Test #2 - Dementia/Delirium Flashcards Preview

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Flashcards in Test #2 - Dementia/Delirium Deck (39):
1

What are some Behavior, Speech and CNS assessments for delirium?

Behavior:
Poor impulse control, withdrawn or agitated 

Speech:
Dull or Rapid and pressured

CNS: 
Anemia, Ischemia, Hypoglycemia, Lack of Vitamin B, Endocrine disorders, toxicity from alcohol or drugs, trauma or infections

 

 

2

What are some affect, Cognition, Interpersonal Relationships and physical assessments for Delirium?

Affect:
Range from apathy to irritability, Labile emotions, laughing or sad, Bizarre behavior at night/Sundowner's

Physical:
Sleep disturbance and tremors, Picking at clothes or the air

Cognition:
Disorganized thinking, Rambling speech and decreased ability to maintain and shift attention, thinking/memory/attention/perception are disturbed
Visual hallucinations/altered perception are common

Interpersonal Relationships:
Families are anxious and frightened

3

What are some Delirium interventions?

Eliminate cause of delirium

Monitor LOC continually

Reorient with each interaction - introduce self and call client by name

Use short, simple, concrete phrases

Keep the room well lit

Provide clocks/calendars

Have client use assistive devices (hearing aids/glasses)

Clarify reality while justifying emotions/feelings

4

When a patient is having Delirium you want to treat the ________ _______ before trying to treat the Delirium.

When a patient is having Delirium you want to treat the UNDERLYING CAUSE before trying to treat the Delirium.

5

What are some cultural considerations when dealing with Dementia?

AMERICA:
Increased risk for Latin Americans and African Americans

EUROPE & ASIA:
Japanese, Italians and thos from Hong Kong are at increased risk

Inc with clients with previous head injuries

Inc with clients with relatives that have AD

Increased in lower educational and socioeconomic levels

6

Early onset of Dementia is rare (5%), and it is related directly to the ________ gene.

Early onset of Dementia is rare (5%), and it is related directly to the ALZHEIMER'S gene.

7

There are 2 etiologies for Dementia, the first one is Neurofibrillary tangles, what does it do?

Twisted Fibrils inside the neuron that disrupt cellular processes and eventually kill the cell

8

There are 2 etiologies for Dementia, the second one is Plaques, what does it do?

It is the quantity of plaques in relation to the person's age that is signifigant

Widened sulci and narrowed gyri

9

Alzheimer's affects what? (3 things)

Communication

Metabolism

Repair process of Neurons in the brain

10

When a patient has Alzheimer's it causes what 3 things?

Memory failure

Personality changes

Difficulty carrying out ADL's

11

There are 4 stages of AD, what are they?

Mild

Moderate

Moderate/Severe

Late/End Stages

12

What are some characteristics of Stage 1 (Mild AD)?

Short term memory loss

Uses memory aids such as lists and routines

Aware of the problem

Depression is common

NOT diagnosable at this stage

13

What are the characteristics of Stage 2 (Moderate AD)?

Progressive Memory Loss

Withdrawn from social activities

Decline in instrumental ADL's
(Money management, cooking, driving)

DENIAL
Fears of "losing" his/her mind

Depression

Confabulation

Symptoms worsen with physical/emotional stress

14

What are some characteristics of Stage 3 (Moderate/Sever AD)?

ADL Losses:
Willingness to bathe, grooming, choosing clothing, toileting, communication, reading/writing

Loss of reasoning ability

Depression resolves as they become unaware of loss

Difficulty communicating

Usually institutionalized or need care 24-7

15

What are characteristics of Stage 4 (Late/End Stage)?

Family recognition/self recognition disappears

Non-Ambulatory

Forgets how to eat, swallow, chew, wt loss

Incontinence

24-7 Care required

Return to infantile reflexes and ultimately death
DEATH USUALLY SECONDARY TO INFECTION OR CHOKING

16

What are 7 warning signs of AD?

Asking same ? over and over

Repeating same story, word for word

Forgetting how to do activities tha twere previously done with ease:
cook, make repairs, play cards

Losing one's ability to pay bills or balance one's checkbook

Getting lost in familiar surroundings

Neglect to perform personal hygeine

Relying on someone else close to them to make decisions or answer questions that they used to handle
 

17

What is another disorder that mimics Dementia?

Pseudodementias

18

What are some causes of Pseudodementias?

Drug Toxicity

Infections (UTI, Pnemonia)

Metabolic disorders

nutritional deficiencies

Depression (MOST COMMON)

CHF

Fever

Terminally Ill

19

What does Donazepil (Aricept) do?

Improves Cognitive funcion

by

Improving cholinergic function by inhibiting acetylcholinesterase

20

What is the inital dose for Donazepil (Aricept) and then what do you increase it to?

5mg for 4-6 weeks

10mg after

21

What are some Side Effects of Dementia Meds (Cholinesterase Inhibitors)?

Headache

Diarrhea

Nausea

Sweating

Bradycardia

Insomnia

22

What do you want to teach about Dementia Meds (Cholinesterase Inhibitors)?

Taking after breakfast may lessen side effects

How to monitor pulse

That is DOES NOT CURE, only slows down the disease

23

What are some Multisciplinary interventions for Dementia?

Speech Therapy

Physical Therapy

Occupational Therapy

Social Workers

Pastoral Counselors

Gene Therapy
New Nerve Growth

24

What are some alternative therapies for Dementia? LOTS OF THEM

Antioxidants
Green tea, grape seed extract, deepest color fruits & veggies

Omega-3 Fish Oil
Salmon, mackerel, sardines

Phosphatidyl Serine
Keep nerve cells flexible

Melatonin
For sleep

Estrogen
May be preventative in women (not useful for existing)

Dehydroepiandrosterone (DHEA)
Regulates Mood

S)adenosylmethionine (SAMs)
Improves cell membrane flexibility, caution in people with cardiac history

Lecithin
Found in soybeans & eggs

Ginkgo Biloba
Increased risk for bleeding

Music

Touch

Animal-Assissted

25

What are some behavior assessments for Dementia?

Wandering

Unable to do Complex Tasks

Frightened by their confusion

Attempt to cover up symptoms

Need assistance dressing

Repetitve behaviors
IE: lipsmacking, pacing

Sundown Syndrome:
Disoriented at days' end, oriented during the day

26

What are some assessments for Affect for Dementia?

Mild stage: Anxiety & depression occur

Moderate Stage: Inc lability of emotions (rage/irritability)

Severe Stage: Person becomes unresponsive to environment

27

What are some cognition assessments for dementia?

Decrease in Concentration

Increased Distractibility

Absent mindedness

unable to make judgements

Language skills begin to deteriorate

Difficulty word-finding

Mod AD: Memory Loss (recent and Remote)

Confabulation: Filling in gaps with imaginary information

Misidentification Syndrom: Familiar people are unfamiliar

Aphasia - Unable to understand language

Agraphia - Unable to read or write

Agnosia - Unable to recognize familiar people or situations

Alexia - Unable to tell what to do with a frying pan, toothbrush, telephone

28

What are some perception assessments for Dementia?

Visual Hallucinations are MOST common

29

What is being unable to understand language?

Aphasia

30

What is it when you are unable to read or write?

Agraphia

31

What is it when you are unable to recognize familiar people or situations?

Agnosia

32

What is it when you are unable to tell what to do with a frying pan, toothbrush, telephone etc?

Alexia

33

What are some Dressing and bathing interventions for AD?

Have pt perform task to their capacity

Always have pt wear own clothes

use clothing w/ elastic/velcro buttons

Label clothing w/name

Give step by step instructions

If resistant to self care come back later and try again

34

What are some nutrition interventions for AD?

Monitor food and fluid intake

Offer finger foods

Weigh pt once a week

During hyperorality make sure pt doesn't eat non-food items

 

35

What are some bowel/bladder function interventions for AD?

Begin bowel and bladder training early

start with bladder control

Evaluate use of diapers

Label bathroom door as well as other rooms

36

What are some sleep interventions for AD?

Keep room well lit b/c pt may be awaken and scared

Maintain calm atmosphere during day

Order non barbituates if neccessary

If meds are indication consider neuroleptics

Avoid the use of restraints

37

What are the 5 A's for Alzheimer's?

38

Dementia Mnemonic

39

Sundowning