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Dementia & Delirium
Medical-Surgical Nursing
| Question | Answer |
|---|---|
| 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
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