CHAPTER 24 Cognitive Disorders

Integrate reminders of previous events into current interactions, such as

"Earlier you put some clothes in the washing machine; it's time to put them in the dryer."

Provide verbal connections about using implements. For example,

"Here is a washcloth to wash your face," "Here is a spoon you can use to eat your dessert."

(Promoting the Client's Safety) What is a good response to give to a client that has dementia and wants to cook for themselves but they might forget they were cooking something?

"I'll sit in the kitchen and talk to you while you make lunch" (suggesting collaboration) rather than "You can't cook by yourself because you might set the house on fire." - In this way, the nurse or caregiver supports the client's desire and ability to engage in certain tasks while providing protection from injury.

What is a proper response for the nurse to tell a pt w/ dementia that is getting interviewed.

"I'm asking these questions so the staff can see how your health is." give the pt ample time to answer too and ask simple question NOT COMPOUND

(DELIRIUM) At times, pt with DELIRIUM may also experience disturbances in the 2. what group most frequently diagnosed with delirium.? 3. What is the cause of DELIRIUM? 4. What is an INCREASED RISK for DELIRIUM? 5. Who are more susceptible to DELIRIUM? especially if they have?

- sleep-wake cycle - changes in psychomotor activity - emotional problems such as anxiety, fear, irritability, EUPHORIA, or APATHY 2. ELDERLY 3. bc of MULTIPLE STRESSORS like TRAUMA to the CENTRAL NERVOUS SYSTEM (cns) DRUG TOXICITY or WITHDRAWAL, METABOLIC DISTURBANCES related to organ failure. 4. -physical illness -older age - hearing impairment -decreased food and fluid intake, medications, and baseline cognitive impairment such as that seen in dementia. 5. children, if they have FEBRILE (fever) or using med. such as ANTICHOLINERGICS

A pt with DELIRIUM, will they have any speech problems?

- yes, it is difficult to understand as it worsens. - they will REPEAT one single topic, RAMBLING, Hard to FOLLow. - may have PRESSURED SPEECH(rapid, forced louder) - at nights. they will scream

What are triggers for dementia people?

-strangers - changes in daily routine -impaired memory The nurse must discover and address these environmental triggers rather than confront the paranoid ideas. ex. client reports that his belongings have been stolen. nurse will respond Let's go look in your room and see what's there.

1. Cognition is the brain's ability to 2.What does PROCESS mean? 3. what does NEUROCOGNITIVE DISODER include?

1. - PROCESS -RETAIN -USE INFORMATION 2. -REASONING -JUDGEMENT -PERCEPTION -ATTENTION -COMPREHENSION -MEMORY 3. -DELIRIUM -major NCD - mild NCD - and their subtypes: DEMENTIA

(Sensorium and Intellectual Processes) 1. What is the 1st sign of DELIRIUM? 2. are delirium people orientated? 3. They demonstrate decreased awareness of the? 4. which memory is impaired on them? recent or immediate memory? 5. Delirium pts also experience Hallucinations and what else?

1. ALTERED LEVEL of CONSCIOUSNESS 2. orientated to people but NOT time n place. 3. environment or situation and instead may focus on irrelevant stimuli such as the color of the bedspread or the room. (REMEMBER the video of the nurse that experience delirium, she was not aware of her surroundings but noises hasher main focus, and heard birds inside her walls) Noises, people, or SENSORY misperceptions easily distract them. 4. recent and immediate memory, so the nurse needs to ask questions repeatedly. 5. HALLUCINATION ex. visual; clients "see" things for which there is no stimulus in reality. ILLUSIONS ex. believing that IV tubing or an electrical cord is a snake and mistaking the NURSE for a FAMILY MEMBER MISINTERPRETATION ex. may hear a door slam and interpret it as a gunshot or see the nurse reach for an IV bag and believe the nurse is about to strike them.

If a person cannot name OBJECTs or people and then progresses to speech that becomes vague or empty and then uses terms like " IT " or " THING" is called? 2. What is echolalia? 3. What is PALILALIA? 4. Apraxia can cause people to lose .. 5. Agnosia? (nosa- nose) 6. executive functioning?

1. APHASIA 2. echoing what is heard 3.repeating words or sounds over and over) 4. the ability to perform routine self-care activities such as dressing or cooking 5. frustrating for clients; they may look at a table and chair but are unable to name them 6. lose the ability to learn new material, solve problems, or carry out daily activities such as meal planning or budgeting.

1. Dementia of the Alzheimer type is the most common type in 2. vascular dementia is more prevalent in ? 3. Dementia of the Alzheimer ( trick: alzheiii) type is more common in what gender? 4. vascular ( trick :muscular) dementia is more common in what gender?

1. North America (60% of all dementias), Scandinavia, and Europe; 2. Russia and Japan. 3.women 4. men

(Nursing Interventions) 1. explain limits and reasons clearly and within the client's ability to understand. 2. Allow the client to make decisions as much as he or she is able to. 3. In a matter-of-fact manner, give the client factual feedback on misperceptions, delusions, or hallucinations (e.g., "That is a chair."), and convey that others do not share his or her interpretations (e.g., "I don't see anyone else in the room."). 4. Teach the client about underlying cause(s) of confusion and delirium.

1. RATIONAL: The client has the right to be informed of any restrictions and the reasons limits are needed. 2. RATIONAL: Decision-making increases the client's participation, independence, and self-esteem 3. RATIONAL: When given feedback in a nonjudgmental way, the client can feel validated for his or her feelings while recognizing that his or her perceptions are not shared by others. 4. RATIONAL: Knowledge about the cause(s) of confusion can help the client seek assistance when indicated.

What does TIME AWAY mean? give me ex.

1. Time away involves leaving clients for a short period and then returning to them to reengage in interaction ex. the client may get angry and yell at the nurse for no discernible reason. The nurse can leave the client for about 5 or 10 minutes and then return without referring to the previous outburst. The client may have little or no memory of the incident and may be pleased to see the nurse on his or her return.

(Roles and Relationships) Will MILD STAGE of dementia affect the person at work? Why do dementia people will be CONFINED to house ?

1. Yes, work is no longer possible given the memory and cognitive deficits. even role as a family is lost. 2. bc they are unable to venture outside w/out the help of someone.

(Sensorium and Intellectual Processes) - Clients lose intellectual function which eventually involves the complete loss of? 2. what are the initial and essential feature of dementia.? 3. Dementia first affects recent or immediate memory? 4. In mild and moderate dementia, clients may make up answers to fill in? 5. What is another HALLMARK for dementia? 6. Clients lose visual spatial relations, which is often evidenced by? 7.Initially, they are disoriented to time in? time and place in? AND to self?

1. abilities 2. Memory deficits 3. 1st recent and immediate memory then y impairs the ability to recognize close family members and even oneself. 4. memory gaps (CONFABULATION) 5. Agnosia. 6. deterioration of the ability to write or draw simple objects 7. mild dementia, time and place in MODERATE DEMENTIA, lose to self is SEVERE.

(Community-Based Care) .... all nursing home residents have Alzheimer disease or some other illness that causes dementia? 2. every person w/ dementia in a nursing home, 2 or 3 w/ similar impairments are receiving care in the community by some combination of? 3. who was the president who fundraised Alzheimer disease? 4. is HOME HEALTH care available? what services do they offer if home health is available? 5. What do ADULT DAY CARE centers provide? 6. What is RESPITE CARE? 7. What are RESIDENTIAL FACILITIES? 8. Clients in residential facilities are often referred for? 9. who can initiate referrals for community-based services?

1. at least half 2. family members, friends, and paid caregivers. 3. Ronald Reagan 4. Yes, through home health agencies, public health agencies, and visiting nurses -bathing, food preparation, and transportation as well as with other support. 5. supervision, meals, support, and recreational activities in group settings 6. offers in-home supervision for clients so that family members or caregivers can run errands or have social time of their own. (so to give them a brake) 7. are available for clients who do not have in-home caregivers or whose needs have progressed beyond the care. THEY require assistance w/ ADLs, LIKE eating , n taking meds. 8. for skilled nursing home placement as dementia progresses. 9. The physician, nurse, or family

(Thought Process and Content) 1. Why is it difficult to assess a pt w/ delirium? 2. Tell me about the thought content of a delirium person. like does it make sense? 3. Thought process is how on a delirium pt ? 4. Clients w/ delirium may exhibit?

1. bc they can't pay attention 2. It is UNRELATED to the situation. Speech is ILLOGICAL and cannot understand. ex. asking how are they feeling and they mumble about the weather. 3. disorganized and make no sense. FRAGMENTED as well. (like not complete to disjoined) 4. DELUSIONS, believe sensory perceptions are real.

(Related Disorders) 1. Substance- or medication-induced mild or major NCD? 2. and how is this characterized?

1. both! 2. neurocognitive impairment that go beyond intoxication or withdrawal

(Promoting the Client's Safety) 1. The nurse teaches clients to request assistance for activities such as

1. getting out of bed or going to the bathroom if they cannot ask for assistance, they will be watched to prevent them from doing any activities to keep them safe.

(Judgment and Insight) 1. a delirium pt judgment intact or impaired? why? 2. Is a pt insight intact or impaired on a delirium pt?

1. impaired. they cannot tell what is harmful n act in their best interest. ex. try to pull out IV, w/out thinking this is going to hurt them n interferes w/ treatment. 2. DEPENDS! some have MILD delirium and recognize they are confused (remember the nurses on youtube that experienced delirium) and likely to improve on their treatment. SEVERE DELIRIUM have NO INSIGHT about the situation.

(Etiology) 1. What is the ETIOLOGY of DELIRIUM?

1. it's IDENTIFIABLE physiological metabolic or cerebral disturbance or disease or from drug intoxication or withdrawal.

(Promoting Adequate Sleep and Proper Nutrition, Hygiene, and Activity) 1. Clients may eat poorly because of? What will a nurse do to help? 2. When does ENTERAL NUTRITION becomes necessary?

1. limited appetite or distraction at mealtimes - nurse will address this problem by giving food the pt likes sitting w/ the pt at meal to provide cues to continue eating having snacks available minimize noise and undue distraction at mealtimes. Be careful they might eat TOO much or INEDIBLE items. Provide carrots and celery sticks to chew can satisfy them w/out gaingin weight. 2. when dementia is severe

Delirium is often caused bc of ? 2. tell me the drugs that can cause delirium? POS TODOS! LMAOO O long ass list.

1. medical illness, alcohol, or other drugs, the nurse obtains a thorough history of these areas. ask the family if the pt isn't giving accurate data. 2. ANESTHESIA ANTIconvulsants ANTIcholinergics ANTIdepressants ANTIhistamines ANTIhypertensives ANTIneoplastics ANTIpsychotics ASSSSSSSSPIRIN BARBIII TURATES arbiturates Benzodiazepines Cardiac glycosides Cimetidine (Tagamet) Hypoglycemic agents Insulin Narcotics Propranolol (Inderal) Reserpine Steroids Thiazide diuretics

Role strain is identified when? 2. role strain include? 3. Caregivers may feel unappreciated by other family members, as indicated by statements such as? 4. role strain can contribute to the neglect or abuse of clients with 5. Caregivers need outlets for dealing with their own feelings. Support groups can help them express? 6. Area hospitals and public health agencies also can help caregivers to locate community resources. nothing on other side. 7. caregivers need support to maintain personal lives. They need to continue to socialize with friends and engage in leisure activities or hobbies rather than focusing solely on the client's care. Caregivers who are rested, happy, and have met their own needs are better prepared to manage the rigorous demands of the caregiver role.Most caregivers need to be reminded to take care of themselves; this act is not selfish but is in the client's best longterm interests. . nothing on other side.

1. n the demands of providing care threaten to overwhelm a caregiver 2. fatigue unrelieved by rest, increased use of alcohol or drugs, social isolation, inattention to personal needs, inability to accept help from others. 3."No one ever asks how I am!" 4. dementia 5. frustration, sadness, anger, guilt, or ambivalence; all these feelings are common.

(Self-Concept) does it have an effect on self concept w/ a pt w/ delirium? 2. What about those that are aware of the situation may feel how (delirium pt) 3. What if delirium has happened bc of Alcohol, drug use, or medication the pt will feel?

1. no but they are frightened or feel threatened 2. helpless or powerless to do anything to change it 3. guilt, shame, and humiliation, or think, "I'm a bad person; I did this to myself." possible long-term problems with self-concept.

(Roles and Relationships) Can delirium people fulfil their role in the family?

1. no, but there are some that regain their level but still have problems.

(Community-Based Care) So lets say the delirium pt is reversed back, can alll their cognitive functions be regained? 2. Because delirium and dementia frequently occur together, clients may have 3. if clients continue to experience cognitive problems.it may be necessary for the nurse or other health care professionals to initiate? 4. Clients and family members or caregivers might benefit from ?

1. no, confusion may persist. 2. dementia 3. referrals to home health visiting nurses or a rehabilitation program 4. support groups to help them deal with the changes in personality and remaining cognitive or motor deficits.

(Psychopharmacology) 1. Do pts w/ HYPOACTIVE DELIRIUM need medications? 2. What would be given to them as med to avoid SELF INJURY? n give me the dose.

1. no, just treatment for their causative condition. 2.SEDATION , ANTIPSYCHOTIC med like , HALOPERIDOL . dose= 0.5 to 1 mg

(CULTURAL CONSIDERATIONS) Remember the CULTURAL AWARE if you ask someone who si the U.S president bc? 2. What do Jehovah's Witnesses not celebrate?

1. not everyone will know the president bc they aren't familiar. - Other cultures may consider orientation to placement and location differently. 2. birthdays so they will have difficulty stating their date of birth.

(Treatment and Prognosis) 1. The primary treatment for delirium is to 2. Delirium is almost always a 3. are People who have had delirium are at higher risk for future episodes?

1. o identify and treat any causal or contributing medical conditions 2. transient (temporary) condition that clears with successful treatment of the underlying cause. - though causes such as head injury or encephalitis may leave clients with cognitive, behavioral, or emotional impairments even after the underlying cause resolves 3. yes

(Judgment and Insight) Clients with dementia have . . . . judgment in light of the cognitive impairment. 2. How is their insight? poor or good?

1. poor, which are at risk for injury bc they cannot evaluate risk or danger. ex. they may wander outside in the winter wearing only thin nightclothes and not consider this to be a risk. 2. LIMITED. At first the pt may be aware of problems w/ memory and cognition and may worry that he or she is "LOOSING MY MIND".

what does GOING ALONG mean? 2. client is fretful, repeatedly saying, "I'm so worried about the children. I hope they're OK," and speaking as though his adult children were small and needed protection. The nurse could say?

1. providing emotional reassurance to clients without correcting their misperception or delusion. nurse does not engage in delusional ideas or reinforce them, but he or she does not deny or confront their existence. ex. 2. There's no need to worry; the children are just fine (going along), DO NOT USE GOING ALONG on DELUSIONS

(Outcome Identification) 1. Treatment outcomes for clients with progressive dementia do not involve regaining or maintaining abilities to function. In fact, the nurse must...? 2.Psychosocial care involves maintaining the client's..?

1. reassess overall health status and revise treatment outcomes periodically as the client's condition changes. 2. independence as long as possible, validating the client's feelings, keeping the client involved in the environment, and dealing with behavioral disruptions respectfully

So, you know delirium people respond to sensory overload, what can you do to handle that situation?

1. reduce environment stimuli bc it gets them distracted and overstimulated. like Tv, radio. also visitors can confused the pt too. tell visitors to have quiet talking w/ one person at a time. - ROOm Well LIT to minimize MISPERCEPTIONS/ILLUSIONS/ have the nurse correct it as a MATTER of FACTLY! -Validate their feelings but not their misperceoption. ex. client hears a loud noise in the hall and asks the nurse, "Was that an explosion?" The nurse might respond,"No, that was a cart banging in the hall. It was really loud, wasn't it? It startled me a little when I heard it." (presenting reality/validating feelings)

What does DISTRACTION MEAN on a dementia pt? give me ex.?

1. shifting the client's attention and energy to a more neutral topic. ex. the client may display a catastrophic reaction to the current situation, such as jumping up from dinner and saying, "My food tastes like poison!" The nurse might intervene with distraction by saying "Can you come to the kitchen with me and find something you'd like to eat?" or "You can leave that food. Can you come and help me find a good program on television?" (redirection/distraction)

(Physiological and Self-Care Considerations) Clients with dementia often experience disturbed?

1. sleep-wake cycles;they nap during the day and wander at night - other ignore internal cues (body cues) that they are hungry or thirsty - others have trouble eating and drinking that dementia takes over SEVERILY. - experience Bladder, bowel incontinence and trouble cleaning themselves. - neglect bathing/grooming

(DELIRIUM) 1. What is DELIRUM? 2. when delirium develop? 3. People w/ DELIRUM , do they have trouble paying ATTENTION? 4. Give me an example of an ILLUSION. 5. Give me an example of an MISINTERPRETATION. 6. Give me an example of an HALLUCINATION.

1. syndrome that involves a disturbance of consciousness accompanied by a change in cognition. 2. short period of time, in hours! , it FLUNCTUATES, or CHANGES throughout the day. 3. yes, also easily DISTRACTED n DISORIENTATED. Sensory disturbances like - ILLUSIONS -MISINTERPRETATIONS -HALLUCINATIONS 4. electrical cord on the floor may appear to them as a snake (illusion). 5.They may mistake the banging of a laundry cart in the hallway for a gunshot (misinterpretation). 6. They may see "angels" hovering above when nothing is there (hallucination).

(Treatment and Prognosis) 1. underlying cause of dementia is identified so that ? give me ex? 2. What do all prognosis involve ? 3. For degenerative dementias, what are kind of therapies for them? 4. Levels of numerous neurotransmitters such as. . . . decrease in dementia. 5. What medication is given to degenerative dementia?

1. treatment can be instituted. ex. vascular dementia, may be stopped with appropriate treatment like (e.g., changes in diet, exercise, control of hypertension, or diabetes). Improvement of cerebral blood flow may stop the progress of vascular dementia in some people. 2. involve progressive deterioration of physical and mental abilities until death 3.no direct therapies have been found to reverse or retard the fundamental pathophysiological processe 4. acetylcholine, dopamine, norepinephrine, and serotonin. NO EPINEPRHINE! 5. CHOLINESTERASE inhibitors

(Mood and Affect) A pt w/ DELIRIUM, there mood will? 2. emotions will be ? 3. When the client feels threatened, they may become ?

1. unpredictable shift 2. anxiety fear irritability anger euphoria and apathy.(lack of interest) 3. o/c COMBATIVE to defend themselves

Medications for dementia are given how much?

1/2 or 2/3

(Other Medical Treatment) While the underlying causes of delirium are being treated, clients may also need other supportive physical measures such as? 2. when can physical RESTRAINTS be used on a pt W/ delirium?

Adequate nutritious food and fluid intake speed recovery. IV fluids or even total parenteral nutrition may be necessary if a client's physical condition has deteriorated and he or she cannot eat and drink. 2. client becomes agitated and threatens to dislodge IV tubing or catheters, but not kept that long bc it would agitate them more.

Which medication is used for depression but can cause delirium?

Antidepressants, so Selective serotonin reuptake inhibitor antidepressants are used because they have fewer side effects.

which medications is used to manage psychotic symptoms of delusions, hallucinations, or paranoia, and other behaviors, such as agitation or aggression 2. are these medications approved for dementia? 3. which medication will help stabilize affective lability and diminish aggressive outbursts? 4. whihc medication can be use w/ Parkinson disease w/ delusions and hallucinations? what is the dose and what is it known for?

Antipsychotics, such as haloperidol (Haldol), olanzapine (Zyprexa), risperidone (Risperdal), and quetiapine (Seroquel), Needs to be careful bc of cardiovascular complications. 2. not approved antipsychotics for dementia treatment, 3. Lithium carbonate, carbamazepine (Tegretol), and valproic acid. 4. Pimavanserin ( 34-mg capsule per day) known to prolong the Q-T interval. note: conventional and atypical antipsychotics are associated with an increased risk of mortality in elderly patients treated for dementia-related psychosis.

DIFFERENCES BETWEEN DELIRIUM VS DEMENTIA rememeber the mnemonic OCD CAMPS

DEMENTIA : Onset= INSIDIOUS - months to years Course= Progressive Duration= Irreversible- months to years Consciousness= often NORMAL Attention=often NORMAL Memory= immediate recall often NORMAL Psychomotor changes= NOT usually present Sleep wake cycle= often NORMAL Delirium: Onset= RAPID, hours to Days Course= Fluctuate, agitation in "SUNDOWNMING" Duration= REVERSIBLE- days to weeks Consciousness= ALTERED Attention= INATTENTION, LACK OF CONCENTRATION Memory= Immediate RECALL impaired Psychomotor changes= HYPERactive or HYPO active Sleep wake cycle=Often reversed

Dementia is: 2. What are those cognitive deficits in Dementia?

DISEASE process marked by PROGRESSIVE cognitive impairment w/ no change in level of consciousness. 2. COGNITIVE DEFICITS 1st Memory IMPAIRMENT Later: it is - APHASIA: deterioration of language function -APRAXIA: impaired ability to execute motor functions despite intact motor abilities. - AGNOSIA: unable to recognize, and name objects despite intact sensory abilites. -DISTURBANCE in EXECUTIVE FUNCTIONING. : so they can't think ABSTRACTLY, plan, start, sequence, monitor, and stop complex behavior.

(Psychopharmacology) How does HALOPERIDOL help on a DELIRIUM pt? Can BEZODIAZIPINES be used on Delirium ? and tell me why if not?

Decrease AGITATION n PSYCHOTIC symptoms and to help sleep. yes, but like the med lorazePAM can WORSEN DELIRIUM especially in elders.

What is the GENETIC COMPONENT identified w/ dimentia? 2. An abnormal APOE gene is known to be linked with? 3. Other causes of dementia are related to

Huntington disease. 2. Alzheimer disease. 3. infections such as human immunodeficiency virus (HIV) infection or Creutzfeldt-Jakob disease (CREW)

1. Korsakoff syndrome meaning? 2. and what was it previous known as?

Long-term use of alcohol that results in dementia 2. amnestic disorder

which is an NMDA receptor antagonist that can slow the progression of Alzheimer in the MODERATE or SEVERE stages?

Memantine

what activities are more likely to put the pt calm?

Music, dancing, pet- or animal-assisted therapy, AROMATHERAPY(use plant or oils in massage) , and multisensory stimulation

Can elders receive lorazePAM medication for their delirium?

NO! it would worsen their DELIRIUM

WHICH has the actions of BOTH cholinesterase inhibition and NMDA receptor antagonist

Namzaric

DIFFERENCES ON THE BOOK DELIRIUM n DEMENTIA

Onset delirium: rapid onset dementia: gradual Duration delirium: hours to days - brief Duration dementia: progressive Level of consciousness delirium: impaired. Level of consciousness dementia: not affected Memory on delirium : Short-term memory impaired Memory on dementia: Short- and then long-term memory impaired, eventually destroyed speech on delirium: slurred, rambling, pressured, irrelevant. speech on dementia: Normal early stage, but progresses to APHASIA. Thought processes delirium: Temporarily disorganized Thought processes dementia:Impaired thinking, eventual loss of thinking abilities Perception delirium: Visual or tactile hallucinations, delusions Perception dementia: absent, but can have paranoia, hallucinations, illusions Mood delirium: Anxious, fearful if hallucinating; weeping, irritable Mood dementia: Depressed and anxious in early stage, labile mood, restless pacing, angry outbursts in later stages

dementia cannot be diagnosed until completion of a ?

POSTMORTEM EXAMINATION

What is usually an enjoyable activity for the client.

Reminiscence

client says "They're here to take me away!" the nurse might say,

Those people are here visiting with someone else. Let's go for a walk and let them visit. (presenting reality/distraction)

Supportive touch means?

Touch can provide reassurance and convey caring when words may not be understood. ex. tucking the client into bed at night is supportive touch.

(Role of the Caregiver) Who is the majority gender to take care of dementia people in their family? 2. why is there a trend to take care of a dementia person at home? 3.

Women and Adult daughters 2. bc high costs of institutional care, dissatisfaction with institutional care, and difficulty locating suitable placements for clients with behaviors that are sometimes disruptive and difficult to manage - other take care of them bc of the desire to reciprocate (respond in kind) for past assistance, to provide love and affection, to uphold family values or loyalty, to meet duty or obligation, and to avoid feelings of guilt.

Can you give Realistic Reassurance to pt with delirium?

Yes, ex. "I know things are upsetting and confusing right now, but your confusion should clear as you get better." (validating/giving information) - also state the time of the day ex. "I know things are upsetting and confusing right now, but your confusion should clear as you get better." (validating/giving information) - Remind them repeatedly your name ex."My name is Sheila, and I'm your nurse today. I'm here now to walk in the hall with you." (reality orientation) - having CLOCK/CALENDER in room - TOUCH can help too

What are the TYPES of dementia?

[Alzheimer disease] - gradual onset(Start) - causes decline in function, like speech, motor function, personality, behavior changes too; paranoia, delusions, hallucinations, inattention to hygiene, n belligerence (aggresive) -atrophy of neurons -SENILE PLAQUE deposits -enlarged 3th n 4th ventricles of brain -Alzheimer disease increases with age - duration of living is 8-10 years - there is a genetic link to both early and late onset. [Lewy body dementia] -progressive cognitive impairment -neuropsychiatric symptoms - motor symptoms. -Delusions and visual hallucinations -Functional impairments may initially be more pronounced(noticeable) than cognitive deficits. - risk on those GENES in families -less common in no hx of genes [Vascular dementia] -symptoms similar to those of Alzheimer disease -onset is abrupt -rapid changes in functioning: a PLATEAU -leveling-off period;more abrupt change;another leveling-off period; and so on. -CT or MRI show LESIONS of the cerebral cortex and subcortical structures bc of DECREASED blood suply [FRONTOTEMPORAL LOBAR DEGENERATION (originally called PICK disease)] - degenerative brain disease -affects frontal and temporal lobes - early sign: personality changes -loss of social skills n inhibitions -emotional blunting(dull) - language abnormalities - onset common 50 to 60 years of age - death occurs in 2 to 5 years. - runs in families [Prion diseases(Creutzfeldt-Jakob disease)] - caused by a prion (a type of protein),can trigger normal proteins in the brain to fold abnormally - Creutzfeldt-Jakob disease is the common prion disease affecting humans. - CNS disorder that develops in adults 40 to 60 years - involves ALTERED VISION, loss of COORDINATION or abnormal MOVEMENTS, and DEMENTIA that usually progresses rapidly (a few months). - encephalopathy is an infectious particle resistant to boiling, some disinfectants (e.g., formalin, alcohol), and ultraviolet radiation. Pressured autoclaving or bleach can inactivate the particle. -MAD COW DISEASE n KARU are other PRIONs. [HIV] infection can lead to dementia and other neurologic problems; these may result directly from invasion of nervous tissue [Parkinson disease] -slowly progressive neurologic condition -symptoms: tremor, rigidity, bradykinesia, and postural instability - bc loss of neurons of the basal ganglia -cognitive and motor slowing, impaired memory, and impaired executive functioning. [Huntington disease] -inherited, dominant gene disease -involves cerebral atrophy, demyelination, and enlargement of the brain ventricles. - symptoms: facial contortions, twisting, turning, and tongue movements. memory loss, decreased intellectual functioning, and other signs of dementia -begins in late 30s or early 40s and may last 10 to 20 years or more before death. [Dementia due to traumatic brain injury] -depend on the location and extent of the brain injury. -a single injury, the dementia is usually stable -Repeated head injury(e.g., from boxing or football) may lead to progressive dementia

(Etiology) Most Common Causes of Delirium?

[PHYSIOLOGICAL or METABOLIC] :such as hypoxia electrolyte disturbances renal or hepatic failure hypoglycemia or hyperglycemia dehydration sleep deprivation thyroid or glucocorticoid disturbances thiamine or vitamin B12 deficiency vitamin C NIACIN protein deficiency cardiovascular shock brain tumor head injury EXPOSURE TO GASOLINE paint solvents INSECTICIDES and related substances [INFECTION:] systemic- SEPSIS , UTI, PNEUMONIA Cerebral- meningitis, encephalitis, HIV, SYPHILLUS [DRUG RELATED] INTOXICATION: ANTICHOLINERGICS, LITHIUM, ALCOHOL, SEDATIVES, HYPNOTICS WITHDRAWAL: alcohol, sedatives, HYPNOTICS reactions to anesthesia, prescription medication, or illicit (street) drugs.

Encourage the client to use written cues such as a

calendar, lists, or a notebook.

A mental status examination 2. What is a pt asked to do? 3. Okay, you are trying to ask hx of a pt w/ dementia they cannot give who else would you ask then?

can provide information about the client's cognitive abilities such as memory, concentration, and abstract information processing. 2. asked to interpret the meaning of a proverb, perform subtraction of figures without paper and pencil, recall the names of objects, make a complete sentence, and copy two intersecting pentagons 3. Interviews with family, friends, or caregivers

Which medications are used for dementia?

cholinesterase inhibitor 1.Donepezil 2.Rivastigmine 3.Galantamine 4.Memantine also TACRINE but it elevates liver enzymes 50 %, so lab test are needed every 1-2 weeks.

how is the metabolic activity in the brain of a dementia person?

decreased.

(Thought Process and Content) As the dementia progresses....? 2. The client may accuse others of

delusions of persecution are common. 2. stealing objects he or she has lost or may believe he or she is being cheated or pursued

[idk what the fuk is NCD] 1. Mild or major NCD due to another medical condition is caused by 2. Unspecified NCD is characterized by?

diseases such as brain tumor, brain metastasis, subdural hematoma, arteritis, renal or hepatic failure, seizures, or multiple sclerosis. 2. neurocognitive symptoms that cause the person distress or impairment, but do not meet the criteria for any other NCD. Neurocognitive deficits due to stroke, head injuries, carbon monoxide poisoning, or brain damage from other medical causes were previously classified as amnestic disorders.

What is REMINISCENCE THERAPY? 2. Rather than lamenting that the client is "living in the past," this therapy encourages family and caregivers to also? 3. Reminiscing, also called ? 4. what may be useful to stimulate remore memory? 5. When verbal language becomes less coherent, the nurse should remain alert to the client's? 6. it is impossible to determine exactly what the client is trying to convey, the nurse might respond like?ex. a client is pacing and looks upset but cannot indicate what is bothering her.

encouraging residents w/ dementia to remember and talk about the past 2. reminisce with the client. 3. nostalgia, uses the client's remote memory, which is not affected as severely or quickly as recent or immediate memory. 4. photos. 5. nonverbal behavior ex. client becomes restless, it may indicate that he or she is hungry 6. You look worried. I don't know what's wrong, but let's go for a walk. (making an observation/offering self)

(Evaluation) Treatment outcomes change constantly as the disease progresses. Give me ex.

ex. Early stage of dementia, maintaining independence may mean that the client dresses with minimal assistance.Later, the client keeps SOME independence by selecting what foods to eat. 2nd ex. Late stage: Pt may maintain independence by wearing his or her own clothes rathe than an Intuitional Nightgown or pajamas.

(Mood and Affect) clients with dementia experience anxiety and fear over the beginning losses of memory and cognitive functions and they will not?

express their feeling to anyone bc they are embarrassed. - Mood becomes more labile - Emotional outbursts are common - display anger and hostility, - demonstrate CATASTROPHIC emotional reactions in response to environmental changes that clients may not perceive or understand accurately or when they cannot respond adaptively

CULTURE: Be aware that Eastern countries and among Native Americans, elders hold a position of authority, respect, power, and decision-making for the family so DESPITE THEIR memory loss. Their daughter or granddaughter might find it ... to make decisions or plans for elders with dementia.

fear, disrespectful ... tf

Does Homocysteine need to be low or high to increase the risk of dementia?

high.

(Mental Health Promotion) People with elevated levels of plasma . . . . are at increased risk for dementia. 2. As levels of plasma . . .. increase, so does the risk for dementia 3. What are known to reduce plasma homocysteine levels, potential therapeutic strategies using these substances may modify or diminish the risk for dementia? 4. People who regularly participate in brain-stimulating activities, such as reading books and newspapers or doing crossword puzzles, are less likely to develop? 5. what is associated with a decreased risk for Alzheimer disease in later life.

homocysteine 2. homocysteine 3. FOLATE VITAMIN B12 BETAINE 4. Alzheimer disease than those who do not. 5. LEISURE TIME PHYSICAL ACTIVITY Having LARGE SOCIAL NETWORK

(General Appearance and Motor Behavior) apraxia meaning?

loss of ability to perform familiar tasks like dressing or combing one's hair, though actual motor abilities are intact. - cannot imitate the task when others demonstrate it for them - severe stage, clients may experience a gait disturbance that makes unassisted ambulation unsafe, if not impossible -uninhibited behavior ( making inappropriate jokes, neglecting personal hygiene, showing undue familiarity with strangers, or disregarding social conventions for acceptable behavior.)

What is the early sign of dementia? 2. in later stages, dementia affects what memory?

memory impairment, recent memory impaired. - difficulty learning new material and forget previously learned material 3. REMOTE memory ( pts forget the names of adult children, their lifelong occupations, and even their names.)

Should you give a pt a sedative such as benz if they have impaired LIVER and Kidney function?

no, bc they could have trouble metabolizing or excreting sedatives.

(Intervention) What is REFRAMING?

offering alternative points of view to explain events

Use a matter-of-fact approach when assuming tasks the client can no longer perform. Do not allow the client to work unsuccessfully at a task for an extended time.

rational: It is important to preserve the client's dignity and minimize his or her frustration with progressive memory loss.

Mild NCD? 2. major NCD

refers to a mild cognitive decline, and a modest impairment of performance that doesn't prevent independent living 2. refers to a significant cognitive decline and a substantial impairment in performance that interferes with activities of daily independent living.

WHAT ARE catastrophic reactions?

verbal or physical aggression, wandering at night, agitation, or other behaviors that seem to indicate a loss of personal control.

Do delirium people need help w/ eating ?

yes, helpful to sit with clients at meals or to frequently offer fluids. also make them use the rr if they do not do that themselves. RANDOM note: daytime exercises is good for them so they can sleep at night. Activities can be: sitting in a chair, walking in the hall, diversional activities.

Do Delirium PT have a PSYCHOMOTOR behavior?

yes, restless n hyperactive, PICKING at bed clothes or making UNCORDINATED attempts to get out of bed. - also SLOW MOTOR behavior - appear SLUGGISH n LETHARGIC w/ little movement. so HYPPOOOO AND HYPPERRRR. remember the video.

(Physiological and Self-Care Considerations) Do delirium people have disturbed sleep wake cycles?

yes. At times, clients also ignore or fail to perceive internal body cues such as hunger, thirst, or the urge to urinate or defecate.

What are the stages for DEMENTIA?

• Mild: Forgetfulness is the hallmark of beginning, mild dementia. It exceeds the normal, occasional forgetfulness experienced as part of the aging process. - difficulty finding words - frequently loses objects - begins to experience anxiety about these losses. - Occupational and social settings are less enjoyable, and the person may avoid them. - remain in the community during this stage. • Moderate: Confusion is apparent(evident), along with progressive memory loss. - can perform tasks but remains oriented to person and place. - still recognizes familiar people. - at the end of this stage, the person cannot live independently and needs assistance because of disorientation to time and loss of information, such as address and telephone number. -The person may remain in the community if adequate caregiver support is available, but some people move to supervised living situations. • Severe: Personality and emotional changes occur. - delusional - wander at night - forget the names of his or her spouse and children - require assistance with ADLs. - live in nursing facilities when they reach this stage, unless extraordinary community support is available.