Term
| Three D's of cognitive impairment |
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Definition
| Dementia, delirium, depression. |
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Term
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Definition
An acutely disturbed state of mind that occurs in fever, intoxication, and other disorders and is characterized by restlessness, illusions, and incoherence of thought and speech.
It is a medical emergency. |
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Term
| At what point in the day should a cognitive assessment NOT be conducted on a senior patient? |
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Definition
| Cognitive assessments should not be conducted immediately upon awakening from sleep, or immediately before and after meals or medical diagnostic and therapeutic procedures. |
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Term
| What are the four delirium prevention "cornerstones?" |
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Definition
Identification of high-risk patients
Identification of risk factors
Prompt and appropriate assessments
Continued sureillance |
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Term
| Most predictive risk factors for delirium |
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Definition
Immobility
Functional deficits
use of restraints or catheters
Medications
Acute illness/Infections
Alcohol or drug abuse
Malnutrition/dehydration |
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Term
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Definition
Quiet or pleasantly confused
Reduced activity
Lack of facial expression |
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Term
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Definition
Excessive alertness
Hallucinations, delusions
Aggressive behavior
Increased psychomotor activity |
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Term
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Definition
| Unpredictable fluctuations between hypoactive and hyperactive delirium. |
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Term
| Precipitating factors for delirium |
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Definition
A total number of medications >6
Infection
Hypoxemia
Dehydration
Electrolyte imbalances |
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Term
| Three tools used to assess patients for delirium |
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Definition
| MMSE-2, Confusion Assessment Method (CAM), and NEECHAM confusion scale |
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Term
| How often is reassessment done upon identifying that a patient is delirious? |
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Definition
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Term
| What is the HELP program? |
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Definition
Hospital Elder Life Program. Focuses on managing six risk factors for delirium: Cognitive impairment
sleep deprivation
immobility
visual impairments
hearing impairments
dehydration |
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Term
| When are pharmacological interventions necessary in treatment of delirious patients? |
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Definition
| When patients are in danger of harming themselves or others, or if nonpharmacological interventions are not effective. |
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Term
| What is the most common form of dementia? |
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Definition
Alzheimer's disease (50-70% of all dementias)
Is also the sixth leading cause of death in the US |
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Term
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Definition
| a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning. |
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Term
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Definition
Early-onset dementia
Late-onset dementa |
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Term
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Definition
Rare form of AD (5% of all AD cases)
Develops between 30 and 60
Results from gene mutation on chromosomes 21, 14, and 1
Offspring in the same generation have a 50/50 chance of developing early-onset dementia in one of the parents has it. |
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Term
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Definition
Accounts for most cases (95%)
Is not genetically inherited |
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Term
| Protective factors against Alzheimer's disease |
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Definition
Higher education
Regular exercise
Healthy diet
Intellectually challenging leisure activity
Active socially integrated lifestyle |
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Term
| Risk factors for Alzheimer's disease |
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Definition
Age >60
Female
Family history
Depression
High fat and cholesterol diet
Smoking
Diabetes mellitus
Hypertension
Head trauma
Obesity |
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Term
| Three stages of Alzheimer's disease |
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Definition
Preclinical
Mild cognitive impairment (MCI)
Alzheimer's dementia |
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Term
| Stage 1: Preclinical Alzheimer's |
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Definition
Patient has measurable changes in the brain, cerebrospinal fluid, blood markers
Has not yet developed symptoms (e.g. memory loss) |
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Term
| Stage 2: Mild Cognitive Impairment Alzheimer's |
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Definition
Memory problems are enough to be noticed and measured but do not compromise the patients function.
There is evidence of change in cognition.
May or may not progress to AD. |
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Term
| Stage 3: Alzheimer's dementia |
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Definition
Memory loss
Word finding difficulty
vision/spatial issues
Impaired reasoning/judgement |
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Term
| Which race has the highest and second highest occurrence of AD? |
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Definition
African American (2 times as likely as white)
Hispanic (1.5 times as likely as white)
Possible due to a higher incidence of hypertension and diabetes in these populations. |
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Term
| Active management of AD includes 5 categories. What are they? |
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Definition
1) Appropriate use of available treatment options
2) Effective management of coexisting conditions
3) Coordination of care among medical providers
4) Participation in activities and adult day programs
5) Taking part in support groups |
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Term
| How often is assessment/reassessment done on a AD patient? |
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Definition
| Every six months after diagnosis or every time there is a change in behavior or increase in the rate of decline. |
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Term
| What seven items does the assessment of a AD patient include? |
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Definition
Daily functioning
Cognitive status
Comorbidities
Behavioral symptoms
Medications
Living arrangements
Safety |
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Term
| What is the first line drug therapy for mild to moderate AD, as well as MCI and vascular dementia, and what are the three drugs? |
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Definition
Cholinesterase inhibitor therapy
Currently available CIs are Donepezil, Galantamine, and Rivastigmine. |
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Term
| Most common side effects with cholinesterase inhibitors and how are they discontinued? |
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Definition
Nausea and diarrhea
Slowly to prevent rapid decompensation |
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Term
| What is the goal of medication therapy related to AD? |
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Definition
| Therapy is directed towards the symptoms and intended to slow, not reverse, cognitive decline. |
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Term
| What are the general nursing interventions in care of Patients with dementia? |
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Definition
-Safety
-Maximizing remaining abilities
-Monitoring impact of dementia on other medical conditions
-Support advance care planning and advanced directives
-Education of caregivers on problem solving, resources access, emotional support, respite, long range planning. |
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Term
| Define reality orientation |
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Definition
| Orienting the person to the day, date, time year, weather, upcoming holidays. |
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Term
| Four strategies used in communication with cognitively impaired patients |
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Definition
Simplification strategies
-Give one-step directions
-speak slowly
Facilitation strategies
-Speak as if to an equal
-Share self
Comprehension strategies
-Identify time confusion
-Find the theme
Supportive strategies
-Introduce self, explain why you're there
-Sit closely, face person at eye level
-limit corrections |
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Term
| Define validation therapy |
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Definition
| Following the persons lead and responding to feelings expressed rather than interrupting to supply factual data. |
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Term
| What are the Behavior and Psychological Symptoms of Dementia (BPSD) |
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Definition
Symptoms of disturbed perception, thought content, mood, and behavior.
E.G. anxiety, depression, hallucinations, delusions, aggression, screaming, restlessness, agitation, resistance to care.
Often precipitate institutionalization. |
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Term
| What is the Progressively Lowered Stress Threshold Model (PLST) and the five stressors that can trigger symptoms? |
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Definition
Symptoms such as agitation are a result of a progressive loss of the person's ability to cope with demands and stimuli when the person's stress threshold is exceeded.
Fatigue, Change of environment, inappropriate stimulus level, demands to perform beyond abilities, physical stressors (e.g. pain). |
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Term
| What is the Need Driven Dementia-compromised Behavior Model (NDDB) |
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Definition
| Behavior carries a message of need that can be addressed appropriately if the person's history, habits, physiological status, and physical and social environment are carefully evaluated. Rather than behavior being viewed as disruptive, it is viewed as having meaning and expressing needs. |
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Term
| When are pharmacological interventions appropriate to consider for demented patients? |
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Definition
When there has been a comprehensive assessment of reversible causes of behavior
the person presents a danger to self or others
nonpharmacological interventions have not been effective
risk/benefit profiles of the meds have been considered. |
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