Term
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Definition
| process that is intellectual and perceptual and closely integrated with an individual’s emotional and spiritual values |
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Term
| What are cognitive disorders as defined by DSM? |
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Definition
Delirium
Dementia
Amnestic disorder
Cognitive disorder not otherwise specified (NOS) |
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Term
| Who is delirium most prevalent in? |
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Definition
nursing home residents age 75 or older
80% of people with a terminal illness develop delirium near death |
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Term
| Delerium always exists ______ to another medical condition or substance abuse |
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Definition
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Term
| Amnestic disorders are always secondary to _________ _______. |
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Definition
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Term
| What is the 4th leading cause of death in the US? |
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Definition
| Alzheimer’s disease (most common dementia) |
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Term
| 80% of dementia is _______ and ________. |
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Definition
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Term
| What are reversible demetias usually attributed to? |
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Definition
| to other pathological processes (neoplasms, trauma, infections, and toxins) |
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Term
| What is the most important risk factor associated w/ alzheimers? |
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Definition
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Term
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Definition
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Term
| What is the chromosome identified that creates a poE? |
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Definition
| a form of a gene on chromosome 19 |
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Term
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Definition
| carries cholesterol in the blood and may be involved in neuronal repair |
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Term
| Is AD effected by ethnicity? |
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Definition
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Term
| Who does delirium occur most often in? |
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Definition
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Term
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Definition
| surgery, drugs, urinary tract infections, pneumonia, cerebrovascular disease, and congestive heart failure |
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Term
| What is the essential feature of delirium? |
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Definition
disturbed consciousness coupled with cognitive difficulties
+Thinking, memory, attention, and perception
+Sundown syndrome (increased confusion in evening hours) common |
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Term
| What are the common symptoms of delirium? |
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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 |
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Term
| What are the goals of assessment when dealing with delirium? |
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Definition
Determine fluctuating LOC
Interview family to determine patient’s normal LOC and cognition
Review medical findings/diagnostic data to help determine underlying conditions |
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Term
| What are common nursing diagnoses associated w/ delirium? |
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Definition
| Risk for injury, Disturbed sleep pattern, Acute confusion, Self-care deficits (specify), Disturbed sensory perception |
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Term
| What is the primary outcome for delirium? |
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Definition
| patient will return to premorbid level of functioning |
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Term
| What are nursing interventions directed towards? |
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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 |
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Term
| What is important to note when communicating with delirium patients? |
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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 |
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Term
| What are long-term goals for delirium? |
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Definition
Patient will remain safe
Patient will be oriented to time, place, and person
Underlying cause will be identified and treated |
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Term
| What are short-term goals for delirium? |
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Definition
Are vital signs stable?
Have patient’s skin turgor and urine specific gravity remained normal? |
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Term
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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 |
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Term
| What is most common type of dementia? |
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Definition
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Term
| What are common symptoms of dementia? |
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Definition
Defensive behaviors in early dementia
-Denial
-Confabulation
-Perseveration
-Avoidance of ? |
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Term
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Definition
| making up of stories to preserve self-esteem when person doesn’t remember |
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Term
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Definition
| repetition of phrases (often occurs under stress) |
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Term
| What is the pathophysiology of AD? |
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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 |
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Term
| What are the main areas of the brain affected by AD? |
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Definition
Frontal Lobes
Temporal lobes
Hippocampus |
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Term
| When does brain damage occur in AD? |
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Definition
| begins long before symptoms appear |
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Term
| What causes brain atrophy? |
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Definition
| Buildup of beta amyloid protein, resulting in neuritic plaques (degenerated neurons) |
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Term
| What happens to deteriorate the hippocampus? |
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Definition
| Neurofibrillary tangles (damaged remains of microtubules allowing nutrients to flow through neurons) forming in hippocampus |
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Term
| What causes granulovascular degeneration? |
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Definition
| (filling of brain cells with fluid and granular material) |
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Term
| What are the cardinal symptoms of dementia? |
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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 |
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Term
| What happens first, short term or long term memory loss? |
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Definition
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Term
| What is the first stage of AD characterized by? |
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Definition
| Characterized by short-term memory loss |
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Term
| What is the second stage of AD characteristzed by? |
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Definition
Progressive memory loss, declines in instrumental activities of daily living, social withdrawal
Read Vignette p. 348 |
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Term
| What is the third stage of AD characterized by? |
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Definition
| Loss of ADL (dressing/grooming), difficulty communicating, institutional care usually needed |
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Term
| What is the fourth stage of AD characterized by? |
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Definition
| Family recognition disappears; forgets how to eat, swallow, chew; mobility problems, institutional care needed |
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Term
| How can alzheimer's be diagnosed? |
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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 |
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Term
| What tests are used when AD is suspected? |
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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) |
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Term
| What are the concepts on the mini mental exam? |
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Definition
Orientation
Registration
Attention
Calculation
Recall
Speech and language, including reading
Score 0-30 (lower score= increase severity AD) |
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Term
| What are the general assessment guidelines for dementia? |
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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 |
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Term
| What are common nursing diagnoses r/t dementia? |
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Definition
| Risk for injury, Impaired verbal communication, Impaired environmental interpretation syndrome, Impaired memory, Chronic confusion, Compromised or disabled family coping |
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Term
| What are the outcomes associated w/ dementia? |
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Definition
directed toward symptoms manifested, with safety outcomes always priority
-Communication needs, caregiver role strain, impaired environmental interpretation, self-care needs |
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Term
| Who is care directed towards? |
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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 |
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Term
| What resources are available for dementia? |
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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 |
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Term
| What are the communication guidelines for demented patients? |
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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 |
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Term
| What safety measurements should be taken? |
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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 |
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Term
| What interventions help with wandering? |
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Definition
| Put mattress on floor, have patient wear MedicAlert bracelet, alert local police/neighbors, put complex locks on doors |
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Term
| What interventions are useful activities for the pt? |
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Definition
| Provide picture books; simple activities using large muscle groups; encourage group activities familiar to patient |
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Term
| How do cholinesterase inhibitors treat dementia? |
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Definition
increase available acetylcholine (thought to enhance memory)
EX:galantamine (Reminyl), rivastigmine (Exelon), donepezil (Aricept |
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Term
| How do N-methyl-D-aspartate treat dementia? |
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Definition
antagonist at NMDA-glutamatergic ion channels, making more acetylcholine available
EX: memantine (Namenda) |
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Term
| Why are mediations for behavioral symptoms used with caution? |
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Definition
Age affects metabolism, absorption, and elimination of drugs
Older adults more sensitive to medications and side effects
Principle: start low and go slow |
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Term
| What medications are used to treat depression w/ dementia? |
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Definition
| SSRIs: for coexisting depression |
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Term
| What medications are used to treat hallucinations, delusions, agitation, combativeness? |
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Definition
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Term
| What are the s/s of parkinson's disease? |
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Definition
Difficulty starting or stopping voluntary movements
Tense muscles
Problems with posture
Slow, shuffling walk
Tremors (shaking) |
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Term
| Psychopathology of parkinson's |
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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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