Q-22 (Created By Me)

PET scan Alzheimer's brain(Be able to identify brain plaques)

- Usually arises in individuals > 60 y/o and includes loss of cortical neurons, enlarged ventricles, and senile plaques and neurofibrillary tangles that appear in the cortex of the brain. - Atrophy (can see on CAT scans and MRI). In the first stage of the illness, there is no apparent decline in memory despite changes that are beginning to occur in the brain.; a PET scan can be used to detect these changes.

(Incomplete) Risk factors of delirium to assess (ie changes in medication, fever, infection, etc) Which medications may cause delirium?

- analgesics - antihistimines - antidepressents - antianxiety agents Length of stay Older, aged patients fluid and electrolytes imbalances oxygen deficiency polypharmacy patients alcohol withdrawal sleep deprived dehydration Extra Note - Heart disease, diabetes mellitus, and physical inactivity

Multiinfarct Dementia (MID, vascular dementia)

- second most common cause of dementia in older adults. - vascular disorders within the brain, result from stroke and severe hypertension - stair-step decline rather than the slow - steady decline of Alzheimer's disease.

Terminal (final) stage of Alzheimer's disease:

- some urinary and fecal incontinence, inability to ambulate or provide self-care, and inability to communicate. - little or no response to surroundings or recognition of family members. Late stages of Alzheimer's individual becomes mute and bedridden.

What is Huntington's disease?

Is an inherited disease that causes progressive degeneration (breakdown) of nerve cells in brain

Apraxia

Problems manipulating things

What is reminiscing

Reminiscence therapy uses the exchange of information between the affected individual their caregivers, family, and friends Reminiscence and life review are effective techniques to help older adults cope with changing life circumstances. - Indulging in enjoyable recollection of past events.

Kubler Ross stages of grief (know the correct order of the stages) Box 25.3 pg 739 FON Kubler Ross stages of grief (1969)

Stage 1: Denial Stage 2: Anger Stage 3: Bargaining Stage 4: Depression Stage 5: Acceptance

A 68-year-old Alzheimer patient is wandering up and down the hospital hallway. What should be the nurse's initial response?

Step 1: Offer assistance to the toilet. When reaching the bathroom, Step 2: point to the toilet sign on the door to reinforce the concept of the toilet.

Wandering in dementia. What should the nurse do to prevent wandering? A nurse is caring for an older adult client who has dementia and wanders at night. Which of the following interventions should the nurse take?

Take the client to the bathroom on a regular schedule.

The term dementia refers to: Which condition is characterized by a decline in intellectual functioning? a. Dementia b. Depression c. Delirium e. Delusion

a progressive loss of intellectual function most commonly related to Alzheimer's disease ________________________________________________ Answer: a. Dementia

Middle Stage of Alzheimer's

difficulty with language, object recognition, and judgment.

Aphasia

inability to speak or use or understand words

Average duration of dementia/ life expectancy What is the average life expectancy of the client following a diagnosis of Alzheimer's?

Ability to complete activities of daily living (ADLs).

PET scan Alzheimer's brain(Be able to identify brain plaques) _______________ is a form of dementia that is a progressive disorder in which the brain atrophies. The cause is not understood.

Alzheimer's Disease

A 70-year-old gentleman who was recently diagnosed with Alzheimer's disease. He pays his bills on time and lives independently. He experiences mild forgetfulness; however, it has not compromised his safety. He has lost interest in attending family functions. What stage of the disorder is this patient experiencing?

Early stage

In which stage of Alzheimer's will the clients experience difficulty with language, object recognition and difficulty with judgement?

Middle stage

Pathophysiology of dementia

Most types of dementia, except vascular dementia, are caused by the accumulation of native proteins in the brain.

_________________ is a type of dementia commonly resulting from cerebrovascular disease and hypertension?

Multi-Infarct Dementia

A nurse is assisting with the admission of an older adult who is confused. Which of the following statements by the client's partner indicates that the client may be experiencing delirium?

"Her behavior changed so quickly, I wasn't sure what was happening."

Creutzfeldt- Jakob disease

- Rare and rapidly progressive; - associated with viral etiology, although isolation of a specific virus has not occurred. - Average age of onset 50-60 yr. - Terminal within 6-12 mo. - No known treatment.

What is the average life expectancy for a client, following a Dx of Alzheimer's?

8 years, but it can last as long as 20 years or more.

Which of the following nursing interventions is particular to a client with Alzheimer's Disease (AD)? (Select all that apply)

- Provide mental stimulation with simple games or activities. - Use calm and reassuring voice. - Maintain regular schedule.

What is Akinesia?

(an abnormal state of motor and psychic hypoactivity). - Slow movement and underactivity. - (Mask-like face, shuffling gait, drooling, pill-rolling, decreased muscle strength)

Agraphia

- (difficulty writing and drawing) - Symptoms of dementia - Noticeable changes in the personality.

Creutzfeldt-Jakob disease is caused by which of the following: What causes creutzfeldt-Jakob disease?

- A virus - A slow virus _____________________________________________ An abnormal infectious protein in the brain called a prion

(Table 33.14) Other Dementia-Related Diseases Huntington's disease

- Age range at diagnosis is 5-70 yr; not necessarily a disease of old age. - Characterized by uncontrollable writhing movements and mental deterioration that terminates in severe dementia. - Begins with disturbances of gait and slurred speech. - Life expectancy after diagnosis is 16 yr.

Nursing interventions to care for a patient with dementia (what type of environment do we provide) Compromised Verbal Communication, related to memory loss and difficulty focusing attention - Use a calm pleasant tone of voice and gestures that correspond to the verbal message - Reminiscence therapy uses the exchange of information between the affected individual their caregivers, family, and friends - maintain contact through touch - use listening skills

- Assess communication patterns. - Provide calm environment with minimal distraction - Use gestures to match simple verbal messages - Use touch to increase attention Use familiar music to enhance recall

HIV associated dementia

- Characterized by forgetfulness, - slowness, poor concentration, - difficulties in problem solving. - Rapidly progressive.

A patient has been admitted with a Dx of confusion. The physicians admission note states that he wants to assess for delirium versus dementia. What should the nurse be aware that the main difference include ?

- Delirium usually has sudden onset and is reversible, - Dementia is chronic and irreversible

Which are possible causes of delirium? (select all that apply)

- Fever or infection (UTI) - Brain trauma; - Electrolyte imbalance; - Medication; - Sleep deprivation From Book - Pain - Fever or infection - Dehydration or malnutrition - Sleep deprivation - Electrolyte imbalances (hyponatremia or hypocalcemia) - Alcohol or drug use, abuse or withdrawal - Medications (analgesics, hypnotics, psychotropics) - Physiological conditions resulting in inadequate oxygenation to the brain

The medical term ____________ refers to the inability to recognize familiar objects.

Agnosia

A nurse places an object in the hand of a client with Alzheimer's disease and asks the client to identify the object. Which of the following terms represents the client's inability to name the object?

Agnosia.

A client with Alzheimer's disease is admitted for hip surgery after falling and fracturing the right hip. The client's spouse tells the nurse about feeling guilty for letting the accident happen and reports not sleeping well lately because the spouse has been getting up at night and doing odd things. Which nursing diagnosis is most appropriate for the client's spouse? a. Defensive coping related to diagnosis of Alzheimer's disease b. Risk for caregiver role strain related to increased client care needs c. Decisional conflict related to lack of relevant treatment information d. Relocation stress syndrome related to hospitalization

Answer: b. Risk for caregiver role strain related to increased client care needs

The family caregiver for a patient with AD expresses an inability to make decisions, concentrate, or sleep. The nurse determines what about the caregiver? a. The caregiver is also developing signs of AD. b. The caregiver is manifesting symptoms of caregiver role strain. c. The caregiver needs a period of respite from care of the patient. d. The caregiver should ask other family members to participate in the patient's care.

Answer: b. The caregiver is manifesting symptoms of caregiver role strain.

NCLEX Caregiver role strain 12. A patient with three school-age children cares for her mother who has Alzheimer's disease. Her mother can no longer safely stay at home alone and needs continual supervision. A nursing diagnosis of caregiver role strain is made. Which nursing intervention is most appropriate? 1. Provide a calm environment with minimal distraction. 2. Access community support to provide opportunity for the caregiver to do errands and spend time with her children. 3. Assess communication patterns between the patient and her mother. 4. Encourage the use of gestures and touch to enhance communication.

Answer: 2. Access community support to provide opportunity for the caregiver to do errands and spend time with her children.

NCLEX: What is dementia? What description for the term dementia is most appropriate? 1. A sudden change in mental status that results from hypoxia, electrolyte imbalances, or some other treatable condition 2. A state of physical and mental deterioration associated with normal aging 3. Loss of awareness of person, place, and time 4. A progressive impairment of intellectual function that interferes with normal activities

Answer: 4. A progressive impairment of intellectual function that interferes with normal activities

Attentive and active listening for grief coping

Attentive Listening A response where the listener clarifies her role, uses attentive nonverbals, honors silence, paraphrases and matches emotion with the listeners. Active Listening requires the listener to -understand, - interpret, - recount, and evaluate what they hear/ It is a structured way of listening and responding to others, focusing the attention on the speaker.

What is delirium? ________________ is an acute brain syndrome, usually temporary with delusions.

Delirium

A family member of a client with dementia asks the nurse the difference between delirium and dementia. Which of the following is the most accurate response to this question?

Delirium is an acute confusion which is usually reversible.

Delirium vs dementia (key differences) A nurse is assessing a pt for delirium versus dementia what should the nurse expect the pt with dementia display?

Flat affect

Kübler-Ross's Stages of Dying A behavior-oriented theory that includes five stages:

From Book • Denial: (Stage 1) Individual acts as though nothing has happened and may refuse to believe or understand loss has occurred. ____________________________________________ • Anger: (Stage 2) Individual resists the loss and may strike out at everyone and everything. ________________________________________________ • Bargaining: (Stage 3) Individual postpones awareness of reality of the loss and may try to deal in a subtle or overt way as though the loss can be prevented. ________________________________________________ • Depression: (Stage 4) Individual feels overwhelmingly lonely and withdraws from interpersonal interaction. ________________________________________________ • Acceptance: (Stage 5) Individual accepts the loss and looks to the future.

The Five Stages of Grief may not be experienced in order, and the length of each stage will vary from person to person.

From Ms Whyte - In the denial stage - clients have difficulty believing a terminal diagnosis or loss. - In the anger stage - clients lash out at other people or things. - In the bargaining stage - clients negotiate for more time or a cure. - In the depression stage - clients are saddened over the inability to change the situation. - In the acceptance stage - clients accept what is happening and plan for the future

Stages of Alzheimer's disease: (early, middle, terminal stage) The early stage consists of a gradual

onset of memory loss and difficulty focusing attention.