Cognition Test

Which imaging technique is specific for Alzheimer disease?

Magnetic resonance spectroscopy (MRS)

Which characteristic about confusion would the nurse keep in mind when an older client with Alzheimer disease is admitted to a long-term care facility?

Occurs with a transfer to new surroundings

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 intervention will the nurse include in a care plan for a client with dementia who wanders?

Assess and treat pain. Avoid loud music, television, and glaring lights. Have family members monitor client activity when possible.

Which need would be essential in clients who have dementia?

To have sameness and consistency in the environment

When assisting a client with Parkinson disease to ambulate, which instruction would the nurse provide the client?

Avoid leaning forward

Risk factors for cog. impairment MEN:

BEING OLD History of stroke Diabetes

Which action would the nurse take for an older client with Alzheimer disease who has intermittent episodes of urinary incontinence?

Take the client to the bathroom at regular intervals

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

precipitated by an infection or medication change

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?"

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.

Which nursing intervention would the nurse implement for a forgetful, disoriented client who has Alzheimer disease?

Managing the client's unsafe behaviors

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

Memantine Alzheimer's Disease

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.

Which intervention would the nurse include when developing a plan of care for an older client with dementia?

Provide consistency in carrying out nursing activities for the client

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

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.

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

Which term would the nurse use to document observing the characteristic gait associated with Parkinson disease?

With a SHUFFLING gait the steps are short and dragging; this is seen with basal ganglia defects.

A therapeutic milieu is

a structured environment that creates a safe, secure place for people who are in therapy

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)

Clients with dementia may

sleep more during the day

To best address the functional and behavioral changes associated with a client's early Alzheimer disease, which action would the nurse encourage the daughter to do?

!!Post a schedule of the client's daily activities.!!

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.

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

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

Rapid-onset confusion

Which ability would the nurse expect of a client in the middle stages of Alzheimer disease to be able to do?

Recall events from the past

Cog. Impairment diagnostic tests

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

Which action would the nurse take for an older client with Alzheimer disease who sleeps very little and becomes more disoriented from sleep deprivation?

Leave a dim light on in the client's room at night.

Which findings would support a client's diagnosis of Parkinson disease? Select all that apply. One, some, or all responses may be correct.

NON-INTENTIONAL TREMORS associated with Parkinson disease result from degeneration of the dopaminergic pathways and excess cholinergic activity in the feedback circuit. A MASKLIKE FACIAL EXPRESSION results from nigral and basal ganglia depletion of dopamine, an inhibitory neurotransmitter. COGWHEEL RIGIDITY is increased resistance to passive motion and is a classic sign of Parkinson disease.

Which goal would the nurse add to the plan of care for a forgetful, disoriented client who has dementia?

Rechannel the client's energies into more appropriate behaviors.

A client is diagnosed with Parkinson disease and receives a prescription for levodopa therapy. Which mechanism of action would the nurse identify for this medication?

Restores the dopamine levels in the brain

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

Which nursing intervention would be helpful in meeting the needs of an older adult with Alzheimer disease?

Simplifying the environment as much as possible by limiting the need for decisions

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

Which approach would the nurse take for a client with Alzheimer disease who is fearful and anxious about being admitted?

!!Reassuring the client with the presence of same staff members!! (DO NOT PUT "EXPLORE REASONS FOR CLIENTS CONCERNS") (fukk the clients concerns)

A client with dementia is confused about what day it is. Which statement made by the nurse is an example of validation therapy?

"Yes, today is the day that you just mentioned."

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

Which intervention would the nurse include in the plan of care for a client with moderate Alzheimer disease?

Maintain a daily routine of living

Which conclusion would the home care nurse make regarding an older adult client with mild Alzheimer disease?

Should be allowed to function independently if therapeutically possible

A client with a diagnosis of dementia of the Alzheimer type has been taking donepezil 10 mg/day for 3 months. The client's partner calls the clinic and reports that the client has increasing restlessness and agitation accompanied by nausea. Which advice would the nurse give the partner?

!!Bring the partner to the clinic for testing and a physical examination!! Many people with dementia experience physical problems such as urinary tract infections but cannot adequately verbalize what is happening. They may just become more restless and agitated. Because the client has been taking this dose for 3 months, the problems probably are not being caused by the medication

Which action would the nurse take when caring for an older adult with a history of recent memory loss?

!!Employ electronic devices that provide alerts.!!

Which approach would the nurse use for a client with Alzheimer disease who expresses fear and anxiety upon admission to a long-term care facility?

!!Reassuring the client with the presence of 1 or 2 staff members!!

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."

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

Risk factors for cog. impairment WOMEN:

BEING OLD, Poor health status Dependency Lack of social support Insomnia

Which nursing action has the highest priority for a client with delirium?

Creating a calm and safe environment

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

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

Which action would the nurse take for a daughter who states that she gives sleeping pills to her live-in mother who has dementia to stop wandering at night?

Explore hiring a home health aide to stay with the client at night

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

Which finding would indicate that a client needs to be evaluated by the health care provider for Alzheimer disease

Forgets home address

Which action would the nurse take for an older resident in a nursing home with Alzheimer disease who hoards leftover food and other seemingly valueless articles and stuffs them into pockets "so the others won't steal them"?

Give the resident a small bag in which to place selected personal articles and food

Which initial nursing intervention would the nurse take for an older adult with delirium who begins acting out while in the dayroom?

Giving the client one simple direction at a time in a firm, low-pitched voice

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

A client with Parkinsonism takes an anticholinergic medication for morning stiffness and tremors in the right arm. During a visit to the clinic, the client complained of some numbness in the left hand. Which intervention would the nurse implement for this client?

Numbness, a sensory deficit, is inconsistent with Parkinsonism; further medical evaluation is necessary. Numbness, even in the absence of other problems, may be indicative of an impending "brain attack" or CVA

Which topic addressed by a new nurse when talking with a client who has neurocognitive disorder due to Lewy bodies would cause the charge nurse to follow-up?

Recent days

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).

constipation treatment

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

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

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?

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

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

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

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

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)

Which characteristic of a therapeutic milieu would the nurse consider important for a confused older adult with socially aggressive behavior?

Sets limits

Antidepressants for Alzheimers disease

SSRIs Sertraline (Zoloft), Paroxitine (Paxil)

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.

The nurse is preparing discharge instructions for a client who has begun to demonstrate signs of early Alzheimer dementia and lives alone, with adult children living nearby. According to the prescribed medication regimen, the client is to take medications six times throughout the day. Which nursing intervention is correct to assist the client with taking the medication?

Contact the primary health care provider and discuss the possibility of simplifying the medication regimen

Which technique would the nurse use for a client with dementia who seems anxious, frequently paces about, and exhibits deteriorating hygiene?

Directing staff members to reinforce reality as needed

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.

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

Which intervention would the nurse implement for a client who is confused and delirious?

!!Directing the client's daily activities on the unit!! The client needs to have activities decided and directed until delirium and confusion clear.

Parkinsonism

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

Which action would the nurse take for an older client with Alzheimer disease who has laid out several outfits on the bed to wear to a recreational session but is still wearing nightclothes?

Help the client select appropriate attire and offer to help the client get dressed