Nurs 1456 midterm
Application of nursing process
Assessment: suicide risk/attempts, physical assessment, timing of onset, self assessment Dx: protection of others and self from impulsive and premeditated acts Psychosocial interventions rt safety: Matter of fact, not authoritarian, non confrontational Low expressed emotion, non threatening posture, flat neutral tone and voice. Avoid personal terms (you and I), consistently set limits, no arbitrary denial of privileges, do not criticize Set limits and expectations Consistent with follow through when rules broken Structure Firm boundaries Seclusion and restraint Pharmacological interventions: Not effective odd (for control B52) Ssri- intermittent explosive DO conduct do- antipsychotic, anti anxiety, minimally effective Avoid all antianxiety agents due to addiction potential Health teaching and health promotion -out of home long term placement if fam are abusive disorganized drug dependent homicidal
Cog symptoms Tbi
Attention concentration memory speed of processing judgment executive control
Client and family education for seizures
Avoid alcohol - ask MD about OTC drugs Where a medical alert bracelet Medication's -never stop anticonvulsant drugs Epilepsy support groups State laws regarding driving Safety issues in home
Pharmacotherapy for TBI - avoid
Avoid meds that lower seizure threshold (Wellbutrin, and typical antipsychotics) or cause confusion(lithium, benzos anticholinergics) Rule out social factors (abuse, neglect caregiver conflict, environmental issues), under treatment is common, TBI patients are more sensitive to side effects-watch closely for toxicity and drug drug interactions
Dementia
Brain cells die, in ability to make and keep memories
conduct disorder
CHILDHOOD behavior is usually abnormally aggressive 6 mo or longer Rights of others are VIOLATED, societal norms or rules are DISREGARDED Complications: academic failure, school suspensions and drop outs, juvenile delinquency, drug and alcohol abuse, and juvenile court involvement Crave excitement do not worry about consequences
Oppositional Defiant Disorder (ODD)
CHILDHOOD angry, irritable Defiant and vindicative: spiteful, malicious revenge, frequently for 6 mo Blames others, easily annoyed by others Conflicts with authority figures, arguing, refusing to comply, academic problems Prefer a large reward, increasing penalties do not work (token economy doesnt work- heres a star then you get toy eventually- this doesnt work)
Diagnostic test for dementia
CT, pet, mini mental state exam, complete physical, and Neuro exam, complete medical and psych history, review of recent symptoms, meds, and nutrition
Conduct DO
Callous, unemotional Shallow, superficial affect Pyromania(start fire- burn garage down), kleptomania(steal)- tension and then relief/pleasure Rates vary 1-10% Prior to 10- poor prognosis (antisocial when older) Males- no remorse, guilt, or concern for others Low self esteem but act tough and powerful Adolescent onset conduct do starts after 10. Males: fight steal vandalize Females: lie truant runaway abuse substances, prostitution
Alzheimer's epidemiology
Cause- unknown, results of genetics lifestyle, and environmental Late onset and female Brain proteins fail to function as usual : tau & b amyloid Greatest risk factor is advanced age Live 8 to 12 years after diagnosis Not every patient experiences, same symptoms or declines at same rate Death usually from aspiration pneumonia, or sepsis
Epilepsy
Chronic disorder characterized by recurrent unprovoked seizure activity may be inherited -2 or more seizures with an unknown cause with in 24 hours. Abnormal in electrical neuronal activity imbalance of neurotransmitters - GABA.
Delirium
Common complication of hospitalization Multifactoral physiological changes Risk factors - Older age, infection, polypharmacy, ICU, fractures, surgery, CVA, aphasia(unable to speak), vision impairment, hearing impairment, restraints, change in hospital rooms, cognitive impairment
TBI interventions
Decrease stimuli(may need to wear glasses at all times for light), no changes in environment, routine, and structure very important, adapt to cognitive changes use of devices from memory
Neurocognitive disorders
Delirium, mild neurocog disorder, major cog disorder, closed head injury
Behavioral emotional symptoms, TBI
Depression, anxiety, agitation, irritability, impulsivity, aggression, mood, strings, paranoia, hallucinations, delusions
Schizoid
Detachment for social relationships. Chooses to be alone. Does not desire nor enjoy relationships. Appears cold and detached -fantasy life. Maybe able to function in solitary occupation. Depersonalization or detachment from world Bleak childhood with little warmth from caregivers Maybe precursor to schizophrenia or delusional disorder Increase prevalence with family history of schizophrenia Management - rarely see help unless an extreme distress Therapy not effective, cannot relate to others Don't force person to interact, group may be harmful without brakes. Problems solving is treatment of choice, focus on social cues Short term antipsychotics for psychosis under extreme stress Risperidal or Zyprexa - improves affect Wellbutrin to increase pleasure in life
Personality disorders frequently occur with
Disorders of mood, eating, anxiety, trauma, and substance use. Ex - bipolar schizophrenic OCD anorexic. Often amplifies emotional dysregulation Common among homeless and incarcerated
Delirium clinical picture
Disturbance in attention Abrupt onset with periods of lucidity -waxes and wanes Disorganized thinking, poor executive functioning, disorientation, anxiety, and agitation for recall, delusions and hallucinations REVERSIBLE
Histrionic disorder management
Do not think they need help - treatment is soft for depression and romantic relationships, end Psychotherapy for losses Firm boundaries - stay solution, focused, and supportive Pharmacological Anti-depressants, anti-anxiety PRN . No benzos
Seizure and fall precautions
Education( hazards, lighting, bathrooms, padding) oxygen and suctioning equipment available, IV site if risk for generalized motor seizures, padded side rails is controversial - may embarrass client, keep side rails up, bed, and lowest position Never force anything into the mouth
Caregiver role strain for TBI
Encourage support groups, may need alternative living arrangement, assist in finding community resources, BIAMI
Impulse control do etiology
Genetic: ODD intermittent explosive do conduct do Neurobiological: Odd: less dense gray matter in left prefrontal cortex- boys have more structural abnormal Intermittent explosive disorder- low serotonin (SSRIs) Conduct disorder- less gray matter bilaterally and left amygdala (emotional reactions and empathy) Psychosocial: Immature coping styles, low self esteem, chaotic and negligent upbringing Environment factors- Abusive rejecting over controlling parents. Major disruptions: foster care placement, severe marital discord, parental separation Larger impoverished fam Relatively low intelligence Parental conflict is more important than if they SEPERATE
Risk factors for personality disorder
Genetics - extreme variations of normal personality traits- anxious, dependency, traits, psychopathic, antisocial, social withdrawal, and compulsivity - neurotransmitter or hormone may regulate and influence temperament - Brain imaging reveals some differences in size and function of specific structures- injury, inability to feel bad Trauma and early childhood (HPA axis) Psychological - Learning theory based on modeling, defense mechanisms Environmental - Childhood neglect, or trauma Genes and traits influence response to environment and environment, influences expression of inherited traits
External forces that may cause tbi
Head being struck by object, falls, acceleration / deceleration of movement, foreign body penetrating brain (bullet), blast or explosion.
Physical symptoms of Tbi
Headache pain n/v dizziness numbness fatigue smell/taste blurred vision sleep disturbances sensitivity to light/noise hearing appetite balance problems transient neuro issues
Borderline continued
High mortality rate Substance abuse is common Can become psychotic during periods of stress Medical diagnosis typically associated with BPD - diabetes, hypertension, chronic back pain, fibromyalgia, and arthritis Runs in family May have hyper, responsive, amygdala with impairment and prefrontal cortex - more vulnerable to emotionally charged communication Fear of abandonment more intense by a biological predisposition Disruption of the separation - individuation of the child from the mother and first year of life. Sexual abuse
Assessment for Tbi
History- evaluate s/s of potential neurosurgical emergencies Patients symptoms and health concerns Detailed info of injury event- mechanism of injury duration severity loc immediate sx course and tx Screen for pre morbid conditions Danger to self/others Injury description / cause Amnesia before/after Loc Early signs Seizures Death injury to others
Epilepsy and seizure DO assessment
How often? How long do they last? When was the last seizure? Aura? Description? Sequence of seizure progression? Observations during? Behavior after? Triggers?-Increased activity, emotional stress, excessive fatigue, alcohol or caffeine, foods or chemicals, insomnia.
Medications to stop motor movement
IV. Valium, IV Ativan, Valium, rectal gel, IV valproate. Prevention of reoccurrence Dilantin, cerebyx, General anesthesia (last resort)
Dementia plan
Identify level of functioning, target care towards the persons immediate needs, connect caregivers to support services, assess caregivers needs-monitor for burnout or abuse. Increased risk for elder abuse. Plan and identify appropriate community resources.
Common characteristics of personality disorders
In flexible and maladaptive to stress Disability in working and loving Ability to evoke interpersonal conflict Capacity to get under the skin of others Difficulty managing impulses
TBI nursing diagnosis
Injury to self for others, risk for suicide, caregiver role strain, pain, memory, impairment, self-care deficits, sleep, disturbance, sensory, perceptual disturbance, self esteem
Borderline personality
Intolerance with abandonment, frantic to avoid Severe impairment and functioning, instability of emotional control, identity, or self image, distortions, unstable mood, and interpersonal relationships Emotional liability - emotions out of proportion to the circumstances Intense sensitivity to perceived rejection Impulsivity without considering the consequences Hostility, anger, irritability, and relationship - may be violent toward partner or property Self-destructive behaviors- Chronic suicidal ideation sometimes with multiple attempts Promiscuous sexual behavior Numbing with substances Cutting self mutilation
Criteria for personality disorders
Lifelong pattern of inexperience and behavior that deviates market Lee from culture. This pattern is manifested two or more of the following areas.; Cognition (perceiving an interpretation) Effectivity (range intensity liability) Interpersonal functioning Impulse control
Pharmacotherapy intervention TBI
Limit quantities of meds due to higher rate of populations, educate, patient and family to avoid alcohol, minimize caffeine and avoid herbal supplements or energy products-may lead to hypertensive crisis, avoid contribute to cognitive slowing fatigue or drowsiness
Personality disorders
Long-standing pervasive maladaptive behavior Onset in early adulthood or adolescent Diagnosed in adulthood -not before age 18 Causes distress and impairment Does not respond usually to short term therapy or meds In touch with reality, unless extreme stress Not voluntary ( rational) Believe their problems originate from the behavior of other people
Histrionic personality disorder
Look - Attention seeking, life of the party, center of attention Emotional attention seeking behavior over-the-top Maybe be overdressed, flirtatious and seductive Self-centered, low frustration tolerance, impulsive, melodramatic, speech is colorful and exaggerated Some evidence of heritability Insincere and lacks depth Vague, physical complaints Begins between 3 to 5. Overly attachment to opposite sex parent - results in fear of retaliation by same-sex parent. May have inborn character traits such as emotional expressiveness in egocentricity.
Narcissistic personality disorder
Look: Arrogance with grandiose view of self importance. Need for constant admiration. Lack of empathy Personal entitlement with lack of social empathy - may lead to exploiting of others Hypersensitive of criticism Feel shame and fear of abandonment Underlying self-esteem is fragile/vulnerable Maybe resolve of childhood neglect and criticism. A child does not learn. The other people can be the source of comfort. Hide feelings of emptiness with exterior of invulnerability and self-sufficiency. Can function, socially, and in high-level occupations - feeds their needs
Paranoid personality disorders
Looks: Males Mistrust, restricted affect, guarded Suspiciousness, hyper, vigilance, hostility, bears grudges Hypersensitive to others May exhibit transient psychosis if stressed Grew up in households, where they were the object of excessive rage and humiliation resulted in feelings of inadequacy - anxious about being harmed or exploited Management - Projection is their primary defense mechanism 10 to reject treatment- difficult to interview Psychotherapy is treatment of choice Anti-anxiety agents may be used to improve relaxation - avoid benzos Agitation and delusions maybe treated with anti-psych meds
If a seizure occurs
Maintain airway and suction as needed, protect for injury, turn client to left side, loose and restrictive clothing, do not restrain, nothing in mouth, at end of seizure- Vital signs, reality, orientation, neural check, oxygen of cyanotic, keep on side, allowed to rest DOCUMENT SEIZURE
Mild mod Tbi consequences
May not be recognized as related to Tbi- Loc Functional deficits - physical and mental Altered personality Altered memory Physical or verbal aggression Agitation Cognitive and learning difficulties Reduced self awareness Problems with sex function Impulsive / inappropriate
Seizure with a known non-neuro cause
Metabolic DO(DM), acute alcohol withdrawal, electrolyte, imbalance heart disease
Tbi severity
Mild- loc few seconds/minutes PTA for less than hour Imaging most often appears normal Mod- loc 1-24 hours PTA 1-24 post surgery Imaging appears abnorm Severe- loc or coma over 24 hrs PTA over 24 hours post surg Imaging abnorm
Dementia early signs
Missing sarcasm, frequent falling, disregard for law, staring, eating objects, losing knowledge of objects, losing empathy, ignoring embarrassment, compulsive, ritualistic behavior, money, trouble, difficulty speaking, slow loss of interest in grooming, such hygiene, hoarding, easily lost on familiar routes, loss of taste and smell
Generalized epilepsy
No identifiable brain lesion Affects both sides of brain Motor seizures or non-motor seizures Childhood begins
Schizotypal personality disorder
Odd beliefs or magical thinking Severe social anxiety and interpersonal deficits Genetic link to schizophrenia Signs of disorder, our childhood or adolescence - target for bullying Structural abnormalities of brain and altered dopamine transmission Brief episodes of hallucinations or delusions Rigid peculiar ideas and rambling communication Odd Appearance and inappropriate behaviors Management - Rarely seek treatment, usually only for depression Behavioral modification therapy - recommended for bizarre thinking and behaviors. Outcomes are poor so treatment goal is leading a satisfactory solitary life. Can be made aware of their misinterpretations of reality, unlike patients with schizophrenia and tight to delusions Antipsychotics, antidepressants, anti anxiety, meds can help - Prolixin
Cluster a
Odd or eccentric Paranoid schizoid schizotypal
Alzheimer's meds are used to
Only slow progression or treat symptoms. Do not treat.
Unknown epilepsy
Origin not known, motor and non-motor seizure
Caregiver effects when caring for client with personality DO
Overwhelming needs of clients may also be overwhelming for caregivers. They may feel: Confused, helpless, angry frustrated Watch for splitting and put up boundaries .
Evaluation for delirium
Patient will remain safe Patient will be oriented by discharge Underlying cause will be treated
Dementia outcomes
Person and family will remain free from injury. Communication, education, level, caregiver role strain, impaired environmental interpretation.: chronic confusion, self-care needs
Dementia interventions
Person centered care approach Provide emotional support Health teaching and health promotion Promote sleep, proper nutrition, hygiene activity Structure the environment and provide routine Have person wear eyeglasses or hearing aids Care
Splitting
Primary defense or coping style used by patients with borderline Inability to view both positive positive and negative aspects of others as part of a whole Patients label one person all good and the others all bad All good person has not met clients that person becomes all bad Creates conflict in staff To decrease conflict among staff : Open communication and meetings Ongoing clinical supervision
Major and minor neurotic disorders
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 w daily functioning, and independence, progressive deterioration
Outcome and planning for delirium
Pt will remain safe and free from injury, during periods of clarity patient will be oriented times 3, patient will remain free from falls and injury while confused with the aid of nursing safety measures Planning - Ensure necessary aid and supportive home team Visual cues in the environment for orientation Continuity of care providers
Aversive therapy
Punishment do not use
Self assessment when working with dementia patient
Realistic, understanding of disease, stress, stress management, support, and educational resources, realistic, outcomes, and recognition when those are achieved, maintaining good self-care
Other therapies for TBI
Rehab, general and focus, exercise, OT, acupuncture, bio feedback
Borderline management
Remain neutral and matter-of-fact Journal about the sequence that led up to the event as well as the consequences before staff discusses. So they can recognize the cause of outburst. Good response to anti-convulsant, mood, stabilizers, low dose, antipsychotics, and omega-3 supplements. LAMICTAL. Zyprexa last because metabolic syndrome and weight gain. Naltrexone reduce self injuring behavior. Cbt - identify and change an accurate core perception of themselves and others DBT - combine CBT with mindfulness, emphasizing being aware of thoughts, and actively shaping them - begin with suicidal behaviors to destructive behaviors to quality of life issues Schema focused therapy - Parts of CBT, with other forms of therapy that focus on the way that people view themselves. Reframing of scheme is based on BPD's dysfunctional self image, and that it affects how people respond to stress environment and interaction with others.
Epilepsy and seizure DO nursing diagnoses
Risk for injury and effective airway and effective breathing pattern and risk for an effective cerebral tissue, perfusion, impaired sensory perception, activity, intolerance, anxiety, social, isolation, and effective role chronic low self-esteem
Delirium nursing diagnosis
Risk for injury, acute confusion risk for deficient fluid volume disturbed sleep pattern, impaired verbal, communication, fear self-care deficits, impaired social interaction
Nursing diagnosis for dementia
Risk for wandering, injury, impaired verbal, communication, impaired, environmental interpretation, syndrome, impaired memory, confusion, caregiver role strain, anticipatory grieving
Evaluation for Alzheimer's
Safety, maintain highest level and functioning, caregiver support
Outcomes and plan for TBI
Safety, self-care needs, coping, caregiver role strain Community resources, and long-term care
Seizure disorders outcomes
Saved during an after seizure, prevent injury, med management, and education, to decrease the frequency of seizures, med, adherence, patient and family, education, self-esteem, achieve a seizure, free status without adverse effects, regain, previous functioning, and roles
Status epilepticus
Seizure activity that lasted longer than 30 minutes or a series of seizures that occur in rapid succession- life-threatening can be convulsive or non-convulsive Causes - Pre-existing epilepsy, genetic, sudden withdrawal from anti-convulsant, infection/fever A alcohol, drug withdrawal, head, trauma, CVA, cerebral edema, metabolic disturbance, cerebral palsy, tumor or neural degenerative disease
Acute seizure
Seizures, occurring and greater intensity number or length and the clients usual seizures. Or they may occur in clusters that are different from the clients typical seizure pattern. Treatment with Ativan or Valium may be given to stop the clusters to prevent the development of status epilepticus. (Seizure that starts and doesn't stop - death OR to get anesthesia.)
antisocial personality management
Set limits on behavior with CONSISTENCY in responses and consequences for actions: ONE CARE MANAGER -matter of fact, no I messages, keep it simple. Don't forget that staff needs to support care manager Assist pt to control impulsive and aggressive behaviors Encourage or to control impulsive and aggressive behaviors Encourage pt to verbalize anger rather than act in aggression or passive aggressive manner Confrontation- point out problem behavior - keep pt focused on self - DBT- learn practice skills w base manager Psychopharmacology- Anti-convulsant since, mood stabilizer - lithium - helps with aggression and impulsivity - B 52 Antipsychotics for safety avoid benzos Ritalin might help if ADHD Careful use of addictive agents
antisocial personality disorder
Sociopaths Symptoms are evident by adolescence. Impulse control and conduct problems as children and adolescence. Around 40 years - symptoms become less Deceitful, manipulative, hostility, charming Hi risktaking, disregard for responsibility, exploits, other others, impulsivity Little to no capacity for intimacy Profound lack of empathy, shallow, unexpressive, and superficial affect Genetic risk of aggressive, disregard trait, and trait of lack of concern for consequences - higher if parent is APD Home life chaotic with abuse substance use DV neglect Brain abnormalities - Reduced gray matter and prefrontal, cortex and temporal lobes - no empathy EEG abnormal Genetic abnormality of MAOA - cannot break down dopamine or serotonin Predators risk for praying on others,
Pharmacotherapy for TBI
Stimulants, antidepressants, non-benzo sleep, agents, NSAID, migraine meds, and I convulsants, mood stabilizers, vestibular suppressant
Delirium prevention strategies
Stimulating the mind, moving, sleeping well, seeing and hearing, staying hydrated, eating
Diathesis stress model
Strong correlation between trauma, neglect and other dysfunctional family or social patterns of interaction on the development of personality disorders
Status epilepticus intervention
Support ABC's - prepare for intubation protect patient from injury Monitor VS and cardiac rhythms - very labile Do not force an airway into the client mouth - provide oxygen via nasal cannula or facemask Establish IV access if not already available and begin infusion .9 sailing - administer drugs as ordered. Observed for side effects and toxicity from the meds.
Epilepsy and seizure disorder drug therapy- don't spend too much time on this
Tiger control, Gabitril, zonogram, Depakote, Topamax, Valium, Mysoline, rotten, rotten, Leacil, fell battle, Dilantin Ativan, Klonopin Keppra phenobarbital, Trileptal Seizures with a medical/secondary cause - remove or treat underlying condition
Generalized motor seizures
Tonic clinic(grand mal), tonic phase - stiffening or rigidity of the muscles, arms and legs, cry out, fall over and loss of consciousness Colonic - rhythmic jerking of extremities Last about two minutes May bite tongue Incontinent Fatigue confusion lethargy for one hour after seizure
Community support for Alzheimer's
Transportation services, supervision, and care when the primary caregiver is out of home, referrals to daycare centers, information on support groups in the community, meals on wheels, information on respite and residential services, telephone numbers for help, home health services, Alzheimer's association, age ways-senior support services
Narcissistic management
Treatment of choices, individual therapy- CBT, family therapy, group therapy Firm boundaries Pharmacological - Lithium- mood swings Antidepressants as needed Avoid benzos
Focal epilepsy
Underlying brain lesion or trauma Effect only one side of brain Motor seizures or non-motor Confusion mood swings, hot, cold flashes goosebumps Absence seizures
When to call 911 for seizure
Usually do not require emergency medical- confusion after seizure is normal. Place on left side in case of vomit. ABC If a seizure is over 5 minutes If the person has a second seizure soon after the first If the person has problems, regaining consciousness If person is having problems, breathing/gurgling If person is injured If seizure happens in water (to as near drowning, drown hours later) Pregnancy (fatal)
Other treatment for epilepsy and seizure DO
Vagal nerve stimulation (magnet)- control of medically, intractable, simple or complex partial seizures Surgical procedures - surgical excision of seizure area of brain Keto diet Cannabis in children
Physical assessment Tbi
Vs focused neuro exam focused vision exam Musculoskeletal exam of head and neck, rom, focal tenderness, Pain seizures Neuro imaging in dx
Cluster B
dramatic, emotional erratic Antisocial borderline narcissistic histrionic
Assessment delirium
*Cognitive and perceptual disturbance- Easily distracted, impaired memory, illusion, hallucination * Physical needs - Wandering, pulling out IVs, falling, self-care deficit, skin breakdown, infection , autonomic signs: tachycardia, sweating, flushed face, dilated pupils, high BP Changes in sleep wake patterns (circadian rhythm whack) Hyper vigilance *Moods and physical behaviors - Agitated or calm lay bile, strike out from fear or anger may cry call out for help, tear off clothing, laugh uncontrollably Erratic and fluctuating * self assessment- Anxiety producing due to unpredictability of patients Missed diagnosis
Alzheimer's bio factors
*Neuro degeneration that begins with the hippocampus(memory) that spreads to the cerebral cortex(executive functioning-pay bills) *Cell death- accumulation of beta amyloid and protein tau *Genetics- 3 gene mutations which lead to devastating early onset from disease. Less than 1% *susceptibility gene APOe e4 gene (supports lipid transport) raises the risk of developing late onset
Personality
- How you define yourself Skills you used to relate to others How you problem solve How you perceive your surroundings Ingrained, enduring pattern of behaving, and relating to oneself and others, including, perceptions, attitudes, and emotions
The progression of Alzheimer's
-Mild cognitive impairment 7 years Begins in medial temporal lobe Sx- short term memory loss -mild Alzheimer's 2 years Spreads to lateral temporal and parietal lobe Sx-reading prob, poor object recognition, poor direction sense - moderate 4 years Spreads to frontal lobe Poor judge impulsive short attention -Severe 3 years Occipital lobe Visual problems
Implementation for delirium
-Prevent physical harm due to confusion, aggression, or fluid and electrolyte imbalance. -Minimize use of restraints (increases confusion) -Perform comprehensive nursing assessment to aid in identifying cause. -Assist with proper health management to eradicate underlying cause. -Use supportive measures to relieve distress.
dementia interventions
-Simplify- verbal message, breakdown task, repeat message as needed, monitor tolerance of stimulation -Promote independence as long as possible possible. -Keep all interactions, calm reassuring. Don't argue. - Time activity to coincide with client calm state Reminiscence therapy - Thinking about or sharing about the past . Keeps client involved and increases self-esteem. (Pandora- music from their teens) - distraction Shifting the clients attention from a triggering situation -Time away Leave the client for short periods of time when overstimulated ignore the outburst Going along Provide emotional reassurance to clients without correcting their misperception or or delusion
delirium- 4 cardinal features
1 acute onset and fluctuating course 2 reduce ability to direct focus shift and sustain attention 3 disorganized thinking 4 disturbance of consciousness (one minute they are fine, five minutes later hard to arouse)
Neuro emergency
ABCDE (disability(unable to move), exposure to injury) Clear fluid leaking from nose or ears Unconscious or a period of altered consciousness, especially a decline N/V Skull deformities - depression or open Vision changes - double Bruised eyes/ skin behind ears Unable to move extremities or lack of sensation (don't move) Seizures or status epilepticus Non symmetrical face unilateral pupillary dilation
Intermittent Explosive Disorder
ADULT disorder (18+) Inability to control aggressive impulse (verbal physical) to people, animals, property, self Leads to problems with: interpersonal relationships, occupational difficulties, criminal difficulties *feel a lot of shame, can't keep job. Males, high cortisol, feels embarrassment -tension, explosive behavior/aggression, feel immediate relief and release feelings, delayed feelings of remorse, regret, embarrassment -increased htn, DM, stress related dos
Generalized non-motor seizure
Absence seizure(petit mal) Stare off into space, sudden, short lapse of consciousness, confusion, mood swings, blinking, mouth, or hand movements
TBI indications for referral to mental health
Acute distress, interventions didn't work, harm to self for others, development of PTSD, exacerbation
Alzheimer's risk factors
Age and family history Cardiovascular disease Social engagement and diet (Mediterranean reduces risk) Heady injury Tbi Dm
Alzheimer meds
All work on acetylcholine -Cholinesterase inhibitors: aricept, exelon (all stages), razadyne ( mild to moderate ad), -NMDA receptor antagonists- (moderate to severe, regulates activity of glutamate) namenda, namzaric, aduhelm - anticonvulsant (first) Depakote and tegretol Used for emotional liability and aggressiveness -antipsychotics Lower dose for elderly, nighttime dose preffered, black box warning for a typical- do not use due to increase risk of CVA death - antidepressants, SSRI - watch for discontinuation syndrome, dizziness, agitation, irritability, nausea may occur with abrupt withdrawal, so taper slowly anxiolytics- use cautiously due to risk for further memory, impairments sedation and falls. Should not be first line except for emergency.
Major neurocognitive disorders
Alzheimer's, dementia with Lewy, bodies, Parkinson's, frontal temporal dementia Vascular, dementia, TBI, substance induced dementia, HIV, prion (mad cow )disease, Huntington's
Tbi definition
An induced structural injury and or physiological disruption of brain function bc of an external force that is indicated by new onset or worsening of at least one of the following clinical signs: Period of loss of or decreased loc Any loss of memory before/after the injury Confusion, disorientation, slowed thinking, agitation, etc Neuro deficits - weakness, loss of balance, change in vision, paresis/plegia, sensory loss, apnea Intracranial leases.
Alzheimer's clinical picture
Anosognosia, confabulation(creating stories and place of missing memories for self esteem), perseveration(repetition of phrase or behavior), avoidance of, memory, impairment, disturbance, and executive functioning, hallucinations, or agitation, aphasia (loss of ability), apraxia (loss of purposeful movements), agnosia (loss of sensory ability to recognize objects), agraphia. (Diminished ability to read or write), hyperorality( put stuff in mouth to explore), hyper metamorphosis (urge to touch everything), sundowning Check for UTI
Cluster C
Anxious and fearful Avoidant, dependent, obsessive compulsive - Narcissist pray on these - want people to make decisions for them
