Week 5 (Exam 2 study material) Flashcards
(102 cards)
1
Q
Cognition
A
Ability of the brain to process, retain, and use information
2
Q
Delirium definition
A
Disturbance of consciousness, accompanied by a change in cognition
3
Q
Delirium is a disturbance in what?
A
Attention and awareness
4
Q
What often accompanies a change in cognition?
A
memory deficit, disorientation, language disturbance
5
Q
What perceptual disturbances can delirium lead to
A
Illusions and hallucinations
6
Q
Symptoms of delirium
A
- Impaired judgement • Impaired orientation • Memory
- Attention
- Consciousness
- Disorganized thinking
- Perception disturbances
- Change in emotions
- Autonomic manifestations
skim over these
7
Q
What are autonomic manifestations of delirium?
A
Tachycardia, sweating, flushed face, dilated pupils, elevated blood pressure
8
Q
Delirium onset
A
Develops over a short period of time, usually presents abruptly
Duration is usually brief and subsides completely on recovery from underlying cause
Symptoms usually fluctuate during the day
9
Q
Treatment of delirium
A
Corrections of underlying condition to promote recover
10
Q
What medical conditions might delirium result from?
A
Infections, febrile illness, metabolic disorders, head trauma, seizures, migraine headaches, brain abscess, stroke, electrolyte imbalance, and others
11
Q
Describe substance-induced delirium and certain substances that can lead to this.
A
May be caused by intoxication or withdrawal from certain substances
• Anticholinergics, antihypertensives, corticosteroids, anticonvulsants, analgesics, and others
• Alcohol, amphetamines, cannabis, cocaine, hallucinogens, inhalants, and others • Toxins, including organic solvents and fuels, lead, mercury, arsenic, carbon
monoxide, and others
12
Q
Delirium tremens
A
Go back and looks
13
Q
Delirium treatment
A
• Underlying causes
• Staff to remain with patient at all times to monitor
behavior and provide reorientation and assurance.
• Room with low stimulus
• Low-dose antipsychotic agents to relieve agitation and aggression
• Benzodiazepines commonly used when etiology is substance withdrawal
14
Q
Neurocognitive Disorders: Mild (mild cognitive impairment) - brief description
A
- Early intervention, slow progression
- Modest cognitive decline from previous functioning
- Does not interfere with ADLs
Gradual onset typically, progressive decline
15
Q
Neurocognitive disorders: Major (Dementia) - brief overview
A
Significant cognitive decline from previous functioning
Interferes with ADLs
Gradual onset, progressive decline
16
Q
What is the most common predisposing factor to neurocognitive disorder?
A
Alzhiemer’s disease (50-80% of all cases)
17
Q
Neurocognitive disorder may be due to what?
A
Prion disease, TBI, Lewy body dementia, Parkinson’s disease, HIV, Huntington’s
18
Q
Primary Neurocognitive Disorder
A
those in which the disorder itself is the major sign of some organic brain disease not directly related to any other organic illness (e.g., Alzheimer’s disease).
19
Q
Secondary Neurocognitive disorder
A
caused by or related to another disease or condition (e.g., H I V disease or cerebral trauma).
20
Q
MND: Dementia - what?
A
- Acquired impairment of memory and other intellectual functions of sufficient severity to interfere with social and occupational functioning
- Severe impairment in memory, judgement, orientation, and cognition
- Severity (mild, moderate, severe)
21
Q
What might someone experience as Dementia progresses?
A
- Aphasia
- Apraxia
- Irritability and moodiness, with sudden outbursts over trivial issues
- Inability to care for personal needs independently
- Wandering away from the home
- Incontinence
22
Q
What is reversible neurocognitive disorder, and what is it often a result of?
A
Temporary dementia
It can occur as a result of: • Stroke • Depression • Side effects of medications • Nutritional deficiencies • Metabolic disorders
23
Q
Alzheimer’s Disease onset
A
Slow, insidious onset. Typically runs a progressive, irreversible course with continuing cognitive decline and behavioral symptoms
7 stages
24
Q
7 stages of Alzheimer’s disease
A
- No apparent s/s
- Forgetfulness
- Mild cognitive decline
- Mild-to-moderate cognitive decline
- Moderate cognitive decline
- Moderate to severe cognitive decline
- Severe cognitive decline
25
Alzheimer's disease - etiology
Neurotransmitter alterations, decreased metabolic activity, plaques and tangles, trauma, genetic factors
26
Prion Disease
caused by a small protein-like infectious particle believed to be responsible for CNS diseases
27
Vascular dementia:
may range from large vessel stroke to microvascular disease; caused by decreased blood supply to the brain.
28
Frontotemporal lobar degeneration
affects frontal & temporal lobes; may be genetic; onset 50-60 yrs
29
Lewy body dementia:
Microscopic protein deposits in nerve cells disrupt the brain’s normal functioning, causing it to slowly deteriorate
30
Parkinson's disease
Loss of neurons of the basal ganglia –
| tremor, rigidity, bradykinesia, postural instability
31
Huntington's disease
(inherited gene) cerebral atrophy, demyelination & enlargement of brain ventricles
32
Nursing role: taking history from someone with neurocognitive disorders
* Obtain physical and psychosocial history from family
| * Family history of Huntington’s, Parkinson’s, Alzheimer’s disease?
33
Nursing assessment for MND
Assess mental status, current and past medications, drug/alcohol history, possible exposure to toxins, neurological functioning
34
NCD psychosocial models of nursing interventions (4)
Reframing (offering alternative points of view to explain events)
Supportive touch (holding the hand of client that is fearful)
Reminiscence therapy (thinking about significant past experiences)
Distraction (shifting client’s attention & energy to a more neutral topic)
35
What are pharmacological interventions for NCD?
* Cholinesterase inhibitors (donepezil, rivastigmine, galantamine)
* NMDA receptor antagonist (memantine/Namenda)
* Antipsychotics
* Antidepressants
* Antianxiety agents
36
Delerium vs Dementia (Compare and contrast)
```
Delirium:
• Rapid onset
• Develops within hours/days
• Level of consciousness is impaired
• Short-term memory is impaired
• Speech maybe slurred, rambling, irrelevant
• Temporary disorganized thinking
• Hallucinations/delusions
• Mood- anxious, tearful, irritable, restless, fearful
```
Dementia:
• Gradual onset
• Progressive decline
• Impaired short/long term memory
• Speech is normal until later stage
• Thinking is impaired until later; loss of thinking ability
• May have paranoia, hallucination, illusions
• Mood- depressed, anxious; later may become labile, restless, pacing, angry outbursts
37
Why are psychiatric disorders harder to diagnose in children?
Children lack ability to describe what is happening
Due to constant changing and developing hard to
know what is normal/abnormal
38
When are neurodevelopmental disorders usually diagnosed in children?
Neurodevelopmental disorders usually diagnosed in infancy, childhood, or sometimes adolescence
-- many persist into adulthood
39
Incidence of Intellectual disability disorder
during time of significant development
40
Intellectual Disability Disorder predisposing factors
```
Genetic factors
Maternal alcohol/drug use
Illness/infection
Pregnancy/perinatal factors
Sociocultural and other mental disorders
```
41
What is assessed during intellectual disability disorder that constitutes a diagnosis?
IQ 70 or lower
Deficits in adaptive functioning (communication, independent living, school work)
Deficits in reasoning, problem solving, abstract thinking
42
Slide 6/27 of neurodevelopmental disorders in children and adolescents
IQ and IDD
43
Intellectual Disability Disorder (IDD) nursing interventions
```
Safe environment
Involvement with family
Staff and environment consistency
Behavior modification (BMOD)
Simple, concrete explanations
Positive feedback
Encourage independence
```
44
Prevalence of autism spectrum disorder
about 1 in 59 children in US
4x more likely in boys
almost 1/2 with a d have average to above IQ
45
autism spectrum disorder: predisposing factors
Don't know cause; brain imaging show enlarged total brain volume; amygdala and striatum in young children enlarged and then tend to decrease over time; genetic factors play big role (not always same gene); advanced parental age (mother); fetal exposure to valproate (med for bipolar disorder), gestational diabetes, gestational bleeding
46
Autism spectrum disorder: what do you see in assessment?
a. impairment in social interactions
b. impairment in communication and imaginative activity
c. restrictive activities and interests
d. stereotyped motor behaviors (sway, clapping)
47
slide 10/27 in W5 neurodev. & other disorders children and adolescents .pdf
Behaviors common with ASD
48
Autism nursing disorder: Diagnoses
Risk for self-mutilation or self injury
Impaired social interaction
Impaired verbal communication
Disturbed personal identity
49
Autism spectrum disorder: interventions
```
Protect from self-harm/self-directed violence
Intervene with diversion
Positive reinforcement
Work 1:1 with patient
Limited number of caregivers
Routine and predictable environment
Familiar objects
```
50
ASD pharmacological interventions
Aripiprazole (Abilify) - 1st generation
Risperidone (Risperdal) - 2nd generation
Both are to give relief of irritable and aggressive s/s
No meds to treat impair s/s (social skills)
FDA approved for irritability
Both are antipsychotics
51
ADHD prevalence
Higher incidence in males; some children grow out of it
52
ADHS predisposing factors
Genetics
Neurotransmitters such as dopamine, NE and possibley serotonin (don't know exact MOA)
Decreased volume and decreased activity in prefrontal cortex (impulsivity)
```
Mother smoking while pregnant
Exposure to substances in utero
Maternal infections (or as child)
Low birth rate
Trauma early in life
Insults to brain while developing
Exposure to lead
Chaotic home/no structure
```
53
ADHD assessment: hyperactive
Rapid speech
54
ADHD assessment: inattentive
```
Impulsivity
Distractibility
Limited attention span Disruptive, intrusive
Fidgeting
Boundless energy
```
55
ADHD Nursing interventions
```
Create safe environment
Decrease stimuli and distractions
Adequate supervision and assistance
Setting clear limits and expectations
Consequences for unacceptable behavior
Group situations to enhance social behaviors
Behavioral Modification (BMOD)
```
56
ADHS pharmacological interventions: CNS stimulants
Amphetamines (Adderall)
Methylphenidates (Ritalin/Concerta)
Stimulants = first line of defense; we do not know MOA beside an increase in dopamine and NE (calm)
57
Side effects of Amphetamines and Methylphenidates to treat ADHD
insomnia, weight loss, suppress growth in children with chronic use, can cause worse anxiety
58
Nurse teaching for Amphetamines and Methylphenidates to treat ADHD
after or with meals
59
When should a client not take Amphetamines and Methylphenidates to treat ADHD
cardiac issues or at risk for cardiac issues
60
What are non-stimulant medications to treat ADHD
Atomoxetine (Strattera) -- increase NE, long term
Bupropion (Wellbutrin) -- increase NE, antidepressant
Guanfacine (Tenex) -- alpha-agonist; mild sedation; tend to have effects on BP because it is a BP med.
Clonidine (Kapvay) -- alpha-agonist; mild sedation; tend to have effects on BP because it is a BP med.
61
What is a tic?
motor movements or vocal phrases that are compulsive or irresistible
-- might start with single tic starting in face then move down body
62
Describe a complex tic
hop, skip, taping, squatting, retracing steps
63
What exacerbates a tic
Stress, not sleeping, caffeine, alcohol, drugs
| -- s/s wax and wane over time
64
What is Tourette disorder and what is the prevalence
Specific tic disorder; presence of multiple motor tic and 1 or more vocal tics (can be simultaneous or periods of motor/vocal only)
More common in males
65
Tourette disorder: predisposing factors
Biological
| Environmental (mother using alcohol while pregnant, low birth weight, complications during birth, infection)
66
What is a Tourette disorder typical diagnosed?
Dx as early as 2; occurs common in childhood
67
Tourette disorder: assessment
The essential feature of Tourette disorder is the presence of multiple motor tics and one or more vocal tics
68
Tourette disorder nursing interventions
```
Decrease stimuli and stressing events
Redirect violent behavior
Mittens or restraints as needed
Group situations
Set limits
Unconditional acceptance and positive regard
```
69
Why do children with Tourettes disorder have risk for violent behavior?
other children making fun of them
70
What the is more effective treatment of Tourette disorder?
Medication in combination with therapy
| -- behavioral therapy, individual therapy, family therapy
71
What is a 1st generation medication that can be used to treat Tourette disorder?
Haloperidol (Haldol) and Pimozide (Orap)
- - help control motor and vocal tics
- - do not use in children/adolescents d/t sfx
72
What are 2nd generation medications that are often used to treat Tourette disorder?
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Ziprasidone (Geodon)
-- more commonly used d/t less severe sfx
73
What are medications that are not antipsychotics that are used for the treatment of Tourette disorder?
Clonidine (Kapvay)
| Guanfacine (Tenex)
74
Separation anxiety disorder: onset and prevalence
Onset: anytime before 18
Most common when child first goes to school
Most common in girls
75
Separation anxiety: Predisposing factors
```
anxiety
genetics
changes or losses
mothers being stressed while pregnant
over protective parents
child/parent having insecure attachment
maternal depression
```
76
Separation anxiety disorder assessment; what do you see?
Developmentally inappropriate reaction
Acute, maladaptive reaction to an overwhelming, identifiable, psychosocial stressor
Impaired school performance
Clinging behaviors, tantrums
Crying, somatic complaints
Nightmares, refusal to sleep alone or away from home
77
Separation anxiety disorder nursing interventions
Treat patient in sensitive, considerate and supportive manner
Anxiety relief measures (safety, comfort from family presence)
Positive reinforcement
Small, attainable goals
School/other support for educational/occupations settings
78
Separation anxiety treatment
Psychotherapy
| May see antidepressant/anxiolytic medications
79
Studies have shown evidence that what neurotransmitters affect eating habits?
NE and serotonin
80
Etiology of eating disorders?
- Specific cause = unknown
- Dieting can be a stimulus
- Tend to run in families (learned)
- May not be genetic, but may stem from personality types or susceptibility or psychiatric disorders
81
Why might someone with anorexia have low levels of epinephrine?
d/t long periods of decreased food intake d/t decreased metabolism
82
Patients with bulimia may have low levels of what?
serotonin
83
What are common characteristics of anorexia nervosa
Life threatening eating disorder
Characterized by food restriction
Intense fear of gaining weight/being fat
Persistent behavior that interferes with weight gain
Disturbance in self-perception of weight/shape
84
BMI of someone with anorexia nervosa
17 or lower
85
Incidence of anorexia nervosa
- Men account for 25% of those with anorexia
- Average age of onset is 12-25 years of age, thus puberty is a strong risk factor
- Third most common chronic disease among young people
86
Anorexia nervosa is characterized by what?
body weight less than the minimum expected weight for age, height and overall health
87
Anorexia nervosa: physical complications
```
Weight loss
Amenorrhea
Lanugo hair
Hypotension
Bradycardia
Hypothermia
Constipation
Polyuria
Electrolyte imbalances
```
88
Clinical course of anorexia nervosa: early stages
Deny negative body image, anxiety about appearance
| Pleased with ability to control weight
89
Clinical course of anorexia: progression of illness
Depression and mood swings apparent
| Isolation and paranoia begin
90
Anorexia nervosa: interventions
- Inpatient, partial hospitalization, outpatient
- Coordinated multidisciplinary care
- Behavior modification to restore weight and nutritional status
- Patient will cooperate with nutritionally sound re-feeding program resulting in a weight gain of 2 pounds/week
- Psychotherapy to deal with unresolved psychological problems
91
Bulimia nervosa is characterized by what?
Recurrent episodes of binging
-- Episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period
Followed by...
Episode followed by inappropriate compensatory behaviors to rid the body of the excess calories: purging
- - Self-induced vomiting, misuse of laxatives, diuretics, or enemas
- - Fasting or excessive exercise may also occur
92
When is one typically diagnosed with Bulimia nervosa
late adolescents or early adulthood
93
Bulimia nervosa predisposing factors
Prone to impulsive behavior, depression, anxiety, and may have trouble with alcohol and substances
94
Bulimia nervosa: physical complications
```
Normal weight range
Dehydration
Electrolyte imbalance
Erosion of tooth enamel
Boerhaave’s Syndrome
Hypertension
Increased workload on heart: angina & respiratory insufficiency Russell’s Sign
```
95
Bulimia nervosa: Interventions
- outpatient psychotherapy (may involve eating disorder program)
- sit with patient 1/2 hour after meal if history of purging
- treat co-occuring disorders
96
How many binge episodes does someone with binge eating disorder have a week (average)
1-14
| Binging is persistant
97
Binge eating disorder is marked by what?
distress regarding binge eating, such as depression, guilt, embarrassment. No purging present
98
Who does binge eating disorder frequently affect
people over 35
99
What are major health risks associated with binge eating disorder?
weight gain and obesity
100
Binge eating disorder interventions
Work with a dietician
- Diary of food intake
- Reduced-calorie, nutritious diet
- Read food content labels
- Establish realistic weight loss and exercise plan
Psychotherapy!
- Identify emotions and feelings during episodes, develop effective coping skills
101
Nursing diagnoses for eating disorders
```
Imbalanced nutrition: Less than body requirements Imbalanced nutrition: More than body requirements
Deficient fluid volume
Ineffective denial
Disturbed body image Low self-esteem
Anxiety
```
102
Pharmacological interventions for eating disorders
Vyvanse (binge)
