Cognition Test

Donepezil is prescribed for a client who has mild dementia of the Alzheimer type. Which information would the nurse include when discussing this medication with the client and family?

Blood tests that reflect liver function will be performed routinely

Alzheimers diagnostic tests Laboratory tests

CT scan, PET scan apolipoprotein E4 (APOE 4) Amyloid beta protein precursor

Risk factors for cog. impairment MEN:

DOH Diabetes OLD History of stroke

Antidepressants for Alzheimers disease

SSRIs Sertraline (Zoloft), Paroxitine (Paxil)

An older client with Alzheimer type dementia, consistently sleeps in a semi-Fowler position in bed. Which area of the client's body would the nurse consider a high risk for developing a pressure injury?

Sacrum

Clients with dementia may

sleep more during the day

Which imaging technique is specific for Alzheimer disease?

Magnetic resonance spectroscopy (MRS)

Risk factors for cog. impairment WOMEN:

ODPIL OLD Dependency Poor health status Insomnia Lack of social support

Alzheimer's disease S&S

Poor judgement and decision making Inability to manage a budget Losing track of the date or season Difficulty holding a convo Misplacing things and being unable to retrace steps to locate it

Which activities would the nurse initiate for a client with Alzheimer disease who is admitted to a long-term care facility?

Weighing the client once a week Having specialized rehabilitation equipment available Establishing a schedule with periods of rest after activities

PD stage 4 Severe Disability PD stage 5

• Akinesia • Rigidity Complete ADL Dependence

The nurse is assessing a client for recall memory. Which statements made by the client indicate that the client's recall memory is intact?

"I came to the hospital in a car." "You asked me to repeat the words apple, street, and chair." "I was admitted on the 24th of September at 5:00 PM in the evening." "I had an appointment with a neurophysician last month."

The nurse is preparing to teach a client who has been prescribed a levodopa-carbidopa preparation for Parkinson disease. What health teaching will the nurse include for the client and family?

"Move slowly when changing positions from sitting to standing." "Report any hallucinations that the client may have." "Note any changes in mental or emotional status." "Pay attention to whether your tremors improve or worsen."

Individual Risk Factors for Cog. Impairment

-Personal behaviors: substance abuse, participation in high-risk activities, accidental injuries -Environmental exposure -Congenital factors: maternal (substance abuse), birth injuries -Genetic conditions -Health-related conditions: acute and/or chronic treatments

Which intervention would the nurse include in the nursing home plan of care for an older adult with Alzheimer disease who has nighttime wandering?

Assign the client to a room near the nurses' station for closer supervision at night.

Which action would the nurse take for an older adult client who is agitated, confused, and actively attempting to get out of bed?

Assign the nursing assistant to stay with the client while the nurse calls the health care provider

Neurocognitive disorder due to Lewy bodies is

Characterized with short-term memory loss, unpredictable cognitive shifts, and sleep disturbances. Thus talking about recent days would be ineffective. Memories of remote events (e.g., married life, working years, young adulthood) usually remains fairly intact.

Cholinesterase inhibitors

Donepezil, rivastigmine, galantamine; slow cognitive deterioration of alzheimer's; contraindicated in patients who have asthma or other obstructive pulmonary disorders; start low dose and gradually increase; give once daily at bedtime?

Health Promotion and Maintenance ALZHEIMERS disease

Eating a balanced diet Eating dark colored fruits and vegetables Using soy products Folate, Vitamins B12, C, and E Exercise Crossword puzzles Learning new hobby Socialization

Dementia vs Delirium

For Delirium: Reorient the patient to reality; provide a safe environment Do not reorient for late stage dementia instead use validation therapy, do not argue with them

The nurse assesses a client with a diagnosis of early-stage Alzheimer's disease. Which assessment findings would the nurse expect for this client?

Forgetfulness Personality changes

Levodopa/Carbidopa

Given together to increase dopamine Used for Parkinson's Decreases tremors and muscle rigidity Levodopa is converted to dopamine in the CNS and carbidopa prevents the breakdown of levodopa Side effects: nausea, vomiting, drowsiness, dyskinesia, orthostatic hypotension, darkening of urine and sweat, possible psychosis High protein meals decreases effectiveness. immediate release (IR), controlled release (CR)

Stress is one of the leading causes of chronic inflammation.

It also has direct links to major age-related health issues, from dementia to Alzheimer's disease.

Cog. Impairment diagnostic tests

Laboratory tests (rule out medical problems) Neuropsychometric testing (memory exam etc.) Brain imaging techniques (MRS)

Which intervention(s) will the nurse include in a care plan for a client with Alzheimer disease?

Limit choices. Toilet every 2 hours. Encourage participation in self-care

NAMENDA or NMDA (N-methyl-aspartate) receptor antagonist

Memantine Alzheimer's Disease

Which characteristic mental change occurs with delirium and differentiates it from dementia?

Rapid-onset confusion

What are signs and symptoms of levodopa toxicity?

Symptoms of overdose may include: severe dizziness, irregular heartbeat, mental/mood changes (such as agitation).

Vascular dementia. This type of dementia is caused by damage to the vessels that supply blood to your brain.

The most common signs of vascular dementia include difficulties with problem-solving, slowed thinking, and loss of focus and organization. These tend to be more noticeable than memory loss.

CAUSES/RISK FACTORS OF Parkinsons disease

Unknown Genetic factors Environmental factors - Exposure to pesticides, Herbicides, and Industrial chemicals and metals Drinking well water Age (being older than 40 yrs old) Decreased estrogen levels

Lewy body dementia S&S

acting out one's dreams in sleep, seeing things that aren't there (visual hallucinations), and problems with focus and attention. Other signs include uncoordinated or slow movement, tremors, and rigidity (parkinsonism).

Dopamine agonists for PD Apomorphine, Pramipexole, Ropinirole, Rotigotine-(transdermal patch to maintain consistent level of dopamine)

adverse effects: orthostatic (postural) hypotension, hallucinations, sleepiness, and drowsiness.

CAM (Confusion Assessment Method)

is a standardized evidence-based tool that enables non-psychiatrically trained clinicians to identify and recognize delirium quickly and accurately in both clinical and research settings.

Mini Cog

is another screening tool that can be administered in 5 minutes or less and requires minimal training. 3 item recall, clock drawing test (CDT)

The mental changes associated with delirium have a rapid onset and are usually

precipitated by an infection or medication change

orthostatic hypotension (levodopa/carbidopa) (Parkinsons Pharmo)

temporary low BP and dizziness when suddenly rising from a sitting or reclining position

A client with moderate dementia asks the nurse to find her son who is deceased. What is the nurse's most appropriate response?

"What did your son look like?"

The nurse is caring for a community-dwelling older adult who is suffering from confusion. Which are the correct nursing interventions in this situation?

Provide a protective environment. Assist with personal hygiene. Promote activities that reinforce reality.

constipation treatment

fluids, high-fiber foods, and exercise should be recommended to help keep the stools soft

Parkinsonism

Having tremor, muscle rigidity, stooped posture, and a shuffling gait. (doesn't guarantee they have parkinsons disease)

Donepezil. (Cholinesterase inhibitor)

-It does not cure dementia. However, it treats some of the symptoms of Alzheimer's disease, Parkinson's disease or dementia with Lewy bodies. -Reduces behavioral symptoms, particularly mood disturbances and delusions -Client should get regular liver function tests and report light stools and jaundice to the primary health care provider Take w meals to avoid side effects? Side effects: constipation, insomnia, nausea, vomiting

Alzheimer's disease. Most common cause of dementia. PATHO:

Alzheimer's disease patients have plaques and tangles in their brains. Plaques are clumps of a protein called beta-amyloid, and tangles are fibrous tangles made up of tau protein. It's thought that these clumps damage healthy neurons and the fibers connecting them. Neurotransmitter abnormalities. Age, Gender, Genetics

The nurse assists in the care of four older clients whose clinical features are shown in the accompanying chart. Which client may have dementia?

Client 1 has normal psychomotor behavior. The attention of the client is also indicated to be normal. Moreover, misperceptions are absent. Client 1 may likely have dementia. Hypokinetic psychomotor behavior, impaired attention, and difficulty in distinguishing between reality and perceptions may signify delirium. Hyperkinetic behavior and inattention with hallucinations may also signify delirium. Psychomotor retardation, easily distractible attention, and illusions may be caused by depression

Factors that Cause Delirium

Drug therapy (especially anticholinergics, opioids, and psychoactive drugs) Fluid and electrolyte imbalances Infections, especially urinary tract infection, pneumonia, and sepsis Fecal impaction or severe diarrhea Surgery (especially fracture hip repair and post transplant) Metabolic problems such as hypoglycemia Neurologic disorders such as tumors Circulatory, renal, and pulmonary disorders causing hypoxia Nutritional deficiencies Hypoxemia (decreased arterial oxygen level) Mechanical ventilation Insomnia Relocation Major loss

Which actions will the nurse take to support cognitive ability in clients who have Alzheimer disease?

Encouraging caregivers to support safe independence Using calendars, clocks, and pictures to support memory Providing a limited number of choices to support decision-making

delirium

an acutely disturbed state of mind that occurs in fever, intoxication, and other disorders and is characterized by restlessness, illusions, and incoherence of thought and speech, confusion

Rivastigmine is a cholinesterase inhibitor

provides a modest short-term cognitive benefit for some people with mild to moderate Alzheimer dementia. It works by increasing acetylcholine at cholinergic synapses. It is NOT approved for people with SEVERE disease

executive function

the cognitive ability to organize and prioritize the many thoughts that arise from the various parts of the brain, allowing the person to anticipate, strategize, and plan behavior

PD stage 2 Mild Stage

• Bilateral limb involvement • Masklike face • Slow, shuffling gait

PD stage 3 Moderate Disease

• Postural instability • Increased gait disturbances

PD stage 1 Initial Stage

• Unilateral limb involvement • Minimal weakness • Hand and arm trembling