Neurocognitive Disorders Flashcards
(33 cards)
Delirium
Characterized by a disturbance in attention and awareness and a change in cognition that develop rapidly over a short period
Delirium s/s
- difficulty sustaining/shifting attention
- distractiblity
- disorganized thinking
- speech that is rambling, irrelevant, pressured, incoherent and that unpredictably switches from subject-to-subject
- impairment in reasoning ability and goal-directed behavior
- illusions/hallucinations
- disturbances in sleep/wake cycle
Delirium predisposing factors
- serious medical, surgical, or neurological conditions
- age > 65
- dementia, depression, falls and elder abuse
- substance w/d and intoxication
- meds
- fam hx
- hypoxia
- nutritional deficiencies
- metabolic disturbances
- endocrine issues
- CVD
- infection
- chemical exposures
Who usually picks up on delirium in a pt first?
Nurses or family
Delerium objective assessments
- VS
- CNS exam
- labs
- check for infection – urine, blood
- check for hypoglycemia
- CMP
- drugs/ETOH
- EEG, CT, MRI, PET
- mental status exams
- MMSE
- nursing Delirium Screening Scale (NU DESC)
Goals in management of delirium
- fix underlying cause
- keep pt safe
- manage ADLs
- manage grief/depression/self-esteem
- care plan
Medical management of delirium
- dx and management of underlying causes
- treat symptoms
- low-dose antipsychotics
- Haloperidol (Haldol)
- Benzodiazepines if delirium d/t substance abuse w/d
Delirium
Nursing care: environmental aspects
- safety (furniture, low-stimulation, well-lit)
- reality orientation (controversy)
Delirium
Nursing care: communication
- keep it simple and factual
- use of distraction
- assure glasses, hearing aides
Delirium
Nursing care: pt needs
- assist with ADLs as needed
- ensure/assist with nutrition needs
- assist family/caregivers
Delirium
Evaluation
- safety
- orientation
- confusion
- agitation
- family needs met?
Neurocognitive disorder (NCD)
Classified as either mild or major
Mild NCD
- known as mild cognitive impairment
- early intervention could prevent or slow progression of the disorder
Major NCD
Previously known as DEMENTIA
NCD manifestations
- impairment in abstract thinking, judgement and impulse control
- uninhibited/inappropriate behavior
- vague language, aphasia
- personality, social conduct changes
- apraxia
- irritability/moodiness
- wandering
- profound memory deficits
NCD predisposing factors
- alzheimers disease
- vascular neurocognitive disorder
- frontotemporal neurocognitive disorder
- TBI
- Lewy body dementia
- Perkinson’s disease
- HIV infection
- substance abuse
- Huntington’s disease
- prion disease
- family hx
NCD subjective assessment
- client or family hx of progression of symptoms/level of severity
- cognitive decline
- how long
- how severe
- what domains affected?
- affect on ADLs
- behavioral/psychotic symptoms
- mood disturbances
- agitation/apathy
- stages of decline
NCD objective assessment
Same as delirium
Alzheimer’s Disease (AD)
- progressive mental deterioration that can occur in middle or old age, due to generalized degeneration of the brain
- the most common cause of premature senility
AD stages of progression of symptoms
1) no apparent symptoms
2) forgetfullness
3) mild cognitive decline
4) mild-to-moderate cognitive decline
5) moderate cognitive decline
6) moderate-to-severe cognitive decline
7) severe cognitive decline
AD etiology
- neurotransmitter alterations
- plaques and tangles
- head trauma
- genetic factors
A client with dementia and chronic confusion is suspected to have Alzheimer disease. Which imaging technique is specific for Alzheimer disease?
Magnetic resonance spectroscopy
Planning and interventions for NCD
- maslow
- SAFETY!!
NCD meds for treatment of cognitive impairment
- Donepezil (Aricept)
- Rivastigmine (Exelon)
- Galantamine (Razadyne)
- Memantine (Namenda)
