Cognitive Impaired Flashcards
(45 cards)
Delirium-
Dementia –
Depression –
Forgetfulness –
acute confused state/reversible/once we find out underlying cause we can FIX IT!
generalized impairment of
intellectual functioning, chronic/progressive
A mood disturbance
characterized by feelings of sadness and
despair
**Disorientation, poor judgement, loss of ability
to calculate, loss of language- not normal
aging changes > requires further assessment
Forgetfulness – normal, confusion -abnormal
Disorientation, poor judgement, loss of ability
to calculate, loss of language- are normal
aging changes >
T or F
F ! - not normal
aging changes > requires further assessment
Forgetfulness – normal, confusion -abnormal
Delirium
Altered mental state caused by a disturbance in brain function, severe confusion
ONSET- sudden over hours to days
Acute, potentially reversible state
Causes of Delirium (7)
- Alcohol/drug withdrawal
- Medications- narcotics, anesthesia, street drugs, drug abuse
3.Head injuries- concussions, multiple falls
4.Fever/ sensory deficits,
sudden confusion,
UTI,
Pneumonia
5.Nutritional deficiencies ( decrease in magnesium leads to confusion)
6.Dehydration/ fluid and electrolyte imbalances
7. Change in sleep cycle
Delirium signs/symptoms
1.Disturbance in consciousness and cognition
2. Restlessness, agitation, hallucinations
3. Mood Labile - an emotional response that is irregular or out of proportion to the situation at hand.
Mood Labile -
an emotional response that is irregular or out of proportion to the situation at hand.
NURSING INTERVENTIONS FOR DELERIUM (6)
- Remove the causative agent (check lab work, assessments)
2.Prevent further damage(injury to self and others)
3.Promote orientation
4.Mild sedation and restraints only if necessary –minimize immobility(need MD order) - Hydrate and Intake and output (I&O)
- Maintain safety for the patient
Interventions cont’
1.Provide a quiet environment, decrease stimuli, adequate lighting due to fluctuating levels of consciousness
2. Plan care when patient appears receptive* ( Mood Labile(irregular emotional response – unstable, rapidly shifting or changing emotions) *
3.Keep conversation simple/clear explanations
4.Don’t ask multiple questions causes frustration
Prevent delerium ( 5)
1.Compensate for sensory deficits(glasses, hearing aides)
2.Ambulate or ROJM activities 3 times/day
3.Avoid multiple new medications
Minimize use of immobilizing devices- catheters, IV’s, restraints
4.Encourage fluids to maintain hydration
5.Use warm milk, herbal teas, relaxation tapes, music to induce sleep and reduce anxiety
I should go into detail what happen to delirium patients .
T or F
F. thats too much information for the patient.
Dementia
Impairment of cognitive functioning that usually is progressive and permanent, interferes with normal social and occupational functions
ONSET- slow, over years
Progressive, may stabilize at times
Chronic
Symptoms- dementia ( 4)
- Cognitive impairment- inability to solve problems
2.Functional losses- ADL’s-something as simple as getting a glass of water
- Behavior changes- restless, aggressive, personality changes
4.Neuropsych- anxiety, depression, hallucinations, yelling out
DEMENTIA- types (6)
Alzheimer’s
Parkinson’s
Huntington’s Chorea
Aids
Tertiary syphilis
Vascular
Parkinson’s-degenerative neurologic disorder-
Initially physical symptoms may eventually develop confusion, loss of nerve conduction, problem solving, recalling information
H untington’s chorea-
hereditary with physical and mental deterioration, onset usually in the 40’s, movement disorder, uncontrolled movements
AIDS –
S&S of HIV has progressed to AIDS (l
Tertiary syphilis –
Vascular –
Korsakoff’s psychosis-
Thiamine-
permanent mental deterioration. Syphills needs to be educated how to treat or will lead to this.
decreased blood flow to the brain d/t aging causes change in functioning (ex: athersclerios)
psychotic d/t alcoholism
Vitamin B complex deficiency
PHASES OF DEMENTIA
Mild-
Moderate –
Severe
moderate difficulty learning, remembering, gets lost at times, depression
forgetting old facts, repeats the same stories, difficulty performing tasks. Confusion – severe memory loss for recent events, decreased ability to concentrate, incr. anxiety, denial, confabulation, lose ability to problem solve
( Apraxia & Agnosia)
damage to nerve cells is widespread, groaning, screaming, mumbling, does not recognize family/friends, dependent on others to perform ADL’s
Apraxia-
Agnosia-
can’t perform MOTOR function
forget how to use something (how to use soap)
Short term memory is better than long term memory in dementia patients.
T or F
F!
Its poor they sometimes hang onto long term memory.
Assessment for dementia ( 4)
- Be aware of expecataion level
- Look at Erikson’s developmental phase that relates to the patient
3.Utilize Mini Mental State Exam (MMSE)
- Document patient behavior
Signs/symptoms of dementia
1.Dependent on others for ADLs (or supervision)
2.Decline in memory for recent events and inability to engage in complex conversations
3.Difficulty finding words
4.Lost of interest in social activities
5Gets lost in familiar areas
6.Abnormal results on MMSE
7. Agitation- restless, wandering, lashing out
Nursing Interventions For Dementia
- Keep safe in the environment
2.Promote sleep, proper nutrition, hygiene, activity
3.Structured environment and adapt daily routine to person’s needs( AM person vs night owl) - emotional support to family and care givers- family involvement important
5.Nursing Interventions cont’
6.Nutrition – familiar and easy to eat
7.Clothing- easy to dress and wash
8.Music, aromatherapy, pets
9.Reminiscence- short term memory poor, long term memory may still be present. Like to talk about childhood - Promote interaction and involvement to maintain functioning
- Reality orientation- limited, do not cause anxiety
- Drugs reduce the risk of progression:
Drugs reduce the risk of progression of dementia (4)
Memantine ( Namenda),
Donepezil HCl (Aricept),
Rivastigmine (Exelon),
Galantamine (Razadyne)
