Unit 6 Neurocognitive Disorders DELEREIUM, DEMENTIA, ALZHEIMERS Chapter 23 Flashcards
What is Delirium
Acute, Suden, onset of confusion can be due to…
- Pain
- Infection
- Dehydration
- Hypoxia
- Immobilization
- Poor or inadequate nutrition
- Environment noise, lack of orienting material, movement to new area
- Sleep deprivation
- Sensory problems, especially hearing and vision
-
Restraint use
SUBSTANCE ABUSE
Cognitive Disturbance and often reversible
Common complication in hospitalized older adult
Always due to underlying cause
Important to identify cause early and treat
Risk Factors: Cognitive impairments, infection, older
age, fracture, polypharmacy
Should a patient who is newly confused, falling, disrobing and fighting with staff be assessed for delirium?
A. Yes
B. No
A. Yes
Is Delirium short term?
YES
Before diagnosing a patient with delirium what should be assessed first?
-obtain family history of baseline of normal functioning
What is the priority way to treat Delirium?
treat the underlying causes
Is delirium a medical emergency?
A. Yes
B.No
A. Yes
**Delirium is a medical emergency that requires immediate attention to prevent irreversible and serious damage **
(Dixon, 2018). Delirium is associated with increased morbidity and mortality and can have lasting long-term consequences, such as permanent cognitive decline (Inouye, 2018).
In hospitalized patients, delirium is associated with longer hospital stays and increased complications
Is delerium progressive or reversible?
REVERSIBLE
S/s of Delirium
Cardinal Symptoms:
◦ Inability to direct, focus, sustain, and shift attention
◦ Abrupt onset
◦ Clinical features fluctuate w/ periods of lucidity(high and low moods)
◦ Disorganized thinking
◦ Poor executive functioning(poor financial management, paying bills
Your patient has active onset hallucinations should you consider delirium?
A. Yes
B.No
A. Yes
Consider delirium when:
◦ Patient abruptly demonstrates a reduced clarity of environment.
◦ Impaired ability to direct, focus, sustain or shift attention
◦ Disorientation
◦ Conversation is difficult
◦ Illusions or Hallucinations
Is safety a priority in patient with delirium?
A. Yes
B. No
A. Yes
Can hallucination or illusions be present in patients with Delirium?
A. Yes
B. No
A. Yes
Consider delirium when:
◦ Patient abruptly demonstrates a reduced clarity of environment.
◦ Impaired ability to direct, focus, sustain or shift attention
◦ Disorientation
◦ Conversation is difficult
◦ Illusions or Hallucinations
Interventions for Delirium
Physical needs
◦ Sx – increased HR, Flushing, hypervigilant
◦ Lighting – Simple environment
◦ Glasses and/or hearing aides
*Make environment simple and clear as possible.**
Eyeglasses, hearing aids, and ade- quate lighting without glare can maximize the person’s ability to interpret more accurately what is going on in the environment.
Interpersonally interacting with the patient when the patient is awake can help to reduce anxiety and misperceptions.
Which of the following s/s is associated with delirium?
A. Diaphoresis
B. Bradycardia
C. Pupil constriction
D. Incontienece
A. Diaphoresis
Autonomic signs—such as tachycardia, sweating, flushed face, dilated pupils, and elevated blood pressure—are often present in delirium. Monitor and document these changes care- fully, as they may require immediate medical attention.
Mood and behavioral changes that patients experience with delirium?
Mood and Behavior
◦ Dramatically change and swing
◦ Anxiety, fear, anger, euphoria
Which of the following should you suspect is a potential cause of delirium in a patient?
A. Family history
B. Potassium 3.8
C. Sodium 145
D. Medication
D. Medication
TREAT THE CAUSE , DISCONTINUE MEDICATION
You should always suspect medications as a potential cause of delirium.
This is especially true when there is polypharmacy and/or use of psychoactive agents.
To recognize drug reactions or anticipate potential interactions before delirium actually occurs, it is important to assess all medications, prescriptions, and over-the- counter agents that the person is taking.
Consultation with a pharmacist is recommended, especially when there is polypharmacy.
How would a nurse prevent delirium if the older adult has polypharmacy?
**To recognize drug reactions or anticipate potential interactions before delirium actually occurs, it is important to assess all medications, prescriptions, and over-the- counter agents that the person is taking. **
medication reconciliation
What is the proper nursing communication technique with a patient with the delirium during the assessment process?
A. repeat the question , patient ability to focus may be reduced.
B. turn on all lights and alarm machines to wake the patient up.
C. Speak loudly while your back it turned against them
D. Have them write out how they feel about themselves
A. repeat the question , patient ability to focus may be reduced.
Which hospital setting would a patient be presented with delirium?
A. Post operative floor
B. Intensive Care Unit
C. Medical surgical floor
D. Psychiatric mental facility
B. Intensive Care Unit
What is the priority outcome for patients with Delirium
Outcomes
◦ Free from injury
What is Dementia
Dementia – broad term used to describe progressive deterioration of cognitive functioning
and global impairment of intellect
Dementia is a umbrella term
◦ Important to rule out Depression or any medical cause
◦ Don’t assume “normal part of aging”
Should you assume memory loss is a part of normal aging?
A. Yes
B. No
B. No
◦ Don’t assume “normal part of aging”
What is Alzheimer’s Disease?
AD, the most common cause of dementia, is a devastating disease that not only affects the person experiencing it but also places an enormous burden on the families and caregiv- ers of those affected.
Risk factors for Alzimers
Risk Factors: Genetics, Cardiovascular disease, Head injury, Traumatic Brain injury, unhealthy
diet, not socially engaged
Which of the following hormones is patients with Alzheimers disease Deficient in ?
A. Estrogen
B. Acetycholine
C. Levothroxixne
D. Antidiuretic hormone
B. Acetycholine
Deficiency of acetylcholine
What is the function of acetylcholine
an important neurotransmitter that plays a role in brain functions, such as memory, and body functions, such as muscle contractions to move your muscles.
How many stages of Alzheimers is there ?
3
◦ Early
◦ Moderate to severe:
◦ Late:
Early Stage Alzheimers
forgetfulness
- Early – Difficulty with recent memory, impaired learning, apathy and depression
The person and their loved ones notice memory lapses. The person may still be able to function independently but will experience:
- Difficulties retrieving correct words or names.
- Trouble remembering names when introduced to new people.
- Challenges in performing tasks in social or work settings.
- Forgetting material that one has just read.
- Losing or misplacing a valuable object.
- Increasing trouble with planning or organizing.
◦ Moderate to Severe Alzheimer’s
Moderate to severe: Visual/spatial and language deficits, psychotic features, agitation and wandering
The person confuses words, gets frustrated or angry, or acts in unexpected ways such as refusing to bathe. Symptoms become noticeable to others and such persons may
* Forget events or their personal history
* Become moody or withdrawn, especially in socially or mentally challenging situations
- Be unable to recall their own address or telephone number or the high school/college from which they graduated.
- Become confused about where they are or what day it is
- Need for help choosing proper clothing for the season or the occasion
- Change sleep patterns, such as sleeping during the day and becoming restless at night
Be at risk of wandering and becoming lost
* Become suspiciousness and delusional or
compulsive, for example, repetitive behavior like hand wringing
Should you use antipsychotics with elder adults?
A. Yes
B. No
B. No
can have Paradoxical effects
Severe Alzheimers
Gait Disturbance, poor judgment, disorientation, confusion, incontinence, difficulty speaking swallowing and walking
Patients lose the ability to respond to their environment, to carry on a conversation, and, eventually, to control movement. They may still say words
or phrases, but communicating pain becomes difficult.
Personality changes may take place and individuals need extensive help with daily
activities. They may:
** Require full-time, around-the-clock assistance with daily activities and personal care**
** Lose awareness of recent experiences and of their surroundings**
- *Experience changes in physical abilities,
including the ability to walk, sit, and eventually swallow** - Have increasing difficulty communicating
- Become vulnerable to infections, especially pneumonia
Assessment Terminology for Alzheimer Disease)
Confabulation – creation of stories/answers in place of actual memories to maintain self-esteem (unconscious
not lying) Defense Mechanism
Perseveration – persistent repetition of a word, phrase or gesture. Continues after the stimulus is stopped.
Agraphia – diminished ability to read or write
Aphasia – loss of language ability
Apraxia – loss of purposeful movement
Agnosia – Loss of sensory ability to recognize objects
Hyperorality – tendency to taste, chew and put everything in mouth
Hyper metamorphosis – urge to touch everything
Sundowning – tendency for mood to deteriorate and agitation increases in the later part of the day or at night
Assess Cognitive Functioning, memory, executive functioning, emotions
Confabulation example
Confabulation is the creation of stories or answers in place of actual memories to maintain self-esteem.
-Confabulation is not lying. When people are lying, they are aware of making up an answer. Confabulation is an unconscious mechanism employed to protect the ego.
For example, here the nurse addresses a patient who has remained in a hospital bed all weekend:
Nurse: Good morning, Ms. Jones. How was your weekend? Patient: Wonderful. On Sunday I went to lunch with my
family.
What is Perseveration
Perseveration is the persistent repetition of a word, phrase, or gesture that continues after the original stimulus has stopped. For example, a person may continue to repeat “hello” long after the initial greeting is over.
What is Agraphia
difficulty Writing
What is Aphasia
Aphasia – loss of language ability
What is Apraxia
Apraxia – loss of purposeful movement
What is Agnosia
Agnosia – Loss of sensory ability to recognize objects
What is Hyperorality
Hyperorality – tendency to taste, chew and put everything in mouth
What is Hyper metamorphosis
Hyper metamorphosis – urge to touch everything
What is Sundowning
Sundowning – tendency for mood to deteriorate and agitation increases in the later part of the day or at night
Assess Cognitive Functioning, memory, executive functioning, emotions
Interventions for patients with Alzheimers Disease
Person Centered Care – focuses on forming meaning relationship with the person who has
dementia and also their caregiver
Educating families about cognitive impairment – Involve families in treatment planning
Community supports
Use of distraction
Finger foods(NO COMPLICATED. FOODS)
Limit number of choices
Monitor nutrition and weight(MONIOTOR FOR WEIGHT LOSS)
Home Care Guidelines
Safe Environment
◦ Falls
◦ Driving/Cooking
◦ Minimize sensory stimulation
Wandering
◦ Medical Alert Bracelet
◦ Notify police, neighborhood
◦ Complex locks on door
Useful Activities
◦ Exercise that allows exercise of large muscles
◦ When ability to read diminishes, provide children’s books
Function of Cholinestrase
Cholinesterase inhibitors. Because a deficiency of neural acetylcholine has been linked to AD, some medications aim to prevent its breakdown. These drugs function by inhibiting cholinesterase from breaking down acetylcholine into its components of acetate and choline. This allows for an increase in the availability and duration of action of acetylcholine, which leads to temporary improvement of some symptoms of AD.
Medications for Alzheimers Disease
Cholinesterase Inhibitors:increases available acetochyline
◦ Donepezil (Aricept)
◦ Rivastigmine (Exalon)
◦ Galantamine (Razadyne ER)
^THESE DRUGS TREAT THE SYMPTOMS OF ALZHEIMERS
There is no cure
Use of Donepezil
◦ Donepezil (Aricept)
-Modestly improves cognition in mild to moderate dementia of Alzheimer’s
Donepezil is also approved for severe Alzheimer’s disease
Small but short lived improvements
Side effects of Cholinesterase Inhibitors
SE –
-Nausea,
-Vomiting,
-diarrhea,
-insomnia,
-fatigue,
-muscle cramps,
-incontinence,
-bradycardia
and syncope.
-GI UPSET
Risk of Side Effects double in those over age 85
NMDA Receptor Antagonist, effects
Memantine (Namenda)
Regulates glutamate activity by blocking NMDA receptors, thereby decreasing excitatory neurotoxicity
Moderate to severe Alzheimer’s disease
SE – Dizziness, agitation, headache, constipation, and confusion
Goal for Patients with Alzheimers
Integrative Therapy and Evaluation
*Aromatherapy
*Calming interventions
*Overall goal is to promote the person’s optimal level of functioning and to delay further regression
*Outcome criteria – individualized, measurable and within the individual’s capabilities
