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AE III Exam 1 > Dementia, Delirium, Depression + Neuro > Flashcards

Dementia, Delirium, Depression + Neuro Flashcards

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1
Q

dementia DSM 5 diagnostic criteria

A

decline in memory PLUS one of the following:

  • unable to generate coherent speech and understand language
  • unable to recognize/identify objects
  • unable to execute motor activities
  • unable to think abstractly, make sound judgements, plan/carry out tasks
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2
Q

tools to assess cognitive function (2)

A
  • mini mental state exam (MMSE)

- mini-cog

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3
Q

behavioral symptoms in dementia (6)

A
  • psychomotor agitation
  • psychosis
  • aggression
  • apathy
  • depression
  • sleep
    (PPAADS)
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4
Q

medications for dementia/Alzheimer’s (5)

A
  • acetylcholinesterase inhibitors
  • Memantine (NMDA receptor antagonist)
  • haloperidol for psychotic symptoms
  • atypical antipsychotics
  • benzodiazepines for agitation/agression
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5
Q

5 A’s of Alzheimer’s

A
  • anomia - inability to remember names of things
  • apraxia - misuse of objects
  • agnosia - inability to interpret sensations
  • amnesia - memory loss
  • aphasia - inability to comprehend/formulate language
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6
Q

stages of Alzheimer’s

A
  • early: mild cognitive decline, noticeable deficits in demanding job situations
  • mild: deficit associated with complicated tasks, withdrawal, apathy, forgetfulness
  • moderate: insomnia, wandering, speech difficulty, difficulty with IADLs
  • moderately severe: deficits in ADLs, total dependence
  • severe: no verbal or self abilities
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7
Q

tool for assessing delirium

A

Confusion Assessment Method (CAM)

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8
Q

CAM criteria

A
  1. acute onset, fluctuating course
  2. inattention
  3. disorganized thinking
  4. altered LOC
    diagnosis requires 1 & 2, and either 3 or 4
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9
Q

meds than can cause delirium

A

anticholinergics, psychoactive drugs

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10
Q

depression screening tools (2)

A
  • geriatric depression scale

- patient health questionnaire-2 (PHQ-2)

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11
Q

geriatric depression scale

A
  • 15 yes/no questions

- highest score: 15 - most severe

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12
Q

medications for depression (3)

A

SSRIs, SNRIs, TCA-related medications

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13
Q

non-pharmacologic treatment for depression

A
  • group and individual therapy - cognitive behavioral therapies (CBT)
  • electroconvulsive therapy (ECT)
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14
Q

three components of ICP

A
  • brain volume
  • cerebral blood volume
  • cerebrospinal fluid
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15
Q

Monro-Kellie Doctrine

A

change in volume of any one component of ICP must be accompanied by a reciprocal change in one or both of the other components to maintain appropriate ICP

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16
Q

early indicators of increased ICP (5)

A
  • change in LOC
  • papilledema (optic disk swelling)
  • slurring of speech
  • delay in response
  • vomiting
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17
Q

late indicators of increased ICP (4)

A
  • further decrease in LOC
  • cushing’s triad
  • pupil changes
  • posturing
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18
Q

treatment/interventions for increased ICP

A
  • IV therapy and vasoactive agents
  • temp control
  • body positioning - HOB 30°, no hip flexion > 90°, log roll
  • maintain ventilation - pO2 > 60 mmHg
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19
Q

meds for increased ICP (3)

A
  • osmotic diuretics - mannitol
  • sedatives/paralytics (opioid narcotics, benzos, sedative-hypnotics, paralytics)
  • barbiturates
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20
Q

two components of LOC

A

arousal/alertness and content/awareness

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21
Q

explain the Glasgow Coma Scale (GCS)

A
  • assessment tool for arousal/alertness
  • three components: eye opening, best verbal, best motor
  • scores: 3-15 - 15 is best, < 7/8 requires further assessment
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22
Q

decorticate posturing

A

abnormal flexion; indicates cerebral hemisphere dysfunction

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23
Q

decerebrate posturing

A

abnormal extension; indicates brainstem dysfunction (worse)

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24
Q

explain the cold caloric test

A
  • tests the oculovestibular reflex, brainstem function

- nystagmus toward stimulus = normal

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25
explain doll's eye movements
- tests the oculocephalic reflex - full doll's eyes - eyes move opposite side of where the head is turned = normal - eyes remain fixed in mid-position as head is turned = brainstem injury
26
Cushing's triad
- increased systolic BP with widened pulse pressure - bradycardia - altered respirations (usually slowed)
27
FAST
tool for early recognition of stroke | face, arms, speech, time
28
NIH stroke scale
- need to be certified to use | - highest score = 42, most severe
29
right-sided stroke symptoms
impulsivity, not aware of deficits
30
left-sided stroke symptoms
language, math deficits | anxiety, depression
31
immediate care for stroke
- ABCs - CT scan - administer rtPA within 3 hours if ischemic - possible endovascular intervention
32
meds for ongoing management of stroke (5)
- anticoagulants - aspirin - antihypertensives - steroids - reduce edema/inflammation in brain - anti-epileptics drugs - seizures may result from stroke - anti-anxiety
33
positioning a stroke patient
- prevent foot drop - reduce external rotation of hip and knee flexion deformity - slings/splits for upper extremities to prevent subluxation of shoulder
34
linear skull fracture
- minor traumatic injury, not life-threatening | - heals over time without intervention
35
depressed skull fracture
- may be visible/palpable, may tear meninges - surgical repair of fracture and meninges, may need to evacuate hematoma - pain management, neuro assessment
36
open/compound skull fracture
- depressed skull fracture with open scalp laceration - at risk for infection - surgical repair of and debridement of wound - pain management, neuro assessment, antibiotics
37
basilar skull fracture
- fracture of one of the bones that make up the base of the skull - can cause tear in meninges, leaking of CSF - test for glucose - allow CSF to drain, dura will close on its own - surgery if injury does not heal in 1-2 weeks
38
basilar skull fracture symptoms (5)
- periorbital ecchymosis (raccoon eyes) - mastoid ecchymosis (Battle's sign) - facial nerve paralysis - otorrhea - rhinorrhea
39
basilar skull fracture nursing interventions
- pain management - neuro assessment - monitor for infection - aseptic technique when changing dressing - use cotton to absorb CSF leak - raise HOB to decrease CSF pressure
40
epidural hematoma cause
- bleeding between dura mater and skull due to high impact to temporal areas of brain - usually associated with linear fracture - usually arterial injury
41
epidural hematoma presentation
brief loss of consciousness --> AO x3 --> loss of consciousness again
42
epidural hematoma management
- surgical evacuation of hematoma - neuro ICU w/ ICP monitor - neuro assessment - sudden changes in LOC, pupils
43
subdural hematoma causes (acute, chronic)
- accumulation of blood between dura and arachnoid layers; usually venous injury - acute: deceleration injury, contusion (anticoagulants) - chronic: low impact injury
44
acute subdural hematoma manifestations (5)
- symptoms present < 48 hours from injury | - drowsiness, headache, confusion, slowed thinking, agitation
45
subacute subdural hematoma manifestations
symptoms present 48 hours-2 weeks from injury
46
chronic subdural hematoma manifestations (6)
- symptoms present > 2 weeks from injury | - headache, lethargy, vomiting, seizures, pupil changes, hemiparesis (one-sided weakness)
47
subdural hematoma management
- surgical evacuation of hematoma - subdural drain placement - frequent neuro assessments
48
subarachnoid hematoma cause
- accumulation of blood between arachnoid layer of meninges and brain - severe head injuries, brain aneurysm
49
subarachnoid hematoma manifestation
nuchal rigidity
50
subarachnoid hematoma management
- placement of IVC, monitor ICP | - neuro assessments
51
intracerebral hematoma cause
- accumulation of blood in brain parenchyma | - results from uncontrolled HTN, ruptured aneurysm, trauma
52
intracerebral hematoma manifestations
headache, decreasing LOC, dilation of one pupil, hemiplegia
53
complications of closed head injury/hematoma (5)
- diabetes insipidus (DI) - SIADH - cerebral salt wasting (CSW) - herniation - seizures
54
diabetes insipidus (DI)
- loss of ADH secretion due to pressure on pituitary gland - urine output > 200 ml/hr - specific gravity < 1.005 - dilute urine - serum sodium > 145 - treatment: IV fluids, vasopressin/desmopressin
55
SIADH
- excess secretion of ADH - urin output < 400 ml/hr - specific gravity > 1.02 - concentrated urine - serum sodium < 135 - dilutional hyponatremia - treatment: fluid restriction
56
cerebral salt wasting (CSW)
- hypovolemia with low serum sodium and urine osmolality | - treatment: sodium replacement - NS IV, oral salt tabs
57
seizure interventions
- prevent injury - place on side to prevent aspiration - stay with patient - monitor for status epilepticus - emergency; suction equipment ready, monitor VS, provide oxygen
58
medications of seizures (7)
- lorazepam (Ativan) for status epilepticus - for all types: divalproex (Depakote), valproic acid (Depakene), phenytoin (Dilantin) - for partial and general tonic-clonic: carbamazepine (Tegretol), phenobarbital (Barbita), primidone (Mysoline)
59
seizures management
- anti-epileptic drugs - vagal nerve stimulation - surgical interventions - limbic resection, anterior temporal lobe resection
60
causes of acquired Parkinsonism
infection, trauma, drug toxicity (phenothiazines, butyrophenones), hydrocephalus, genetic/hereditary diseases
61
early signs of Parkinson's (3)
- loss of flexibility - aching - fatigue
62
4 cardinal symptoms of PD
- resting tremors - bradykinesia - slow movement - rigidity - cog-wheeling - postural instability
63
meds for PD (5)
- levadopa - dopamine agonists - COMT inhibitors - dopamine releasers - MAO-B inhibitor
64
levadopa side effects (4)
- tardive dyskinesia - orthostatic hypotension - delirium - hallucinations
65
drugs that assist levadopa (4)
- carbidopa - increases absorption (Sinemet) - COMT inhibitors - stalevo - MAO-B inhibitors
66
normal pressure hydrocephalus (NPH)
- accumulation of CSF causing ventricles of brain to enlarge - can occur after injury or stroke - treat w/ VP shunt
67
NPH triad of symptoms
- gait disturbance - dementia, forgetfulness - urinary incontinence

AE III Exam 1 (3 decks)

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