MH Neurocognitive Disorders

dementia occurs in

-Alzheimers -multi infarctions -Huntington's chorea -MS and brain tumors -Wernicke-Korsakoff syndrome (chronic alcoholics)

symptoms of dementia

-aphasia -apraxia -agnosia

S&S of dementia/delerium

-limited attention span -easily distracted -confusion, disorientation -impaired judgement -delusions, hallucinations -labile affect -anxiety and depression -recent and remote memory deficits -confabulation -impaired coordination -increased psychomotor activity -slurred speech -decreased personal hygiene -sleep deprivation, day night reversal -incontinence and constipation

nursing interventions for demential/delerium

-provide safe, consistent environment -maintain health, nutrition -assist with ADL's -provide support to patient and family -provide routine -mark the bathroom clearly -reorient as needed -simple, direct statements

The nurse determines that a history of which mental health disorder would support the prescription of taking donepezil hydrochloride? 1.Dementia 2.Schizophrenia 3.Seizure disorder 4.Obsessive-compulsive disorder

1.Dementia Donepezil hydrochloride is a cholinergic agent that is used in the treatment of mild to moderate dementia of the Alzheimer's type. It increases concentration of acetylcholine, which slows the progression of Alzheimer's disease. The other options are incorrect and are not indications for use of this medication.

An older client diagnosed with delirium becomes agitated and confused at night. Which action should be the nurse's most important strategy to minimize the client's risk for injury? 1.Turn off the television and radio, and use a night-light. 2.Keep soft lighting and the television on during the night. 3.Change the client's room to one nearer the nurses' station. 4.Play soft instrumental music all night, and do not turn down the lights.

1.Turn off the television and radio, and use a night-light. A night-light is needed for client safety to reduce the risk of falls if the client should get out of bed unattended. It is important to reduce environmental stimulation and provide a consistent daily routine for a disoriented client. Noise levels, including radio and television, may add to the confusion and disorientation. Moving the client to a room near the nurses' station is not the first action.

The nurse is performing an assessment on a client with dementia. Which piece of data gathered during the assessment indicates a manifestation associated with dementia? 1.Use of confabulation 2.Improvement in sleeping 3.Absence of sundown syndrome 4.Presence of personal hygienic care

1.Use of confabulation The clinical picture of dementia ranges from mild cognitive deficits to severe, life-threatening alterations in neurological functioning. For the client to use confabulation or the fabrication of events or experiences to fill in memory gaps is not unusual. Often, lack of inhibitions on the part of the client may constitute the first indication of something being "wrong" to the client's significant others (e.g., the client may undress in front of others, or the formerly well-mannered client may exhibit slovenly table manners). As the dementia progresses, the client will have difficulty sleeping and episodes of wandering or sundowning.

Which assessment finding would be a manifestation associated with dementia? 1.Catatonia 2.Confabulation 3.Presence of ritualistic behaviors 4.Increased display of inhibited behaviors

2. Confabulation The clinical picture of dementia varies from the development of mild cognitive defects to severe, life-threatening alterations in neurological functioning. For the client to use confabulation or fabrication of events or experiences to fill in memory gaps is common. Ritualistic behaviors are associated with obsessive-compulsive disorder, while catatonia is a psychotic reaction. Often, lack of inhibition on the part of the client constitutes the first indication to the client's significant others that something is "wrong."

A client diagnosed with delirium becomes disoriented and confused at night. Which intervention should the nurse implement initially? 1.Move the client next to the nurses' station. 2.Use an indirect light source and turn off the television. 3.Keep the television and a soft light on during the night. 4.Play soft music during the night, and maintain a well-lit room.

2.Use an indirect light source and turn off the television. Provision of a consistent daily routine and a low-stimulating environment is important when a client is disoriented. Noise, including radio and television, may add to the confusion and disorientation. Moving the client next to the nurses' station may become necessary but is not the initial action.

The nurse is caring for a client diagnosed with Alzheimer's disease. The nurse should anticipate that the client has changes in which component of the nervous system? 1.Glia 2.Peripheral nerves 3.Neuronal dendrites 4.Monoamine oxidase

3.Neuronal dendrites Alzheimer's disease is characterized by changes in the dendrites of the neurons. The decrease in the number and composition of the dendrites is responsible for the symptoms of the disease. The components in the other options are not related to the pathology of Alzheimer's disease.

The nurse is reviewing the medical record of a hospitalized client who received electroconvulsive therapy (ECT) 3 years ago for the treatment of depression. Which assessment data would support that the therapy resulted in retrograde amnesia in the client? 1.The staff needs to frequently reorient the client to the rules of this current unit. 2.The client has demonstrated difficulty remembering the address of the family's new home. 3.The medical record states that the client experienced memory loss for 2 days after the ECT treatment. 4.During the admission interview, the client can't remember why the ECT treatment was originally prescribed.

4.During the admission interview, the client can't remember why the ECT treatment was originally prescribed. When ECT is performed, the client may experience disorientation, attention difficulty, and transient neurological abnormalities, which usually resolve within a few hours or days. The most prominent adverse effect is short-term anterograde and retrograde amnesia. Retrograde amnesia is defined as difficulty recalling information learned before ECT. This kind of amnesia may be long-term. Anterograde amnesia is defined as the loss of the client's ability to retain newly learned information. This kind of amnesia usually resolves within the first few weeks after ECT treatments. Memory loss for 2 days after the procedure indicates short-term amnesia.

The nurse is caring for a client diagnosed with Alzheimer's disease who is demonstrating characteristics of agnosia. Which client behavior supports the presence of this cognitive deficiency? 1.The client has difficulty with balance when rising from the chair. 2.The client has lost the cognitive ability to fold his own clothes. 3.The client recognizes his children but has difficulty calling them by name. 4.When asked to pick up the cup, the client consistently fails to identify the cup.

4.When asked to pick up the cup, the client consistently fails to identify the cup. When illness (Alzheimer's disease) affects the temporal-parietal-occipital association cortex, the client may experience the inability to identify well-known objects and people. This is called agnosia. Ataxia describes altered motor function. The client also may experience difficulty finding the right word to use, called aphasia, and an inability to perform familiar skilled activities, called apraxia.

Neurocognitive Disorder

Abnormal psychological or behavioral signs and symptoms that occur as a result of cerebral disease, systemic dysfunction, or use of or exposure to exogenous substances These disorders go beyond normal aging and there must be significant impairment in cognitive functioning

Delerium

Acute process that, if treated, is usually reversible

dementia

cognitive impairment characterized by gradual progressive onset irreversible

change in care of a neurocognitively impaired adult can cause:

confusion

treatment of delerium

correct the cause

confabulation

false memory created to fill in gaps in memory

onset of delirium

rapid over a short period of time

delerium occurrs in response to

specific stressors (infection, drug reaction, substances, electrolyte imbalance, head trauma, sleep deprivation)