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OA Exam 1 > OA: Cognitive Disorders > Flashcards

OA: Cognitive Disorders Flashcards

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….

A

two or more brain functions are significantly impaired and irreversible

23
Q

Hypotheses-cholinergic

A

low levels of acetylcholine present

24
Q

Amyloid plaques

A

neurofibrillary tangles

-loss of connections between cells and cell death

25
Q

TAU

A

TAU proteins become twisted inside nerve cells

26
Q

Warning signs of AD

A
  • 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
Q

Stages of AD

A

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
Q

Top Risk factors for dementia

A
  • age
  • family hx
  • genetics
29
Q

Contributing pathophysiologic processes

A
  • cholinergic hypothesis

- NMDA receptor

30
Q

NMDA receptor

A

overstimulated which results in excessive release of glutamate

31
Q

glutamate

A

excitatory neurotransmitter

32
Q

Medications for dementia

A
  • Anti-cholinesterase inhibitors
  • NMDA receptor antagonists
  • anti-depressants/anti-anxiety agents
  • atypical anti-psychotics
33
Q

Anti-cholinesterase inhibitors

A

reduce breakdown of acetylcholine

  • donepezil
  • rivastigmine
34
Q

NMDA receptor antagonists

A

limit effects of glutamate

-memantine

35
Q

anti-depressants/anti-anxiety agents

A

-may use SSRI; effective for both depression and anxiety

36
Q

atypical anti-psychotics

A

used when patients have hallucinations or delusions

-used in lower dosages than with mental illness

  • seroquel
  • olanzapine
  • risperidone
37
Q

What do you monitor with atypical anti-psychotics?

A

sedation

38
Q

Nurse’s role with dementia meds

A

understand intended effect

-expect OA patient to receive lower dosages of these meds

“Start low, Go slow”

39
Q

Assessment strategies used on admission for dementia

A
  • MMSE
  • MOCA
  • Mental status exam
40
Q

Assessment strategy used on admission for delirium

A

CAM scale

41
Q

Daily assessment

A
  • oriented x4

- questions about daily events as tolerated

42
Q

Questions to ask family

A
  • Challenging behaviors?
  • How pt performs ADLs?
  • Sleep pattern disrupted?
  • Communication problems?
43
Q

CARES Model

A

-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
Q

Habilitation Tenets

A

validates emotions, maintains dignity, creates moments for success, uses all of remaining skills

45
Q

5 tenets of habilitation

A
  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
Q

Physical Environment

A
  • maintain safety
  • allow freedom when possible
  • take keys away if needed
  • may not allow to cook or smoke without supervision
47
Q

Self care deficits for bathing

A
  • have everything ready in advance
  • warm room
  • undressing: use distraction
48
Q

Self care deficits for dressing

A
  • choose specific spot to dress and another to undress
  • match items
  • simple clothes
  • don’t argue to change clothes: distract
49
Q

Self care deficits for toileting

A
  • 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
Q

Problem behaviors

A
  • 90% with AD demonstrate behavior problems
  • can lead to caregiver stress
  • major factor for nursing home placement
51
Q

When following the 5 tenents, we….

A

decrease the number of situations which might provoke patient

52
Q

Cues to distress

A
  • increased vocals
  • agitation
  • withdrawal
  • changes in function
  • recognize and treat promptly
53
Q

Sundowning

A
  • 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
Q

ATD model

A

A: anticipate
T: tolerate
D: do not agitate

OA Exam 1 (6 decks)

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