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NURS2518 : The Older Client > Week 5 : Cognition > Flashcards

Week 5 : Cognition Flashcards

1
Q

Nursing Process:
What are the 6 functions of clinical judgement?

A
  1. Recognize Cues
  2. Analyze Cues
  3. Prioritize Hypotheses
  4. Generate Solutions
  5. Take Actions
  6. Evaluate Outcomes
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2
Q

What does AAPIE stands for ?

A

Assessment
Analyze
Planning
Implementation
Evaluation

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3
Q

Definition of Cognition in the textbook

A

the mental action or the process of acquiring knowledge and understanding through thought, experience, and the senses.

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4
Q

Continuum of Cognitive Functions : name examples that falls under the categories

Cognitive Impairment

Basic Cognitive Functioning

Higher order cognitive functioning

A

Basic = perception
patterns
recognition
attention

High= learning
comprehension
insight
problem solving
reasoning

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5
Q

What does an intact cognition means ?

A

that the individual exhibits cognitive behaviours within the normal range for age and culture

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6
Q

true or false. Level of cognition can change over time and if cognitive impairment is present, the degree of impairment can only be severe

A

false. it can be mild to severe

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7
Q

In an individual with impaired cognition there may be deficiencies in any of the domains of cognitive function: name the 6 domains

A

1) perceptual motor function
2)language
3) learning and memory
4) social cognition
5) complex attention
6) executive function

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8
Q

Cognition : Age related factors

Define if the statement is true :
Older adults experience physiological changes such as decrease in the size of the brain, number of neurons, and neurotransmitter efficiency

However, such physiological changes are not necessarily associated with loss of cognitive function

A

true

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9
Q

true or false. cognitive impairment or intellectual loss is a part of the aging process. Though this can be indicative of disease process.

A

False! it is not part of the aging process but it is right that it is an indicative of disease process

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10
Q

5 types of memories are what?

A

declarative episodic memory
declarative semantic memory
immediate working memory
working memory
procedural memory

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11
Q

Cognitive Function : Memories ( where are the anatomic location)
declarative episodic memory
declarative semantic memory
immediate working memory
working memory
procedural memory

A

hippocampus
medial thalamus
temporoparietal association cortices
primary auditory or visual cortex
lateral frontal cortex
basal ganglia, association neocortices

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12
Q

* Must know* ( on the midterm )

What are 7 types of dementia

A

1) Alzheimer’s disease ( AD)
2) Vascular dementia
3) Mixed dementia
4) Parkinson’s disease dementia
5) Dementia with Lewy bodies
6) Dementia due to Cretzfeldt-Jacob disease
7) Frontotemporal dementia

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13
Q

this is the most common type of dementia ( accounting for 70-80% of cases)

A

Alzhemier’s disease

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14
Q

Describe if the statement below is correct, if not why is it not correct? :

Alzhemeir’s disease abnormalities are deposits of lewy bodies and twisted strands of the protein tau which forms inside the nerve cells of the brain

A

false.

This is a false statement. abnormalities are deposits of the protein fragment beta amyloid ( plaques) and twisted strands of the protein tau ( tangles)

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15
Q

Name early symptoms of Alzhemier’s disease

A

difficulty remembering names, and recent events, difficulty expressing oneself with words, spatial depression.
Language disturbance may also be presenting symptom

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16
Q

What are the late symptoms of Alzheimer’s disease

A

impaired judgement, disorientation, behaviour changes, difficulty speaking, swallowing and walking

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17
Q

What is the second most common type of dementia ?

A

vascular dementia

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18
Q

true or false. vascular dementia: impairment is caused by an increased blood flow to parts of the brain due to cerebrovascular events ( stroke or transcient ischemic episodes)

A

false.

decreased blood flow ( not increased)

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19
Q

True or false. Patients who suffer with vascular dementia symptoms often overlap with those of AD, although memory may not be as seriously affected.

A

true

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20
Q

What are the characteristics of mixed dementia ?

A

Characterized by the hallmark abnormalities of AD and another type of dementia ( most commonly vascular dementia, but also other types such as dementia with lewy bodies)

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21
Q

What is the characteristics of Parkinson’s disease dementia?

A

onset of dementia at least 1 year after onset of Parkinson’s disease symptoms

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22
Q

this is the hallmark abnormality is lewy bodies ( abnormal deposits of the protein alpa-symuclein) that orms inside the nerve cells of the brain

A

this is called Dementia with lewy bodies

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23
Q

true or false. Symptoms of dementia with lewy bodies is similar to AD, including problems with memory and judgement as we as behaviour changes.

A

true

24
Q

When dealing with a dementia patient with lewy bodies what should we avoid?

A

they have a severe sensitivity to neuroleptic drugs, and thus these mediations should be avoided

25
Q

What does the symptoms include in Dementia with lewy bodies ?

A

symptoms include fluctuating alertness, attention, and cognition, visual hallucinations, and Parkinsonism ( muscle rigidly and tremors )

26
Q

this involves brain atrophy, especially in the frontal and temporal lobes.

A

Frontotemperol dementia

27
Q

The Older Adult Experiencing Dementia:

Responsive behaviours may include the following behaviours :

A

agitation/restlessness, physical aggression, vocalization, wandering, shadowing, hoarding, resistance to care, etc.

28
Q

Older adults with impaired cognition related to a disease process such as Dementia may demonstrate a responsive behaviour as a result of …..

A

physical condition not treated
emotional needs not addressed
sensory overload or deprivation
disorder of vision or perception
interplay between triggers and responses

29
Q

true or false. older adults cognition should be further investigated
( might be delirium or dementia ) have to take assessments

A

true

30
Q

The Older Adult Experiencing Dementia Tools to Assess Cognition
In the Clinical setting, commonly used screening tools to access cognition include

A

MMSE
MoCA ( montreal cognitive assessment tool)

31
Q

Older adult who is presenting with responsive behaviours may have an undiagnosed disease process such as

A

dementia , depression , or delirium

32
Q

The Older Adult Experiencing Dementia Tools to Assess Cognition:
A change of cognition in an older adult may be followed by a more a

A

comprehensive assessment

33
Q

true or false. An older adult with a known disease process ( previously diagnosed) related to cognitive impairment, assessment tools can be used to motor disease progression

A

true

34
Q

The Older Adult Experiencing Dementia :

Critical to include as a part of your clinical assessment: what question should you include?

A

what is the underlying reason the older adult with dementia demonstrating a responsive behaviour

35
Q

true or false.
in order to reduce the underlying reason, the older adult with dementia demonstrating a responsive behaviour. you should talk to the family member, talk to the team.

A

true

36
Q

Think about it ** What can interdisciplinary team ( and the older adult’s support persons ) can do to provide safe and compassionate care to older adult with a responsive behaviour ?

A
37
Q

The Older Adult Experiencing Dementia : Possible Underlying Reasons

A

Physical Condition not treated
Emotional needs not addressed
Sensory overload or deprivation
Disorder of vision and perception
Interplay between triggers and responses

38
Q

true or false. generate solutions/take action are these questions should be consider?

1) address physical and emotional needs. Is the older adult in pain? Is the older adult feeling isolated or depressed?

2) Is there too much/light or noise in the room

3) In the older adult able to see or hear properly ? Are their eyelashes clean? Are they wearing hearing aides?

A

all these questions should be consider when it comes to generating and taking actions

39
Q

Is delirium a medical emergenecy?

A

yes it is a medical emergency

40
Q

The Older Adult experiencing ______:

serious, preventable, treatable , and often unrecognized condiiton

A

delirium

41
Q

The older adult experiencing delirium : changes in

A

attention, consciousness, and altered sleep wake patterns

42
Q

Risk Factors of delirium

A

advanced age, dementia, depression, functional dependency , medications, surgery, infections, serious illness , and physical restraints

43
Q

The Older Adult Experiencing Delirium : Functional consequences

A

longer hospital stays, increased mortality , increased dependency
- delirium predicts development of dementia and acceleration of cognitive decline

44
Q

When assessing delirium, we have to use what ?

A

CAM
AIDA
acute onset, fluctuating on-course
Inattention
Disorganized
Altered level of conciousness

45
Q

In this assessment: what is this describing ?

Progressive decline in cognitive function, characterized by cognitive deficits in memory, understanding, judgement, decision-making, communication as well as changes in personality and behaviour

A

dementia

46
Q

True or false. Dementia :
Assessment ( ongoing ) needs to be an interprofessional collaboration including the individual’s support persons

A

true

47
Q

Identify if this is true when it comes to interventions in dementia :

Person- centered care : Look beyond the disease and the takes we perform with the person within and our relationship with them. The focus is not on what we need to do for the person but rather on the person himself or herself and how to enhance well-being and quality of life

A

true

48
Q

Interventions with dementia patient : with responsive behaviours we need to address a potential underlying cause such as

A

poor physical health, problems in cognition, and communication
emotional/spiritual vulnerability
activities not reflective of the older adult’s strengths
unsettling environment
previous trauma

48
Q

how may points do we have to distinguish to know that delirium is present ?

A

1 and 2

48
Q

how many points do we have to distinguish for CAM positive ?

A

three or four

48
Q

Interventions for delirium :
immediate treatment o underlying cause of delirium:
what are the examples of underlying causes we could look at ?

A

infection, pain, sleep deprivation, dehydration, adverse mediation effects, fluid and electrolyte imbalance, sensory impairment, and emotional/spiritual distress

48
Q

differentiating delirium, depression, and dementia :

the onset
course over 24 hours
conciousness
alertness

A

onset : delirium = sudden abrupt
depression = recent, may relate to life change
dementia = insidious, slo ( over years ), often unrecognized until deficits are obvious

course over 24 hours : delirium = fluctuating, often worse at night
depression= fairly stable, may be worse in the morning
dementia= fairly stable = may change with stress

conciousness : delirium= disturbed
depression= clear
dementia = clear

alertness : delirium= increased, decreased, variable
depression: normal
dementia = generally normal

Psychomotor activity :
delirium = increased, decreased, or mixed
depression = variable, agitated, or slowed down
dementia= normal, may have apraxia or agnosia

49
Q

in the following :
match the duration with delirium, depression, dementia
a) variable, at least 2 weeks and may be chronic
b) years
c) hours to weeks

A

a= depression
b= dementia
c= delirium

50
Q

with the following characteristics name the following condition correlating with it :
( attention )

a= little impairment
b= disordered fluctuates
c= generally normal but may have trouble focusing

A

a= depression
b=delirium
c= dementia

51
Q

describe the characteristics describing these in differentiating delirium, depression, and dementia

orientation
thinking
perception
affect

A

orientation : delirium = usually imapired, fluctuates
depression = usually normal : may answer “ i dont know to questions, or may not answer
dementia = often impaired

thinking : delirium= disorganized , rambling, illogical, or incoherent
depression = may be slow; hopelessness, helplessness
dementia = difficulty finding words, preservation, impoverished thoughts, difficulty with abstraction, delusions in severe cases

perception : delirium = disturbed; illusions, hallucinatins, misperceptions
depression= misperception usually absent
dementia= intact, hallucinations in severe cases

affect : delirium = variable but may look disturbed, frightened
depression= flat
dementia = slowed response

52
Q

what is agnosia, aphasia and apraxia?

A

Agnosia: The inability to recognize common objects, familiar faces, or sounds, despite intact sensory abilities

Aphasia: Loss of the ability to use and understand spoken and written language

Expressive aphasia - speak
Receptive aphasia - hear

Apraxia: Impaired ability to manipulate objects or perform purposeful acts despite intact sensory abilities

53
Q

what is neuroplasticity?

A

the ability for brain to adapt to the needs of environment

NURS2518 : The Older Client (13 decks)

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