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Mental Health

Module 10 - Impaired Cognition

What age is considered "older adulthood"? 65 years to death
What is a fact of older adulthood? More than half of adults over 65 years of age are living at home with a spouse or are maintaining a household alone
Physical aging process varies greatly and is affected by what? Genetics, early physical health care, early mental health care, current lifestyle practices, and attitude
What is integrity? State of wholeness
What is despair? Not achieving a state of wholeness
An individual who has developed integrity, has done what? Accepts the worth and uniqueness of his/her lifestyle
What is life filled with for older adults who have not reached a sense of wholeness? Despair
What physical adaptations can prevent medical problems in older adults? Aerobic and muscle strengthening
What does a sound physical body have a better chance of? Housing a sound psychosocial "body"
What do older adults have problems related to? Money, adequacy of food, housing, and health care
What mental health problems can arise when they worry about money? Depression, anxiety, and paranoia
What types of problems occur with housing in the older adult? Having "too much house" (to large to take care of) to having no housing at all
What often becomes a companion to an older adult after the death of a spouse or significant other? Depression
Why are older adults at risk for substance abuse? Metabolize and excrete drugs slowly
What may contribute to the misuse of medications? Sight and memory; drug interactions are big risk (patient's see multiple physicians and use many different pharmacies)
What is the best way to refer to medications when teaching patients about medications? Name and provide written instructions
What is elder abuse? Any action that takes advantage of an older person or his/her emotional well-being or property
What is exploitation? Improper use of a person for one's own profit
What is aging? Process of growing older
What is gerontophobia? Fear of aging and refusal to accept the mainstream of society
What is ageism? Practice of stereotyping older persons as feeble, dependent, and nonproductive
What is crystalized intelligence? Specialized accumulated knowledge (nursing, engineering, tech skills) that remain intact until 75 years or older; may remain intact until death
What is hoarding? Act of collecting and saving assorted, seemingly useless items
What is functional assessment? An analysis of the client's ability to perform the activities of daily living. The environment in which the client lives, as well as cultural & social patterns
What is memory loss? Natural par of the aging process relating to the inability to recall certain details or events
What is confusion? Mixed up, bewildered, or uncertain
What is delirium? Change of consciousness that occurs quickly
What is dementia? Loss of multiple abilities, including memory, language, and the ability to think and understand (judgment & abstract thought)
What are some causes of dementia? Metabolic disorder, Electrical disorder, Neoplastic disease, Degenerative disease, Arterial disease, Mechanical disorder, Infectious disease, Nutritional disorder, Drug toxicity
What is Alzheimer's Disease? Progressive, degenerative disorder that affects brain cells and results in impaired memory, thinking, and behavior
What is probably the most common mental health disorder of late adulthood? Depression
What can nurses assess for that signal the onset of depression? Behaviors
What are the different ways that depression can be treated? Individual and group therapy, as well as medications
What are some physical signs & symptoms of depression? Abdominal pain, nausea & vomiting, dry mouth, muscle aches, headaches
What are some cognitive (intellectual) signs & symptoms of depression? Confusion, agitation, paranoia, focus on the past, thoughts of death and suicide, decreased memory
What are some emotional signs & symptoms of depression? Fatigue, increased anxiety or dependence, feeling useless, hopeless, or helpless, lack of interest
What are some behavioral signs & symptoms of depression? Difficulties with ADL, changes in appetite and/or sleeping patterns, low energy, poor grooming, withdrawal from people & activities
What are different types of individual or group therapy for depression? Reminiscence or validation therapy
What is validation therapy? Caregiver buys into client's illusions and plays along until an opportunity to refocus behaviors is present
What does cognition refer to? Higher brain function: intelligence, learning, judgment, reasoning, knowledge, understanding, and memory
What is cognitive impairment? A disruption in higher brain function that results in confusion
What are the most significant losses in cognition? Slower response times and impaired short-term memory
Is confusion normal or not normal in older adulthood? Not normal
What are the five D's of confusion? Damage, Delirium, Dementia, Depression, and Deprivation
What is often the first sign of a drug reaction? Confusion
What are the causes of dementia? Primary (Alzheimer's disease) and secondary as result of disease such as HIV
What types of dementia are there? Vascular dementia and Alzheimer's Disease
What are the two categories of AD? Early onset (before age 65) and late onset
Is AD a normal part of aging? No
What does AD involve? Gradual, progressive death of one's brain and it's functions
What are the stages of AD? Early, Intermediate, Severe, and End
What is the early stage of AD? Loss of recent memory; inability to learn, process information, and retain information, and language problems
What is the intermediate stage of AD? Inability to recall any recent events or process new information
What is the severe stage of AD? Inability to do anything (patient requires total care)
What is the end stage of AD? Leads to coma and death can occur
What are the three major goals for therapeutic interventions of AD? Provide for clients safety and well being; manage client's behaviors therapeutically; and provide support for family, relatives, and caregivers
What do you do when a client with AD is behaving inappropriately? Redirect to less stressful activity
What OTC medications are considered high alert drugs that may cause confusion? Medications used to treat cold & flu, diarrhea, hay fever, and insomnia
What is sundowners syndrome? Group of behaviors characterized by confusion, agitation, and disruptive actions that occur in the late afternoon or evening
What issues may contribute to sundowners syndrome? Hunger, thirst, pain, need to eliminate, feelings of fear, insecurity, isolation, little contact with other people, recent move, and recent change is routine
What are therapeutic nursing interventions for sundowners syndrome? Maintain comfort, toilet as necessary, keep dry, control pain, reduce environmental stimulation, maintain daily routine, provide soothing music, provide reassurance & companionship during evening hours
What are signs and symptoms of AD? Memory loss, difficulty performing tasks, disorientation to time and place, changes in personality
What does memory loss as it relates to AD? Short-term, forgets and never remembers, troubles with association
What does difficulty performing tasks as it relates to AD? Forgets what order to put clothes on, prepares meal but then forgets to serve it, leaves the car running
What does disorientation to time and place as it relates to AD? Gets lost on one's own street, forgets where he/she is or how he/she got there
What is changes in personality as it relates to AD? May become angry, anxious, apathetic, depressed, fearful, irritable, suspicious, may become agitated in situations where memory problems are causing difficulties
What is affective loss? Slow drain of one's personality; emotional control declines as the individual fades into childlike, antisocial, or emotionally labile behaviors
What is a nursing intervention for the early stage of AD? Supervise and protect persons safety
What is a nursing intervention for the severe stage of AD? Be attentive to needs that can no longer be expressed; arrange for nursing home care
What drugs can be used for treatment of AD? Aricept (donepezil), Exelon (rivastigmine), Razagyne (galantamine), Namenda (memantine)
What are side effects to Aricept (donepezil)? Nausea, vomiting, diarrhea, dizziness, headache, insomnia, high/low blood pressure
What are side effects to Exelon (rivastigmine)? Tremors, confusion, insomnia, depression, anxiety, headache, sleepiness, fatigue, nausea, vomiting, anorexia, diarrhea, constipation, increased sweating, UTI, weight changes
What are side effects to Razadyne (galantamine)? Anemia, slowed heart rate, blood in urine, nausea, vomiting, anorexia, gas, diarrhea, urinary incontinence, weight decrease
What are the nursing interventions for clients with AD? Treat person not disease, treat as individual, establish & maintain commun., provide physical rest, care, & exercise, maintain safe & supportive environ., maintain routine & consistency, manage difficult behaviors w/o reacting
What are communication techniques for a person with AD? Always approach from front, speak in normal tone of voice, face person as you talk, minimize hand movements, avoid setting w/increased levels sensory stimulation, use simple words & short sentences, ask yes/no questions, allow plenty of time for response
What are orienting environmental cues? Keep environment safe and "user friendly", use ramps, grab bars, no throw rugs, use large signs to identify rooms, label drawers with large letters & simple words, use clocks & calendars, cover doors w/ curtains/posters to discourage wandering
What is life review therapy? A systemic reflection of one's personal history in which one learns to evaluate, integrate, and accept life as it has been lived
What is audio presence intervention? Playing of tape-recorded memories by family members to help decrease agitation
What accompanies the caregiver when caring for a client with AD at home? Tremendous physical and emotional burdens; there are various sources of support help family members through this difficult journey
Created by: tandkhopkins