Shared Flashcard Set

Details

Elderly Clients Whose Mental Health is Affected
unit 7
39
Nursing
Undergraduate 2
03/26/2011

Additional Nursing Flashcards

 


 

Cards

Term

 

 

General

info

about

ELDERLY Clients

Definition

MI more prevelant

 

Psychosis increases >65yrs old

more frequent suicide

 

Dementia is the 4th leading cause of death

 

15% have chronic physical probs. that can result in neg. psychological responses

Term

 

 

 

AGEISM

Definition

Bias vs. older people b/c of their age

Dislike for elderly

Dicrimination

stereotypes

facts & myths

Results of ageism

Term

 

ISSUES AFFECTING

the

MENTAL HEALTH

of

ELDERLY CLINETS

Definition

chemical & physical restraints

death & dying

AIDS

suicide (elderly white males)

alcoholism

Term

 

 

 

COGNITIVE DISORDERS

Definition

Cognition:

The act, process, or result of knowing, learning, or understanding.

 

Cognitive Disorders:

Psychiatric disorders that are manifested in deficits in memory, perceptions, & prob.solving.

Term

 

 

Categories

of

COGNITIVE DISORDERS

Definition

Delirium

 

Dementia

 

Amnestic Disorder

 

Mental disorders due to general medical conditions

 

Substance related disorders

Term

 

 

 

DELIRIUM

Definition

Disturbances in consciousness

Change in cognition

Develops over a short period of time= hrs to days

Common in hospitalized pts (esp. elderly)

Always 2* to another physiological condition

Is a transient disorder

IF underlying condition corrected, complete recovery should occur

 

2* physiological EX. infections, meds, post-op, febrile

Term

 

 

 

Risk Factors

for

DELIRIUM

Definition

Advanced age

pre-existing illness

infection

pain

admission to long-term care facility

electrolyte or metabolic imbalances

Term

 

 

 

DELIRIUM

Assessment

Definition

4 CARDINAL FEATURES:

 

1) Acute onset & fluctuating course

 

2) Inattention

 

3) Disorganized thinking

 

4) Disturbance of consciousness

Term

 

 

 

DELIRIUM

Assessment

cont.

Definition

*COGNITIVE & PERCEPTUAL DISTURBANCES:

-illusions

-hallucinations

-atten. deficits

-visual tactile hallucinations cuase anxiety

 

PHYSICAL NEEDS:

SAFETY

simple & clear in comm. w/pt

elevate HOB

eye glasses, hearing aides,clocks, calendars

skin care

potential INC

Obs. for increased HR, B/P, fever

 

MOOD & PHYSICAL BEHAVIORS:

r/t mood @ moment

Labile

confusion

fear

Term

 

 

NSG DX

for

DELIRIUM

Definition

Risk for injury

 

Acute confusion

 

Deficient fluid volume

 

Insomnia, Sleep deprivation

 

Impaired verbal comm.

 

Fear

 

Self-care deficit

 

Disturbed though process

Term

 

 

 

DELIRIUM

Outcome Identification

Definition

Pt will return to premorbid level of functioning

 

Pt will remain safe & free from injury while in hospital

 

Pt will be oriented to time, place, & person (state where they are)

 

Pt will be free from FALLS & injury

 

Pt will be free from hallucinations/decreased in # of admission

Term

 

NSG

Interventions

&

Implementations

w/Delirium

Definition

TX the underlying organic causes

-meds

-tx infection

-tx fever

 

Antipsychotic or anxiety meds

-titrate carefully, dropped too rapidly or titrated too much can cause probs.

 

Frequent supervision

 

Use simple language, direct comm.

reorientation via comm.

night lights

soothing music

use calm matter of fact approach

hearing aides in, glasses on

Term

 

 

NSG Eval.

of

DELIRIUM

Definition

Is the client safe?

 

Is client oriented to time, place, & person

 

Has client's anxiety decreased?

Term

 

 

 

DEMENTIA

Definition

Develops more slowly

Progressive deteroration of cognitive functioning & global impairment of intellect

No change in consciousness

Diff. w/memory, thinking, & comprehension

****majority of DEMENTIAS are irreversible****

Term

 

 

 

DEMENTIA

cont.

Definition

develops more slowly

multiple cognitive deficits

Steady decline

 

REVIEW p. 371

Term

 

 

DEMENTIA:

 

PRIMARY  vs. SECONDDARY

Definition

PRIMARY:

-irreversible

-progressive

-not 2* to any other disease

-EX. Alzheimer's disease:70% of all dementias, Pick's disease

 

SECONDARY:

-result of some other pathological process

-EX. AIDS related dementia, TB, parkinsion's, syphillus, Bvit deficiencies

-can be TX

-can be reversed

Term

 

 

 

ALZHEIMER'S DISEASE

(AD)

Definition

progressive deteroration of cognitive functioning

 

Early onset: <55

Late onset: >65

 

Triggers:

Patho= brain shrinks, surface becomes smoother.

down syndrome

advancing age

increased cholesterol levels

decreased folic acid

heart disease

Term

 

 

NSG

Assessment

of

AD

Definition

Defense behaviors:

 

- Denial

 

- Confabulation= making up stories

 

-Perseveration= intensified r/t stress

 

-Avoiding questions

(not on pupose, or consciously)

Term

 

 

 

CARDINAL SIGNS

of

AD

Definition

*AMNESIA=

short-term memory

 

*APHASIA=

loss of speech & language, loss of right word(s)

 

*APRAXIA=

impaired motor skills

EX. tying shoes-now cannot

 

*AGNOSIA=

loss of recognizing fam. ojects

 

*Disturbances in executive functioning

Term

 

 

 

DX

of

AD

Definition

Other disorders can mimic AD

 

ALSO:

Drug toxicity

Infection

Nutritional deficits

Metabolic diorders

Term

 

 

 

Disease Progression

of

AD

Definition

 

 

8-10 years

 

3-20 years

Term

 

 

STAGES

of

ALZHEIMER'S DISEASE

(1-4)

Definition

STAGE 1) (mild) forgetfulness

 

STAGE 2) (mod) confusion

 

STAGE 3) (mod to severe) unable to identify fam. objects or people

 

STAGE 4) (late) end-stage

- agraphia= can't read or write

- hyperality= everything in mouth

- blunted emotions= end up in stupor

Term

 

 

NSG DX

for

AD

Definition

Risk for injury

 

Impaired verbal comm.

 

Impaired enviro. interpretation syndrome

 

Impaired memory

 

Confusion

 

Caregiver role strain

Term

 

 

 

AD

Outcomes & Identification

Definition

Areas to target:

injury

comm.

agitation level

carefiver role strain

impaired enviro. interpretation: chronic confusion

self-care needs

Term

 

 

 

AD  NSG

Planning

Definition

geared towards person's immediate needs

 

identify level of functioning

 

assess caregiver's  needs

 

plan & identify appropriate community resources

Term

 

 

AD

NSG

Implementation

Definition

counseling & comm. techniques

 

health teaching & health promotion (important legal & finacial)

 

referral to community supports

 

pharmacological interventions

 

speak well= calm & effectively no matter what they are saying

Term

 

 

 

AD

MEDS

Definition

Donepezil(Aricept)

 

Rivastigmine(Exelon)

 

Galantamine(Reminyl)

 

Memantine(Namenda)

Term

AD meds

 

 

Donepezil

(Aricept)

Definition

inhibits breakdown of acetycholine (slow deteroration of mental breakdown)

mild-mod

mod-severe

does not effect liver

 

SE= N/V/D

 

DOSE:

5mg daily (2 yrs) can go up to 10mg

 

Term

AD meds

 

 

Rivastigmine

(Exelon)

Definition

cholinesterase inhibitor

 

DOSE:

multiple daily doses (2 doese), 3-12mg

If dose is tolerated increase @2weeks

Term

AD meds

 

Galantamine

(Reminyl)

Definition

cholinesterase inhibitor

mild-mod

 

DOSE:

2X daily, 8-16mg (extended release X1, if needed)

 

SE= N/V/D, wt loss

 

 

Term

AD meds

 

 

Memantine

(Namenda)

Definition

regulates glutamate; excess glutamate leads to neuron deteroration

 

Delays S/SX= mod-severe

 

DOSE:

5mg daily, increase dose weekly up to 20mg

 

SE= dizziness, confusion, constipation

Term

 

AD meds

are

used

to

TX

other behavioral symptoms

Definition

psychotic symptoms

 

severe mood swings

 

anxiety

 

verbal & physical aggression

 

behavioral s/sx

Term

 

 

 

AMNESIC DISORDER

Definition

Loss of short-term & long-term memory sufficient to cause some impairment in functioning

 

ALWAYS 2* to some other cause

 

Disorientation

 

Confabulation

Term

 

 

Primary

causes

of

AMNESIA

Definition

head trauma

 

tumor

 

stroke

 

cardiovascular disease

 

substance abuse

 

toxin exposure= lead, mercury, carbon monoxide, insecticides.

Term

 

 

 

TX of

AMNESIA

Definition

Remove underlying cause

EX. tx lead toxicity

 

Rehab=

to prevent any further probs.

 

can still have some memory impairment, if TX can be prevented.

Supporting users have an ad free experience!