Exam 3

the nurse finds a client with schizophrenia lying under a bench in the hall. The client says "God told me to lay here" what is the best response by the nurse?

"I didnt hear anyone talking; what else did you hear god say?"

Cardinal symptoms of delirium

- inability to direct, focus, sustain, and shift attention - abrupt onset with clinical features that fluctuate with periods of lucidity - disorganized thinking and poor executive functioning - agitation, anxiety, disorientation

Anosognosia

A condition in which a person with an illness seems unaware of the existence of his or her illness. Resistant to help

Depressant toxicity

Agitation, confusion, lethargy, nystagmus, dysrhythmia, rapid/ weak pulse

Alzheimer's pathophysiology

Amyloid plaques and neurofibrillary tangles, loss of connection between neurons, neuron death

Flumazenil

Antidote to depressants. Short half life may require many doses.

2nd generation drugs

Aripiprazole Clozapine- side effect neutropenia Lurasidone Olanzapine Risperidone Quetiapine Ziprasidone

Signs of alcohol use

Ascites, jaundice, fatigue, abdominal discomfort

The home health care nurse visits an older adult couple living independently. The wife cares for the husband, who has mild Alzheimer's Disease. Which intervention would the nurse implement for them?

Assess the wife for caregiver burden

meds for alcohol withdrawal

Benzos and barbs for seizures. Lorazepam iv for those who can't take po meds. Chlordiazoxide for those who can take po meds. Phenobarbital. Sedation for hyperactivity- dexmedetomidine. Propranolol and clonidine to stabilize vitals

Depressant withdrawal

Benzos and barbs. Hyperactivity during withdrawal, manifestations similar to alcohol withdrawal

Delirium tremens meds

Benzos, carbamazepine, valproate, chlorpromazine, haloperidol, chlordiazepoxide

A client with Alzheimer's dementia 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 - the client is probably not having med issues, more likely a UTI

Alcohol screening tools

Cage, audit, niaaa, ciwaa

1st generation drugs

Chlorpromazine- Fluphenazine- Haloperidol- QT elongation (can cause fatal torsades) Loxapine Perphenazine Pimozide Thioridazine Trifluoperazine

delirium assessment tool

Confusion Assessment Method (CAM)

Treatment of neuroleptic malignant syndrome

Cooling blanket, antipyretic, antihypertensive, ekg monitoring. give bromocriptine, dantrolene (muscle relaxer)

Disulfiram

Daily oral medication to sustain abstinence of alcohol; type of aversion therapy Causes nausea, vomiting, sweating, palpitations, and hypotension if alcohol is consumed

Signs of iv drug use

Damaged veins, endocarditis, hepatitis/ hiv

Drug abuse screening tool

Dast

Signs of opiate and stimulant use

Decreased appetite, emancipated appearance, excessive diarrhea, dilated pupils(stimulant), pinpoint (opioids), restless, sweaty

Retrogenesis

Degenerative changes occur in reverse order in which they were acquired

Predictors of onset of delirium

Dementia, stress, surgery, sleep deprivation, pain, depression, disease burden, sedation, analgesia, anesthesia

Nursing management dementia

Distract, redirect, reassure, quiet/ non stimulating environment, safety, nutrition (feeding). Infection- uti, pneumonia

Alzheimer's causes

Exact cause unknown. Likely multiple factors. DM, head trauma, tbi, genetics

First generation have which side effect more often

Extra pyramidal symptoms

Nursing management delirium

Fluid/ electrolytes, neuro status monitoring, limit decision making, quiet/ non stimulating environment

Down Syndrome (Trisomy 21)

GI or heart defects. Immune disorders, spinal problems

AD Meds

Galantamine- early onset AD Donepizil- GI side fix Rivastigmine (Exelon)- GI side fx (available in a patch) N-Methyl-D-Aspartate (NMDA) Receptor Antagonist- memantine (namenda) protects brain nerve cells from glutamate

Chronic effects of alcohol abuse

Gastritis, pancreatitis, portal Htn, esophageal varices, ascites, thrombocytopenia (can't clot), jaundice

Opioid withdrawal symptom management

Gi meds for nausea or fluids. Acetaminophen for pain. Sedatives

Nurses working with clients who have a diagnosis of dementia should adopt a common approach of care, because these clients have a need to do what?

Have sameness and consistency in their environment

CIWAA scale interpretation

Higher score means higher risk for seizure and need for meds

A client with a history of alcoholism if found to have wernicke encephalopathy associated with Korsakoff syndrome. what does the nurse anticipate will be prescribed?

IV infusions of thiamine

hyperactive delirium

Increased psychomotor activity, such as rapid speech, irritability, and restlessness

A healthcare provider prescribes disulfiram for a client who abuses alcohol. The nurse teachers the client that disulfiram will have which action?

It causes severe adverse reaction if alcohol is consumed. Example, N/V, hypotension, headache, tachycardia, tachypnea, flushing

Aphasia

Loss of language ability. Difficulty finding words -> speaks only a few words -> babbling or mutism

fetal alcohol spectrum disorder

Manifestations in baby: small upper lip, short nose, small head circumference, joint/ bone deformities, heart defects, slow physical growth

Strattera (atomoxetine) for ADHD

May take up to 6 weeks for therapeutic response. Used in pts with anxiety, active substance use disorders or tics. Side effects: GI disturbances, urinary retention, dizziness, fatigue, insomnia. Increased risk of liver injury and elevation in hr bp. Monitor liver panel and vitals. Extreme caution in pts w depression, may increase suicidal ideation.

AD manifestations

Memory loss, Less personal hygiene, decreased concentration, unpredictable behavior, delusions and hallucinations

Stimulant toxicity

Meth, cocaine, adhd drugs. Sympathetic overdrive. No antidote. Gastric lavage and activate charcoal which binds to stimulant

Stimulant meds for ADHD

Methylphenidate (Ritalin) Mixed amphetamine salts (Adderall). Risk of misuse and insomnia is a common side effect. Take med no later than 4pm. Other side effects: appetite suppression, headache, abdominal pain, lethargy

Dementia Assessment Tool

Mini mental state examination (MMSE)

Alzheimer's assessment tools

Mini-Cog, MMSE. Imaging- ct, mri, pet to see nerve cells

Opioid toxicity

Morphine, codeine, fentanyl, methadone, heroin. Agitation, confusion, lethargy, nystagmus, dysrhythmia, rapid/ weak pulse

Diminish alcohol cravings

Naltrexone, nalmefene, acamprosate, citalopram, ondansetron

1st generation drug side effects

Nms, eps

Chronic conditions in adults with Down syndrome

Obesity, sleep apnea, Alzheimer's, hypothyroidism congenital heart disease, cervical spine disease

Delirium meds

Only for severe agitation. Dexmedetomidine (Precedex)- for sedation in ICU. Haloperidol- Risperidone- Olanzapine (zyprexa)- Quetiapine- Lorazepam- short acting

Schizophrenia overview

Onset at 15-25 years old. More common in males. Delusions, hallucinations, disorganized speech, Catalonia, negative symptoms, functional impairment

Alcohol withdrawal

Peaks at 24-98 hours. Usually 48. Signs: agitation, anxiety, increased hr, diaphoresis, nausea, tremors, hyperactivity

Schizophrenia manifestations

Positive symptoms- delusions, illusions, hallucinations, alterations in speech Negative symptoms- less initiative, pleasure in activities, lack of emotional expression Cognitive symptoms- impaired memory, information processing, concrete thinking

FASD in adults

Problems w learning, memory, attention span, inappropriate sexual behavior

Phases of schizophrenia

Prodromal— onset, mild changes Acute- exacerbation of symptoms Stabilization- symptoms diminish, move toward previous level of function Maintenance- new baseline

What is Alzheimer's disease?

Progressive, irreversible, degenerative neurological disease characterized by loss of cognitive function and disturbed behavior. Forgetfulness progressing to inability to recognize familiar faces, places and objects

Treatment of extrapyramidal symptoms

Reduce dose. Goal is to restore dopamine and relax muscles. Benadryl, anticholinergic benztropine.

AD, dementia behavioral problems

Repetitiveness, delusions, hallucinations, aggression, altered sleep patterns, wandering, hoarding, resisting care

Alterations in behavior

Rigidity, motor restlessness, hard to speak or move, repitive behavior, echopraxia, little or no response to stimuli

The primary objective of nursing intervention for clients with dementia, delirium, and other cognitive disorders is to maintain what?

Safety within the environment

Naloxone

Short acting antidote to opioids. Nalmefene lasts longer

Side effects of antipsychotics

Td, nms, eps, sedation, weight gain, agranulocytosis, hepatotoxicity

Vitamin deficiency in alcoholism

Thiamine- wernickes encephalopathy causing altered gait and ocular motor abnormalities. Korsakoff's syndrome is more severe and chronic form of wernickes Folic acid- aids in production of RBcs. Lack of leads to anemia

THINK (delirium)

Toxic situations Hypoxemia Infection, immobility Non pharmacological interventions K, electrolyte imbalances

late ad manifestations

Unable to communicate, cannot perform adls, becomes unresponsive and incontinent

Persevation

Unintentional repetition of a word or phrase

Alterations in speech

Word salad, clang association, neologisms, echolalia

2nd generation drug overview

a-typical. Blocks dopamine and serotonin receptors. Reduces negative and positive symptoms. Side effects- weight gain, dyslipidemia, type 2 dm

What is dementia?

acquired neurological syndrome characterized by progressive deterioration in intellectual functions, judgment, thinking, visuospatial skills, constructional abilities, language, memory, emotions and behavior.

delirium tremens

alcohol withdrawal delirium. 2-3 after last drink and can last 2-3 days. Tachycardia, high bp, convulsions, seizures, fever, hallucinations, confusion

schizophrenia is associated with both positive and negative symptoms. while assessing a client with schizophrenia, the nurse notes that the client is experiencing positive symptoms; what does the nurse observe that leads to this conclusion?

auditory hallucinations

Sundowning

becoming restless and agitated in the late afternoon, evening, or night

alpha 2 adrenergic agonists for ADHD

clonidine- guanfacine-

dysphasia

difficulty speaking

meds for alcohol abstinence

disulfiram, naltrexone, acamprosate

Opioid withdrawal

dysphoric mood, nausea or vomiting, muscle aches, diarrhea, fever, yawning, insomnia, pupillary dilation or sweating, and weepiness or runny nose

what would be a priority concern for a client admitted with withdrawals from cocaine?

impaired judgement

Agraphia/dysgraphia

inability to write

ADHD symptoms

inattention, hyperactivity, impulsivity

a school nurse is asked to present an educational program on ADHD to the staff of an elementary school. what should the nurse emphasize about this disorder?

its major clinical manifestation is easy distractibility

hypoactive delirium

lethargy, slowed speech, decreased alertness, apathy

Apraxia

loss of purposeful movement in the absence of motor or sensory impairment. For example, Patient becomes unable to put clothes on properly

a client with a 20-year history of excessive alcohol use has developed jaundice and ascites and is admitted to the hospital. which is the priority nursing action during the first 48 hours after the clients admission?

monitor vital signs. pulse and temp will increase before client demonstrates other signs of withdrawal

which physical skin finding indicates opioid abuse?

needle marks.

A client with diagnosis of schizophrenia who's receiving haloperidol has a sudden change in health status. BP unstable, hr 128, rr 26, temp 105F, diaphoresis, severe muscle rigidity, decreasing level of consciousness.

neuroleptic malignant syndrome

the nurse is planning care for a school aged child with ASD who has been hospitalized for some tests. which intervention should the nurse plan to implement

placing the child in a private room to decrease stimulation

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

rapid onset of confusion

Neuroleptic Malignant Syndrome

side effect of antipsychotic. Hyperthermia, tachycardia, sweating, muscle rigidity, tremors, renal failure, leukocytosis (high WBC), AMS

Extrapyramidal symptoms

side effect of antipsychotic. Tardive dyskinesia (repetitive, involuntary movements) , akathisia (pacing), bradykinesia (slow movement)

What is delirium?

state of temporary, acute mental confusion

Agnosia

the inability to recognize familiar objects. Seen in severe AD. Leads to need for total care because patient cannot recognize toilet/ soap

Hyperorality

the need to taste, chew, and put everything in one's mouth

Confabulation

the unintended false recollection of episodic memories

1st generation drug overview

typical. Blocks dopamine receptors. Reduce positive symptoms, agitation, aggression. Elevated prolactin secretion.

Autism symptoms

unresponsive, uncommunicative, repetitive speech, rigid in routines or rituals, resistant to change