral problems, Stabilize mood

* treating depression can improve their cognitive ability

A

. Antiseizure drugs

46
Q

antiseizure drugs

A

Depakin and tegrteol

47
Q
  1. 2,000 IU/day -Slows disease
  2. -Debatable, some concerns that it causes bleeding
  3. – Unproven Anti inflammatory action, Thought to slow disease process, se: bleeding
  4. Hormone Replacement Therapy
A

Alzheimer’s Disease OTC Drug Therapy
Vitamin E
Gingko biloba
NSAIDS

48
Q
  • Past health history: stroke family history
    • Medications-decrease symptoms
    • Health perception
    • Nutritional State= difficulty eating properly
    • eliminating properly: incontinence
    • sleep rest pattern: insomnia
    • Cognitive perceptual state: forgetful, withdrawn
A

Alzheimer’s Disease Nursing Assessment

1. Subjective data

49
Q
  • Disheveled appearance
    • Mini-Cog, Mini Mental Status Exam
    • Neurologic
A

alzheimers objective data

50
Q

disoriented to date an time

A

early

alzheimers

51
Q

inability to perform simple tasks

A

middle alzheimers

52
Q

unable to do adls or self care

A

late alzheimers

53
Q
  1. -Maintain functional ability as long as possible
    • Maintain safe environment= prevent falls
    • Personal care needs met
    • Dignity maintained
A

Alzheimer’s Disease Planning

Overall goals for patient

54
Q
  • Reduce caregiver stress
    • Maintain personal, emotional, and physical health
    • Cope with long-term effects associated with caregiving, progress the more they depend on the caregiver
A

Overall goals for caregiver

alzheimers

55
Q
  1. Physical exercise- keep active and involved
  2. Mental exercise
    Ex: Ballroom dancing, Learning new language, Board games, Crossword puzzles, Playing a musical instrument, Reading
  3. Pay attention: One task at a time
  4. Organize: notebooks for important info, to do list, post it notes, calendars, planners
  5. Mentally connect new information with other meaningful things: names, songs,
  6. Laugh and exercise- oxygenates blood
  7. Drink plenty of water
  8. Don’t smoke
  9. Sleep
A

Preservation of Cognitive Function

56
Q

Cantaloupe, Blueberries, Sweet Potatoes, Asparagus, Watermelon, Strawberries, Cherries, Tomatoes, Red cabbage, Radishes, Poly unsaturated oils, Oily fish: mackerel/salmon, Vitamin B

A

Foods Help Memory-

57
Q
  • Antioxidants may be of benefit
  • Promote safety in physical activities and driving
  • Recognize and treat depression= can cause cog function to increase*
A

Alzheimer’s Disease Nursing Interventions

58
Q
  • Diagnosis traumatic for patient and family
  • Patient often responds with Depression, Denial, Anxiety and fear, Isolation
  • Nurse should assess for depression and suicidal ideation
  • Counseling and antidepressants may be indicated
  • Family members may be in denial, delaying critical early care
  • Nurse should also assess family members and their ability to cope and accept diagnosis: can delay treatment
  • Ongoing monitoring important
  • Work in collaboration with patient’s caregiver
  • Teach caregiver how to manage care
  • patients subject to other health care problems like uti, falls, pneumonia, adverse effects of medications: caregiver and nurse will notice most of the time the pt won’t
  • Change enviro to hospital can cause delirium
A

Alzheimer’s Disease Acute Intervention

59
Q
  • Most patients cared for in their home
  • Assess support system because they take on the care
  • Various facilities should be evaluated look at stage of disease, later stage needs more care
  • In early stages memory aids may provide benefit: notes, reminders, pictures meaning
  • Drugs must be taken regularly, caregiver responsible bc pt doesn’t remember
  • Adult day care- gives caregiver a break, provides stimulation
  • Demands on caregiver can exceed resources when total care is needed, keep assessing
  • Person may need to be placed in a long-term care facility
  • Special units for patients are growing in long-term care facilities
  • Emphasis on safety
A

Alzheimer’s Disease Ambulatory and Home Care

60
Q

-Help to shift mood, help manage stress induced agitation, stimulate positive interactions, facilitate cognitive function, Coordinate motor movements= Rhythmic responses require little mental processing.
-Influenced by the motor center of the brain that responds directly to auditory rhythmic cues.
-Remains intact late into the disease process
-Selections from the individual’s young adult years are likely to have the strongest responses
Early stages pick unfamiliar music
Late stages pick music from early childhood

A

Adjunct Therapies Music Therapy

61
Q

-Percussive sounds and fairly quick tempos, tends to naturally promote movement, such as toe taps

A

Stimulative Music”

62
Q

”-Assist with activities of daily living: Mealtime to rouse individuals who tend to fall asleep, During bathing to facilitate movement from one room to another

A

Slightly Stimulative Music

63
Q

quiets-Ballads and lullabies= relaxation, Include unaccented beats, no syncopation, slow tempos, and little percussive sound. Preparing for bed or any change in routine that might cause agitation.

A

Sedative music”

64
Q
  • Used more in long term facilities helps spark memoires, encourages verbalization, promotes self-esteem
  • Environment: important, dedicated space and time
    9: 30 am to 11:30 am or after lunch - higher cognitive functioning
  • Eliminate background noise=to hold concentration
  • Maintain eye contact= to hold concentration
  • Choose pictures carefully: sketchpad, Large, colorful pictures, brightly colored markers
    • More unrealistic pictures the better it is for the patient
  • Only open-ended questions : “What should we call the person?” “Where are they going?” “What is going on here?”
A

Adjunct Therapies STORYTELLING

65
Q
  • Occur in 90% of patients
  • These problems include Repetitiveness, Delusions, Illusions, Hallucinations, agitation, resisting care, wandering
  • Are a patient’s way of responding to precipitating factor Pain, Frustration, Temperature extremes, Anxiety
  • Nursing strategies to address difficult behaviors: Redirection, Distraction, Reassurance
    • Do not threaten or restrain patient if frustrated
  • redirect the patient to what time it is and the activities for the day that will actually happen
A

Alzheimer’s Disease Behavioral Problems

66
Q
  • Verbally abusive or threatening
    • Physically threatening, i.e. kicking or pinching
    • Overreacting to a situation, or a very minor setback or criticism.
    • Causes include: Feeling threatened or humiliated, Frustration, not being understood, lack of self-control, decrease awareness of the rules
A

Aggressive Behavior

67
Q

Don’t take it personally, Identify triggers, stay calm and keep self-separated from the argument, don’t show your anxious will cause them to be b=more aggressive, give space, distract their attention, take care of issue without restraint, call for assistance if needed

A

Dealing with Aggression:

68
Q
  • can occur in delirium or dementia, circadian rhythms are off
    • Patient becomes more confused and agitated in late afternoon or evening, Cause is unclear, Remain calm and avoid confrontation
    • Can start yelling, resist, wandering
A

Sundowning

69
Q

: Create a quiet, calm environment, Maximize exposure to daylight, Evaluate medications, Limit naps and caffeine, Consult health care provider on drug therapy, Familiar attendant – family help reorient

A

Nursing interventions sundowning

70
Q

-Injury from falls, Ingesting dangerous substances, Wandering, Injury to others and self, Fire or burns

A

Alzheimer’s Disease Safety Risks

71
Q

Home safety check, family education, Supervision, register with Safe Return (government funded program a picture of patient is sent to the local emergency response, if someone calls and says they are lost and helps them to find)

A

interventions for safety risk

72
Q
  • Pain should be recognized and treated promptly/ assess frequently
  • Monitor patient’s response
  • Patients can have difficulty communicating complaints
  • May exhibit changes in behavior
A

Alzheimer’s Disease Pain Management

73
Q
  • Under nutrition problem in middle and late stages, don’t like to eat lose interest (long term care facility big thing-hard b/c decreased staff)
  • Quiet and unhurried environment
  • Easy-grip utensils
  • Offer liquids frequently
  • Thicken liquid if trouble swallowing, soft food
  • Finger foods may allow self-feeding-function at highest ability
  • gastric tube (ng, peg) short term solution
A

Alzheimer’s Disease Eating and Swallowing Difficulties

74
Q
  • In late stages patient will be unable to perform
  • Dental problems likely to occur
  • Patient may pocket food (stick in cheek), adding to potential tooth decay and abscess=discomfort to aggression
  • Inspect mouth regularly, and mouth care should be provided
A

Alzheimer’s Disease Oral Care

75
Q

-prompt evaluation and treatment
Urinary tract infection- bc don’t go to bathroom hold or can’t get to it
Pneumonia-can’t move, swallowing problems=aspiration
Death by sepsis

A

Alzheimer’s Disease Infection Prevention

76
Q
  • In late stages patient at risk for skin breakdown -immobility
  • Tend to rashes, areas of redness
  • Keep skin dry and clean
  • Change patient’s position regularly, assess regularly
A

Alzheimer’s Disease Skin Care Elimination Problems

77
Q

-disrupts all aspects of personal and family life
-Very stressful-role reversal child take care of parent
-Caregivers also exhibit adverse consequences
-Work with caregiver to
Assess stressors
Identify coping strategies
Find a support group – local alzheimer’s association chapter

A

Alzheimer’s Disease Caregiver Support

78
Q
  • Functions at highest level of cognitive ability
  • Performs self-care, bathing, dressing, and toileting with assistance as needed
  • Experiences no injury
  • Uses assistive devices appropriately for ambulation support
  • Uses effective coping strategies to manage grief related to diagnosis of
  • Verbalizes reality of health situation
  • Remains in restricted area during ambulation and activity-prevent injury, don’t want wandering and getting lost
A

Alzheimer’s Disease Evaluation Patient goals

79
Q

second most common, protein deposits in the nerve cells brain in areas of thinking, memory, and movement
-Cause is unkown, goes unrecognized bc its hard to dx
Tx-no standard
Nursing care- same as dementia

A

Lewy Body Dementia-

80
Q

Dementia plus two of the following indicates a possible diagnosis
-Extrapyramidal signs such as bradykinesia, rigidity, and postural instability, but not
always a tremor
Fluctuating cognitive ability, sleep disturbances
Hallucinations

A

lewy body dementia sx

81
Q

Rare and fatal brain disorder, Caused by a prion protein
Earliest symptoms: memory impairment, behavior changes
-Disease progresses rapidly -mentor deterioration, involuntary movement, weakness in the limbs, lead to blindness, then coma
-No diagnosis or treatment

A

Creutzfeldt-Jakob disease (CJD)-

82
Q

Type of frontotemporal dementia, Rare brain disorder

Major distinguishing characteristic is marked symmetric lobar atrophy of temporal and/or frontal lobes, shrink

A

Pick’s disease-

83
Q

Sx: disturbance in behavior, sleep, personality, then memory loss
-Relentless progression-can’t stop it

A

picks disease sx

84
Q

Uncommon disorder, obstruction of flow of cerebral spinal fluid/ Meningitis, encephalitis, or head injury may cause condition
- If diagnosed early, disease is treatable by surgery place a shunt=can’t get memory back

A

Normal-pressure hydrocephalus-

85
Q

Symptoms: dementia, urinary incontinence, difficulty walking=unsteady balance, constant headache

A

normal-pressure hydrocephalus sx

life span (23 decks)

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