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Unit 3A - Cognitive Disorders
Test 1
60
Nursing
Undergraduate 3
06/06/2014

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Cards

Term
What is cognition?
Definition
process that is intellectual and perceptual and closely integrated with an individual’s emotional and spiritual values
Term
What are cognitive disorders as defined by DSM?
Definition
Delirium
Dementia
Amnestic disorder
Cognitive disorder not otherwise specified (NOS)
Term
Who is delirium most prevalent in?
Definition
nursing home residents age 75 or older
80% of people with a terminal illness develop delirium near death
Term
Delerium always exists ______ to another medical condition or substance abuse
Definition
secondary
Term
Amnestic disorders are always secondary to _________ _______.
Definition
An underlying cause
Term
What is the 4th leading cause of death in the US?
Definition
Alzheimer’s disease (most common dementia)
Term
80% of dementia is _______ and ________.
Definition
Irreversible and primary
Term
What are reversible demetias usually attributed to?
Definition
to other pathological processes (neoplasms, trauma, infections, and toxins)
Term
What is the most important risk factor associated w/ alzheimers?
Definition
AGE
Term
WHich AD is inherited?
Definition
Early onset
Term
What is the chromosome identified that creates a poE?
Definition
a form of a gene on chromosome 19
Term
What is a poE?
Definition
carries cholesterol in the blood and may be involved in neuronal repair
Term
Is AD effected by ethnicity?
Definition
no
Term
Who does delirium occur most often in?
Definition
Older adults
Term
What causes delirium?
Definition
surgery, drugs, urinary tract infections, pneumonia, cerebrovascular disease, and congestive heart failure
Term
What is the essential feature of delirium?
Definition
disturbed consciousness coupled with cognitive difficulties
+Thinking, memory, attention, and perception
+Sundown syndrome (increased confusion in evening hours) common
Term
What are the common symptoms of delirium?
Definition
Abrupt disruption in perception of environment
Disturbance in consciousness (awareness of time, place, and person)
Cognitive and perceptual disturbances
Illusions (false perception of real stimuli)
Hallucinations (primarily visual and tactile)
Autonomic hyperactivity (increased vital signs)
Hypervigilance (constantly alert and scanning room)
Labile mood swings
Agitation and anger
Term
What are the goals of assessment when dealing with delirium?
Definition
Determine fluctuating LOC
Interview family to determine patient’s normal LOC and cognition
Review medical findings/diagnostic data to help determine underlying conditions
Term
What are common nursing diagnoses associated w/ delirium?
Definition
Risk for injury, Disturbed sleep pattern, Acute confusion, Self-care deficits (specify), Disturbed sensory perception
Term
What is the primary outcome for delirium?
Definition
patient will return to premorbid level of functioning
Term
What are nursing interventions directed towards?
Definition
maintaining patient safety; communicating in simple, concrete phrases; using reality orientation aids (clocks, calendars); maintaining same staff if possible; and encouraging family to be supportive
Term
What is important to note when communicating with delirium patients?
Definition
Keep distractions to minimum when communicating with patient
Always identify self
Speak slowly, with short, simple words/phrases
Focus on one piece of information at a time
Talk with patient about familiar and meaningful things in life
Reinforce reality when patient is delusional or having illusions
Have patient wear any eyeglasses/hearing aids
Use reality orientation tools: clocks, calendars, well-lit room, family pictures
Term
What are long-term goals for delirium?
Definition
Patient will remain safe
Patient will be oriented to time, place, and person
Underlying cause will be identified and treated
Term
What are short-term goals for delirium?
Definition
Are vital signs stable?
Have patient’s skin turgor and urine specific gravity remained normal?
Term
What is dementia?
Definition
Progressive deterioration in intellectual functioning, memory, ability to problem solve/learn new skills, decline in ability to perform activities of daily living and impaired judgment
Term
What is most common type of dementia?
Definition
Alzheimer's
Term
What are common symptoms of dementia?
Definition
Defensive behaviors in early dementia
-Denial
-Confabulation
-Perseveration
-Avoidance of ?
Term
What is confabulation?
Definition
making up of stories to preserve self-esteem when person doesn’t remember
Term
What is perseveration?
Definition
repetition of phrases (often occurs under stress)
Term
What is the pathophysiology of AD?
Definition
Changes are greatly accelerated in AD
Decrease in weight of brain, occupies less space
Widening of the cerebral sulci
Narrowing of the gyri
Enlargement of ventricles
Term
What are the main areas of the brain affected by AD?
Definition
Frontal Lobes
Temporal lobes
Hippocampus
Term
When does brain damage occur in AD?
Definition
begins long before symptoms appear
Term
What causes brain atrophy?
Definition
Buildup of beta amyloid protein, resulting in neuritic plaques (degenerated neurons)
Term
What happens to deteriorate the hippocampus?
Definition
Neurofibrillary tangles (damaged remains of microtubules allowing nutrients to flow through neurons) forming in hippocampus
Term
What causes granulovascular degeneration?
Definition
(filling of brain cells with fluid and granular material)
Term
What are the cardinal symptoms of dementia?
Definition
Amnesia: memory loss
Aphasia: loss of language ability
Apraxia: loss of purposeful movement in absence of sensory/motor impairment
Agnosia: loss of sensory ability to recognize objects
Disturbances in executive functioning
Planning, organizing, abstract thinking
Term
What happens first, short term or long term memory loss?
Definition
Short term
Term
What is the first stage of AD characterized by?
Definition
Characterized by short-term memory loss
Term
What is the second stage of AD characteristzed by?
Definition
Progressive memory loss, declines in instrumental activities of daily living, social withdrawal
Read Vignette p. 348
Term
What is the third stage of AD characterized by?
Definition
Loss of ADL (dressing/grooming), difficulty communicating, institutional care usually needed
Term
What is the fourth stage of AD characterized by?
Definition
Family recognition disappears; forgets how to eat, swallow, chew; mobility problems, institutional care needed
Term
How can alzheimer's be diagnosed?
Definition
No definitive test for AD

Important to rule out other causation like Depression, neurological, medical problems, effect of medications, nutritional deficits, fluid and electrolyte imbalances
Term
What tests are used when AD is suspected?
Definition
Studies such as PET, SPECT, and MRI can diagnose cerebral atrophy
Mental status questionnaires (Mini-Mental Status Exam) increase early detection , or Saint Louis University Mental Status Exam (SLUMS)
Term
What are the concepts on the mini mental exam?
Definition
Orientation
Registration
Attention
Calculation
Recall
Speech and language, including reading
Score 0-30 (lower score= increase severity AD)
Term
What are the general assessment guidelines for dementia?
Definition
-Rule out other possible causes
-Determine potential for self-other harm
-Explore family knowledge of disease
-Rvw meds
-Determine current cognitive fxn
-Determine safety measures necessary
Term
What are common nursing diagnoses r/t dementia?
Definition
Risk for injury, Impaired verbal communication, Impaired environmental interpretation syndrome, Impaired memory, Chronic confusion, Compromised or disabled family coping
Term
What are the outcomes associated w/ dementia?
Definition
directed toward symptoms manifested, with safety outcomes always priority

-Communication needs, caregiver role strain, impaired environmental interpretation, self-care needs
Term
Who is care directed towards?
Definition
patient’s and caregiver’s immediate needs
like:
Transportation services, supervision/care when primary caregiver not at home, referrals to day care centers, information on support groups
Term
What resources are available for dementia?
Definition
www.nunstudy.org
www.alzheimer.ca
www.cms.gov
www.nia.nih.gov/Alzheimers/caregiving
www.aoa.gov
www.medicare.gov
www.longtermcare.gov
www.alz.org
Term
What are the communication guidelines for demented patients?
Definition
1. Always identify self and call patient by name
2. Speak slow
3. One piece of info at a time
4. Talk about meaningful and familiar things
5. reinforce reality if it does not cause undue anxiety
6. Intervene in arguments between patients
7. Use reality orientation aids: clocks, calendars, family pictures, signs
Term
What safety measurements should be taken?
Definition
Restrict use of car, remove throw rugs, minimize sensory stimulation; if patient becomes upset—listen and then change subject, label all rooms and drawers, install safety bars in bathroom
Term
What interventions help with wandering?
Definition
Put mattress on floor, have patient wear MedicAlert bracelet, alert local police/neighbors, put complex locks on doors
Term
What interventions are useful activities for the pt?
Definition
Provide picture books; simple activities using large muscle groups; encourage group activities familiar to patient
Term
How do cholinesterase inhibitors treat dementia?
Definition
increase available acetylcholine (thought to enhance memory)

EX:galantamine (Reminyl), rivastigmine (Exelon), donepezil (Aricept
Term
How do N-methyl-D-aspartate treat dementia?
Definition
antagonist at NMDA-glutamatergic ion channels, making more acetylcholine available

EX: memantine (Namenda)
Term
Why are mediations for behavioral symptoms used with caution?
Definition
Age affects metabolism, absorption, and elimination of drugs
Older adults more sensitive to medications and side effects
Principle: start low and go slow
Term
What medications are used to treat depression w/ dementia?
Definition
SSRIs: for coexisting depression
Term
What medications are used to treat hallucinations, delusions, agitation, combativeness?
Definition
Atypical antipsychotics
Term
What are the s/s of parkinson's disease?
Definition
Difficulty starting or stopping voluntary movements
Tense muscles
Problems with posture
Slow, shuffling walk
Tremors (shaking)
Term
Psychopathology of parkinson's
Definition
Parkinson’s disease is primarily associated with the gradual loss of cells in the substantia nigra of the brain. This area is responsible for the production of dopamine. Dopamine is a chemical messenger that transmits signals between two regions of the brain to coordinate activity. For example, it connects the substantia nigra and the corpus striatum to regulate muscle activity.
If there is deficiency of dopamine in the striatum the nerve cells in this region “fire” out of control. This leaves the individual unable to direct or control movements. This leads to the initial symptoms of Parkinson’s disease. As the disease progresses, other areas of the brain and nervous system degenerate as well causing a more profound movement disorder.
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