Exam 3

Question 1

Delirium (causes)

Answer 1

Acute, rapid, reversible
Metabolic or UTI can take longer to treat

Question 2

Delirium s/sx

Answer 2

Difficulty sustaining attention, distractibility, disorganized thinking, rambling, incoherent speech, disoriented to time and place, recent memory impairment, agitation/restlessness, emotional instability, tachycardia, sweating, dilated pupils, flushed face

Question 3

Delirium risk factors

Answer 3

General medical condition - head trauma, seizures
Metabolic disorder
Substance induced - drugs/toxins

Question 4

Alzheimer’s stages

Answer 4

Stage 1: No symptoms
Stage 2: Forgetfulness
Stage 3: Mild cognitive decline; gets lost, difficulty concentrating, planning, organizing, pt will try to hide symptoms
Stage 4: Mild to moderate cognitive decline; trouble with finances, traveling alone, trouble remembering recent events, denial of symptoms, withdrawal from family and friends
Stage 5: Moderate cognitive decline; trouble with address/phone number, time of day, forgetting major events, assistance needed for daily activities
Schedules and structure to orient pt
Stage 6: Moderate to severe cognitive decline; extensive assistance, forgetting family members, incontinence, sensory alterations
Stage 7: Severe cognitive decline; don’t recognize family members, inability to speak, serious decline in ADL’s and movement, loss of motor skills/walking

Question 5

Predisposing factors for dementia/AD

Answer 5

Hypothyroidism, hyperparathyroidism, pituitary insufficiency, uremia, encephalitis, brain tumor, pernicious anemia, thiamine deficiency, MS, pellagra, uncontrolled epilepsy, cardiopulmonary insufficiency, fluid and electrolyte imbalances, CNS and systemic infections, systemic lupus erythematosus

Question 6

Types of NCD (neurocognitive disorder)

Answer 6

Vascular
Frontotemporal
TBI
Lewy body disease
Parkinson’s
HIV infection
Huntington’s disease

Question 7

Vascular NCD

Answer 7

Stroke patients, result of death of nerve cells, confusion, risk of injury, abrupt onset, smoking increases risk

Question 8

Frontotemporal NCD

Answer 8

Shrinking of frontal and temporal lobes, cause is unknown
- genetics may play a role, behavioral and personality changes, speech/language difficulty

Question 9

TBI NCD

Answer 9

Amnesia is common, repeated head trauma - dementia pugilistica, emotional lability, ataxia, impulsivity

Question 10

Lewy body disease

Answer 10

Similar to Alzheimer’s, progresses more rapidly, early appearance of visual hallucinations and Parkinsonian features, progressive, irreversible, 25% of all NCD

Question 11

Parkinson’s disease

Answer 11

Caused by loss of nerve cells in substantia nigra and decrease in dopamine activity
tx: Levodopa

Question 12

HIV infection

Answer 12

Caused by brain infection or HIV virus, early stages not noticeable, progresses to cognitive decline

Question 13

Huntington’s disease

Answer 13

Genetic, dx in adulthood, damage in basal ganglia and cerebral cortex, profound dementia and ataxia

Question 14

Nursing dx for NCD

Answer 14

Risk for trauma
Impaired verbal communication
Disturbed sensory perception
Risk for other-directed violence
Impaired memory
Self-care deficit
Compromised or disabled family coping
Disturbed thought processes

Question 15

Cholinesterase inhibitors (examples and MOA)

Answer 15

Aricept (donepezil), Namenda (memantine)
- delays destruction of acetylcholine, can delay progression in early stages

Question 16

Antipsychotic examples

Answer 16

Risperdal (risperidone), Seroquel (quetiapine), Zyprexa (olanzapine), Geodon (ziprasidone), Abilify (aripiprazole)

Question 17

Antidepressant examples

Answer 17

Zoloft (sertraline), Paxil (paroxetine)
SSRIs: first line, few side effects
Trazodone (Desyrel): Used for insomnia in low doses and depression in higher doses
Dopaminergic agents: Tx for severe apathy

Question 18

Tricyclic antidepressants

Answer 18

Avoided due to anticholinergic and cardiac side effects

Question 19

Antianxiety med examples

Answer 19

Ativan (lorazepam), Valium (diazepam)

Question 20

TNPAP

Answer 20

TnPAP strives to assist those nurses who are struggling with drug addiction and/or mental health issues obtain an accurate diagnosis, quality treatment if recommended, and then ongoing monitoring once the nurse has achieved a stable recovery to assist them in long term maintenance of their sobriety

Question 21

Intoxication s/sx

Answer 21

Disinhibition, sexual/aggressive impulses, mood lability (mood swings), impaired judgment, slurred speech, unsteady gait, nystagmus, flushed face

Question 22

Withdrawal s/sx

Answer 22

Coarse tremors, N/V, malaise, tachycardia, sweating, elevated BP, anxiety, depressed mood, irritability

Question 23

Withdrawal tx

Answer 23

Tx: Benzodiazepines, anticonvulsants, multivitamin therapy, thiamine

Question 24

Delirium tremens

Answer 24

Due to alcohol withdrawal
Hallucinations, shaking, confusion, sweating, tachycardia

Question 25

Medications used in recovery phase for ETOH and other addictions

Answer 25

disulfiram (Antabuse): drinking deterrent - induces N/V with drinking
naltrexone (ReVia): blocks pleasure of drinking
nalmefene (Revex): reduces alcohol consumption and prevents opioid overdose
SSRIs
acamprosate (Campral): reduces desire to drink

Question 26

Positive symptoms of schizophrenia

Answer 26

Delusions, alterations in speech, hallucinations

Question 27

Negative symptoms of schizophrenia

Answer 27

Affect (diminished, blunted)
Alogia (short answers)
Anergia (lack of energy)
Anhedonia (lack of interest/pleasure)
Avolition (apathy)
Asociality (reduced social interaction)

Question 28

Nursing dx for schizophrenia and nursing considerations

Answer 28

Disturbed sensory perception: observe for signs of hallucinations, distract from hallucinations
Disturbed thought process: do not argue, focus on reality
Social isolation
Risk for violence: self-directed or other-directed
Impaired verbal communication: facilitate trust and understanding, orient to reality
Self care deficit
Disabled family coping
Ineffective health maintenance
Impaired home maintenance

Question 29

Atypical antipsychotics MOA

Answer 29

Serotonin and dopamine antagonist

Question 30

Atypical antipsychotics side effects

Answer 30

Weight gain, increased risk for diabetes, cardiovascular disease, and hypertension

Question 31

Anticholinergic side effects

Answer 31

Nausea, skin rash, sedation, orthostatic hypotension, photosensitivity, hormonal effects, ECG changes, hypersalivation, weight gain, hyperglycemia, diabetes, increased mortality risk in elderly with dementia, reduction in seizure threshold, agranulocytosis, extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome

Question 32

Extrapyramidal side effects

Answer 32

Pseudoparkinsonism: Drug induced parkinson’s symptoms, shuffled gait, muscle stiffness
Akinesia: Loss of voluntary muscle movement
Akathisia: Inability to stay still
Dystonia: Muscle twitching
Oculogyric crisis: Eye deviates upwards
Tardive dyskinesia: Tongue movements

Question 33

Extrapyramidal tx

Answer 33

Anticholinergic drugs

Question 34

Neuroleptic malignant syndrome cause

Answer 34

Antipsychotics
Occurs from dopamine blockage

Question 35

Neuroleptic malignant syndrome
s/sx

Answer 35

MEDICAL EMERGENCY
Decreased LOC, increased muscle tone, high fever, hypertension, sweating, tachycardia, drooling

Question 36

Neuroleptic malignant syndrome
tx

Answer 36

D/C antipsychotic drug
Tx: Dopaminergic medications - bromocriptine (Parlodel) and dantrolene (Dantrium)

Question 37

Serotonin syndrome symptoms

Answer 37

Agitation, anxiety, restlessness, disorientation, diaphoresis, hyperthermia, tachycardia, nausea, vomiting, tremor, muscle rigidity, hyperreflexia, myoclonus, dilated pupils, ocular clonus, dry mucous membranes, flushed skin, increased bowel sounds, and a bilateral Babinski sign