Neurocognitive

46問 • 2年前

問題一覧

What does the clinical picture of delirium look like?

Disturbance in attention, Abrupt onset with periods of lucidity (acute), Disorganize thinking, Disorientation, Anxiety and agitation, Poor recall, Delusions and hallucinations (usually visual)

What are some physiological causes of delirium?

Cognitive impairment, Immobilization, Pshychoactive medications, Dehydration, Infection, Sleep deprivation, Vision or hearing impairment

What are risk factors of developing delirium?

Elderly, Infcetion (UTI!), Polypharmacy, ICU, Fractures surgery, stroke, Aphasia, vision impariment, hearing issues, Restraint use, Change in hospital rooms, Cognitive impairment

Select physical needs for delirium

Wandering, pulling out IVs, falling, Self care deficits, Tachycardia, sweating, flushed-face, Dilated pupils, high BP, Changes in sleep wake patterns, Hypervigilance, There’s always an underlying cause for delirium!

Select the moods and physical behaviors displayed in delirium.

Agitated or calm, Labile, Strike out from fears or anger, May cry, call out for help, tear off clothing, laugh uncontrollably, Erratic & fluctuating

Assessment Guidelines

Do not assume confusion is dementia in the older patient, Assess for acute onset and fluctuating levels of awareness, Assess the person’s ability to attend to the immediate environment, Establish usual level of cognition, plus past cognitive impairment, Identify disturbances in physiological status and stabilize

Select more assessment guidlines for delirium

VS, LOC, neuro status, Potential for injury, Avaiablility of immediate medical interventions to help prevent irreversible brain damage, Monitor situational factors that worsen or improve symptoms

Interventions/ implementation for delirium:

Prevent physical harm due to confusion aggression or F&E imbalance, Minimize use of restraints, Assist with identification and treatment of cause!, Use supportive measures to relieve

Major and Minor neurocognitive disorders

NOT acute, progressive deterioration of cognitive functioning and global impairment of intellect (dementia), No change in consciousness, Difficulty with memory, problem solving and complex attention, Mild: Does not interfere with ADLs; does not necessarily progress, Major: Interferes with daily functioning and independence

Select DSM-5 Criteria for Mild neurocognitive disorder

Evidence of modest cognitive decline from previous level of performance in one more cognitive domains, Cognitive deficits do not interfere with independence in everyday activities, Cognitive defictis do not occur exclusively in the context of delirium, Cognitive deficit is are not better explained by another mental disorder

Major neurocognitive disorders (Dementia umbrella)

Alzheimer’s disease, Frontotemporal lobar degeneration, Lewy body disease, Parkinson’s disease, With progression, Traumatic brain injury, Cerebrovascular disease

Alzheimer’s clinical picture

Distinguished between normal forgetfulness and memory deficits in dementia, Memory loss interferes with ADLs

Early signs of Alzheimer’s

Missing sarcasm, Frequent falling, Disregard for the law, Staring, Eating objects, Losing knowledge of objects, Losing empathy, Ignoring embarrassment, Compulsive ritulistic behavior, Money troubles, Difficulty speaking, Slow loss of interest in grooming/ hygiene, Hoarding, Easily lost on familiar routes (usually first sign or check book balancing)

True or false? Most common epidemiology for Alzheimer’s is late-onset and female.

True

Select Risk factors for Alzheimer’s disease.

Genetics (if early), Cardiovascular disease, Head injury and trauma, Exercise and sleep, Social engagement and diet, Education and mental stimulation

Select assessment data for Alzheimer’s.

Confabulation, Preservation, Agraphia, Hyperorality, Aphasia, apraxia, agnosia, Sundowning

Match term to definition. Creation of stories in place of missing memories to maintain self-esteem.

Confabulation

Match term to definition. Repitition of phrases or gestures long after stimulus is gone.

Preservation

Match term to definition. Diminishing ability to read or write.

Agraphia

Match term to definition. Tendency to put everything in the mouth.

Hyperorality

Match term to definition. Loss of language ability.

Aphasia

Match term to definition. Loss of purposeful movement.

Apraxia

Match term to definition. Inability to interpret sensations and hence to recognize things.

Agnosia

Match term to definition. Tendency for mood to drop and agitation to rise as light of day diminishes.

Sundowning/ sundown syndrome

Select diagnostic tests for Alzheimer’s.

Computed tomography scan (CT) (R/O physical cause), Positron emission tomography (PET), Mini mental status exam (draw a clock), Complete physical and neurological exam, Complete medical and physical history, Review of recent symptoms, meds, and nutrition

Select assessment guidelines for Alzheimer’s.

Evaluate current cognition level, Identify and address and threats to safety, including home, Review medications (this is in the slides a lot, I think… does that mean something?🤔), Interview family to assess preparation&coping, Review available resources, Identify teaching & guidance needs regarding sundowning!

Select what’s included in self assessment for nurses for Alzheimer’s.

Realistic understanding of the disease, Stress management, Support and educational resources, Realistic outcomes and recognition when these are achieved, Maintaining good self-care

What nursing diagnosis can lead to abuse?

Caregiver stress

Select interventions/implementation for Alzheimer’s.

Person-centered care approach, Health teaching and health promotion, Referral to community supports, Promote sleep, proper nutrition, hygiene, activity, Structure the environment and provide routine, Make sure person has eyeglasses and/or hearing aides if necessary, Don’t change structure of home at all (move furniture etc.)

Select more interventions/ implementation for Alzheimer’s.

Simplify verbal messages, breakdown tasks (one step at a time 👣), repeat messages as needed monitor tolerance of stimulation, Promote independence as long as possible 🕺, Keep all interactions calm, and reassuring🧘🏻‍♀️, Time activity to coincide with client calm state🕰️, Reminiscence therapy: thinking about or sharing about past, keeps clients involved and increases self esteem ⏳

Select community support for Alzheimer’s.

Transportation services, Supervision and care when the primary caregiver is out of the home, Referrals to day care centers, Info on support groups in community, Meals on wheels, Info on respite and residential services, Phone numbers for help lines, Home health services

Select the rule of thumb for older adults for medications.

“Start low and go slow”🐢

Medications are only used to _____ or treat ______. Select answers in order.

Slow, Symptoms

For pharmacotherapy there is 2 subgroups, what are they?

Meds for cognitive symptoms, Meds for behavioral symptoms

Select the medications/ types of medications used for cognitive symptoms of Alzheimer’s.

Cholinesterase inhibitors, Rivistigmine transdermal system (Exelon patch), NMDA receptor antagonist

Select the medications used for behavioral symptoms of Alzheimer’s.

None approved; risk is high; antipsychotics used off-label and with extreme caution, Last resort risks are high

There is also integrative therapy what is it?

Omega-3 fatty acids

Select the cholinesterase inhibitors. (They prevent breakdown of acetylcholine-minimala benefit after 1 year)

donepezil/ (Aricept) No liver toxicity, rivistigmine (Exelon) SE: nausea, poor appetite & weight lost patch available to ⬇️GI symptoms, galantamine (Razadyne) Decreases agitation Do not use with renal, hepatic or cardiac impairment Has extended release

Select statements true to the NMDA (N-methyl-D-apartate) antagonists.

Regulates activity of glutamate, memantine (Namenda), Blocks effects of excess glutamate which is toxic in excess amounts, Used for moderat to severe Alzheimer’s

Select statements true to NMDA receptor antagonist and cholinesterase inhibitors.

Combination drug, donepezil & memantine (Namzaric), Used for moderat to severe Alzheimer’s

Next medications are the ones used for behavioral symptoms but remember none of them are actually approved for that use. They are used off label for Alzheimer’s with extreme caution!

Thank you!😁

Anticonvulsants used for Alzheimer’s

Depakote, Tegretol, Used for emotional lability

Select statements true to antipsychotic use for Alzheimer’s.

Lower dose for elderly, Nighttime dose preferred, Black box warning due to ⬆️risk of CVA & death

Select statements true to antidepressant use for Alzheimer’s.

Watch for discontinuation syndrome- dizziness, agitation, irritability, nausea, taper these off slowly!, SSRI’s

Select the statement true to anti anxiety medications use in Alzheimer’s.

Use cautiously due to risk for further memory impariment, sedation, and falls

Acute onset of disordered think is most associated with:

Delirium

Health assessment questions

ユーザ名非公開 · 15問 · 2年前

Health assessment questions