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nurs 211

impaired cognition: dementia, delerium,

Classification of Aging: what is older; elderly; aged; very old 55-64; 65-74; 75-84; 85 and older
when aging what causes the most frequent limitation on adls musculoskeletal
psych changes with aging: memory function- short or long term deteriation with age; what ppl have less memory decline; short; well educated mentally active ppl;
psych changes with aging: intellectual functioning- does socialization abilities decline; what skills decline socialization abilities; problem solving skilss
psych changes with aging: learning ability- ability to learn increases or decreases with age; they need greater time for what does not decrease with age but score lower on performance tests requiring rapid response; learning
adaptation to the tasks of aging: they are predisposed to what bc of loss; grief from loss can cause ___ overload; depression; bereavement
adaptation to the tasks of aging:what contributes the the well being of the elder; what becomes more stable in elderly over time; good psychosocial factors affecting adjustment later in life are what social networks; self identity; sustained family relationships, maturity of ego relationships, absence of alcoholism, absence of depressive disorder
adaptation to the tasks of aging: what is a myth among the elderly; what are dying persons fears; what does someone most desire when dying death anxiety; abandonment, pain and confusion; someone to talk to
theories of aging: developmental task theory- erikson described the primary task of old age as what; if elder does not meet integrity what feelings dothey have being able to see one's life as having lived with integrity; despair
theories of aging: disengagement theory- this is the process of withdrawal by older adults from what; social roles and responsibilities;
theories of aging: activity theory- opposite of what theory; belief that the way to age is to be ___; disengagement theory; active;
theories of aging: continuity theory- the person's previously established ____ is basis for predicting adjustment to the changes in aging; ex coping abilities; a person who enjoys social activities will continue over a lifetime or a person wno enjoyed a solitude and limited activities will continue the same
dementia: what is the onset; what is the course of impairment; what age insidious; gradual progressive course of cognitive impairment; 65 and older and very common in 85 and older
dementia: what type of memory loss; along with the memory loss what other cognitive defects are there; short and long term; aphasia, apraxia, agnosia, disturbed executive function
def aphasia language problems
def apraxia organization problems
def agnosia unable to recognize an object or tell their purpose
def disturbed executive function personality and inhibition
classifications of dementia: primary dementia- the dementia is a major sign of what disease; is it r/t any other organic illness; ex; what happens in this organic brain disease; no; Alzheimer's; diminished brain metabolic activity and brain atrophy
classifications of dementia: secondary dementia- caused by what; ex another disease or condition; HIV, head trauma, Parkinson's, Huntington's, substances, CVA
classifications of dementia: reversible dementia- common; can dementia be determined reversible often; what can be done; ex very small % of ppl; no; determined by underlying pathology and early tx; cerebral legions, depression, medication side effects, hydrocephalus, vit or nutritional deficiencies, CNS infections and metabolic disorders
symptoms of dementia: what is behavior; what is neglected; is language effected; difficulty naming objects is r/t what; uninhibited and inappropriate; personal hygiene and appearance; maybe; aphasia;
symptoms of dementia: what change is common; as disease progresses what happens to motor activities; so that is the motor functions personality changes; inability to carry out them (apraxia); apraxia
symptoms of dementia: they wander where; impairment in what; away from home; abstract thinking, judgment, impulse control
stages of dementia: stage 1: what are the s/s no s/s
stages of dementia: stage 2: what are s/s forgetfullness
stages of dementia: stage 3: there is a mild decline in what; the dcline interferes in what; ex of this stage cognition; work performance; gets lost when driving, difficulty recalling names, decline in ability to plan or organize
stages of dementia: stage 4: what continues to decline; there is more pernounced ___; ex mod cognition decline; confusion; forgets major events in personal hx, unable to perform tasks such as shopping, unable to understand news events
stages of dementia: stage 5: this is termed what type of dementia; ex early; loss of ability to perform, adls independently, forget address, names ofclase relatives, disoriented to place and time, frusteration and self absorption are common
stages of dementia: stage 6: what is the cognitive decline; this is what type of dementia; ex; what happens to body functions mod to severe decline; middle; unable to recall recent major life events, forget spouse's name, disorientated to surroundings iscommon, unable to manage ADLS without assist; incontinence
stages of dementia: stage 6: what are psychomotor s/s; what is a common s/s; loss of what skills happen wandering, obsessiveness, agitation and aggression; sundowning; language skills
stages of dementia: stage 7: what is cognitive decline; what is the type of dementia; they cannot recognize what; ex of issues severe; late; family members; immobility, decreased immune system, decreased appetite, speech and language severely impaired
sundowning: this causes an altered what; def; thought process; increased confusion late in the afternoon evening r/t fatigue, lack of sensory stimuli, or biological needs
sundowning: interventions routine nap after lunch, involve in favorite activity, use nightlights or TV, allow to get up and walk around, safe activities, don't restrain, assess for pain
why should it be dx; to find treatable conditions, find treatable s/s, identify caregivers
vascular dementia: cause; how common is this type; what deteriation occurs; prognosis worse or better then alzheimers; what happens significant cerebrovascular disease;2nd most common type; intellectual; worse; blood vessels of the brain are affected, interrupted flow and progressive intellectual deterioration occurs
vascular dementia: more or less abrupt then alzheimers; cause from mini ___; progress of s/s occurs in steps or gradual declines; can it improve sometimes; the pattern of decline is regular or irregular more; strokes; steps; yes; irregular
vascular dementia: what is cause of strokes; tx HTN, emboli; manage cardio/cerebrovascular disease, control HTN, DM
Alzheimers: characterized as the syndrome of s/s identified as ___ in the DSM; how many stages; dementia; 7;
what is the most common form alzheimers
Alzheimers: what is onset like; what is the crouse of disorder; when do first s/s usually occur slow and insidious; progressive and deteriorating; before 65yo;
Alzheimers: what are early s/s; when does late onset occur; what are the the s/s of late onset behavioral disturbances like wandering and agitation; > 65 yo; behavioral disturbances with wandering and agitation;
s/s unique to Alzheimers: they have what 2 things; unique delusions and visual hallusinations
s/s unique to Alzheimers: imposter syndrome- def; akal one's house is not home or family abandoned them; capgras syndrome
s/s unique to Alzheimers: phantom border- this is the belief that someone is uninvited and living where; in the affected individuals home - typically in the attic or upper floorw
s/s unique to Alzheimers: tend to think what about their own children; the believe what about their spouse that they are babies; that the are unfaithful
s/s unique to Alzheimers: what is the name for the visual hallucinations; what do the hallucinations consist of; what are risk factors; Charles bonnet syndrome; well defined organized and clear images over which the subject has little control of;
Charles bonnet syndrome: risk factors; what is cause bilateral visual system impairment, declining visual acuity, cognitive deficits, stroke, and alzheimers disease; changes in the visual system may alterreceptive fields in the visual cortex and lead to spontaneous neuronal discharge and phantom vision
Alzheimers: how can acetylcholine alteration cause this; when acetylcholine is reduced this reduces the amount of what; less neurotransmission = what; the enzyme required to produce acetylcholine is dramatically reduces in the brain; neurotransmitters; decreased cognitive processes;
Alzheimers: are genetics a cause; what other preventable cause yes; head trauma
Alzheimers: therapies- why is exercise used; eating more ____ can slow rate ofcognitive decline ; what vit should be in diet; prevent and control what diseases to increase brain circulation; veggies; E and C; DM, hyperlipidemia, HTN, heart disease
dementia screening: what is done; why are dx tests done; what dx tests are done; physical exam, mini mental, dx tests; to rule out anything abnormal; CBC< met profile, HIV< RPR,TSH, B12,CT, MRI, PET
dementia screening: what does FDDNP pet scan do; the FDDNP molecule binds to tangles and plaques in brain
dementia screening: is there curative tx no
dementia symptomatic tx what are they meds, attention to the environment, family support can enhance level of functioning
caregiver support: caregivers who received 6 months of intensive help with care giving strategies were better how; what are caregiver strategies; they had significant improvements in overall quality of life, had lower rates of clinical depression; information sharing, instruction, role play, problem solving, skills training, stress management techniques, telephone support groups;
what is reach resource for enhancing Alzheimer caregivers health
meds for dementia: cholinesterase inhibitors- name them; what are side effects; effect Aricept, Exelon, razadyne; nausea, diarrhea; boost the levels of a chemical messenger involved in the memory and judgement
meds for dementia: NMDA receptor antagonists- name them; side effects; effect; what med can it be combined with memantine (Namenda); increase BP; reduces high levelsofglutamate in the brain,slows neuronal degradation and progression of the disease; cholinesterase inhibitors
delirium: characterized by a disturbanceof what; there is a change in what; consciousness; cognition;
def ofcognition the mental process of knowing, including aspects such as awareness, perception,reasoning,and judgment
delirium: rapid or slow onset; duration is long or brief rapid; brief
delirium: how long does it last; how is it reversible; not more then a month; with correction of underlying determinants;
delirium: s/s- they have difficulty sustaining and shifting ____; how is focus; how is thinking; what is speech; what is reasoning; attention; difficult; disorgansized; rambling, irrelevant, pressured and incoherent; impaired and no goal directed behavior
delirium: s/s- what is there LOC; what is issue short or long term memory disoriented to time and place; short
delirium: what psych issues are common; what happens in dreams; state of awareness is affected by what; what happens in state of awarenessness; illusions and hallucainations; vivid ones and nightmares; sleep; hypervigilance, hypersolmnolence, insomnia;
delirium: def hypervigilance; def hypersomnolence heightened awareness to environmental stilmuli; excessive sleepiness
delirium: what is the psychomotor activity; what happens to emotions; agitated, purposeless movements, vegetative state resembling catatonic stupor; they are instable
delirium: what are emotions; what are autonomic s/s fear, anxiety, depression, irritability, anger, euphoria, apathy; tachycardia, sweating, flushed face, dilated pupils, and high BP
delirium due to a general medical condition: what can cause this infections, metabolic disorders, fluid or lyte imbalance, hepatic or renal disease, thiamine def, head trauma,
what may cause thiamine def ETOH abuse
substance induced delirium: how do meds cause this; name the meds; the side effects; anesthetics, analgesics, psychotropics with anticholinergic effects, anticonvulsants, antihistamines, antihypertensives, lithium, GI meds, immunosuppresives, steroids
delirium: toxin exposure- what toxins can cause this organophosphates, insecticides, carbon monoxide, volatile substances
delirium: suctance withdrawal- cause; when can it happen with withdrawal reduction or termination of high dose ETOH, sedatives, hypnotics, anxiolytics; with in a few hours to 4 wks
delirium:what is the cause of it due to multiple etiologies more then 1 general medical condition or combined medical substance use
amnestic disorder: what is attention span; how is learning; what memory deficits short or long term; they cannot recall what; what is most difficult to recall past or present info normal; inability to learn new info; short and long; previously learned info; past
amnestic disorder: why do they engage in making stuff up; making stuff up is aka; bc they cannot remember;
amnestic disorder: what is emotion; how does it differ from dementia; bland; there is no impaired abstract thinking, no other disturbances of higher cortical function, no personality changes
amnestic disorder: what is onset; what is the duration; duration depends on what; acute or insidious; variable; the severirty and cause of condition;
amnestic disorder: what are predisposing medical conditions; head trauma, brain cancer, cerebral anoxia, herpes encephalitis, poorly controlled dm, brain surgery, cerebrovascular disease;
amnestic disorder: what is substance induced causes; ETOH, sedatives, hyponotics, anxiolytics, meds and toxins;
amnestic disorder: how long to s/s last if they are transient; what does it mean is s/s are chronic; what could cause transient s/s <1 month; they last >1 month; cerebrovascular disease, arrhythmias, migraine, thyroid disorders, and epilepsy;
amnestic disorder: assessment- what are specific cognitive changes; what happens with language; what might be found in he physical assessment attention span, thinking process, problem solving, memory; there is difficulties; signs of damage to the nervous system
diagnotistcs for delirium or amnesia: what labs; what scans; hepatic or renal functions, glucose, lytes, metabolic and endocrine, nutritional def, toxic substances; EEG, CT scan/MRI, lumbar puncture
goals for delirium or amnesia: not experience physical harm, not harm self or others, makeneeds known to caregivers, maintain orientation at optimum ability, complete ADLs with assist, maintain scheduled routine, maintain wt
nursing dx for delirium or amnesia: why is there a risk for trauma; wandering is a means to handle what; interventions for wandering rt wandering; stress; provide a safe environment;
Catastrophic reaction: what happens to client; s/s of this they are overwhelmed; crying, pacing, restlessness, combative, critical
Catastrophic reaction: prevent what; limit what; don't take what personally situation; decision making; reaction
nursing dx for delirium or amnesia: why is there a risk for injury; what is short term goal; what type of environement should there be; r/t agitation and anger; wil not harm self or others; low stimuli;
agitation: refrain from what; never ask what; what type of voice; link bevaior to what; what type of touch; restraints and reasoning; why; low warm voice; need; catious nurturing touch
altered thought process: r/t what; AEB what; what is goals; interventions cerebral hypoxia, degeneration; confusion, disorientation, inaccurate interpretation of environment; will make needs known to caregivers; promote security, clocks and calenders, validate what is real, divert attention from what is not real, remove stresso
altered thought process r/t suspicion: this is viewed as a result of things beyond what; intervientions; their control; keep duplicate items, help search and validate their concern, non-defensive reaction to accusations, no lectures or confrontations, approach from from
ineffective coping: evidenced by what; they are looking for what; interventions hoarding behaviors; something familiar; store frequently used items in easy access, learn hiding places, make sure food is not spoiled, distract client if found where they do not belong
delirium: we should orient to what; what should environment be; reality; low level of stimuli
reminiscence therapy: stimulation of life memories helps older adults to what; work through their lossess and maintain self esteem;
validation therapy: for whom; accept whatever dementia pt claims as what; accept the values and beliefs as what confused clients with mod to severe dementia; their reality; reality
Created by: jmkettel