Week 6: Dementia Flashcards
What is the pathophysiology behind Alzheimer’s disease?
accounts for 60-80% of dementia cases. Beta amyloid deposition and neurofibrillary tangles lead to loss of synapses and neurons resulting in gross atrophy of areas of the brain. Can also be genetic (familial alzheimer’s disease) affecting people as young as 30
What is vascular dementia?
Dementia Caused by microscopic bleeding and blood vessel blockage causing atrophy of brain tissue
What is frontotemporal dementia?
dementias predominantly affecting behaviour, personality and language. Can cause emotional blunting, promiscuity, progressive aphasia, obsessions, etc. Can also be genetically inherited (familial frontotemporal dementia)
What instrumental activites of daily living are critical to review in an individual with cognitive decline?
-Are they able to safely drive?
-Can they handle finances
What is Lewy body dementia?
closely related to parkinson’s disease predominantly affecting movement and may include visual hallucinations
What is posterior cortical atrophy?
mainly affects visual and spatial perception causes vision loss due to brain’s inability to process input, causes holes in vision
What teaching should be provided with administration of cholinesterase inhibitors (Donezepil)? Select all that apply.
A) Take this drug in the morning
B)Swallow the tab let whole, take a glass of water
C) Notify MP if trouble urinating or muscle weakness
D) You may have nausea, taking with food may help
E) Keep the tablet in a blister pack until you are ready to take the medicine
A, C, D, E
-Take in the morning to avoid nightmares
-Medication has a risk for hypokalemia (causes oliguria and muscle weakness)
What cognitive skills may decline in an older adult?
Verbal fluency
Logistical analysis/Fluid intelligence
Selective attention
Object naming
Complex visuospatial skills
For each behavior listed, specify whether it is associated withdelirium (DL) or dementia (DM).
a. Gradual and insidious onset
b. Hallucinations or delusions
c. A sudden, acute onset of symptoms
d. Progressive functional impairment
e. Personality changes with emotional lability
f. Incoherent interactions with others
g. Possible wandering behavior
h. Lucid at times, but often worsens at night
Delirium: B,C,F,H
Dementia: A,D,E,G
What are the main symptoms in primary progressive aphasia?
predominately affects language skills
Which tests can be used to help diagnose dementia?
MRI (rule out head trauma, visualize structural changes), vision and hearing eval, urinalysis (rule out UTI), Electroencephalogram, CBC
What is the role of Donezepil in Alzheimer’s management?
-Can compensate for the loss of cholinergic brain cells, improving symptoms and slowing deterioration of cognition in short to medium term, but cognitive decline will continue at increased rate in long term.
What do you need to teach about donepezil? Select all that apply.
a) “The best time to take donepezil is in the morning.”
b) “Swallow each tablet whole. Drink a glass of water afterward.”
c) “Notify the provider if you have trouble urinating or muscle weakness.”
d) “You may have some nausea. Taking the medication with food may help.”
e) “Keep the tablet in the blister pack until you are ready to take the medicine.”
Correct answers are: a, c, d, eThe tablet should not be swallowed whole but allowed to dissolve on the tongue. After itdissolves completely, the patient should drink a glass of water. Taking donepezil in the morninglessens the common side effect of insomnia
What are some teachings the nurse may provide to family members of someone diagnosed with Dementia?
-Do not allow him to go out alone. Place locks on the doors and install a door alarm device that would provide warning if he opens the door.
* Register with a safe return program and obtain a wearable tracking device for them to help with locating him if he wanders.
* Obtain a medical alert bracelet that has his name, address, and telephone number.
* Alert neighbours about wandering tendencies.
* He must stop driving.
* Do not allow him to do potentially dangerous activities, such as cooking, alone. Placelocks on the stove dials.
* Ensure that the home has good lighting, install handrails in stairways and bathroom,and remove area rugs
Why should future planning for advance directives and financial concerns be discussed at the time of diagnosis for someone with dementia?
People diagnosed with AD need to examine and update their financial and health carearrangements as soon as possible. Advanced planning can help them clarify their wishesand make informed decisions about health care and financial arrangements while they stillhave the capability to understand the aspects and consequences of legal decision making
