NUR 400 Chapter 39

Which goal would the nurse add to the plan of care for a forgetful, disoriented client who has dementia? a. restrict gross motor activity to prevent injury b. prevent further deterioration in the client's condition c. maintain scheduled activities through behavior modification d. rechannel the client's energies into more appropriate behaviors

d. rechannel the client's energies into more appropriate behaviors

What is the disturbance in consciousness and change in cognition that develops over a short period of time?

delirium

____________________ is a disturbance in consciousness and change in cognition over a short period of time.

delirium

Which mental health problems are most common in older adults?

depression, anxiety disorders, dementia

What is the purpose of a geropsychiatric nursing assessment?

determination of current and past health, functional status and the response to mental health problems

What is late onset dementia?

develops after age 65 and is more common

What is early onset dementia?

develops at 65 years or younger and is rapidly progressing

What is executive function?

planning, decision making, working memory

What does donepezil (aricept) do?

prevent ACh breakdown

What is the primary treatment goal for delirium?

prevention or resolution of the delirious episode with return to previous cognitive status

How does rivastigmine work?

prevents ACh and butrylcholine breakdown

How does Galantamine work?

prevents ACh breakdown, modulates nicotinic receptors

What is social cognition?

recognition of emotions, ability to consider another's mental state

What are the priorities of treatment with delirium?

rule out or treat life threatening illness, stop all suspected medications, monitor changes, attend to safety issues

What does nursing care of dementia depend on?

stage of disease and availability of family care

What is subcortical dementia?

structures inside the brain and brainstem are affected

What is the definition of memory?

the ability to recall what has been learned or experienced

What is affected with cortical dementia?

the cortex of the brain

T/F: Alzheimer's disease is progressively degenerative dementia.

true

T/F: In older adults, delirium is often mistaken for dementia which in turn leads to inappropriate treatment.

true

T/F: Rivastigmine patches are used for Severe AD.

true

T/F: memory is a facet of cognition

true

T/F: neurocognitive disorders represent a clear change from a previous level of functioning.

true

T/F: neurofibrillary tangles are made of abnormally twisted protein threads which disrupt cellular signaling.

true

T/F: older adults are more likely to report somatic symptoms rather than psychological.

true

T/F: patients with moderate dementia require assistance with ADLs.

true

T/F: perceptual motor is visual perception.

true

T/F: the mainstay pharmacologic treatment in Alzheimer disease is acetylcholinesterase inhibitors, which delay the decline in cognitive functioning.

true

T/F: delirium is usually reversible

true if the underlying cause is identified

_______________ is failure to recognize or identify objects despite intact sensory function

Agnosia

What is cortical dementia?

Alzheimer's disease

____________________ is based on a system of interrelated abilities such as perception, reasoning, judgment, intuition, and memory that allow one to be aware of self and surroundings.

Cognition

Impaired ________ is the key diagnostic criterion for delirium

Consciousness

___________ is a disturbance in consciousness and a change in cognition that develops over a short period of time and is usually reversible when the underlying cause id identified and treated quickly.

Delirium

The nurse is caring for an elderly patient with delirium. The patient's room is near the nurses station, they have their glasses and the nurse frequently goes into the room to verbally orient the patient. What other interventions should be part of the nursing plan for this patient? select all that apply. a. provide adequate lighting b. provide a high carb diet c. ensure clock is visible and easy to read d. encourage the family to bring familiar belongings to the patient to keep in the room

a, c, d

Which factors are unique to delirium when distinguishing between dementia and delirium? Select all. a. slurred speech b. lability of mood c. long term memory loss d. visual or tactile hallucinations e. insidious deterioration of cognition f. a fluctuating LOC

a, d, f

which intervention would the nurse implement for a client with Alzheimer disease who has become agitated and aggressive and is incontinent of urine and feces? a. manage the behavior b. prevent further deterioration c. focus on the needs of the spouse d. establish an elimination rewards program

a. manage the behavior

What chemical responsible for cognitive functioning is decreased with Alzheimer's disease?

acetylcholine

What is the essential feature of dementia that needs to be present for diagnosis? :

cognitive decline from a previous level of function in one or more domain

How can Rivastigmine be administered?

patch or PO

What is the diagnostic criteria for delirium?

- Impaired consciousness - Less aware of environment; loss of ability to focus - Problems in memory, orientation, language

What changes are involved with "normal aging"? Select all that apply. a. decreased sensory abilities b. decreased pulmonary and immune functions c. decreased engagement with life d. decreased intellect

a, b

What are the risk factors for development of delirium?

- preexisting cognitive impairment - severe illness - advanced age - brain damage - sleep deprivation - stress

T/F: dementia is differentiated by symptom patterns.

FALSE

What is Memantine(Namenda)?

NMDA antagonist

What is Galantamine (Razadyne)?

cholinesterase inhibitor

What is donepezil (Aricept)?

cholinesterase inhibitor

_______________ dementia is caused by dysfunction or deterioration of deep gray-or-white-matter structures inside the brain and brain stem

Subcortical

What is rivastigmine (exelon)?

cholinesterase inhibitor

What drug classes of medications can be used for management of apathy in patients with AD?

cholinesterase inhibitors, antidepressants

What is dementia?

chronic cognitive impairment differentiated by cause

What is aphasia?

alterations in language ability

What drug classes of medications can be used for management of depression in patients with AD?

antidepressants

What drug classes can be used for management of psychosis in patients with AD?

antipsychotics, cholinesterase inhibitors

What is often disrupted with subcortical dementia?

arousal, attention and motivation

What drug classes of medications can be used for treatment of Aggression symptoms in someone with AD?

atypical antipsychotics, anticonvulsants, antidepressants

What drug classes of medications can be used for management of psychomotor agitation in patients with AD?

atypical antipsychotics, anticonvulsants, antidepressants, benzodiazepines

What is the only way to 100% verify if a patient was suffering from dementia?

autopsy

Which clients would not be suitable for a therapeutic milieu designed for clients with cognitive disorders? a. client with confusion related to moderate Alzheimer disease b. client with confusion and lethargy secondary to delirium c. client with dementia and apathy related to Parkinson disease d. client with memory deficits related to history of TBI

b. client with confusion and lethargy secondary to delirium

What type of plaques are in the brain with alzheimer's?

beta-amyloid plaques

How does Memantine work?

blocks toxic effect of excess glutamate, regulates action of glutamate

How is dementia differentiated?

by cause, not by symptom patterns

How are neurocognitive disorders characterized?

by declining cognitive function from a previous level of functioning

Which domains of function are reviewed to look for decline in order to diagnosis dementia?

executive function, learning and memory, language, perceptual motor or social cognition

Strategies such as _______, ________, and ________ can support and protect the patient's cognitive reserve.

exercise, education, cognitive stimulation

What is agnosia?

failure to recognize or identify objects

T/F: An appropriate intervention of agitation in patients with dementia is the administration of benzos on long-term basis.

false

T/F: similar to Alzheimer disease, all neurocognitive disorders are reversible and progressive.

false

T/F: the most commonly identified cause of delirium is metabolic disturbance

false

What symptoms are present with severe dementia?

gait and motor disturbances, bedridden, inability to perform ADLs, incontinence, long term care

What is apraxia?

impaired ability to execute movement

What symptoms are present with MODERATE dementia?

inability to retain new info, personality/behavior changes, increasing long term memory loss, wandering, agitation, confusion

What is the definition of cognition?

interrelated abilities such as perception, reasoning, judgement, intuition, and memory

What symptoms are present with MILD dementia?

loss of memory, language difficulties, mood swings, personality changes, diminished judgment, apathy

What are the most common causes of delirium in older adults?

medications, infections, fluid/electrolyte imbalances, hypoxia

What is used Galantamine(Razadyne) used for?

mild to moderate Alzheimers

What is donepezil(Aricept) used for?

mild to severe Alzheimer's disease

What is Memantine used for?

moderate to severe AD

What does cognition allow for?

one to be aware of self and surroundings