Term
| What are cognitive disorder Nursing interventions are focused on? |
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Definition
| protecting patient dignity, preserving functional status, and promoting well-being for cognitively impaired patients. |
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Term
| what are the three main cognitive disorders? |
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Definition
| delirium, dementia, and amnestic disorder |
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Term
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Definition
| Delirium “is characterized by a disturbance of consciousness and a change in cognition that develop over a short period of time |
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Term
| what type of priority is a client that starts to suffer from delirium? |
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Definition
| It should be considered to be a priority problem, and immediate attention should be given to prevent irreversible and serious damage |
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Term
| how fast is the onset of delirium? |
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Definition
| Sudden, over hours to days |
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Term
| how fast is the onset of dementia? |
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Definition
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Term
| what are some of the main contributing factors to delirium? |
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Definition
| Hypoglycemia, fever, dehydration, hypotension; infection, other conditions that disrupt body's homeostasis; adverse drug reaction; head injury; change in environment (e.g., hospitalization); pain; emotional stress |
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Term
| what are some of the main contributing factors to dementia? |
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Definition
| Alzheimer's disease, vascular disease, human immunodeficiency virus infection, neurological disease, chronic alcoholism, head trauma |
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Term
| What is "Sundown syndrome" or "sundowning"? |
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Definition
| when the behaviors of delirium/dementia get worse at night than in the day. |
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Term
| what is the emotional state of someone suffering from delirium? |
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Definition
| Rapid swings; can be fearful, anxious, suspicious, aggressive, have hallucinations and/or delusions |
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Term
| what type of emotional state does someone with dementia have? |
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Definition
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Term
| which disease is possibly reversible? delirium or dementia? |
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Definition
| delirium is reversible with timely treatment.. dementia is progressive and irreversible. |
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Term
| what is the prevalence of delirium in the elderly population? |
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Definition
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Term
| what is the prevalence of delirium in intensive care patients |
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Definition
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Term
| what are factors that put patients for high risk of delirium? |
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Definition
| hese factors include existing cognitive impairment (especially on admission to the hospital), low functional autonomy, polypharmacy (especially benzodiazepines, narcotic analgesics, and anticholinergics), and clinical severity of the primary illness ( |
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Term
| what are the 4 cardinal features of delirium? |
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Definition
1. Acute onset and fluctuating course
2. Inattention
3. Disorganized thinking
4. Disturbance of consciousness |
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Term
| nursing assessment for delirium includes what 3 things? |
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Definition
| observation of (1) cognitive and perceptual disturbances, (2) physical needs, and (3) moods and physical behaviors. |
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Term
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Definition
| errors in perception of sensory stimuli. A person may mistake folds in the bedclothes for white rats or the cord of a window blind for a snake. |
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Term
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Definition
| false sensory stimuli (see Chapter 15). Visual hallucinations are common in delirium, and tactile hallucinations may also be present. For example, individuals experiencing delirium may become terrified when they “see” giant spiders crawling over the bedclothes or “feel” bugs crawling on or under their bodies. |
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Term
| what is a very common and important nursing diagnosis for those with delirium/dementia? |
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Definition
| Risk for injury related to confusion, as evidenced by sensory deficits or perceptual deficits. |
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Term
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Definition
| progressive deterioration of cognitive functioning and global impairment of intellect with no change in consciousness. Dementia is manifested as difficulty with memory, thinking, and comprehension. |
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Term
| name several different types of dementia |
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Definition
| Alzheimer's type, vascular dementia, Lewy body disease, Pick's disease, Huntington's chorea, alcohol-related dementias (including Korsakoff's syndrome), Creutzfeldt-Jakob disease, and the dementias associated with Parkinson's disease, acquired immunodeficiency syndrome (AIDS), and head trauma. |
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Term
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Definition
| irreversible, progressive, and not secondary to any other disorder |
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Term
| define secondary dementia |
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Definition
| occurs as a result of some other pathological process (e.g., metabolic, nutritional, or neurological). AIDS-related dementia is an example of a secondary dementia that is increasingly seen in health care settings |
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Term
| how does Alzheimer spread in the brain? |
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Definition
| it starts in the hippocampus and gradually spreads to the cerebral cortex |
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Term
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Definition
the creation of stories or answers in place of actual memories to maintain self-esteem. For example, the nurse addresses a patient who has remained in a hospital bed all weekend:
Nurse: Good morning, Ms. Jones. How was your weekend?
Patient: Wonderful. I discussed politics with the President, and he took me out to dinner. |
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Term
| what is the difference between confabulation and lying? |
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Definition
| lying is conscious, confabulation is not. |
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Term
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Definition
| the repetition of phrases or behavior) |
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Term
| what is Amnesia or memory impairment. |
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Definition
| Initially the person has difficulty remembering recent events. Gradually, deterioration progresses to include both recent and remote memory. |
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Term
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Definition
| loss of language ability) |
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Term
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Definition
| loss of purposeful movement in the absence of motor or sensory impairment) |
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Term
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Definition
| loss of sensory ability to recognize objects). For example, the person may lose the ability to recognize familiar sounds (auditory agnosia) |
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Term
| define Disturbances in executive functioning |
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Definition
| planning, organizing, abstract thinking). The degeneration of neurons in the brain results in the wasting away of the brain's working components. These cells contain memories, receive sights and sounds, cause hormones to secrete, produce emotions, and command muscles into motion. |
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Term
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Definition
| A disorder that mimics dementia |
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Term
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Definition
| inability to read or write) |
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Term
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Definition
| the need to taste, chew, and put everything in one's mouth) |
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Term
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Definition
| manifested by touching of everything in sight |
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Term
| signs of stage 1 alzheimers |
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Definition
s
Shows short-term memory losses; loses things, forgets
Memory aids compensate: lists, routines, organization
Aware of the problem; concerned about lost abilities
Depression common—worsens symptoms
Not diagnosable at this time |
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Term
| signs of stage 2 alzhiemers |
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Definition
Shows progressive memory loss; short-term memory impaired; memory difficulties interfere with all abilities
Withdrawn from social activities
Shows declines in instrumental activities of daily living (ADLs), such as money management, legal affairs, transportation, cooking, housekeeping
Denial common; fears “losing his or her mind”
Depression increasingly common; frightened because aware of deficits; covers up for memory loss through confabulation
Problems intensified when stressed, fatigued, out of own environment, ill
Commonly needs day care or in-home assistance |
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Term
| Stage 3 alzhiemers signs (Moderate to Severe)Ambulatory dementia |
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Definition
hows ADL losses (in order): willingness and ability to bathe, grooming, choosing clothing, dressing, gait and mobility, toileting, communication, reading, and writing skills
Shows loss of reasoning ability, safety planning, and verbal communication
Frustration common; becomes more withdrawn and self-absorbed
Depression resolves as awareness of losses diminishes
Has difficulty communicating; shows increasing loss of language skills
Shows evidence of reduced stress threshold; institutional care usually needed |
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Term
| signs of Stage 4 (Late)End stage alzhiemers |
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Definition
Family recognition disappears; does not recognize self in mirror
Nonambulatory; shows little purposeful activity; often mute; may scream spontaneously
Forgets how to eat, swallow, chew; commonly loses weight; emaciation common
Has problems associated with immobility (e.g., pneumonia, pressure ulcers, contractures)
Incontinence common; seizures may develop
Most certainly institutionalized at this point
Return of primitive (infantile) reflexes |
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Term
| what would be the right NOC nursing diagnosis for an alzhiemers patient that was showing Common behaviors include hoarding, regression, and being overly demanding? |
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Definition
Ineffective coping.
Family caregivers may experience compromised or even disabling family coping. |
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Term
| what is the main drug used for alzheimer's disease patients? |
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Definition
| CHOLINESTERASE INHIBITORS |
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Term
| name the 5 CHOLINESTERASE INHIBITORS approved by the FDA for treatments |
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Definition
| tacrine hydrochloride (Cognex), donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne, formerly marketed as Reminyl). Memantine (Namenda) normalizes levels of glutamate, a neurotransmitter that may contribute to neurodegeneration |
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Term
| what is the drug of choice for AD patients? |
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Definition
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Term
| cholinesterase inhibitors side effects |
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Definition
| nausea, diarrhea, and vomiting. In addition, they should be used with caution when patients are taking nonsteroidal antiinflammatory drugs (NSAIDs) |
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Term
1. A 73-year-old woman with pneumonia becomes agitated after being admitted to the intensive care unit through the emergency department. She is placed in soft restraints when she continues to try to leave her bed despite being too weak to walk. Her vital signs are erratic, and her thinking seems disorganized. During her first 24 hours in ICU, the patient varies from somnolent to agitated, and from laughing to angry. Her daughter reports that the patient “was never like this at home.” What is the most likely explanation for the situation?
1. Pneumonia has worsened the patient's early-stage dementia.
2. The patient is experiencing delirium secondary to the pneumonia.
3. The patient is sundowning due to the decreased stimulation of the intensive care unit.
4. The patient does not want to be in the hospital and is angry that staff will not let her leave. |
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Definition
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Term
2. Intervention(s) appropriate for a hospitalized patient experiencing delirium include which of the following? Select all that apply.
1. Immediately placing the patient in restraints if she begins to hallucinate or act irrationally or unsafely
2. Assuring that a clock and a sign indicating the day and date is displayed where the patient can see it easily
3. Being prepared for possible hostile responses to efforts to take vital signs or provide direct physical care
4. Preventing sensory deprivation by placing the patient near the nurses’ station and leaving the television and multiple lights turned on 24 hours per day
5. Speaking with the patient frequently for short periods for reassurance, assisting the patient in remaining oriented, and ensuring the patient's safety
6. Anticipating that the patient may try to leave if agitated and providing for continuous direct observation to prevent wandering
7. Promoting normalized sleep patterns by encouraging the patient to remain awake during the day and facilitating rest at night |
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Definition
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Term
3. Which statement about dementia is accurate?
1. The majority of people over age 85 are affected by dementia.
2. Disorientation is the dominant and most disruptive symptom of dementia.
3. People with dementia tend to be distressed by it and complain about its symptoms.
4. Hypertension, diminished activity levels, and head injury increase the risk of dementia. |
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Definition
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Term
4. Mrs. Smith dies at the age of 82. In the 2 months following her death, her husband, aged 84 and in good health, has begun to pay less attention to his hygiene and seems less alert to his surroundings. He complains of difficulty concentrating and sleeping and reports that he lacks energy. His family sometimes has to remind and encourage him to shower, take his medications, and eat, all of which he then does. Which response is most appropriate?
1. Arrange for an appointment with a therapist for evaluation and treatment of suspected depression.
2. Reorient Mr. Smith by pointing out the day and date each time you have occasion to interact with him.
3. Meet with family and support persons to help them accept, anticipate, and prepare for the progression of his stage II dementia.
4. Avoid touch and proximity; these are likely to be uncomfortable for Mr. Smith and may provoke aggression when he is disoriented. |
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Definition
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Term
5. Which of the following intervention(s) would be beneficial for those caring for a loved one with Alzheimer's disease? Select all that apply.
1. Guide the family to restrict the patient's driving as soon as signs of forgetfulness are exhibited.
2. Recommend switching to hospital-type gowns to facilitate bathing, dressing, and other ph ysical care of the patient.
3. Discourage wandering by installing complex locks or locks placed at the tops of doors where the patient cannot readily reach them.
4. For situations in which the patient becomes upset, teach loved ones to listen briefly, provide support, and then change the topic.
5. Encourage caregivers to care for themselves, as well as the patient, via use of support resources such as adult day care or respite care.
6. If the patient is prone to wander away, encourage family to notify police and neighbors of the patient's condition, wandering behavior, and description. |
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Definition
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