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

Dementia, Delirium, Depression + Neuro Flashcards

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
Q

explain doll’s eye movements

A
  • 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
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26
Q

Cushing’s triad

A
  • increased systolic BP with widened pulse pressure
  • bradycardia
  • altered respirations (usually slowed)
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27
Q

FAST

A

tool for early recognition of stroke

face, arms, speech, time

28
Q

NIH stroke scale

A
  • need to be certified to use

- highest score = 42, most severe

29
Q

right-sided stroke symptoms

A

impulsivity, not aware of deficits

30
Q

left-sided stroke symptoms

A

language, math deficits

anxiety, depression

31
Q

immediate care for stroke

A
  • ABCs
  • CT scan
  • administer rtPA within 3 hours if ischemic
  • possible endovascular intervention
32
Q

meds for ongoing management of stroke (5)

A
  • anticoagulants - aspirin
  • antihypertensives
  • steroids - reduce edema/inflammation in brain
  • anti-epileptics drugs - seizures may result from stroke
  • anti-anxiety
33
Q

positioning a stroke patient

A
  • prevent foot drop
  • reduce external rotation of hip and knee flexion deformity
  • slings/splits for upper extremities to prevent subluxation of shoulder
34
Q

linear skull fracture

A
  • minor traumatic injury, not life-threatening

- heals over time without intervention

35
Q

depressed skull fracture

A
  • may be visible/palpable, may tear meninges
  • surgical repair of fracture and meninges, may need to evacuate hematoma
  • pain management, neuro assessment
36
Q

open/compound skull fracture

A
  • depressed skull fracture with open scalp laceration
  • at risk for infection
  • surgical repair of and debridement of wound
  • pain management, neuro assessment, antibiotics
37
Q

basilar skull fracture

A
  • 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
Q

basilar skull fracture symptoms (5)

A
  • periorbital ecchymosis (raccoon eyes)
  • mastoid ecchymosis (Battle’s sign)
  • facial nerve paralysis
  • otorrhea
  • rhinorrhea
39
Q

basilar skull fracture nursing interventions

A
  • 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
Q

epidural hematoma cause

A
  • bleeding between dura mater and skull due to high impact to temporal areas of brain
  • usually associated with linear fracture
  • usually arterial injury
41
Q

epidural hematoma presentation

A

brief loss of consciousness –> AO x3 –> loss of consciousness again

42
Q

epidural hematoma management

A
  • surgical evacuation of hematoma
  • neuro ICU w/ ICP monitor
  • neuro assessment - sudden changes in LOC, pupils
43
Q

subdural hematoma causes (acute, chronic)

A
  • accumulation of blood between dura and arachnoid layers; usually venous injury
  • acute: deceleration injury, contusion (anticoagulants)
  • chronic: low impact injury
44
Q

acute subdural hematoma manifestations (5)

A
  • symptoms present < 48 hours from injury

- drowsiness, headache, confusion, slowed thinking, agitation

45
Q

subacute subdural hematoma manifestations

A

symptoms present 48 hours-2 weeks from injury

46
Q

chronic subdural hematoma manifestations (6)

A
  • symptoms present > 2 weeks from injury

- headache, lethargy, vomiting, seizures, pupil changes, hemiparesis (one-sided weakness)

47
Q

subdural hematoma management

A
  • surgical evacuation of hematoma
  • subdural drain placement
  • frequent neuro assessments
48
Q

subarachnoid hematoma cause

A
  • accumulation of blood between arachnoid layer of meninges and brain
  • severe head injuries, brain aneurysm
49
Q

subarachnoid hematoma manifestation

A

nuchal rigidity

50
Q

subarachnoid hematoma management

A
  • placement of IVC, monitor ICP

- neuro assessments

51
Q

intracerebral hematoma cause

A
  • accumulation of blood in brain parenchyma

- results from uncontrolled HTN, ruptured aneurysm, trauma

52
Q

intracerebral hematoma manifestations

A

headache, decreasing LOC, dilation of one pupil, hemiplegia

53
Q

complications of closed head injury/hematoma (5)

A
  • diabetes insipidus (DI)
  • SIADH
  • cerebral salt wasting (CSW)
  • herniation
  • seizures
54
Q

diabetes insipidus (DI)

A
  • 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
Q

SIADH

A
  • excess secretion of ADH
  • urin output < 400 ml/hr
  • specific gravity > 1.02 - concentrated urine
  • serum sodium < 135 - dilutional hyponatremia
  • treatment: fluid restriction
56
Q

cerebral salt wasting (CSW)

A
  • hypovolemia with low serum sodium and urine osmolality

- treatment: sodium replacement - NS IV, oral salt tabs

57
Q

seizure interventions

A
  • prevent injury
  • place on side to prevent aspiration
  • stay with patient
  • monitor for status epilepticus - emergency; suction equipment ready, monitor VS, provide oxygen
58
Q

medications of seizures (7)

A
  • 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
Q

seizures management

A
  • anti-epileptic drugs
  • vagal nerve stimulation
  • surgical interventions - limbic resection, anterior temporal lobe resection
60
Q

causes of acquired Parkinsonism

A

infection, trauma, drug toxicity (phenothiazines, butyrophenones), hydrocephalus, genetic/hereditary diseases

61
Q

early signs of Parkinson’s (3)

A
  • loss of flexibility
  • aching
  • fatigue
62
Q

4 cardinal symptoms of PD

A
  • resting tremors
  • bradykinesia - slow movement
  • rigidity - cog-wheeling
  • postural instability
63
Q

meds for PD (5)

A
  • levadopa
  • dopamine agonists
  • COMT inhibitors
  • dopamine releasers
  • MAO-B inhibitor
64
Q

levadopa side effects (4)

A
  • tardive dyskinesia
  • orthostatic hypotension
  • delirium
  • hallucinations
65
Q

drugs that assist levadopa (4)

A
  • carbidopa - increases absorption (Sinemet)
  • COMT inhibitors
  • stalevo
  • MAO-B inhibitors
66
Q

normal pressure hydrocephalus (NPH)

A
  • accumulation of CSF causing ventricles of brain to enlarge
  • can occur after injury or stroke
  • treat w/ VP shunt
67
Q

NPH triad of symptoms

A
  • gait disturbance
  • dementia, forgetfulness
  • urinary incontinence

AE III Exam 1 (3 decks)

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