Cognitive Process Flashcards
1
Q
“the systematic way a person thinks, reasons, and uses language”
A
cognition
2
Q
What does cognition require?
A
- consciousness
- thought
- memory
- learning
- language
3
Q
What part of brain coordinates cognition?
A
Cerebral Cortex
4
Q
3 things required for perception to occur?
A
- functioning sensory system
- neurotransmission
- processing
5
Q
what is neurotransmission?
A
when receive stimuli and sensory receptors receive it, neural impulse is sent to brain to be interpreted
6
Q
What are 3 types of sensory receptors?
A
extero, proprio, intero (receptors)
7
Q
3 things about exteroreceptors?
A
- external
- vision, hearing, pain, and somatic receptors
- anything that responses to stimuli from external environment
8
Q
3 things about proprioreceptors?
A
- position
- inner ear, muscles, tendons, joints
- relates to bodiesphysical state, position, sensation of movement
9
Q
3 things about interoreceptors?
A
- internal
- viscera and deep tissue-reflex level (unaware- BP,O2)
- relates to change in internal environment
10
Q
“state of awareness, responsiveness”
A
consciousness
11
Q
“insight process of reasoning- take a stimuli and determine its meaning”
A
judgement
12
Q
“ability to store and recall”
A
memory
13
Q
“ones ability to understand”
A
comprehension
14
Q
Language is based on ____ data
A
subjective
15
Q
Newborn/infants do not have______developed and interpret through _________
A
Sensorimotor- speech not developed, interpreting through 5 senses and expressive through behavior
16
Q
which age develops object permanence?
A
toddler-preschooler
17
Q
which age is egocentric, develops concrete thinking and can say 200/understand 300 words?
A
toddler/preschooler
18
Q
which age develops abstract thinking?
A
school age to adolescent
19
Q
Are cognitive impairments considered normal part of aging?
A
nope
20
Q
Factors affecting cognitive fxn?
A
Oxygenation**- most important Circulation Nutrition Fluid and Electrolyte Balance Medications Medical Environment
21
Q
brain requires ___% of oxygen for functioning
A
20
22
Q
What comes first in CPR?
A
CAB- circulation!
23
Q
What mineral is needed for hemoglobin?
A
Iron
24
Q
Low iron increases risk for what?
A
oxygen deficiency, anemia
25
____% of glucose is used by the brain
25
26
Which electrolyte has the biggest influence on water? why?
Na, can pass thru BBB Freely
27
most important electrolyte for changes in mental status?
Na
| -low/high sodium = confusion
28
Which metabolic by-product affects cognition?
high ammonia
Metabolic by-products
-kidney or liver impairment
29
med to lower ammonia?
lactalose
30
Meds that effect cognition?
- Act directly on CNS- anti seizure, opioids, hypnotics
- Side Effect
- Toxicity- too much med/not clearing med properly
31
define delirium
ACUTE change in mentation, consciousness, or the ability to maintain attention.
32
is delirium preventable?
yep
33
2 things delirium increases
- mortality risk
| - length of hospital stay
34
Can delirium cause long term cognitive impairment?
yep
35
Where does delirium most commonly occur?
icu
36
3 tyoes of delirium
- hyperactive
- hypoactive
- mixed
37
what is hyperactive delirium, how is it manifested?
patient is disruptive, jumping out of bed, inattention, calling out frequently
**easiest to assess
38
how is hypoactive delirium manifested?
most common, patient lying in bed sleepy/lethargic/uneasy to rouse
**Highest risk of mortality , most common, least diagnosed
39
which delirium is most common and has highest mortality risk?
hyoactive
40
What is mixed delirium?
hyperactivity + very sleepy, wax on/wax off
41
delirium risk factors
Medications (benzo)
Anesthesia
ICU on Ventilator
Stroke
Dementia
Respiratory Failure
Sepsis
Drug Abuse
Alcohol Abuse
Isolation
42
2 steps for assessing delirium?
- patients cognitive baseline must be determined
| - Confusion Assessment MEdthod (CAM)
43
CAM assesses for:
onset, inattention, disorganized thinking, altered level of consciousness
is this acute change from baseline?
did patient experience inattention in conversation?
was patient disorganized in thinking?
Was patient anything other than alert?
44
Nursing Management of Delirium
Early ambulation
Limit restraint use
Promote adequate sleep
Frequent reorientation
Enhance sensory stimuli
45
do meds prevent delirium?
heck no
46
define dementia
Progressive impairment of intellectual function and memory.
Gradual Decline- not acute
Permanent
47
causes of dementia
trauma, circulation, genes, alteration in neurotransmitters, infection agents
48
dementia: Cerebral atrophy or shrinking of cortex =
Alzheimer Dementia
49
dementia: Inadequate blood flow due to plaques or arterial brain lesions =
Vascular dementia
50
which patients are at high risk for vascular dementia?
patients with strokes are at higher risk
51
dementia: Nerve cell loss and impairment of frontal and anterior temporal lobes
=
Frontotemporal Dementia
52
dementia: Clumps of protein causing neurodegeneration=
Lewy Body Dementia
53
parkinson's dementia diagnosis?
If dementia occurs greater than 1 yr after Parkinson’s
54
symptoms of depression in elderly
Forgetfulness
Fatigue
Changes in behavior or mood
55
which of the 3 D's does not have treatment?
Dementia
56
Which of 3 D's has acute onset?
Delirium
57
What is Dysarthria?
-Impaired speech related to motor control, weakness, paralysis, or incoordination of the oral musculature
-Hearing not impacted
-Can write or select words appropriately
→ damage to peripheral or central nervous system might be cause
58
is hearing impacted with dysarthria?
nope
59
Primary cause of aphasia?
stroke
60
what is aphasia?
Complete or partial loss of language abilities.
61
what is expressive aphasia?
limited, unable to find right words they want to express
| Anomia→ problems with word retrieval
62
which kind of aphasia has anomia?
expressive aphasia
63
what is anomia?
problem with word retrieval
64
what is receptive aphasia?
speech is articulated but they are having a hard time understanding what you are saying or what is written in front of them
65
what is global aphasia?
severe and extensive damage - can’t speak, read, write
66
expressive aphasia effects what part of brain?
broca or motor
67
Receptive aphasia effects what part of brain?
wernicke or sensory
68
What can the nurse use to assess alterations in cognitive function?
Mini-Mental Status Exam or Pfeiffer
Pfeiffer
10 questions
A correct response gets a 1
Score of 7 or less indicates cognitive impairment
69
on the Pfieiffer exam a score less then what indicates cognitive impairment?
7
70
First neurological signs of reduced oxygen?
confusion, lethargy, altered mental status
71
Electrolytes linked to cognitive impairment?
sodium, calcium
72
What would a problem with kidneys or liver show?
confusion, ammonia/urea build up, jaundice
73
What do you do if someone has trouble speaking or understanding and it is acute?
- mini mental status exam
| - check O2
74
What do you do if someone has trouble speaking or understanding? (chronic)
- creating structure to day
- familiarity
- allowing time for rest breaks for self and patient
- gestures, communication board
75
What can you use to help orient the patient back to reality?
whiteboard, open blinds, who you are,
76
What would you NOT want to do with confused patient?
argue
77
What may help make a hospital less unfamiliar to a patient?
-decorate, personal items, continuity of care
78
Recommendations for individuals with progressive cognitive impairment
1. family support
2. day and respite care
3. Socialization therapies
4. Long term care
