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OA Exam 1 > OA: Cognitive Disorders > Flashcards

OA: Cognitive Disorders Flashcards

(54 cards)

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1
Q

Concept of cognition

A

Process–>Store–>Retrieve–>Apply–>Acquire

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2
Q

Mental Status Exam

A
  • oriented x4
  • memory
  • cognitive function
  • thought process
  • judgment
  • perception
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3
Q

Concepts related to cognition which explain physiological changes in cognition

A
  • oxygenation
  • perfusion
  • homestasis/regulation (fluid and electrolyte balance; inflammation)
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4
Q

Delirium

A

new onset of change in cognition, function, or behavior

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5
Q

Clinical manifestations of delirium

A
  • trouble paying attention
  • fluctuating levels of consciousness
  • patient calm during day, restless at night
  • hyper or hypoactive
  • disoriented
  • illusions
  • hallucinations
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6
Q

3 manifestations more unique to delirium than dementia

A
  • trouble paying attention
  • fluctuating levels of consciousness
  • patient calm during day, restless at night
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7
Q

3 strategies that can be used to understand and assess situations for altered cognition

A
  • mental status exam
  • related concepts
  • concept of cognition
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8
Q

Settings where delirium likely to occur

A
  • intensive care setting (most likely)
  • hospital
  • postoperatively
  • pts with dementia in hospital
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9
Q

Possible causes of delirium

A
  • surgery
  • drugs
  • infections (UTI or Pneumonia)
  • cerebrovascular dz
  • CHF
  • hypoglycemia
  • fever
  • dehydration
  • head injury
  • environmental changes
  • prolonged sleep deprivation
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10
Q

CAM scale

A
  • screens specifically for signs of delirium
  • interview-style
  • 5 mins
  • consists of 2 parts
  • accounts and controls for ageism
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11
Q

1st part of CAM scale

A

screens for overall cognitive impairment

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12
Q

2nd part of CAM scale

A

screens specifically for traits associated with reversible confusion

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13
Q

CAM is highly effective in _______, but does not _______

A

identifying delirium

measure severity

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14
Q

Nursing process associated with delirium/dementia

A

Assessment: CAM scale
Intervention: identify any contributing factors (priority) and maintain patient safety

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15
Q

Alzheimer’s Disease

A

chronic, progressive, degenerative disease of the brain

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16
Q

most common type of dementia

A

AD

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17
Q

Dementia

A

progressive loss of cognitive function that is steady and irreversible

clinical syndrome of cognitive deficits that involves memory impairments and a disturbance of at least one other area of cognition

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18
Q

Dementia affects…

A

memory, thinking, language, judgment, behavior

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19
Q

aphasia

A

A language disorder that affects a person’s ability to communicate.

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20
Q

Apraxia

A

Difficulty with skilled movements even when a person has the ability and desire to do them.

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21
Q

agnosia

A

inability to interpret sensations and hence to recognize things, typically as a result of brain damage.

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22
Q

Providers only diagnose patients if….

Study These Flashcards
A

two or more brain functions are significantly impaired and irreversible

23
Q

Hypotheses-cholinergic

Study These Flashcards
A

low levels of acetylcholine present

24
Q

Amyloid plaques

Study These Flashcards
A

neurofibrillary tangles

-loss of connections between cells and cell death

25
TAU
TAU proteins become twisted inside nerve cells
26
Warning signs of AD
- misplacing things - losing ability to retrace steps - decreased/poor judgment - withdrawal from work/social - changes in mood and personality - memory loss that disrupts daily life - challenges in planning and problem solving - confusion with time and place - new problems with words in speak and writing
27
Stages of AD
Seven stages of AD Reisberg Model 1. no impairment 2. normal age-related forgetfulness (not noticed by others) 3. mild cognitive impairment (noticed) 4. mild or early stage AD (withdrawal from social/memory) 5. moderate AD (unable to live alone) 6. moderate-severe AD (max. assistance with ADLs) 7. Severe AD (lose ability to respond and function with out continuous assistance)
28
Top Risk factors for dementia
- age - family hx - genetics
29
Contributing pathophysiologic processes
- cholinergic hypothesis | - NMDA receptor
30
NMDA receptor
overstimulated which results in excessive release of glutamate
31
glutamate
excitatory neurotransmitter
32
Medications for dementia
- Anti-cholinesterase inhibitors - NMDA receptor antagonists - anti-depressants/anti-anxiety agents - atypical anti-psychotics
33
Anti-cholinesterase inhibitors
reduce breakdown of acetylcholine - donepezil - rivastigmine
34
NMDA receptor antagonists
limit effects of glutamate -memantine
35
anti-depressants/anti-anxiety agents
-may use SSRI; effective for both depression and anxiety
36
atypical anti-psychotics
used when patients have hallucinations or delusions -used in lower dosages than with mental illness - seroquel - olanzapine - risperidone
37
What do you monitor with atypical anti-psychotics?
sedation
38
Nurse's role with dementia meds
understand intended effect -expect OA patient to receive lower dosages of these meds "Start low, Go slow"
39
Assessment strategies used on admission for dementia
- MMSE - MOCA - Mental status exam
40
Assessment strategy used on admission for delirium
CAM scale
41
Daily assessment
- oriented x4 | - questions about daily events as tolerated
42
Questions to ask family
- Challenging behaviors? - How pt performs ADLs? - Sleep pattern disrupted? - Communication problems?
43
CARES Model
-person-centered approach for any person in any situation at any level of cognitive decline/impairment ``` C: connect with person A: assess behavior R: respond appropriately E: evaluate what works S: shares with others ```
44
Habilitation Tenets
validates emotions, maintains dignity, creates moments for success, uses all of remaining skills
45
5 tenets of habilitation
1. make the physical environ. work 2. know communication remains possible 3. focus on remaining skills 4. live in patient's world: behavioral changes 5. enrich the patient's life
46
Physical Environment
- maintain safety - allow freedom when possible - take keys away if needed - may not allow to cook or smoke without supervision
47
Self care deficits for bathing
- have everything ready in advance - warm room - undressing: use distraction
48
Self care deficits for dressing
- choose specific spot to dress and another to undress - match items - simple clothes - don't argue to change clothes: distract
49
Self care deficits for toileting
- schedule visits - looks for fidgeting or picking at groin - look for pattern when accidents occur - adequate lighting - bedside commode at night - withhold fluid at night - big meal at lunch
50
Problem behaviors
- 90% with AD demonstrate behavior problems - can lead to caregiver stress - major factor for nursing home placement
51
When following the 5 tenents, we....
decrease the number of situations which might provoke patient
52
Cues to distress
- increased vocals - agitation - withdrawal - changes in function - recognize and treat promptly
53
Sundowning
- limit naps and caffeine - provide safe place for pacing and muttering - quiet space to watch tv or listen to music - provide activity when sunsetting - improve lighting to avoid shadows
54
ATD model
A: anticipate T: tolerate D: do not agitate

OA Exam 1 (6 decks)

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