Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
97 Cards in this Set
- Front
- Back
Cognitive Disorders
-Interventions for patients with cognitive disorders are: (3) |
focused on protecting patient dignity,
preserving functional status, & promoting well-being |
|
Delirium:
-characterized by: -when does it develop? |
a disturbance of consciousness and a change in cognition
-that develop over a short period of time |
|
Delirium:
comorbidity -when would recovery occur? |
always secondary to another physiological condition and is a transient disorder (short lasting)
-if the underlying condition is corrected, complete recovery should occur -secondary to medical conditions |
|
Delirium:
major causes are: (3) |
-nervous system diseases, (alzheimers, MS, parkinsons, muscular distrophy, stroke, brain cancer/tumors, head ache)
systemic disease (cardiac failure) --hypertension, diabetes, AIDS, arthritis, MS and either intoxication or withdrawal from a chemical substance |
|
Delirium:
-can occur in children but more frequently in older adults – what are the common causes in an older adult? |
surgery,
introduction of meds, UTIs, cerebrovascular disease, CHF, pneumonia, fevers PICS FUC |
|
Delirium:
-factors that predispose someone to delirium: (3) |
existing cognitive impairment (esp on admission to hospital),
low functional autonomy, polypharmacy (esp. benzodiazepines, narcotic analgesics, anticholinergics) |
|
Delirium:
treatment: |
-entire medical team need to determine what the underlying cause is and treat it, then delirium will resolve
|
|
Delirium:
onset? etilogy? |
-abrupt onset (happens suddenly)
-always something that causes it to happen |
|
Delirium / Assessment
-pts with delirium may appear withdrawn, agitated, or psychotic. -what is another symptom they may experience? |
-sundowning –symptoms and problem behaviors become more pronounced in the evening (can occur in dementia and delirium)
|
|
Delirium:
-how is their ability to focus? -what may the nurse have to do? |
-the ability to focus, sustain, or shift attention is impaired,
questions may be repeated |
|
Delirium:
-diffiiculty with what? -when do disorentation and confusion the worst? what makes the patient very fearful? |
-difficulty with orientation (usually intact to the extent of one’s identity)
-disorientation and confusion are a lot worse at night and early morning disorentation |
|
Delirium:
nursing assessment includes observations of |
-1) cognitive and perceptual disturbances,
2) physical needs 3) moods and physical behaviors |
|
Delirium:
-4 cardinal features |
-acute onset
-fluctuating course (there may be periods during the day where their LOC or orientation is intact and other moments where it is not) -inattention (can’t tend to what your saying) thinking is disorganized -consciousness is disturbed (hypervigilant, agitated, very alert, lethargic) |
|
Delirium:
-main emotional experience is |
fear
|
|
Delirium:
what does anything going on in the enviornment cause? |
-anything going on in the envt causes an exaggerated response
|
|
Delirium:
illusions, hallucinations, delusions - what is common? |
-illusions are common (telephone cord is a snake)
-hallucinations (visual hallucinations –schizo=auditory) |
|
Delirium:Cognitive and Perceptual Disturbances
give example of each |
-cognitive: memory deficits
-perceptual: perception is the processing of information about one’s internal and external envt (illusions and hallucinations are ex) |
|
Delirium:Cognitive and Perceptual Disturbances
false sensory stimuli – |
hallucinations
|
|
Delirium:Cognitive and Perceptual Disturbances
errors in perception of sensor stimuli (the stimuli is a real object in the envt but it is misinterpreted, usually as an object of the patient’s projected fear) can be explained and clarified |
illusion
|
|
Delirium:Cognitive and Perceptual Disturbances
Hallucinations -2 most common |
visual hallucinations are common in delirium and tactile hallucinations may also be present –ex: seeing spiders crawling over the bed, or feeling bugs crawling on their bodies (auditory hallucinations occur more often in schizophrenia)
|
|
Delirium:Cognitive and Perceptual Disturbances
-delirium pts are most often aware that something is very wrong “my thoughts are all jumbled” True or False |
true
|
|
Delirium: Physical needs
-the person with delirium has trouble processing stimuli in the environment and confusion magnifies the problem, nurses should make the physical environment as |
simple and clear as possible (clocks and calendars can help w/ orientation to time) (eyeglasses, hearing aids, lighting can help interpret the envt more accurately
|
|
Delirium: Physical needs -autonomic signs are present, such as:
|
(tachycardia, sweating, flushed face, dilated pupils, elevated BP) are often present
|
|
Delirium: Physical needs
hypervigilance, which means? |
-hypervigilance (pts are extraordinarily alert, eyes constantly scan the room, difficulty falling asleep or may be actively disoriented and agitated throughout the night)
|
|
Delirium: Physical needs
the nurses 2 goals are: |
-safety is a priority (restraint can be necessary) for months they can remember being tied down for months. so we want to restrain as the last resort. (delirium)
-monitoring that anxiety and trying to keep it at a level where physical behavior of agitation is not pronounced and safety is not a risk |
|
Delirium: Physical needs
what is 1 way the nurse can lower anxiety? |
- meet with the pt on a regular basis (not when they are totally out of it) they can help reduce anxiety
|
|
Delirium
-in finding the underlying cause, what should the nurse make sure to check? |
- medications need to be assessed b/c they can cause delirium (interactions, new medications)
|
|
Delirium: Mood and Physical Behaviors
tell me about their mood swings and physical behaviors? |
-individuals moods and physical behaviors may change w/in a short period (moods may swing back and forth among fear, anger, anxiety, euphoria, depression, apathy)
|
|
Delirium: Mood and Physical Behaviors
what is often accompanied by physical behaviors associated with feeling states |
–liable moods
|
|
Communication w/ someone who is delirious
-how should you approach them? -what should you say? |
-approach pt from the front, they need to see you
-say their name “john” each time you are initiating contact -let them know who you are “I’m amy, I’m your nurse” |
|
Communication w/ someone who is delirious
-what should you always inform them of? -what tone of voice should you use? |
-inform them of what’s going to happen “I am going to take your BP”
-maintain a clear, calm, low voice, use as few words as possible (they can’t take in much) |
|
Diagnosis of delirium patient
-people can perceive the envt in a distorted way and objects are often misperceived -people and objects may be misinterpreted as threatening or harmful and pts can act on these misinterpretations (main issue is ________) |
safety
---what else is always present??? RISK FOR INJURY |
|
Outcomes of delirium patient
overall outcome is that the delirious pt will |
-return to the premorbid level of functioning
|
|
Delrium
-is COMPELTE recovery possible? |
-if the underlying disorder is corrected, complete recovery is possible.
|
|
Delrium
if the underlying disorder is not corrected and persists, what can result? |
irreversible neuronal damage can occur
|
|
Delirium
-nursing concerns/interventions can center on: |
-preventing physical harm due to confusion, aggression, electrolyte and fluid imbalance
-identifying the cause -eradicate the underlying cause -relieve distress -acute delirium pt should never be left alone |
|
Evaluation
-long term outcome criteria for pt experiencing delirium include (3) |
-pt will remain safe
-pt will be orientated to time place and person by discharge -underlying cause will be treated and ameliorated |
|
Interventions for delirium management
-assist with needs related to: -what about the envt/stimuli -how many nurses should meet with the pt? |
nutrition, elimination, hydration, & personal hygiene
remove stimuli that create misperception (pictures/tv) meet with the pt 1 on 1 (family too) |
|
-defined as:
progressive deterioration of cognitive functioning and global impairment of intellect with no change in consciousness |
dementia
|
|
Dementia
-manifested by difficulty with (3) |
memory, thinking, comprehension
|
|
-______ is the most common cause of dementia in older adults
|
Alzheimer’s disease
|
|
-defined as:
a progressive brain disorder marked by impaired memory and thinking skills |
Alzheimer’s disease
|
|
-defined as:
marked by progressive deterioration in intellectual functioning, memory, ability to solve problems and learn new skills, decline in the ability to perform ADL |
-dementia --
|
|
-defiend as:
a progressive deterioration of personality accompanied by impairment in judgment |
dementia
|
|
dementias can be classified as primary or secondary
what is primary? |
-primary is irreversible, progressive, and not secondary to any other disease
-Alzheimer’s and vascular dementias are primary, progressive, and irreversible |
|
dementias can be classified as primary or secondary
what is secondary? |
-occurs as a result of some other pathological disease (metabolic, nutritional, neurological)
|
|
primary or secondary dementia
-Alzheimer’s |
primary
|
|
primary or secondary dementia
vascular dementias |
primary
|
|
primary or secondary dementia
AIDS related dementia is an example |
secondary
|
|
primary or secondary dementia
-other dementias can result from viral encephalitis, pernicious anemia, folic acid deficiency, and hypothyroidism |
secondary
|
|
primary or secondary dementia
-korsakoff’s syndrome, caused by thiamine (vit b) deficiency, which can be associated with prolonged, heavy alcohol ingestion |
secondary
|
|
-majority of dementia is Alzheimer’s --2nd kind is
|
cerebrovascular (strokes in the brain)
|
|
Alzheimer’s Disease
etiology: |
unknown
-biological factors: neuronal tangles -genetic factors: family history -envt factors: increasing age, down syndrome, and head injury, cardiovascular disease (high BP, high cholesterol, low levels of vitamin folate) |
|
- four defense mechanisms that people with early Alzheimer’s use in an attempt to cover their loss of memory in order to protect their self-esteem are:
|
-denial –
-confabulation- -perseveration- -avoidance of questions- |
|
Alzheimer’s Disease defense mechanisms
denial is the _______ |
-–unconscious protective defense against the terrifying reality of losing one’s place in the world
|
|
Alzheimer’s Disease defense mechanisms
avoidance of questions to maintain: |
-- to maintain self-esteem unconsciously in the face of severe memory deficits
|
|
Alzheimer’s Disease defense mechanisms
perseveration, is the: |
repetition of phrases or behavior, seen with stress,
|
|
Alzheimer’s Disease defense mechanisms
confabulation, is the: |
creation of stories or answers in place of actual memories to maintain self esteem, it’s unconscious
|
|
Alzheimer’s Disease defense mechanisms
-when someone is losing their memory/thinking clearly/make decisions, it’s a terrifying experience when they know it’s happening. .therefore they engage in denial for what reason?? |
for fear of losing their mind
|
|
Alzheimer’s Disease defense mechanisms
make something up / making up an answer. it’s not lying. it’s not conscious. |
confabulation
WHY DO THEY DO IT??? it’s a way to be able to answer and protect their self-esteem. |
|
Alzheimer’s Disease defense mechanisms
stuck on 1 thought/concept/word and you’re repetitive about it. can’t let it go. --that intensifies under stress |
-perserveration:
|
|
Alzheimer’s Disease defense mechanisms
avoidance of questions: why do they do this? |
cuz they can’t answer them, they might change the subject or divert you
|
|
primary vs secondary dementia
slow onset |
primary
|
|
primary vs secondary dementia
marked by a number of deficits -inability to do ADLs -memory -judgement -mood and personality changes |
primary
|
|
primary vs secondary dementia
irreversible |
primary
|
|
cardinal symptoms observed in AD/dementia
amnesia |
-or memory impairment: initially the person has difficulty remembering recent events..gradually deterioration progresses to include both recent and remote memory
|
|
cardinal symptoms observed in AD/dementia
aphasia: |
- loss of language ability (initially the person has problems finding the correct word, then is reduced to a few words, and finally reduced to babbling)
|
|
cardinal symptoms observed in AD/dementia
apraxia: |
-: loss of purposeful movement in the absence of motor or sensory impairment (apraxia of gait, person loses the ability to walk) apraxia of dressing, person is unable to put clothes on properly
|
|
cardinal symptoms observed in AD/dementia
agnosia: |
- loss of sensory ability to recognize objects (lose ability to recognize familiar sounds (auditory agnosia=such as the door bell, telephone, car horn, and can extend to glass, pencil, toothbrush, even their own body parts or family members
|
|
cardinal symptoms observed in AD/dementia
disturbances in executive functioning: |
- (planning, organizing, abstract thinking) –degeneration of neurons in the brain –they are cells that contain memories receive sights and sounds, cause hormones to secrete, produce emotions, command muscles into motion
|
|
cardinal symptoms observed in AD/dementia
loss of language ability (maybe in the beginning they have a hard time finding the right word but in the later stages, the ability to communicate is gone (might be mute) |
aphasia
|
|
cardinal symptoms observed in AD/dementia
not able to dress themselves, walk independently |
apraxia
|
|
cardinal symptoms observed in AD/dementia
please pass be the broccoli is what I would say / person with dementia would say “please pass me that thing that looks like a tree” they may want cranberry juice “please pass me that red stuff I like to drink” |
agnosia
|
|
cardinal symptoms observed in AD/dementia
not able to do finances |
disturbance in executive functioning
|
|
Diagnostic tests for dementia
-________needs to be assessed for |
depression
|
|
Diagnostic tests for dementia
-depression occurs in the ____ stage -depression is common in the ____stage -after the ______stage, the persons mind is too far gone to feel the loses the deperssion |
-depression occurs in the 1st stage
-depression is common in the 2nd stage -after the 2nd stage, the persons mind is too far gone to feel the loses the depression |
|
Diagnostic tests for dementia
-_________is the most common disorder that gets missed when someone has dementia |
-depression is the most common disorder that gets missed when someone has dementia
|
|
Guidelines for communication w/ people with dementia
-when you talk with a person, choose a topic that is meaning full for them what is a key way to communicate with patients? |
(reminiscence is key way to communication with pts)
-playing music from their era -TV or movies from their era |
|
Guidelines for communication w/ people with dementia
what should the nurse avoid? |
-avoid orientation, ?s, and probing
|
|
Guidelines for communication w/ people with dementia
-when they are verbally aggressive, what should the nurse do? |
distract them and talk about a familiar object
going along with validation or going along* (lets say you want the pt to eat in the dining room with other people but the pt becomes agitated and says he needs to get dressed b/c I have my daughters wedding) what do you do? “lets eat and then go get dressed” ----you go along with what the pt is saying, validating w/ what they are experiencing/thinking and do not challenge them. maybe you could say “how nice you are going to your daughters wedding! lets get something to eat and then go get dressed” |
|
Managing behavior / dementia
-______is more useful intervention when someone has dementia |
distraction
-distract them from w/e seems to be upsetting them |
|
Managing behavior / dementia
what is the nurses motor "going along with _____ and: -limit what? -don't take them where? |
-going along with validation and going along
-limit the # of choices (don’t overwhelm them) -don’t take them into an unfamiliar situation (keep it as familiar as possible) |
|
Managing behavior / dementia
agitation and combativeness is often managed with: |
-medication (any antipsychotics)
-recent research talks about sudden cardiac death and that a whole cardiac workup is necessary |
|
dementia
-any ________ can present a risk of cardiac death to the elderly (3 deaths for every 1000 pts ..the higher the dose, the higher the risk of sudden death) |
antipsychotic
|
|
dementia
-they don’t find that the cardiac risks are relative to children (_______ is what needs to be controlled because your setting them up for cardiac death) |
weight gain
|
|
Alzheimer’s
is progressive and often leads to death (3 ex) |
-it’s progressive
-often leads to death (malnutrition, infection, choking) |
|
Alzheimer’s
-_____ stage of Alzheimer’s is the hardest for family members |
-last stage of Alzheimer’s is the hardest for family members
|
|
Alzheimer’s
-main intervention: |
preserving their dignity
HOW DO YOU DO THAT?? (not asking ?s that they can’t answer) |
|
Alzheimer’s
Implementation (2) |
-positive regard
-maintaining dignity |
|
Health teaching and health promotion of cognitively impaired patients/families
-family members need to know what to expect regarding the course of the disease - the most important learning need that families have who are caring for family a member with dementia: |
where to get help (professional counseling and education regarding the process and progression of the disease) **test**
|
|
Health teaching and health promotion of cognitively impaired patients/families
-research says what exercise can help prevent dementia? -what other things can you tell the family to do to prevent dementia? |
-240 minutes (4 hours) a week of aerobic exercise a week can prevent dementia
-memory strategies when older |
|
Dementia & Delirium
-priority nursing diagnosis is |
“risk for injury”
|
|
Dementia & Delirium
-nursing diagnosis for family? |
-what about for family for dementia or Alzheimer’s “knowledge deficit about the disorder” or “caregiver role strain”
|
|
Pharmacological
AD -is there a cure? |
-no cure for AD
-5 drugs approved by the FDA to slow the progression |
|
-deficiency of ___________ has been linked to AD, medications aimed at preventing its breakdown
what medication has been developed to help? |
acetylcholine
(cholinesterase inhibitors)All cholinesterase inhibitors have the positional to cause nausea, diarrhea, and vomiting. |
|
Pharmacological / AD
-all the dedication is aimed at increasing __________ |
-all the dedication is aimed at increasing Acetylcholine
|
|
-antipsychotics (conventional and atypical) are no longer indicated for dementia-related psychosis b/c they are associated with what?
-overall outcome for treatment are to promote (what 2 things) |
increased risk of death
the persons optimal level of functioning and to delay further regression whenever possible |