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NUR 202 Week 11 > Problems r/t Neurocognitive Disorders > Flashcards

Problems r/t Neurocognitive Disorders Flashcards

* Alzheimer’s Disease * Vascular neurocognitive disorders * Frontotemporal neurocognitive disorder * Lewy body dementia

1
Q

Delirium

✣ disturbance in attn & awareness
✣ change in cognition
✣ diff sustaining & shifting attn
✣ extremely distractible
✣ disorganized thinking prevails

A

✣ rambling speech, irrelevant, pressured, incoherent
✣ disorientation to time & place
✣ emotional instability
✣ hallucinations/illusions
✣ sleep-wake cycle dist
✣ fluctuating psychomotor activity

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2
Q

Autonomic manifestations of Delirium

✣ tachycardia
✣ sweating
✣ flushed face
✣ dilated pupils
✣ elevated BP

A
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3
Q

Predisposing Factors of Delirium

✣ Systemic infections
✣ Hepatic or renal failure
✣ Febrile illness
✣ Head trauma

A

✣ Metabolic disorders, like fluid & electrolyte imbalances, hypercarbia, or hypoglycemia
✣ Seizures
✣ Hypoxia & COPD
✣ Migraine ha’s

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4
Q

✣ Brain abscess or brain neoplasm
✣ Nutritional deficiency
✣ Uncontrolled pain
✣ Burns

A

✣ Stroke/heat stroke
✣ Orthopedic & cardiac surgeries
✣ Social isolation

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5
Q

Other Etiological Implications of Delirium

  • Substance Intoxication Delirium & Substance Withdrawal Delirium
    > e.g., alcohol, cannabis, cocaine, inhalants, sedatives, anxiolytics, opioids, hypnotics

Medication-Induced Delirium
> e.g., antihypertensives, anticholinergics, steroids, anticonvulsants, analgesics, anesthetics

A
  • Delirium d/t another medical condition or to multiple etiologies
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6
Q

Neurocognitive Disorder (NCD)

  • Impairment in the cognitive functions of thinking, reasoning, memory, learning, & speaking
  • Mild or major
A
  • Mild NCD - mild cognitive impairment
  • Major NCD - can be reversible or progressive
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7
Q

Neurocognitive Disorder (NCD)

✩ Primary: Alzheimer’s disease (AD) [most common]

A

✩ Secondary: c/b or r/t another dz or cond (e.g., HIV, cerebral trauma)

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8
Q

Reversible NCD: Temporary (temporary dementia)

  • Stroke
  • Depression
  • S/e of rx’s
  • Nutritional deficiencies
  • Metabolic disorders
A

NCD Impairment

! abstract thinking, judgement, & impulse control
! social conduct
! behavior
! personal appearance & hygiene neglected
! possibly lang effects (aphasia)
! personality change
! mood changes
! ability to perform ADL’s, work

In most clients, NCD runs a progressive, irreversible course

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9
Q

?

Is the inability to carry out motor activities despite intact motor function

A

Apraxia

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10
Q

Stages of Alzheimer’s Disease

A

Stage 1

No apparent symptoms

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11
Q

Stage 2

Forgetfulness

A

Stage 3

Mild cognitive decline/disorder

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12
Q

Stage 4

Mild-to-moderate cognitive decline

e.g., confabulation occurs

A

Stage 5

Moderate cognitive decline

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13
Q

Stage 6

Moderate-to-severe cognitive decline

e.g., can become incontinent w/urine and/or feces

A

Stage 7

Severe cognitive decline

e.g., bedfast, aphasic

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14
Q

Predisposing Factors of NCD’s: Categories

✶ NCD d/t Alzheimer’s dz
✶ Vascular NCD
✶ Frontotemporal NCD
✶ NCD d/t TBI
✶ NCD d/t Lewy Body dementia
✶ NCD d/t Parkinson’s dz
✶ NCD d/t HIV infection

A

✶ Substance-induced NCD
✶ NCD d/t Huntington’s dz
✶ NCD d/t prion dz
✶ NCD d/t another medical condition
✶ NCD d/t multiple etiologies
✶ Unspec NCD

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15
Q

NCD d/t Alzheimer’s dz

  • Onset is slow & insidious
  • Progressive & deteriorating
  • Memory impairment, behavioral changes
  • Mult factors influence development
A

Possible causative factors:

  • Neurotransmitter alterations (e.g., acetylcholine)
  • Plaques & tangles (that lead to neuron death)
  • Head trauma
  • Genetic factors (e.g., familial pattern)
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16
Q

Vascular NCD

  • Significant cerebrovascular dz
  • More abrupt onset than in AD, course is more variable
A

Directly r/t an interruption of blood flow to the brain
- HTN
- Cerebral emboli
- Cerebral thrombosis

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17
Q

Frontotemporal NCD

  • Occurs as a result of shrinking of the frontal & temporal anterior lobes of the brain
  • Prev called Pick’s dz
A
  • Exact cause is unknown but genetics appears to be a factor
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18
Q

NCD d/t TBI

  • Amnesia is the most common neurobehavioral sx following head trauma
  • Repeated head trauma can result in dementia pugilistica
A
  • Synd characterized by emotional lability, dysarthria, ataxia, & impulsivity
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19
Q

NCD d/t Lewy Body Dz

  • Similar to AD, but progresses more rapidly
  • Appearance of Lewy bodies in the cerebral cortex & brainstem
A
  • Progressive & irreversible
  • May account for 25% of all NCD cases
20
Q

NCD d/t Parkinson’s Dz

  • Loss of nerve cells located in the substantia nigra
  • Decr in dopamine activity
A
  • Cerebral changes in NCD d/t PD sometimes resemble those of AD
21
Q

NCD d/t HIV Infection

  • Brain infections w/opportunistic organisms or by the HIV-1 virus directly
A
  • Sx’s may range from barely perceptible changes to acute delirium to profound cognitive impairment
22
Q

Substance-Induced NCD

  • NCD can occur as the result of substance reactions, overuse, or abuse
  • Alcohol, sedatives, hypnotics, anxiolytics, & inhalants
A
  • Drugs that cause anti-cholingeric s/e’s
  • Toxins, like lead & mercury
23
Q

NCD d/t to ?

  • This is transmitted as a Mendelian dominant gene
  • Damage occurs in the areas of the basal ganglia & the cerebral cortex
  • Client usually declines into a profound state of dementia & ataxia
A

Huntington’s dz

24
Q

NCD d/t prion dz

  • Manifestations: problems w/coordination or other movement disturbances along w/rapidly progressing dementia
  • 5-15% of cases of prion dz have a genetic component
  • Sx’s may develop @ any age in adults, but typ occur between 40-60 yrs
A
  • Clinical course is extremely rapid, w/the progression from diag to death in <2 yrs
  • Most common form of prion dz in humans is Creutzfeldt-Jakobs dz
25
Q

NCD d/t Another Medical Condition

  • Hypothyroidism
  • Hyperparathyroidism
  • Pituitary insufficiency
  • Uremia
  • Encephalitis
  • Brain tumor
  • Pernicious anemia
  • Thiamine deficiency
  • MS
A
  • Uncontrolled epilepsy
  • Cardiopulmonary insufficiency
  • F&E imbalances
  • CNS & systemic infections
  • SLE
26
Q

?

A dz c/b a deficiency of nicotinic acid (niacin)

A

pellagra

27
Q

Patient Assessment: Client History

  • mood swings, personality, behavior changes, catastrophic emotional reactions
  • cognitive changes - attention span, thinking process, problem-solving, memory
A
  • language difficulties
  • orientation to person, place, time, situation
  • appropriateness of social behavior
28
Q

NCD versus Pseudodementia

A
29
Q

Physical Assessment

  • Neurological exam: mental status, alertness, muscle strength, reflexes, sensory perception, language skills, & coordination
  • Mental status exam in NCD
A
  • Psychological tests - r/o pseudodementia/depression
30
Q

Diagnostic Lab Evaluations

Blood & urine tests
* Various infections
* Hepatic & renal dysfunctions
* Diabetes or hypoglycemia
* Electrolyte imbalances
* Metabolic & endocrine disorders
* Nutritional deficiencies
* Presence of toxic substances

A

Other

  • EEG
  • CT
  • PET
  • MRI
  • LP to examine CSF
31
Q

Outcome Criteria

  • Has not experienced physical injury
  • Has not harmed self or others
  • Has maintained reality orientation to the best of his or her capability
A
  • Discusses positive aspects about self & life
  • Participates in ADLs w/assistance
32
Q

Nursing Diagnoses in NCD

A
33
Q

Risk for Trauma: Goals/Interventions

  • Arrange the furniture & other items in the room to accommodate the client’s disabilities
  • Keep the lowest position
  • Consider room near nurse’s station or 1:1
A
  • Assist w/ambulation
  • Decrease stimuli
  • Remain calm & undemanding
  • Consider movement therapy and/or use of antipsychotics
34
Q
  • Keep the individual on a structured schedule of recreational activities & a strict feeding & toileting schedule
  • Provide a safe, enclosed space for pacing & wandering
A
  • Walk w/the individual for a while & gently redirect him or her back to the care unit
  • Ensure that outdoor exits are electronically controlled
35
Q

Disturbed Thought Processes/Impaired Memory & Disturbed Sensory Perception - Goals/Interventions

  • Try to keep the client as oriented to reality as possible
  • Use clocks & calendars w/large #’s that are easy to read
  • Use colorful signs
A
  • Encourage family & close friends to be a part of the client’s care
  • Provide the client w/radio, television, & music if they are diversions the client enjoys
  • Ensure that noise lvl is controlled to prevent excess stimulation
36
Q
  • Reminiscence therapy
  • Consistency in safe members
  • Monitor for med s/e’s
A
  • Minimize focus on delusional thinking
  • Provide hearing aid or glasses if usually worn
  • Reassurance of safety
37
Q

Impaired Verbal Communication - Goals/Interventions

  • Provide clear, simple one-word direction
  • Use non-verbal gestures
  • Approach from front
  • Consistency in staff
A

Self-Care Deficit - Goals/Interventions

  • Simple, structured environment
  • Provide assistance as needed
38
Q

Patient & Caregiver Education

A

Treatment Modalities: Delirium

  • Determine & correct underlying cause
  • Attend to F&E status, hypoxia, anoxia, & diabetic problems
  • Remain w/client @ all times, provide orientation & assurance
  • Low stimuli lvl
  • Agitation/aggression may require treatment w/rx
39
Q

Treatment Modalities: NCD

  • Primary consideration = ETIOLOGY
  • Complete clinical workup to identify syndrome & its causes
  • General supportive care incl security, stimulation, patience, nutrition
A
40
Q

Medications in NCD

Cognitive impairment: ____

  • Donepezil
  • Rivastigmine
  • Galantamine
A

cholinesterase inhibitors

41
Q

NMDA receptor antagonist

____

A

Memantine (Namenda)

42
Q

Pharmaceutical agents for agitation, aggression, hallucinations, thought disturbances, wandering = ____

Risperidone
Olanzapine
Quetiapine
Haloperidol
Pimavanserin (PD)

Consider anticholinergic effects

A

antipsychotics

43
Q

Depression = Antidepressants

SSRIs
* Sertraline
* Paroxetine

Tricyclic Antidepressant
* Nortriptyline

  • Trazodone
A
44
Q

Anxiety = Benzodiazepines

  • Diazepam
  • Chlordiazepoxide
  • Alprazolam
  • Lorazepam
  • Oxazepam
A
45
Q

☆ Antipsychotics in Lewy Body Disease ☆

A

☆ Understand how Alzheimer’s meds work ☆

NUR 202 Week 11 (2 decks)

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