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Fall 2015 Nursing School > 317 Final > Flashcards

317 Final Flashcards

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1
Q

Delirium is sometimes

A

Reversible

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2
Q

According to the American psychiatric Association what are the four components of delirium?

A

Disturbance of consciousness

Change in cognition

Fluctuation

Caused by a medical condition

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3
Q

How can delirium be prevented?

A

By recognition of high risk patients.

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4
Q

Routine screening for delirium is part of a comprehensive nursing care for

A

Elderly

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5
Q

CHARACTERISTICS of Delirium

A 
Rapid onset
Altered level of consciousness 
Erratic lucidity and somnolence 
Disturbed attention 
Disorganized thinking 
Sleep-wake cycle is affected
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6
Q

CHARACTERISTICS of Delirium

A 
Rapid onset
Altered level of consciousness 
Erratic lucidity and somnolence 
Disturbed attention 
Disorganized thinking 
Sleep-wake cycle is affected
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7
Q

Three types of delirium

A

Hyperactive

Hypoactive

Mixed

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8
Q

Delirium risk factors (6)

A

Old age

Pain

Dementia

Surgery

Medications

Psychosocial/environment changes

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9
Q

Delirium CAUSES (6)

A

Drug toxicity interaction

Infection process

Metabolic and endocrine disorders

CNS lesion

New disease process

Changes in chronic illness

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10
Q

Because of delirium, it is important to measure baseline prior to admission for patients with

A

Dementia

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11
Q

4 components of CAM

A

Mental status altered from baseline

Inattention

Disorganized thinking

Altered level of consciousness

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12
Q

Nursing interventions for delirium (7)

A 
Provide eye glasses and hearing aids
Avoid restraints
Avoid psychotherapeutic drugs
Avoid excessive stimulation
Adequate lighting 
Calm reassuring person 
Provide familiar objects
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13
Q

Another delirium intervention includes removing “tethers.” For example

A

IVs and catheters

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14
Q

Some more delirium interventions…

A

Evaluate medications

Pain management

Increase physical activity

Oxygen

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15
Q

Evaluate medications for

A

Discontinue of “unnecessary” or high risk medications.

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16
Q

What practical forms of increased physical activity help with delirium?

A

Walking

PT

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17
Q

What is the suspected cause of sundowning?

A

Changes in circadian rhythm

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18
Q

Reversible causes of dementia (7)

A 
Thyroid disease 
Vitamin B12 deficiency 
Depression
Tumors 
Infections 
Vasculitis
Normal pressure hydrocephalus
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19
Q

Non-reversible dementias

A

Frontaltemporal

Lewy Body

Creutzfeld-Jakob

Huntington’s

Vascular

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20
Q

20% of dementia cases

A

Vascular dementia

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21
Q

Vascular dementia it was once called

A

Muti-infarct dementia

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22
Q

Caused by death of nerve cells from poor blood flow

A

Vascular dementia

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23
Q

Which disease has unknown cause and cure?

A

Alzheimer’s

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24
Q

Changes in the brain in Alzheimer’s Disease

A

Death of neurons

Amyloid/neuritic senile plaques

Neurofibrillary tangles

Reduced brain weight

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25
ApoE4 is an allele linked to
Alzheimer's
26
MMSE score of greater than or equal to 21
Mild Alzheimer's
27
Personality change is what stage of Alzheimer's?
Mild stage
28
May be able to maintain ADLs with minimal assistance
Mild stage
29
MMSE score 10-20
Moderate Alzheimer's
30
With severe Alzheimer's the patient is unable to (3)
Communicate Smile Hold head up
31
Which stage of Alzheimer's involves incontinence?
Severe stage
32
MMSE less than or equal to 9
Severe Alzheimer's
33
Alzheimer's diagnosis
``` Health history Physical exam Neurological/MMSE Monitoring symptoms across time Blood studies and urinalysis Electrocardiogram CT scan ```
34
Alzheimer's drugs types
Cholinesterase inhibitors Memantine (nemenda)
35
3 leading causes of death in Alzheimer's patients
Cardiac arrest Pneumonia Sepsis
36
CNS changes affect the patients ability to interpret
Pain
37
Assessing pain in dementia patients (4)
Attempt self report Observe behaviors Attempt analgesic trial Use best practice tools from Hartford
38
What is used for assessing pain in patients with dementia?
PAINAD scale
39
In terms of pharmacokinetics, there is no significant change in quantity absorbed, but the time to onset or peak may be
Delayed
40
In the elderly, SQ tissue
Decreases
41
In the elderly, connective tissue
Increases
42
Possible decreased absorption via (2)
Injections Topical/transdermal
43
Changes to the drug distribution increase risk for
Adverse drug reactions
44
Why do renally excreted drugs build up in the elderly?
They are not eliminated fast enough
45
Which type of drug has dehydration side effects in the elderly?
Anti-cholinergic
46
Urinary retention Cardiac arrhythmias Increased fall risk Delirium/hallucinations/agitation Caused by what drug type?
Anticholinergic
47
All the negative side effects of anti-cholinergic drugs are worse in patients with
Dementia
48
List of 48 medications not recommended for anyone greater than 65 years old
Beer's Criteria
49
5 common drug types on Beer's List
Anticholinergic Antipsychotics Tricyclics antidepressants Barbiturates Benzodiazepines
50
MMSE score lower than 24 is associated with
Difficulty managing medications
51
What should the patient know about their medications? (7)
``` Name Dosage Time of day How Why Side effects Meds borrowed or not used? ```
52
Interventions to decrease ADE's (4)
Educating patients and caregivers Decrease number of medications Alternative therapies Set up a pill box system
53
Symptoms of pain in elderly (4)
Confusion Restlessness Fatigue Aggression
54
Why might a patient avoid pain management?
Fear of addiction Think pain is a normal part of aging Fear of being labeled as a bad patient Don't believe pain is manageable
55
Why might the nurse avoid pain management?
Lack of typical signs and symptoms Lack of assessment Misinformation about addiction Pain is a normal part of aging
56
Sleep interventions (7)
``` Rituals Relaxation techniques Decrease caffeine Avoid alcohol Bedtime snacks Physical activity Adequate sun ```
57
Homeopathic sleep interventions like...
Chamomile
58
What is a last resort sleep intervention?
Hypnotics/sleep medications
59
The chemical disruption of neurotransmitters like norepinephrine and serotonin
Depression
60
Risk factors for depression (6)
Psychosocial stressors/loss Medical conditions Functional impairments Lack of social support Adverse medication effects Alcohol
61
Hormonal changes suspected in elderly depression (4)
Elevated cortisol levels Altered growth hormone Altered response to thyroid hormone Serotonin
62
Surprising hallmark of major depression
Psychomotor agitation or retardation
63
Depression is often chronic and recurrent in people with
CV disease
64
Depression can occur after a
Stroke
65
Cognitive impairments such as loss of focus can occur because of
Depression
66
This is why depression is often an antecedent to
Dementia
67
Stroke in the ???? Side of the brain is associated with?????
Left, depression
68
What 2 assessment tools are used for depression?
PHQ2 GDS
69
Demographics/risk for depression
Advanced age Living alone Male Caucasian Hoplessness Substance abuse
70
Evaluate medications and alcohol as contributors to
Depression
71
Basic things to improve depression
Diet Nutrition Patient education Referral to support groups
72
It is important for the nurse to not only treat the patient, but also the
Caregiver
73
Some ways to help the caregiver (4)
Support groups Community resources Respite Family counseling
74
Medicare for those under 65 if
Long term disability End stage renal disease

Fall 2015 Nursing School (17 decks)

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