Cognition

What are four types of pharmacotherapy drugs used to treat the symptoms of Alzheimer's?

- Anxiolytics and hypnotics - Antidepressants - Antipsychotics - Indirect-acting cholinergic agonists

What are examples of risks for cognitive impairment related to health-related conditions?

- Chemotherapy - diabetes (hyper/ hypoglycemia) - depression - pregnancy - UTI - age

What are the clinical manifestations of late stage Alzheimer's?

- Difficulty communicating - Total care

What are 2 types of Alzheimers?

- Familial: seen in younger adults, progresses quickly - Sporadic: diagnosed after the age of 60 and accounts for most cases of the disease

What are examples of risks for cognitive impairment related to congenital and genetic conditions?

- Fetal alcohol syndrome - familial disease

What would constitute higher order cognitive functioning?

- Learning - Comprehension - Insight - Problem solving - Reasoning - Decision Making - Creativity - Metacognition

What constitutes basic cognitive functioning?

- Perception - Pattern recognition - Attention

What are 3 categories of cognitive impairment?

- Physiologic - Psychiatric - Learning disabilities

There are many classifications of antidepressant but which were the 3 discussed in class?

- Tricyclic (TCA's) - Monoamine oxidase inhibitors (MAIO's) - Selective serotonin reuptake inhibitors (SSRI's)

What are the clinical manifestations of early stage Alzheimer's?

- changes in memory - difficulty planning/ organizing

What are the clinical manifestations of moderate stage Alzheimer's?

- confusion - ADL/ IADL dysfunction - Personality changes

What are examples of risks for cognitive impairment related to personal behavior?

- drug abuse - high risk activities - eating disorders

What are examples of risks for cognitive impairment related to environement?

- lead exposure - abusive home life

*test taking trick: Benzos often end in what?

-am

What is apraxia?

A cognitive disorder of voluntary movement where one cannot execute a purposeful activity despite the presence of adequate mobility, strength, sensation, coordination and comprehension. ie cannot brush their hair even though they know what it means to brush hair and know how it is performed.

What is risperidone used to treat?

Agitation and combativeness

What is the underlying pathophysiologic issue with Alzheimers disease?

Amyloid Plaques and neurofibrillary tangles

What is the only way to definitively diagnose Alzheimer's?

An autopsy, any diagnosis of the disease is a presumptive diagnosis

Between anxiolytics and hypnotics, which cause sleep and which prevent feelings of tension and fear?

Anxiolytics - prevent feelings of tension/ fear Hypnotics - cause sleep

Which class of antipsychotic come with black box warnings?

Atypical

Which class of antipsychotic work by blocking both dopamine and seratonin receptors?

Atypical

How are anxiolytics and hypnotics classified?

Benzodiazepines

Which classification of cholinergic agonist works by adding acetylcholine?

Direct-acting

What are 2 classifications of cholinergic agonists?

Direct-acting Indirect-acting

A cholinesterase inhibitor is an example of an indirect acting cholinergic agonist. What is an example of a cholinesterase inhibitor and how does it work?

Donepezil it inhibits the enzyme that breaks down acetylcholine thereby allowing for more acetylcholine and thus more stimulation of those acetylcholine receptor sites

True or False? A person with dementia has Alzheimer's?

False, there are about a hundred different causes of dementia and Alzheimer's is an example of just one of them (though does account for about 68%)

What prototype for an SSRI was mentioned in class?

Fluoxetine (Prozac)

Which classification of cholinergic agonist stimulates acetylcholine receptor sites?

Indirect-acting

What were the 2 prototypes for Benzos given in class?

Lorazepam and alpraxolam

Dementia is categorized by what?

Multiple cognitive defects *ex. memory + aphasia, memory + apraxia...

When should a patient undergo a cognitive assessment?

On admission, on discharge and if they are transferred as well after any major change in drug regimen. *takeaway is that we need to be continually assessing

A low score on the MMSE indicates what?

Some form of impairment. The lower the score the more severe the impairment

What was the example given for secondary prevention of cognitive impairment?

The MMSE, Mini-mental sate examination

With which of the classifications is there a concern with "the cheese effect"?

The Monoamine oxidase inhibitors (MAIO's)

What is an important teach back concerning SSRI's?

The effects can take weeks to reach full impact and a patient who does not understand this may stop taking the medication too soon due to ignorance of this detail

What is your priority intervention for a patient who presents with cognitive impairment?

The implementation of safety measures. There will always be something compromising the patients safety. *think NCLEX

How do plaques and tangles impair cognitive function?

Their accumulation begin to block signals and (now) unused neurons begin to die resulting in a loss of neurons and ultimately a loss of volume of the brain

What makes prescribing Benzodiazepines for Alzheimer's problematic?

They can make you very tired and slow and most patients with Alzeimer's are older adults who more likely already have ambulatory dysfunction increasing their risk for falls

True or false? There are treatable forms of dementia.

True. Dementia can be caused by infection or a nutrition deficit in which case treating the infection/ deficit will treat the dementia

Which class of antipsychotic can have extrapyramidal symptoms?

Typical

Which class of antipsychotic work by blocking dopamine receptors?

Typical

What are 2 classes of Antipsychotics and what are prototypes for each?

Typical: haloperidol Atypical: risperidone

How are laboratory tests used in assessing for Alzheimer's

Used to rule out any other causes for the cognitive impairment. It is a diagnosis of exclusion

When are anxiolytic and hypnotic type drugs often prescribed?

When there is a previous history of anxiety/ depression

How is brain imaging used in assessing for Alzheimer's?

Will rule out strokes and such. Will not see the plaques and tangles but could see a loss of brain volume but this could be due to the aging process

When addressing a potential cognitive impairment where should you start in your assessment?

With the physical assessment, many physical things can lead to cognitive impairment

What is aphasia?

a cognitive disorder that affects a person's ability to express and understand written and spoken language.

The son of a client with Alzheimer's disease reports feeling guilty for wishing, at times, that his father would die. What is the nurse's best response? a) "Being responsible for your father's care must be difficult." b) "There is no reason to feel guilty. You've given your father excellent care." c) "Perhaps you should consider putting your father in a nursing home." d) "Everyone in your situation must feel like that at times."

a) "Being responsible for your father's care must be difficult."

The client with dementia states to the nurse, "I know you. You are Margaret, the girl who lives down the street from me." Which response by the nurse is most therapeutic? a) "Mrs. Jones, I am Rachel, a nurse here at the hospital." b) "Mrs. Jones, I told you already, I am Rachel, and I do not live down the street." c) "Now Mrs. Jones, you know who I am." d) "I think you forgot that I am Rachel, Mrs. Jones."

a) "Mrs. Jones, I am Rachel, a nurse here at the hospital."

The son of a client with Alzheimer's disease excitedly tells the nurse, "Mom was singing one of her favorite old songs. I think she is getting her memory back!" What response by the nurse is most appropriate? a) "She still has long-term memory, but her short-term memory will not return." b) "I am so happy to hear that. Maybe she is getting better." c) "I am glad she can sing even if she cannot talk to you." d) "Do not get your hopes up. This is only a temporary improvement."

a) "She still has long-term memory, but her short-term memory will not return."

The client is to undergo a series of diagnostic tests to determine if the client's cognitive impairment is treatable. Which state can lead to nonreversible cognitive impairment? a) Alzheimer's disease b) delirium c) cerebral abscess d) electrolyte imbalance

a) Alzheimer's disease

A client diagnosed with dementia wanders the halls of the locked nursing unit during the day. To ensure the client's safety while walking in the halls, what should the nurse do? a) Assess the client's gait for steadiness. b) Restrain the client in a geriatric chair. c) Administer PRN haloperidol to decrease the need to walk. d) Administer PRN lorazepam to provide sedation.

a) Assess the client's gait for steadiness.

During a home visit to an elderly client with mild dementia, the client's daughter reports that she has one major problem with her mother. She says, "She sleeps most of the day and is up most of the night. I cannot get a decent night's sleep anymore." Which suggestions should the nurse make to the daughter? Select all that apply. a) Engage the client in simple, brief exercises or a short walk when she gets drowsy during the day. b) Promote relaxation before bedtime with a warm bath or relaxing music. c) Ask the client's health care provider (HCP) for a strong sleep medicine. d) Establish a set routine for rising, hygiene, meals, short rest periods, and bedtime. e) Have the daughter encourage the use of caffeinated beverages during the day to keep her mother awake.

a) Engage the client in simple, brief exercises or a short walk when she gets drowsy during the day. b) Promote relaxation before bedtime with a warm bath or relaxing music. d) Establish a set routine for rising, hygiene, meals, short rest periods, and bedtime.

A client with Alzheimer's disease has a nursing diagnosis of Risk for injury related to memory loss, wandering, and disorientation. To prevent injury, which nursing intervention should appear in this client's care plan? a) Remove potential hazards from the client's environment. b) Provide the client with detailed instructions. c) Keep the client sedated whenever possible. d) Use restraints at all times.

a) Remove potential hazards from the client's environment.

A client with Alzheimer's disease mumbles incoherently and rambles in a confused manner. To help redirect the client's attention, the nurse should encourage the client to: a) fold towels and pillowcases. b) participate in a game of charades. c) perform an aerobic exercise. d) play cards with another client.

a) fold towels and pillowcases. *Folding towels and pillowcases is a simple activity that redirects the client's attention. Also, because this activity is familiar, the client is likely to perform it successfully. Cards, charades, and aerobic exercise are too complicated for a confused client.

A 62-year-old client reports being tired all the time, having trouble sleeping, and having trouble thinking. The nurse should: a) further assess the client's mental status and health history. b) inform the client about the normal aging process. c) advise the client to discontinue daytime napping. d) refer the client to a senior citizens' support group.

a) further assess the client's mental status and health history.

The nurse is conducting a mental status examination on a client with a cognitive disorder. Which finding does the nurse judge to be an impairment in abstract thinking? a) inability to find a similarity between a bird and a butterfly b) ability to remember the wedding day c) inability to state the home address d) memories regarding a vacation 5 years ago

a) inability to find a similarity between a bird and a butterfly

The husband of a patient who was diagnosed 6 years ago with Alzheimer's disease approaches the nurse and says, "I am so excited that my wife is starting to take donepezil for her illness." The nurse should tell the husband a. "The medication is effective mostly in the early stages of the illness." b. "The adverse effects of the drug are numerous." c. "The patient will attain a functional level equal to that of 6 years ago." d. "Effectiveness in the terminal stage of the illness is scientifically proven."

a. "The medication is effective mostly in the early stages of the illness." Not a cure but will help slow the progression

How do cholinergic agonists work?

adds to, enhances or increases cholinergic response

An elderly client with Alzheimer's disease has been living with his grown child's family for the past 6 months. He wanders at night and needs help with activities of daily living. Which statement by his child suggests that the family is successfully adjusting to this living arrangement? a) "It's difficult dealing with Dad. It's a thankless job." b) "Dad has presented many challenges. We have alarms on all the outside doors now. Respite care gives us a break." c) "We had no idea this would be so difficult. It's our cross to bear." d) "Dad really seems to be making progress. We're hoping he'll be able to move back into his house soon."

b) "Dad has presented many challenges. We have alarms on all the outside doors now. Respite care gives us a break."

A client with Alzheimer's disease says, "I'm so afraid. Where am I? Where is my family?" How should the nurse respond? a) "You know where you are. You were admitted here 2 weeks ago. Don't worry, your family will be back soon." b) "You are in the hospital and you're safe here. Your family will return at 10 o'clock, which is 1 hour from now." c) "I just told you that you're in the hospital and your family will be here soon." d) "The name of the hospital is on the sign over the door. Let's go read it again."

b) "You are in the hospital and you're safe here. Your family will return at 10 o'clock, which is 1 hour from now."

A client with early dementia exhibits disturbances in mental awareness and orientation to reality. The nurse should expect to assess a loss of ability in which other area? a) balance b) judgment c) endurance d) speech

b) judgment *Clients with chronic cognitive disorders experience defects in memory orientation and intellectual functions, such as judgment and discrimination. Loss of other abilities, such as speech, endurance, and balance, is less typical.

Nursing staff are trying to provide for the safety of an elderly client with moderate dementia. The client is wandering at night and has trouble keeping her balance. She has fallen twice but has had no resulting injuries. The nurse should: a) have the client sleep in a reclining chair across from the nurse's station. b) move the client to a room near the nurse's station and install a bed alarm. c) ask a family member to stay with the client at night. d) help the client to bed and raise all four bedrails.

b) move the client to a room near the nurse's station and install a bed alarm.

Which food should the nurse tell the patient to avoid while taking phenelzine? a. Roasted chicken b. salami c. fresh fish d. hamburger

b. salami "the cheese effect" foods high in tyramine - those that are fermented, pickled, aged, or smoked - must be avoided because when they are ingested in combination with MAIO's, a hypertensive crisis occurs

The nurse determines that the son of a client with Alzheimer's disease needs further education about the disease when he makes which statement? a) "I did not realize the deterioration would be so incapacitating." b) "I get tired of the same old stories, but I know it is important for Dad." c) "I woke up this morning expecting that my old Dad would be back." d) "The Alzheimer's support group has so much good information."

c) "I woke up this morning expecting that my old Dad would be back."

The client in the early stage of Alzheimer's disease and his adult son attend an appointment at the community mental health center. While conversing with the nurse, the son states, "I am tired of hearing about how things were 30 years ago. Why does Dad always talk about the past?" The nurse should tell the son: a) "I want you to understand your dad's level of anxiety." b) "Reminding your dad that you have heard that story will help him stop." c) "Your dad lost his short-term memory, but he still has his long-term memory." d) "You need to be more accepting of your dad's behavior."

c) "Your dad lost his short-term memory, but he still has his long-term memory."

When providing family education for those who have a relative with Alzheimer's disease about minimizing stress, which suggestion is most relevant? a) Allow the client to go to bed four to five times during the day. b) Test the cognitive functioning of the client several times a day. c) Maintain consistency in environment, routine, and caregivers. d) Provide reality orientation even if the memory loss is severe.

c) Maintain consistency in environment, routine, and caregivers.

A client is newly diagnosed with Alzheimer's disease. When planning this client's care, the nurse should focus on: a) helping to reverse the disease. b) preventing loss of the client's cognitive functions. c) providing a safe, structured environment. d) helping the client recognize his physical limitations.

c) providing a safe, structured environment.

A client is in the first stage of Alzheimer's disease. The nurse should plan to focus this client's care on: a) monitoring the client to prevent minor illnesses from turning into major problems. b) offering nourishing finger foods to help maintain the client's nutritional status. c) providing emotional support and individual counseling. d) suggesting new activities for the client and family to enjoy together.

c) providing emotional support and individual counseling.

A patient who has been taking fluoxetine 20mg daily for the past 3 days states, "This medicine is not doing me any good. I am still so depressed." Which response by the nurse is most appropriate? a. "Perhaps we will need to increase your dose." b. "Let's wait a few days and see how you feel." c. "It can sometimes take up to 4 weeks to feel the full effects." d. "It is too soon to tell if your medication will help you."

c. "It can sometimes take up to 4 weeks to feel the full effects." The patient needs to be informed of the time lag involved in antidepressant medications, typically take 2-4 weeks for the meds to get the full effect of the medication

The healthcare provider prescribes risperidone for a patient with Alzheimer's disease. The nurse anticipates administering this medication to help decrease which behavior? a. sleep disturbances b. depression c. agitation d. confusion

c. agitation An antipsychotic it is most effective with combatativeness and agitation

While a patient is taking alprazolam, which of the following should the nurse instruct the patient to avoid? a. chocolate b. cheese c. alcohol d. shellfish

c. alcohol Any central nervous system depressant will have additive depressive effects

A man found wandering in a local park is unable to state who or where he is or where he lives. He is brought to the emergency department, where his identification is eventually discovered. The client's wife states that he was diagnosed with Alzheimer's disease 3 years earlier and has experienced increasing memory loss. She tells a nurse she is worried about how she'll continue to care for him. Which response by the nurse is most helpful? a) "Because of the nature of your husband's disease, you should start looking into nursing homes for him." b) "Do you have any children or friends who could give you a break from his care every now and then?" c) "You may benefit from a support group called Mates of Alzheimer's Disease Clients." d) "What aspect of caring for your husband is causing you the greatest concern?"

d) "What aspect of caring for your husband is causing you the greatest concern?"

The client with Alzheimer's disease has been prescribed donepezil 5 mg at bedtime. Which instruction should the nurse give to the client's daughter? a) Observe her mother for signs of constipation. b) Give her mother an extra dose if needed at night. c) Take her mother to the clinic next week for blood work. d) Avoid suddenly stopping the medication.

d) Avoid suddenly stopping the medication. *Abrupt cessation of donepezil may result in rapid deterioration of client functioning. Donepezil does not cause liver toxicity, so monitoring of blood serum levels is not necessary. Extra doses of donepezil are not given on an as-needed basis. Donepezil is more likely to produce diarrhea than constipation.

A client with agnosia as a result of vascular dementia is staring at dinner and utensils without trying to eat. Which intervention should the nurse attempt first? a) Pick up the fork and feed the client slowly. b) Save the client's dinner until her family comes in to feed her. c) Say, "It is time for you to start eating your dinner." d) Hand the fork to the client and say, "Use this fork to eat your green beans."

d) Hand the fork to the client and say, "Use this fork to eat your green beans." *Agnosia is the lack of recognition of objects and their purpose. The nurse should inform the client about the fork and what to do with it. Feeding the client does not address the agnosia or give the client specific directions. It should only be attempted if identifying the fork and explaining what to do with it is ineffective. Waiting for the family to care for the client is not appropriate unless identifying the fork and explaining or feeding the client is not successful.

When communicating with the client who is experiencing dementia and exhibiting decreased attention and increased confusion, which intervention should the nurse employ as the first step? a) asking the client to go for a walk while talking b) using gentle touch to convey empathy c) rephrasing questions the client does not understand d) eliminating distracting stimuli such as turning off the television

d) eliminating distracting stimuli such as turning off the television

While assessing a client diagnosed with dementia, the nurse notes that her husband is concerned about what he should do when she uses vulgar language with him. The nurse should: a) say nothing and leave the room. b) tell her to stop swearing immediately. c) tell her that she is very rude. d) ignore the vulgarity and distract her.

d) ignore the vulgarity and distract her.

What are amyloid plaques?

deposits of beta amyloids

What is the MMSE comprised of?

eleven cognitive tasks

What is agnosia?

inability to process sensory information often involving a loss of ability to recognize familiar objects, people, sounds etc but it is not related to a loss of memory

What are Neurofibrillary tangles?

tangled bundles of non-functioning neurons

Which of the classifications of antidepressant do we see used most today?

the selective serotonin reuptake inhibitors (SSRI's)