T2 - Neurocognitive Disorder (Josh) Flashcards
If Delirium progresses, what can it become?
Hallucination
Illision
—- is an acute and rapid (sudden or over several days) onset of disturbance in attention, awareness, and cognition (p. 333 text)
Delirium
What must happen to be diagnosed w/ Mild Neurocognitive Disorder?
changes that impact cognitive functioning
Difference b/t Alzheimer’s and Vascular Neurocognitive Disorder?
VND has a more ABRUPT onset
Difference b/t Alzheimer’s and Vascular NCD.
Vascular NCD is more abrupt onset
— is a loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss
Agnosia
An example of a treatable form of NCD is one that is caused by which of the following (SATA)?
a) Multiple Sclerosis
b) Multiple small brain infarcts
c) Electrolyte imbalances
d) HIV
e) Folate deficiency
c) Electrolyte imbalances
e) Folate deficiency
Causes of Major NCD:
- Alzheimer’s disease
- Frontotemporal lobar degeneration
- Lewy body disease
- Vascular disease
- Traumatic brain injury
- Substance/medication use or withdrawal
- HIV infection
- Prion disease
- Parkinson’s disease
- Huntington’s disease
— is helpful for the families of client’s w/ NCD.
Respite
- offering them a time away from the constant care of the client
Mr. Stone is a client w/ a diagnosis of Vascular NCD. In explaining the disorder to the family, which of the following is correct?
a) He will probably live longer than if his disorder was of the Alzheimers type
b) Vascular NCD shows step-wise progression. This is why he sometimes seems okay
c) Vascular NCD is caused by plaques and tangles that form in the brain.
d) The cause of Vascular NCD is unknown
b) Vascular NCD shows step-wise progression. This is why he sometimes seems okay
NCDs are differentiated according to —
etiology
— goes beyond normal issues of aging.
Mild neurocognitive disorder
A person w/ a Neurocognitive Disorder — have delirium.
CAN
- NCD symptoms will worsen
Which area of the brain is involved in delirium and NCD?
Reticular Activation System
- responsible for consciousness, attention, and sleep-wake cycle
Risk Factors for Alzheimer’s
- Age
- Female
- Brain Trauma
- Family History
In addition to disturbances in cognition and orientation, individuals w/ Alzheimers may also show changes in… (SATA)
a) Personality
b) Vision
c) Speech
d) Hearing
e) Mobility
a) Personality
c) Speech
e) Mobility
A nurse is making a home visit to a client who is in late stage of Alzheimer’s disease. The client’s spouse, who is the primary caregiver, wishes to discuss concerns about the client’s nutrition and the stress of providing care. Which of the following is an appropriate action by the nurse?
a) Verify that a current power of attorney document is on file
b) Instruct the client’s spouse to offer finger foods to increase oral intake
c) Provide information on resources for respite care
d) Schedule the client for placement of an enteral feeding tube
c) Provide information on resources for respite care
Factors that reduce the risk/delay the onset of NCD.
- Good lung function
- Physical exercise
- Life long learning
- Healthy nutrition
- Quality and active social life
- Stimulating environment
- Quality sleep
- Stress management
- Optimistic outlook
– is most preventable and the second most common form of NCD.
Vascular NCD
What will allow interventions for Mild NCD to be most effective?
early detection
With —- there is significant decline from a previous level of performance in one or more cognitive domains — such as complex attention, executive function, learning, memory, language, perceptual-motor or social cognition.
Major NCD
Stages of Alzheimer’s (according to ATI)
1) No impairment
2) Very mild cognitive decline (Forgetfullness)
3) Mild cognitive decline
4) Moderate cognitive decline
5) Moderately Severe cognitive decilne
6) Severe cognitive decline
7) Very Severe cognitive decline
— is usually secondary to another medical condition (infection, substance use, etc.)
— is not related to another mental health disorder and irreversible and progressive.
Delirium
NCD
The — is a series of specific connected neurons and neural fibers (neuronal circuits) that originate from the brain stem and connect to regions of the brain (Thalamus, Hypothalamus, Cerebral Cortex, Cerebellum).
Reticular Activation System
The prevalence of vascular NCD is higher in —
men
Alzheimer’s Disease accounts for — of all cases of NCDs.
50 – 60%
- 5.4 million people have Alzheimer’s
- Early onset with symptoms beginning before age 65
- Late onset with symptoms beginning after age 65
— —- are a those in which a clinically significant deficit in cognition or memory exists, representing a change from a previous level of functioning (p. 332 text and p. 136 ATI).
Neurocognitive disorders (NCDs)
Mrs. G has been diagnose w/ NCD due to Alzheimer’s disease. The priority nursing intervention is…
a) Ensuring that she receives food she likes, to prevent hunger
b) Ensuring that the environment is safe, to prevent injury
c) Ensuring that she meets the other patients, to prevent social isolation
d) Ensuring that she takes care of her own ADLs, to prevent dependence
b) Ensuring that the environment is safe, to prevent injury
– in an older adult can mimic the early stages of alzheimers.
Depression
The night nurse finds Ms. G, a client w/ Alzheimers, wandering the hall at 4am and trying to open the door to the side yard. Which statement probably reflects the most accurate assessment of the situation?
a) That door leads to the patio. It’s nighttime, you don’t want to go outside now.
b) You look confused. What is bothering you?
c) This is the patio door. Are you looking for the bathroom?
d) Are you lonely? Perhaps you’d like to go back to your room and talk for a while.
c) This is the patio door. Are you looking for the bathroom?
A nurse in a long-term care facility is caring for a resident who has major NCD and attempts to wander out of the building. The client state, ‘I have to get home.’ Which of the following is an appropriate response by the nurse?
a) You have forgotten that this is your home.
b) You cannot go outside w/out a staff member.
c) Why would you want to leave? Aren’t you happy w/ your care?
d) I am your nurse. Let’s walk together to your room.
d) I am your nurse. Let’s walk together to your room.
— is intentionally making up information to fill in gaps in memory; to save face, protect self esteem
Confabulation
Hallucination or Ilusion?
Thinking the stethescope is a snake.
Illusion
A nurse is caring for a client who has Alzheimer’s disease and is beginning to experience noticeable short-term memory loss. When discussing a new prescription for donepezil, the nurse should include which of the following in the teaching?
a) You should avoid taking OTC acetaminophen while on donepezil
b) You can expect the progression of cognitive decline to slow w/ donepezil
c) You will be screened for underlying kidney disease prior to starting donepezil.
d) You should stop taking donepezil if you experience nausea or diarrhea.
b) You can expect the progression of cognitive decline to slow w/ donepezil
When do delirium symptoms become worse?
Afternoon and Evening (Sundowning)
Mrs. G has been diagnose w/ NCD due to Alzheimer’s disease. The cause of this disorder is which of the following?
a) Multiple small brain infarcts
b) Chronic ETOH abuse
c) Cerebral abscess
d) Unknown
d) Unknown
One of the hallmarks of Alzheimer’s Disease is the accumulation of — between neurons.
amyloid plaques
- amyloid is a general term for protein fragments that the body produces
A — is a syndrome of chronic and possibly progressive intellectual and functional impairment involving memory, language, emotion, cognition, and changes in the personality (Text p. 359 and ATI).
neurocognitive disorder
In —-, the client avoids answering questions by repeating phrases or behavior.
perseveration
Stage — Alzheimer’s can look like normal age-related changes in cognitive function.
2
In Alzheimer’s, which protein in the neuron is abnormal, causing the microtubules to collapse.
tau
—- is seeing or hearing what is not there.
Hallucination
— repeating phrases or behavior when memory has failed
Perseveration
A neurocognitive disorder caused by Alzheimers is —
A neurocognitive disorder caused by something like HIV is —
Primary
Secondary
Which of the following is the most appropriate in helping an Alzheimers client with ADLs? (SATA)
a) Perform ADLs for her
b) Provide her written list of activities she is expected to perform
c) Assist her w/ step-by-step instructions
d) Tell her that if her morning care is not completed by 9am, it will be performed for her
e) Encourage her and give her plenty of time to perform as many ADLs as possible independently
c) Assist her w/ step-by-step instructions
e) Encourage her and give her plenty of time to perform as many ADLs as possible independently
Common defense mechanisms for Cognitive Disorders.
- Denial
- Confabulation
- Perseveration
S/S of Neuroleptic Malignant Syndrome
FEVER
- Fever
- Elevated enzymes
- Vitals instability
- Encephalopathy
- Rigidity of muscles
Which of the following is NOT associated w/ increased chance of NCD due to Alzheimers?
a) Multiple small strokes
b) Family history of Alzheimers
c) Head trauma
d) Advanced age
a) Multiple small strokes
— is a misrepresentation of a real stimulus.
Illusion
How long does delirium last?
brief
few days to a month
– and – are UNCONSCIOUS attempts to maintain self-esteem when memory has failed.
Perseveration
Confabulation
—- describes a level of cognitive decline that requires compensatory strategies and accommodations to help maintain independence and perform activities of daily living.
Mild Neurocognitive Disorder
A nurse is performing an admission assessment for a client who has delirium related to an acute UTI. Which of the following are expected finding? (select all that apply)
a) History of gradual memory loss
b) Family report of personality changes
c) Hallucinations
d) Unaltered LOC
e) Restlessness
b) Family report of personality changes
c) Hallucinations
e) Restlessness
Is confabulation lying?
No, they are not lying, it is an unconscious defense mechanism to maintain self-esteem when memory fails
Neurocognitive Disorders include…
- Delirium
- Mild NCD
- Major NCD
How is sundowning managed?
- controlling pain
- reduce stimulation
- turn on lights to help minimize shadows,
- distract with a quiet simple activity as folding clothes and towels,
- have them get physical activity and exercise daily,
- keep naps short during the day and not too close to bed time,
- help them to get enough rest at night,
- do not serve caffeinated drinks in the afternoon or evening (stimulating and may add to confusion and anxiety),
- do not provide alcoholic drinks (may add to the confusion and anxiety),
- do not plan many activities during the day (too tiring).
Ms. G, who has NCD due to Alzheimers, has trouble sleeping and wanders around at night. Which of the following would be best to promote sleep in Ms. G?
a) Ask the doc to prescribe flurazepam
b) Ensure that Ms G gets an afternoon nap so she will not be overtired at bedtime
c) Make Ms. G a cup of tea w/ honey before bed
d) Ensure that Ms. G gets regular physical exercise during the day
d) Ensure that Ms. G gets regular physical exercise during the day
With — vital signs are unstable
With — vital signs are typically stable.
Delirium
NCD
Mrs. G, who has NCD due to Alzheimers, says to the nurse, “I have a date tonight, I always have a date on Xmas.’ Which of the following is the most appropriate response?
a) Don’t be silly. Its not Xmas
b) Today is Tuesday Oct 21. We will have supper soon and your daughter is coming to visit.
c) Who is your date with?
d) I think you need som more meds. I’ll bring them now.
b) Today is Tuesday Oct 21. We will have supper soon and your daughter is coming to visit.
A nurse is making a home visit to a client who has Alzheimer’s disease to assess the home for safety. Which of the following are appropriate suggestions to decrease the client’s risk for injury? (Select all that apply)
a) Install childproof door locks
b) Place rugs over electrical cords
c) Mark cleaning supplies w/ colored tape
d) Place the client’s mattress on the floor
e) Install light fixtures above stairs
a) Install childproof door locks
d) Place the client’s mattress on the floor
e) Install light fixtures above stairs
Increased wandering, confusion, and agitatino in the late afternoon/early evening.
Sundowning
- the closer to evening, the more confused/agitated the client becomes
The number one thing to decrease chance of NCD is –
good lung function
Pseudo dementia is —-
depression
Which of the following meds have been indicated in the improvement in cognitive functioning in mild to moderate Alzheimer’s (SATA)?
a) Donepezil
b) Rivastigmine
c) Risperidone
d) Sertraline
e) Galatamine
a) Donepezil
b) Rivastigmine
e) Galatamine
