QUIZ 6 N222

NCD Causes

Due to: -Alzheimer's disease •70% of cases -Frontotemporal -Lewy bodies -Vascular (decreased blood flow) -HIV infection -Parkinson's disease -Huntington's disease -Traumatic brain injury

Enabling

Facilitating continued use of substance

benzo overdose antidote

Flumazenil

Apraxia

Forgetting how to move (loss of purposeful movement) -How to put clothes or how to drive

Aphasia

Forgetting how to talk -Stuttering, struggling w/ words, & how to tell a story

Agnosia

Forgetting how to use ur senses (Touch, Taste, Smell, Hear, & See) -Grandpa see's u BUT DOESN'T know who you are -DOESN'T know if it's their name -Hearing a doorbell BUT picking up the NON-RINGING telephone instead -Hears a doorbell & DOESN'T get up to answer the door

Mild Alzheimer's

Forgetting stuff that everyone forgets, BUT starting to happen ALOT MORE FREQUENTLY; forgetting the CASUAL STUFF ALOT more -Client is still independent -No confusion

Addiction (voluntary or involuntary?)

INVOLUNTARY -Addiction is an illness

CAGE Questionnaire

C-cut (Do u feel u should cut down on drinking?) A-annoyed (Do u get annoyed when people criticize u on ur drinking?) G-guilty (do u feel guilty of ur drinking habits?) E-eye opener (do u ever need an eye-opener in the morning?)

Safety Issues of Severe Alzheimer's

Can't WALK: -Bedridden= ulcers -Muscle atrophy -Skin breakdown -Fall risk Can't VERABLIZE: -Can't share their feelings or say their needs -↑Depression= ↑SI Can't SWALLOW -Malnutrition/FVD -Aspiration -Needs total care

Pharmacological Interventions

Cholinesterase Inhibitors: -Donepezil -Rivastigmine -Galantamine

Severe Alzheimer's

Client has forgotten how to: Walk, Talk, & Swallow

NCD

-SLOW & PROGRESSIVE -Irreversible -When identified, we know what's happening (Neuronal Degeneration) -Typically NON-emergent -Manifestations: Typically MAINTAINS ALOC

Delirium Causes

-Substance intoxication / withdrawal -Infection (Clozapine=Agranulocytosis, Sepsis, UTI or PNA) -Medication SE/toxicity Toxicity= Lithium, Neuroleptic malignant syn, Hyperpyremia, Serotonin Syndrome -Severe malnutrition= Hypernatremia, Hypoglycemia (malnourished & low blood suga) -Surgery -Many other potential causes

Treatment Meds

-Withdrawal: diazepam, carbamazepine, clonidine, chlordiazepoxide, phenobarbital, naltrexone -Abstinence: disulfiram, naltrexone, acamprosate

What do Benzos do?

-↑seizure threshold= ↓seizure risk

Downers

-↓Vitals, LOC, Brain activity, & Physical activity

Tolerance

-PT NEEDS MORE of a substance to reach that Euphoria (dangerous since ur introducing MORE chemicals in ur body)

Intoxication

-PT consumed an EXCESS AMOUNT of a substance

Delirium

-ACUTE, RAPID onset of severe symptoms -Reversible -When identified, we don't know what's causing it -A MEDICAL EMERGENCY due to: Can lead to Brain damage, Irreversible trauma, & Death -Manifestations: ALOC & Mood swings

Communication techniques for Dementia clients

-Agree, never argue -Divert, never reason -Distract, never shame -Reassure, never lecture -Reminisce, never say "remember" -Repeat, never say "I told U" -Do what they can do, never say "U can't" -Ask, never demand -Encourage, never condescend -Reinforce, never force

NCD Terms

-Aphasia -Apraxia -Agnosia

What is Sundowning?

-As the sun goes down, the client's presentations (manifestations) gets WORSE

Negative impact on role responsibility?

-Being sloppy drunk in public places -Being so drunk that u can't do ur norm activities

Withdrawal

-Body spazzes out in a VARIETY of DANGEROUS WAY due to the substance leaving the body

Alcohol Use Disorder

-CAGE Questionnaire -Enabling & Codependence

Cholinesterase Inhibitors Contraindications

-COPD -Asthma -NSAIDS -antihistamines -TCA -antipsychotics

Similarities between Delirium & Neurocognitive Disorders?

-Confusion/disorientation -Impaired memory & attention span -Anxiety & agitation -Sundowning

Disulfiram

-DON'T take during Withdrawal phase since it causes INTENSE N/V & diarrhea

NCD previously known as: _______

-Dementia

What are some home safety measure for Alzheimer's Disease PTs?

-Extra door locks on the doors -Label cabinets -Put mattress on the floor -Well lit enviro -No clutter -No rugs -No electrical wires -"Baby proof" some cabinets -Remove gas knobs from stove -Put colored duck tape on steps -Hand rails -Non-slip socks

Moderate Alzheimer's

-Forgetting they own a car -Who you are -What u look like -What their house looks like -That they're on meds -Client is STILL independent -Ambulatory -Good strength

Safety Issues of Mild Alzheimer's

-Forgetting to take meds in the morning -Accidentally OD or double dosing -Leaving stove or H2o running

Cholinesterase Inhibitors SE

-GI upset, NVD -Bradycardia -Syncope

Abstinence meds

-Helps PT stay off substance (kicks craving)

Withdrawal meds

-Helps PT stay safe & physiologically stable -Helps u chill out -Helps w/ vitals & cravings

Theme

-If ↑ in Intoxication, than ↓ in Withdrawal -If ↓ in Intoxication, than ↑ in Withdrawal

Per the DSM-5... Criteria for Substance Use Disorder:

-Loss of control -LG amounts of time spent on acquiring the drug, using the drug, or recovering from excessive use of the drug -Negative impact on role responsibility -Desire to quit, BUT inability to do so

Safety Issues of Moderate Alzheimer's

-MOST DANGEROUS stage of Alzheimer's -This is when wandering occurs/begins

NCD NSG Care

-Maintain Safety Risk for injury Risk for fall Risk for FVD -Reorient the pt -Well lit environment, low stimulus

Codependence

-Maladaptive -NOT helping PT -Subliminally telling PT it's okay to continue sub. use since u keep covering for the PT -A type of enabling -Fam/friend feels like they're helping PT but they're making the prob. worse!!!

Stages of Alzheimer's Disease

-Mild -Moderate -Severe

Acute onset of disordered thinking is most associated with A. Delirium B. Neurocognitive disorder C. Depression D. Dysthymia

A. Delirium (reversible)

What is the most appropriate goal of therapy for the client with vascular dementia? a. Avoid confusing conversations b. Maintain optimal functioning c. Promote steady improvement d. Improve interpersonal relationships

b. Maintain optimal functioning

The nurse is caring for a client with delirium. Which nursing intervention would be highest priority? a. Maintaining consistency in routine b. Maintaining physiological safety c. Promoting optimal level of functioning d. Promoting orientation to person, place, and time

b. Maintaining physiological safety

A patient with dementia walks to the bathroom and attempts to brush his teeth, but he can't remember how to do it. Which problem is evident? A. Aphasia B. Apraxia C. Agnosia

B. Apraxia (loss of purposeful movement)

Opioid Pupil

Intoxication: Constricted Withdrawal: Dilated (Intoxicated w/ Opioids= little "o")

Amphetamine

Intoxication: ↑ Withdrawal: ↓

Cocaine

Intoxication: ↑ Withdrawal: ↓

Alcohol

Intoxication: ↓ Withdrawal: ↑

Benzos

Intoxication: ↓ Withdrawal: ↑

Opioids

Intoxication: ↓ Withdrawal: ↑

Addictive Substances

Most Important for ATI: -Alcohol -Amphetamines -Benzos -Cocaine -Opioids Less Important: -Caffeine -Cannabis -Hallucinogens -Inhalants -Tobacco

Opioid overdose antidote:

Naloxone (Narcan)

Delirium NSG Care

Stabilize client then Find the cause!

Could a PT experience Delirium & Neurocognitive Disorder @ the same time?

YES but rare

A nurse's neighbor says, "My sister has been diagnosed with bipolar disorder but will not take her medication. I have tried to help her for over 20 years, but it seems like everything I do fails. Do you have any suggestions?" Select the nurse's best response. a. "The National Alliance on Mental Illness offers a family education series that you might find helpful." b. "Since your sister is noncompliant, perhaps it's time for her to be changed to injectable medication." c. "You have done all you can. Now it's time to put yourself first and move on with your life." d. "You cannot help her. Would you like to weigh the pros and cons of discontinuing your relationship?"

a. "The National Alliance on Mental Illness offers a family education series that you might find helpful."

During the third week of treatment, the spouse of a patient in a rehabilitation program for substance abuse says, "After this treatment program, I think everything will be all right." Which remark by the nurse will be most helpful to the spouse? a. "While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol." b. "It will be important for you to structure life to avoid as much stress as you can and provide social protection." c. "Addiction is a lifelong disease of self-destruction. You will need to observe your spouse's behavior carefully." d. "It is good that you are supportive of your spouse's sobriety and want to help maintain it."

a. "While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol."

A patient diagnosed with a serious mental illness lives independently and attends a psychosocial rehabilitation program. The patient presents at the emergency department seeking hospitalization. The patient has no acute symptoms but says, "I have no money to pay my rent or refill my prescription." Select the nurse's best action. a. Involve the patient's case manager to provide crisis intervention. b. Send the patient to a homeless shelter until housing can be arranged. c. Arrange for a short in-patient admission and begin discharge planning. d. Explain that one must have active psychiatric symptoms to be admitted.

a. Involve the patient's case manager to provide crisis intervention.

When planning care for an older adult client with dementia, the nurse would arrange for increased supervision of the client at what time of day? a. Night b. Noon c. Morning d. Afternoon

a. Night

Select the priority outcome for a patient completing the fourth alcohol-detoxification program in the past year. Prior to discharge, the patient will: a. state, "I know I need long-term treatment." b. use denial and rationalization in healthy ways. c. identify constructive outlets for expression of anger. d. develop a trusting relationship with one staff member.

a. state, "I know I need long-term treatment."

In the emergency department, a patient's vital signs are BP 66/40 mm Hg; pulse 140 beats/min; respirations 8 breaths/min and shallow. The nursing diagnosis is Ineffective breathing pattern related to depression of respiratory center secondary to narcotic intoxication. Select the priority outcome. a. The patient will demonstrate effective coping skills and identify community resources for treatment of substance abuse within 1 week of hospitalization. b. Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/min, and respirations at or above 12 breaths/min. c. The patient will correctly describe a plan for home care and achieving a drug-free state before release from the emergency department. d. Within 6 hours, the patient's breath sounds will be clear bilaterally and throughout lung fields.

b. Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/min, and respirations at or above 12 breaths/min.

Symptoms of withdrawal from opioids for which the nurse should assess include: a. dilated pupils, tachycardia, elevated blood pressure, and elation. b. nausea, vomiting, diaphoresis, anxiety, and hyperreflexia. c. mood lability, incoordination, fever, and drowsiness. d. excessive eating, constipation, and headache.

b. nausea, vomiting, diaphoresis, anxiety, and hyperreflexia.

The treatment team discusses the plan of care for a patient diagnosed with schizophrenia and daily cannabis abuse who is having increased hallucinations and delusions. To plan effective treatment, the team should: a. Provide long-term care for the patient in a residential facility. b. Withdraw the patient from cannabis, then treat the schizophrenia. c. Consider each diagnosis primary and provide simultaneous treatment. d. First treat the schizophrenia, then establish goals for substance abuse treatment.

c. Consider each diagnosis primary and provide simultaneous treatment.

Which factor is least associated with increased incidence of Alzheimer's disease? a. Head trauma b. Advanced age c. Excessive alcohol consumption d. Family history of Alzheimer's disease

c. Excessive alcohol consumption

A 70 year old client with Alzheimer's disease becomes verbally abusive toward the nursing staff. What is the most appropriate action for the nurse to take? a. Administer lorazepam to calm the client b. Apply four-point restraints to physically control the client c. Speak in a calm, caring tone of voice, and attempt to divert the client's attention d. Advise the client that unit privileges will be withheld if the behavior continues

c. Speak in a calm, caring tone of voice, and attempt to divert the client's attention

Family members of an individual undergoing a residential alcohol rehabilitation program ask, "How can we help?" Select the nurse's best response. a. "It's important that you visit your family member on a regular basis." b. "Alcoholism is a lifelong disease. Relapses are expected." c. "Use random search and destroy tactics to keep the home alcohol free." d. "Make your loved one responsible for the consequences of behavior."

d. "Make your loved one responsible for the consequences of behavior."

A patient diagnosed with an alcohol abuse disorder says, "Drinking helps me cope with being a single parent." Which therapeutic response by the nurse would help the patient conceptualize the drinking objectively? a. "Sooner or later, alcohol will kill you. Then what will happen to your children? b. "I hear a lot of defensiveness in your voice. Do you really believe this?" c. "If you were coping so well, why were you hospitalized again?" d. "Tell me what happened the last time you drank."

d. "Tell me what happened the last time you drank."

Which service would be expected to provide resources 24 hours a day, 7 days a week if needed for persons with serious mental illness? a. Clubhouse model b. Cognitive Behavioral Therapy (CBT) c. Cognitive Enhancement Therapy (CET) d. Assertive Community Treatment (ACT)

d. Assertive Community Treatment (ACT)

The nurse wants to enroll a patient with poor social skills in a training program for patients diagnosed with schizophrenia. Which description accurately describes social skills training? a. Patients learn social skills by practicing them in a supported employment setting. b. Patients learn to improve their attention and concentration. c. Group leaders provide support without challenging patients to change. d. Complex interpersonal skills are taught by breaking them into simpler behaviors

d. Complex interpersonal skills are taught by breaking them into simpler behaviors

Which of the following is most characteristic of cognitive disorders? a. Catatonia b. Depression c. Feeling of dread and doom d. Deficit in memory

d. Deficit in memory

Which nursing diagnosis is most appropriate for an older adult client experiencing visual and auditory hallucinations? a. Interrupted family processes b. Ineffective role performance c. Impaired verbal communication d. Disturbed Sensory Perception

d. Disturbed Sensory Perception

A patient diagnosed with schizophrenia has had multiple relapses. The patient usually responds quickly to antipsychotic medication but soon discontinues the medication. Discharge plans include follow-up at the mental health center, group home placement, and a psychosocial day program. Which strategy should apply as the patient transitions from hospital to community? a. Administer a second-generation antipsychotic to help negative symptoms. b. Use a quick-dissolving medication formulation to reduce "cheeking" c. Prescribe a long-acting intramuscular antipsychotic medication. d. Involve the patient in decisions about which medication is best.

d. Involve the patient in decisions about which medication is best.

The daughter of a 70-year-old male client with dementia is attending a caretaker support meeting and asks a nurse for a definition of dementia. The nurse responds: a. A personal neglect in self-care b. Poor judgment, especially in social situations c. Memory loss occurring as a natural consequence of aging d. Loss of intellectual abilities sufficient to impair self-care

d. Loss of intellectual abilities sufficient to impair self-care

Cocaine & Amphetamine are...

↑ in Intoxication

Uppers

↑Vitals, LOC, Brain activity, & Physical activity

All the others are ...

↓ in Intoxication