Neurocognitive Disorders Flashcards
(33 cards)
What is the onset, cause and prognosis of delirium ?
- sudden and fluctuating over the course of hours to days (immediate medical intervention)
- underlying medical conditions such as UTI, substance use, effects of meds
- reversible with proper and timely treatment
What is the onset, cause and prognosis of dementia ?
- slowly, over months to years
- alzheimer’s, vascular disease, HIV, neurological, chronic alcoholism, head trauma
- not reversible, progressive
What are some S&S of delirium ?
- disturbance in attention
- abrupt onset with periods of lucidity
- disorganized thinking
- poor executive functioning
- disorientation
- anxiety and agitation
- poor recall
- delusions and hallucinations (usually visual)
What are the 4 cardinal features of delirium ?
- acute onset and fluctuating course
- reduced ability to direct, focus, shift, and sustain attention
- disorganized thinking
- disturbance of consciousness
What are some assessments of delirium ?
- don’t assume acute confusion is dementia
- assess for acute onset and fluctuating levels of awareness
- assess ability to attend to immediate environment including responses to RN care
- establish their usual level of cognition (ask family)
- assess for past cognitive impairments (existing diagnosis or more risk factors)
- identify disturbances in physiologic status (infection, hypoxia, and pain)
- assess VS, LOC, neurologic status
- assess for potential for injury
- maintain comfort measures
- monitor factors that worsen or improve symptoms
- assess for availability of immediate medical interventions to help prevent irreversible brain damage
What are some RN interventions for delirium ?
- prevent physical harm due to confusion, aggression or fluid and electrolyte imbalance
- minimize use of restraints (increases confusion)
- perform comprehensive RN assessment to identify cause
- assist with proper health management to eradicate underlying cause
- use supportive measures to relieve distress and agitation
- if hallucination: well-lit room without shadows/glare, limit noise and stimulation
What is frontotemporal dementia ?
impaired social cognition, disinhibition, apathy, compulsive behavior, poor comprehension and language difficulties
What is dementia with lewy bodies ?
fluctuating cognition, early changes in attention, and executive function
- sleep disturbances
- visual hallucinations
- muscle rigidity
- other parkinsonian features
What are some key points of Alzheimer’s ?
- cholinergic pathways are selectively destroyed (decreased ACh)
- hippocampus and amygdala are significantly affected (past memories go away)
- brain atrophy seen on MRI
- neuronal death and neurotransmitter deficency are thought to be present
What are some S&S of Alzheimer’s ?
- memory impairment
- disturbances in executive functioning
- denial
- avoidance of questions
- aphasia: loss of language ability
- apraxia: loss of purposeful movement
- agnosia: loss of sensory ability to read or write
- confabulation: creation of stories or answers in place of actual memories to maintain self-esteem
- perservation: persistent repetition of words, phrase or gestures
- sundowning: mood deterioriation and increase in agitation late in day or night
What occurs in mild Alzheimer’s disease ?
noticeable memory lapses
- may still be able to function independently
- difficulty retrieving correct words or names
- trouble remembering names when introduced to new people
- greater difficulty performing tasks in social or work settings
- forgetting material that one has just read
- losing or misplacing a valuable object
- trouble with planning or organizing
What occurs in moderate Alzheimer’s ?
confuses words, gets frustrated or angry, acts in unexpected ways
- forget events or own personal history
- become moody or withdrawn, especially in social or mentally challenging situations
- unable to recall own address of phone number, or high school or own college
- become confused about where they are and the day
- need help choosing proper clothing for season or occasion
- trouble controlling bladder and bowel
- changing sleep patterns
- risk of wandering or getting lost
- become suspicious, delusional or compulsive
What occurs in severe Alzheimer’s ?
loses the ability to respond to their environment, carry on conversation, and eventually control movement
- need extensive help with ADLs
- lose awareness of recent experiences and their surroundings
- require high full-time assistance with ADLs
- experience changes in physical activity (walking, siting, swallowing)
- increased difficulty communicating
What are some assessments for Alzheimer’s ?
- eval current level of cognitive and daily functioning
- identify threats to safety and security
- eval safety of person’s home environment if possible
- review medications
- interview family to gain complete picture of background & personality of pt
- explore how informed and prepared family is
- discuss coping with family members
- review available resources
- identify needs of the family and provide guidance
What are some RN interventions for Alzheimer’s ?
- education family/staff on interaction with confused patients
- engage pt in self-care activities (simple, step-by-step instruction)
- meaningful acitivities/exercise
- intellectual/physical stimulation
- reduce over-stimulation
- meditation/massage
- redirect to familiar topics for anxiety and agitation
- calming music
- pet therapy
What meds are used for mild-moderate alzheimer’s ?
Cholinesterase inhibitors
- rivastigmine
- galantamine
What are characteristics for Cholinesterase inhibitors ?
- increases available ACh which slows deterioration of cognitive functioning
- Exelon patch good for pt’s who forgot how to swallow
- SE: N/V/D, insomnia, fatigue, muscle cramps, incontinence, bradycardia, syncope
What meds are used for moderate to severe alzheimer’s ?
- NMDA antagonist: Memantine & Memantine/Donepezil
What are some characteristics of NMDA antagonists ?
- regulates glutamate activity by blocking NMDA receptions (decreases excitatory neurotoxicity)
- no evidence that it modifies underlying disease
- SE: dizziness, agitation, HA, constipation, and confusion
What are some meds for behavioral symptoms ?
No meds are FDA approved
- antidepressants: decrease anxiety & compulsive behaviors (SSRIs and trazodone)
- antipsychotics: tx of psychosis & agitation (use with caution)
- due to increased risk of CV events, CVA and death
- avoid long term use of Benzo’s: helpful in highly anxious patient
- associated with increased falls, disinhibition, over-sedation and worse confusion
- useful for acute sedation before procedure
What are cluster A personality disorders ?
Eccentric/Odd/Bizarre
- paranoid
- schizoid
- schizotypal
What are cluster B personality disorders ?
Erratic
- borderline
- narcissistic
- histrionic
- antisocial
What are the cluster C personality disorders ?
Anxious
- avoidant
- dependent
- obsessive-compulsive
What are the characteristics of paranoid disorder ?
Description:
- social anxiety in childhood
- jealous, controlling as adults
- unwillingness to forgive and projection of feelings
Interventions:
- counteract mistrust: adhere to schedule and avoid being overly-friendly, project neutral but kind affect
- psychotherapy vs. group therapy
- shortterm antidepressants
