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Secondary Final: CI Screening
N/A
32
Nursing
Graduate
03/09/2012

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Cards

Term
cognitive impairment
Definition
dysfunction in any one or several of the areas previously identified that interferes with daily life
Term
causes of cognitive impairment
Definition
stress, depression, substance use/abuse, physiological causes (50+), delirium, MCI, dementia
Term
prevalence in US of MCI
Definition
11-17%
Term
annual conversion rate to dementia
Definition
highly variable: 4-25%
Term
dementia defn
Definition
a syndrome of progressively worsening cognitive function, beginning with disorientation and emory loss, through loss of executive functioning, gross personality changes and ending with complete inability to care for self; AD is most common dementia
Term
AD is what percentage of all dementias
Definition
about 65%; 4.9 million Americans have AD
Term
percentage of vascular dementia
Definition
about 15%
Term
prevalence of dementia in persons >65 in US
Definition
6-8%. Increases to almost 50% in persons >85
Term
why do nurses need to know about CI?
Definition
patient education, ability of patient to care for him/herself at home, medication management, assist with procedures in the hospital, safety
Term
screens for CI
Definition
mini mental state examination, sweet 16, clock drawing test, mini-cog, MOCA
Term
Elements of Cognition
Definition
1. orientation to person, place, time 2. registration (ability to name objects) 3. attention/concentration 4. recall (form of memory) 5. language 6. executive function
Term
Limitations of CI screening
Definition
does not provide a diagnosis--only probability of CI, affected by culture, affected by education
Term
how many adverse events in hospitals are medication-related?
Definition
1 in 3; more than half are preventable
Term
how many older persons experience ADEs
Definition
35%; 50% judged preventable
Term
How many >65 taking meds; more than 5
Definition
79%; 39% taking >5 medications
Term
common drug-drug interactions
Definition
warfarin, digoxin, ACE inhibitors, phenytoin
Term
common OTC interactions
Definition
CV systemic effects, effect digoxin levels, adverse interactions with Warfarin
Term
What is a PIM
Definition
Potentially Inappropriate Medication
Term
What are risk factors for ADR
Definition
dementia, multiple cormorbidities, renal insufficiency, recent hospitalization, >85 years, multiple prescribers, regular use of alcohol, prior ADR
Term
risky med classes for ADRs
Definition
anticholinergics, benzodiapezepiens, antipsychotics, sedatives, NON-ASA, non COX2 NSAIDS, TCAs, opiods, corticosteroids, Warfarin
Term
ADE
Definition
adverse drug event: injury occurring during drug therapy resulting from appropriate or suboptimal care. Includes adverse drug rx during normal use or as a result of an error
Term
ADR
Definition
adverse drug reaction: noxious or unintended effect of a drug that occurs at a normal therapeautic dose
Term
Beers
Definition
Beers criteria for PIM use in older adults; considered best practice for care of older adults, 2 parts
Term
Interventions 1
Definition
1. patient education & empowerment 2. comprehensive med history on admission 3. interdisciplinary collaboration: if something doesn't seem right--ASK physician, pharmacist
Term
Interventions: Understand prescribing principles
Definition
1. start low and go slow, less is more 2. discontinue unnecesary meds 3. try nonpharm interventions 4. recommend safer drugs 5. optimize drug regimen 6. avoid the prescribing cascade 7. avoid inappropriate meds
Term
Preventive interventions
Definition
1. consider new sx as possible ADR before giving new med 2. watch out for wrong drug choices (Beers) 3. document therapeutic and AE of meds consistently 4. contribute to a culture of safety that allows for exploration of all ADRs
Term
Discharge Interventions
Definition
1. reconciliation: consider adapting dosing times realistically for persons living at home 2. adherence issues 3. paatient and caregiver education: who will be giving meds?
Term
Mentes No-no's
Definition
1. demerol 2. amitriptyline (Elavil) 3. antipsychotics w/ persons with dementia 4. benzodiazepines
Term
delirium
Definition
temporary state, cannot maintain attn, can be d/t systemic issue, such as a UTI
Term
average ambulatory patient on how many meds?

average institutionalized patient on how many?
Definition
4.5

7
Term
how many older adults take OTC meds?
Definition
90%

older adults consume more than 1/3 of all prescription drugs, 40% of all OTC meds
Term
what percentage of older adults experience ADEs? how many preventable?

prevalence of ADR-related hospitalizations
Definition
35%, 50% preventable


5-35%
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