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N3526 Psychiatric and Mental Health Care > Final - Neurocogntivie > Flashcards

Flashcards in Final - Neurocogntivie Deck (26):

What is delirium?

It is an organic mental disorder characterized by a cluster of cognitive impairments with an acute onset and identification of a specific precipitating stressor


What are the characteristics of delirium?

  1. A disturbance in attention and awareness
  2. Develops over a short period of time and tends to fluctuate in severity during the course of a day
  3. An additional disturbance in cognition (memory deficit, disorientation, language, visuospatial ability, perception)
  4. Disturbances in 1 and 3 are not better explained by another neurocognitive disorder
  5. Direct result of:
    • Medical condition
    • Substance intoxication or withdrawal
    • Exposure to a toxin
    • Multiple etiologies


What classifies someone as having substance intoxication delirium?

When symptoms in Criteria A and C predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention


Describe the realtionship between age and gender and delirium?

  • Risk is greater for women
  • Most prevalent in children and those over 60 years of age
  • Children may be more prone than adults
    • Medication
    • Febrile response
    • Anxiety


What is the prognosis for a patient with delirum?

  • Medical emergency!!!
  • Reversible if diagnosed and treated early
  • May remit spontaneously
  • May progress to dementia and other chronic problems
  • With treatment- 1 to several weeks
  • 10% of clients progress to coma and death


What would you use to assess a patient for possible delirium?

  • Mental status exam
  • Mini-mental status exam
  • Assess memory, thought processes, attention, and concentration
  • Involve family members and significant others as historians
  • Behavioral rating scales
  • Assessment of medication combinations


What are some nursing interventions for delirum?

  • Individualized, based on cause 
  • Prioritize patient safety
  • Use alternatives to physical restraints , use least restrictive methods first!!
  • Reality based treatment --> music, flowers to smell,
  • Avoid escalating anxiety --> reduce noise, coordinate the lighiting,
  • Pharmacological interventions
    • benzodiazepines  (would wnat to use adavan & serax because of short halflife)
    • anxiolytic (BuSpar)
    • antipsychotics
    • dexmedetomidine
  • Delirium assessment
  • Pain management
  • Early mobilization
  • Elimination of unnecessary medication
  • Interdisciplinary team management


What are some outcomes for patients with delirium?

  • No injuries
  • Return to baseline functioning
  • Ability to communicate thoughts and feelings
  • Ability to understand others


What is the criteria to be diagnosed with major neurocognitive disorder?

  • Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains:
    • Attention
    • Executive function
    • Learning
    • Memory
    • Language
    • Perceptual-motor
  • The cognitive deficits:
    • Interfere with independence in everyday activities
    • Do not occur exclusively in the context of a delirium
    • Are not better explained by another mental disorder


What is the critqeria to be diagnosed with mild NCD?

  • Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains:
    • Attention
    • Executive function
    • Learning
    • Memory
    • Language
    • Perceptual-motor
  • The cognitive deficits:
    • Do not interfere with independence in everyday activities
    • Do not occur exclusively in the context of a delirium
    • Are not better explained by another mental disorder


What are the characteristics of major or mild NCC due to Alzheimer's?


What are some characteristics of Alzheimer's?

  • More common in women than men
  • Number 1 mental health problem in elderly


What are some risk factors for Alzheimer's?

  • Advancing age
  • Family history
  • APOE- ɛ4
  • Mild Cognitive Impairment (MCI)
  • Cardiovascular disease risk factors
  • Social engagement and diet
  • Traumatic Brain Injury (TBI)


How can alzheimer's be diagnosed?


What are some biological theories for the cause of Alheimer's?

  • Amyloid cascading hypothesis
  • Cholinergic theories
  • Genetic theories


What are some nursing interventions for a patient with Alzheimer's?

  • Safety
  • Breaking down tasks
  • Encouragement
  • Orientation --> calendar's, newspapers, clocks,
  • Frequent assessment
  • Safe places to wander
  • Remotivation therapy-->
  • Medication management


What is sundowning?

Confusion and agitation with the conset of evening?


What is confabulation?


What are the pharmacological interventions for alzheimer's?

Cholinesterase inhibitor therapy
  • tacrine (Cognex)
  • donepezil (Aricept)
  • galantamine (Reminyl, Razadyne)
  • rivastigmine (Exelon)
Antipsychotic therapy
  • haloperidol (Haldol)
  • risperidone (Risperdal)


How are patients with Major or Mild Vascular NCD diagnosed?  Describe the pathophysiology

  • Small emboli or strokes
  • Computed tomography (CT) and magnetic resonance imaging (MRI)
  • Multiple lesions of the cerebral cortex and the sub-cortical structures of the brain
  • EEG may reveal focal lesions
  • Diagnosis based on:
    • history of CAD
    • reported episodic decline in function
    • physical examination of neurological abnormalities


What is the prognosis for patients with mild or major vascular NCD?

  • May be preventable
  • Aggressive treatment may reduce incidence and severity
  • Early indicators/Risk factors
    • Risk for CAD
    • Declining scores on mental status exams


What are some nursing interventions for dementia (neurocognitive declines)?

  • Medication management
    • Nootropics  - “smart drugs”
  • Family support and education
  • Manage therapeutic environment
  • Physical assessment
  • Monitoring and maintenance
    • vital signs
    • fluid and nutritional intake
    • sleep-wake cycle
    • skin care


What are some Interventions for Patients With NCD:
Chronic Confusion

  • Use simple concise language with a low pitched voice
  • Use concrete rather than abstract language  --> give them options
  • Eliminate distracting background stimuli
  • Arrange the unit with a reality orientation board
  • Place cherished familiar objects in room
  • Don't agree or disagree, redirect the patient, talk about the patient's feelings.
  • Refrain from confronting or arguing
  • Refrain from agreeing or disagreeing with delusions


Interventions for Patients With NCD:
Social Interaction, Impaired
Self-Care Deficits

  • Ensure patients have dentures, glasses, and hearing aids when needed
  • Adhere to routine care
  • Engage clients in short, routine social interactions
  • Assess client’s ability to perform once familiar motor tasks and offer assistance when necessary


What are some issues of caregiving with patients with dementia?

  • Disruption in family dynamics
  • Caregiver fatigue
  • Depression
  • Financial
  • Cultural
  • Spiritual


What are some family interventions for patients with dementia?

  • Refer to support groups in community
  • Provide other information about support systems in community
  • Refer family members for a physical examination
  • Provide health promotion education
  • Teach stress management skills
  • Teach about medications
  • Explain patient may use confabulation in social situations and give rationale
  • Inform family that client responds better to reminiscences about the past rather than to “here and now.”