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Dementia & Delirium

Medical-Surgical Nursing

What is dementia? A neurocognitive disorder characterized by dysfunction or loss of memory, orientation, attention, language, judgement, and reasoning
What is the leading cause of dementia? Neurodegenerative conditions, the majority of which being Alzheimer's disease
What is a loss of cognitive function resulting from ischemic or hemorrhagic brain lesions caused by cardiovascular disease? Vascular dementia
What is another name for vascular dementia? Multiinfarct dementia
What occurs when 2 or more types of dementia are present at the same time? Mixed dementia
What is the most common combination in mixed dementia? Alzheimer's disease and vascular dementia
What is an uncommon disorder characterized by an obstruction in the flow of CSF, causing a buildup of CSF in the brain? Normal pressure hydrocephalus
What are the clinical manifestations of normal pressure hydrocephalus? Dementia, urinary incontinence, and difficulty walking
Describe the neurological degeneration associated with dementia in terms of onset. Gradual and progressive over time
What does diagnosing dementia focus on? Determining the cause
What screening are often done when assessing for dementia? Cobalamin deficiency and hypothyroidism
Which form of dementia can often be prevented? Vascular dementia
What are preventive measures for vascular dementia? Treatment of risk factors (e.g., hypertension and diabetes)
What is Alzheimer's disease (AD)? A chronic, progressive, neurodegenerative disease of the brain
How long after diagnosis of AD is the disease typically fatal? 4-8 years
What if the greatest risk factor for AD? Age
Which sex is more likely to develop AD? Women
Which race is more likely to develop AD? African-Americans
True or False: Diabetes increases the risk of developing AD or other types of dementia. True
What are 4 characteristic findings of AD in the brain? Amyloid plaques, neurofibrillary tangles, loss of connection between neurons, and neuron death
In which area of the brain do amyloid plaques develop first in AD? In the areas used for memory and cognitive function, including the hippocampus
What at neurofibrillary tangles? Abnormal collections of twisted protein threads inside neurons
True or False: Clinical manifestations often precede the pathologic changes associated with dementia. False; Pathologic changes occur first
What are the 3 stages of AD? Mild, moderate, and severe
What are the initial manifestations of AD related to? Changes in cognitive functioning
What is apraxia? The inability to manipulate objects or perform purposeful acts
What is visual agnosia? The inability to recognize objects by sight
What is retrogenesis? The process in AD patients in which degenerative changes occur in the reverse order in which they were acquired
What are the stages in the AD spectrum? Preclinical stage, mild cognitive impairment, and dementia due to AD
What is mild cognitive impairment (MCI)? A state of cognitive function in which individuals have problems with memory, language, or another essential cognitive function that are severe enough to be noticeable to others.
True or False: No drugs have been approved for the treatment of MCI? True
What does the treatment of MCI consist of? Ongoing monitoring
What is the only way to definitively diagnose AD? Autopsy
When can a clinical diagnosis of AD be made in the living? When all other possible conditions that can cause cognitive impairment have been ruled out
How can the degree of cognitive impairment be determined in patients with AD? With use of neurophysiologic testing tools, such as Mini-Cog and MMSE
What is the highest score possible on the Mini-Cog? 5
What score is positive screening for dementia on the Mini-Cog? 0-2
What does interprofessional care for AD focus on? Controlling the undesirable behavioral manifestations that may be exhibited and providing support for the family
Why should antipsychotic drugs be used cautiously in patients with dementia? They have shown to increase the risk of death in older dementia patients
What are some behavioral problems that may manifest with AD? Repetitiveness, delusions, hallucinations, agitation, aggression, altered sleeping patterns, wandering, hoarding, and resisting care
True or False: Behavioral manifestations are often the patient's way of responding to a precipitating factor. True
What are nursing strategies that address difficult behavior in patients with dementia? Redirection, distraction, and reassurance
What is sundowning? A specific type of agitation when the patient becomes more confused and agitated in the late afternoon or evening.
What are possible causes of sundowning? A disruption in circadian rhythm, fatigue, unfamiliar environment, noise, medications, reduced lighting, and sleep fragmentation
What are the most common infections in patients with AD? UTIs and pneumonia
What is delirium? A state of temporary but acute mental confusion.
What is a main contributing factor to delirium? Impairment of cerebral oxidative metabolism
What are some neurotransmitter abnormalities that can contribute to delirium? Cholinergic deficiency, excess release of dopamine, and both increased and decreased serotonergic activity
What is the leading risk factor for delirium? Dementia
True or False: Delirium can occur after a relatively minor insult in a vulnerable patient. True
What other contributing factors have been linked to delirium? Sleep deprivation, stress, surgery, pain, and depression
What drugs can contribute to delirium? Sedative-hypnotics, opioids, benzodiazepines, and drugs with anticholinergic properties
Which opioid is especially linked to the onset of delirium?
What are the early clinical manifestations of delirium?
What are the later manifestations of delirium? Agitation, misperception, misinterpretation, and hallucinations
How long can delirium last? 1-7 days
What is a key distinction between delirium and dementia? The person who exhibits sudden cognitive impairment, disorientation, or clouded sensorium is more likely to have delirium than dementia.
What is a reliable tool for assessing delirium? The Confusion Assessment Method (CAM). See Table 59-18, p. 1416
What should be done after delirium has been diagnosed? Explore potential causes
How can you prevent delirium? Recognize high-risk patients (e.g., neurologic disorders, sensory impairment, and older age)
What should you give priority to when caring for a patient with delirium? Creating a calm and safe environment
When should drug therapy be used in patients with delirium? Drugs should only be used when nonpharmacologic interventions have failed in patients with severe agitation
What drug is commonly used in ICU settings for sedation?
What are side effects of antipsychotics to consider when giving them to delirium patients? Sedation, hypotension, extrapyramidal side effects (e.g., tardive dyskinesia, athetosis), muscle tone changes, and anticholinergic effects
How can the extrapyramidal side effects of antipsychotics be reduced?
What is tardive dyskinesia? Involuntary muscle movements of the face, trunk, and arms
What is athetosis? Involuntary writhing movement of the limbs
Created by: shrewsburysd