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Neurocognitive lecture Flashcards

1
Q

What is a neurocognitive disorder

A

Disturbances in
* Orientation
* Perception
* Memory
* Intellect
* Judgement
* Affect
Resulting in brain dysfunction

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2
Q

What are some effects of Neurocognitive disorders

A
  • Cannot understand facts
  • Cannot connect appropriate feelings to events
  • Results in inability to meet challenges of living (ADL)
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3
Q

Three main categories of neurocognitive disorders

A
  • Delirium
  • Dementia
  • Mild neurocognitive disorder
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4
Q

Normal aging

A
  • Some mild degree of forgetfulness is normal
  • Mild cognitive impairment does not always progress to severe cognitive impairments
  • Does not interfere with a person’s social or occupational behavior
  • Memory complaints are more related to depression vs normal aging
  • Intellectual function, capacity for change and productive engagement remain stable
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5
Q

Pseudodementia

A

Treatable disorders, that mimic dementia, usually depression

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6
Q

Possible causes of delirium

A
  • Restraints
  • HAC (Alcohol induced)
  • Falls
  • Sleep deprivation
  • Aspiration
  • Pneumonia
  • Pressure ulcers
  • Insufficent food intake
  • Drugs
  • Hypoglycemia
  • Fever
    *

Pt with delirium from drug withdrawl are at increased risk for seizures

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7
Q

Morbidity of delirium

A

Some fail to recover, can worsen over time to a stupor, dementia, coma, death

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8
Q

Complications of delirium

A

Increase risk for complications
* Falls
* Malnutrition
* decubiti
* Aspiration pneumonia
* Prolonged hospitalization

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9
Q

Decubiti

A

Pressure ulcers

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10
Q

S+S Delirium

A
  • Disorientation and confusion that fluctuates (Also sundowning)
  • Decreased LOC, looks scared
    *Acute onset
  • Last hours to weeks
  • Reversible if diagnosed and treated (Can lead to further exasperation if not)
  • Disruption of sleep wake cycle (Sundowning)
  • Disturbed psychomotor behavior (Agitation, purposeless movement to catatonic stupor)
  • Disorientation, incoherent memory disturbances
  • Altered perception in forms of illusions, hallucinations and delusions
  • Alterations in thinking, disorganized, irrational, delusions
  • Hypervigilant, to stupor or semi coma
  • Autonomic instability (Tachycardia, sweating, flushed face, dilated pupils, elevated BP)
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11
Q

Is delirium a primary or secondary medical condition

A

it’s always secondary to a medical condition

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12
Q

Causes of delirium: D

A

Drugs

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13
Q

Causes of delirium: E

A

Electrolyte imbalances (Dehydration)

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14
Q

Causes of delirium: L

A

Lack of drugs
* Withdrawal, pain

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15
Q

Causes of delirium: I

A

Infection
* Uti or pneumonia
* Syphilis
* Meningitis

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16
Q

Causes of delirium: R

A

Reduced sensory input
* Hearing or vision deficits

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17
Q

Causes of delirium: I

A

Intracranial
* CVA
* Subdural hemorrhage

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18
Q

Causes of delirium: U

A
  • Urinary retention/fecal impaction
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19
Q

Causes of delirium: M

A

Myocardial/pulmonary

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20
Q

Lab analysis for delirium

A
  • Urine analysis (UTI)
  • Liver enzymes
  • Glucose test
  • Electrolytes
  • Thyroid test
  • Vitamin B12
  • Drug and alc test
  • Rapid plasma reagin for syphilis
  • HIV testing
  • CT and MRI (CVA)
  • Lumbar puncture (Meningitis)
  • PET scan
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21
Q

Population most affected by delerium

A

Older adults

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22
Q

How long does delirium last

A

1 week to one month

Depending on underlying cause and age

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23
Q

Does delirium have permanent damage

A

Yes if left untreated, however if the underlying condition is treated then a complete recovery should occur

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24
Q

Delirium safety assessment

A
  • Pt wants to pull out IV, and cath
  • Falling out of bed
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25
Delirium comfort assessment
Sensory input is impaired, need to assess for pain, cold and positioning
26
Autonomic S+S of delirium
* INcreased vitals * Tachycardia * Sweating * Flushed face * Dilated pupils * elevated BP
27
Delirium Assessment: Physical
* Safety * Comfort * Vitals * **Drug** reactions or interactions * Electrolyte disturbances * Sleep wake disturbances * Infection (Done by provider)
28
Gold standard treatment for delirium
Prevention and early mgmt
29
Nursing interventions for delirium
* Early mgmt and prevention * Neuro checks regularly * Safety * Fall prevention/ prevent injury * Determine underlying cause * Electrolyte balance * Hydration and nutrition * Turn and position Q2hr * Therapeutic milieu environment * Introduce self and call pt by name (Reorientated) * Hallucinations: enforce reality * One piece of info at a time, short concrete sentences * make sure pt wears glasses and hearing aids * Reorientated (Clocks, calendars, well lit room, family pictures) * Educate and include family
30
Dementia etiology
* Interaction between genes, lifestyle and environment * Not a specific disease but a group a symptoms that can be caused by many different diseases * Different categories of dementia have different etiologies but a similar clinical picture * This is beyond the normal effects of aging
31
Dementia onset
Over months, not sudden
32
Dementia causes
* Alzheimer's * Vascular disease * HIV * Alcoholism
33
Dementia alterations in consciousness
None
34
Dementia mood/affect
Flat and or delusional
35
Dementia speech
Incoherent, **slow** speech
36
Is dementia reversible
No
37
Dementia memory
Impaired memory and judgment
38
Delirium Onset
Sudden: Hours to days
39
Delirium consciousness
Altered level of consciousness
40
Delirium mood/ affect
Labile mood, swinging
41
Delirium: Speech
Incoherent **RAPID** speech
42
Delirium memory
Impaired memory or judgment
43
Alzheimer's disease
* Most common cause of dementia * Mixed pathologies ( Can occur with other forms of dementia (Lewy- body or CVD)) * Early clinical symptoms * Late clinical symptoms
44
Alzheimer's disease: Early symptoms
* Memory impairment * Apathy * Depression
45
Alzheimer's disease: Late symptoms
* Impaired communication * Poor judgment * Physical impairment
46
Vascular dementia
* Occurs from cerebral blood vessel dmg (Stroke) * Ischemic or hemorrhagic processes * More common as mixed pathology (Not the only one) *** Cognitive and motor function impairment **
47
Initial symptom of vascular dementia
* Impaired executive functioning (Task management and higher level thinking)
48
Lewy body dementia
* Abnormal aggregations of proteins * Develops in the cortex * similar S+S to alzheimer's * Visuospatial impairment * Occurs with parkinson's disease
49
What protein is abnormal in lewy body dementia
Alpha-synuclein
50
Early S+S lewy body dementia
Sleep disturbances
51
Frontotemporal lobar degeneration (FTLD)
* Early symptoms * Memory is typically spared in early changes * Atrophy of frontal and temporal lobes * Abnormal protein inclusions * Earlier age of onset
52
Early symptoms of Frontotemporal lobar degeneration (FTLD)
Behavioral changes
53
TBI related dementia
* Occurs secondary to a tbi, from brain rattling around * Depending on severity of TBI symptoms may eventually subside or may be perm
54
dementia pugilistica-syndrome
TBI based dementia, caused by repeated injury Characterized by * Emotional instability * Dysarthria * Ataxia * Impulsivity Chronic traumatic encephalopathy Injury to frontal lobe and poor impulse control
55
Nursing assessment dementia
* Safety (Home environment, general) * PLan with family how mgmt labile moods, aggressive behavior, nocturnal delirium catastrophic reactions * Eval for suicide or aggression * Review meds including over the counter * Asses for evidence of abuse or neglect
56
Agraphia
S+S dementia Inability to read or write
57
Hyperorality
S+S of dementia Need to taste, chew and place objects in one's mouth
58
Hypermetamorphosis
S+S dementia Touching everything that one can see
59
Hallucinations and delusions interventions
* Minimize focus on delusional thinking * Reassure them they ar esafe * Never argue * DO not ignore reports of hallucinations: what they perceive is real to them and they can be disturbed by them (May need anti psych meds) * Assess for med side effects * Ensure hearing aids and glasses are available and working * Distraction techniques * Assess if hallucinations are problematic for pt
60
Risk for injury: Dementia
* Pt wants to pull out iV, foley, feeds * Wandering * Falling * Pressure injuries (From immobility) * Skin integrity
61
Pt care: Dementia
* Food and fluid intake monitoring * Monitor electrolytes * Vitals * Assistive devices * Weigh pt weekly * Offer finger foods * Ensure safety of solid foods (**Avoid hard candy, popcorn nuts**) * **Dysphagia can occur** try pureed foods or ensure or decision about tube feeding
62
Non pharm interventions: Dementia
* Reduce physical and chemical restraints * mgmt of pain * provide sensory stimulation activities and socialization * improve communication * Hearing aids and glasses * Regular toileting * relaxation strategies, massage * outdoor opportunities
63
Non pharm interventions: Dementia, memory enhancement
* Reinforce short and long term memory * Remind pt what they had for breakfast and what activities recently occured * Fill in blanks casually when memory falters * Encourage story telling of earlier years
64
Pharm interventions for dementia: Cholinesterase inhibitors
* FDA approved for alzheimer's (AD) * Lessens impairment in cognition, behavior and function in ADL as disease process advances * Makes more Acetylcholine available by inhibiting breakdown, stimulates nicotinic receptors to make more Ach * Mild to moderate AD * Some efficacy in lewy body dementia
65
Cholinesterase inhibitor: drug names
Donepezil (Aricept) Rivastigmine (Exelon) Galantamine (Razadyne)
66
Cholinesterase inhibitor: Side effects
* Effects are time limited * **GI disturbances** (N+V+D, increased gastric upset=risk for ulcers) * **Take with food** to minimize GI upset * Sedation and weight gain are **Unusual** * Rare effects is it worsening asthma * Lethal in overdose
67
Memantine (Namenda)
"Artificial magnesium" , known as a cognitive enhancer * NMDA- glutamatergic ion channel antagonist * Blocks over secretion of glutamate * **FDA approved for use during MODERATE to SEVERE stages of AD** * Does not stop or reverse effect of disease, just slows progression
68
Memantine (Namenda): SE
* Dizziness, HA, constipation
69
Antidepressants in Dementia
* Well tolerated in older pt (used in much lower doses) * Treats depression symptoms and anxiety * Need to avoid meds with anticholinergic side effects (Like TCA) * Older pt are at higher risk of anticholinergic tox
70
Trazodone
Antidepressant used to treat insomnia
71
Atypical antipsychotics in dementia
* NOT indicated for used in dementia * Increased risk of for stroke in elderly dementia pt * Black box warnings associated with increased risk of death in elderly pt who display psych behaviors (Cardio relate) * **Limited use only** * **Behavioral interventions preferred**

NSG 470 (26 decks)

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