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GRCC 141 dem & del

GRCC PN141 dementia and delirium

QuestionAnswer
A degenerative neurological disorder that doesn't go away Dementia
Delirium A degenerative neurological disorder that goes away
What is dementia It is Chronic, Irreversible, Progressive, it affects the Elderly, it leads to impaired cognitive and intellectual fxn
What is delirium It is acute, usually reversible, sudden onset, affects all ages, and is short term Short term
Who is at risk for delirium? M > F is at greater risk, dementia increases risk for delirium, person with an acute illness, BUN/Crt levels, Mult. Meds that interact negatively, ETOH consumption, Depression, Pain, lyte imbalance, infection.
What causes delirium? Infection (elderly;Medications; ETOH;Drugs;Cardiovascular disease (O2);Post-operative;Neoplasm; Trauma;Metabolic (fluid imbal, etc);
Which degenerative neurological disorder has characteristics of confusion, sudden onset, mood changes and usually only lasts no longer than a month? Delirium
Delirium characteristics Short lived confusion (<wk-month) Usually temporary Disoriented Misinterpretation of surroundings, environment (sounds, sights, etc) Hallucinations
What response would you expect from a pt who has delirium and seems to be disoriented. Being disoriented makes them fearful.
Often times a pt with delirium will misinterpret their surroundings or environnment Misinterpreting the environnment resulting in potentially frightening illusions
Delirium and hallucinations Sometimes these patients are misdiagnosed with dementia or depression because they tend to be subdued, quietly confused, disoriented, and apathetic.
Characteristics of delirium Acute onset; Alertness (extremes); Attention (easily distracted); Orientation (time/place);Memory (short term); Thinking (rambling, unpredictable);Perception (hallucinations, illusions);Psychomotor (hyper to hypoactive)
How should a nurse approach a pt who is in a delirious state? Should approach pt calmly and try to re-orient them. Help them eliminate hallucination and don't pretend you see smae things.
Diagnosing and characteristics of delirium Acute onset; Alertness (extremes);Attention (easily distracted);Orientation (time/place); Memory (short term);Thinking (rambling, unpredictable);Perception (hallucinations, illusions);Psychomotor (hyper to hypoactive)
What affects patients alertness if they are experiencing delirium? They are likely feeling fearful.
T or F. Short term memory loss IS a sign of delirium False
Nursing problems Risk for Injury; Disturbed Thought Process; Sleep Disturbances; Communication; Family coping
Nursing goal for treatment of delirium Address cause of confusion During episodes of confusion: consider Safety,Comfort,and how to Relieve anxiety
Nursing goal for caregiver of delirium pt. Need to continue to assess health and emotional status of Caregiver
Nurse assessment and application for a delirium patient should include the following data: Medication assessment;Pain control; Adeq nutrition, Fluids & Electrolyte bal; Oxygen;Reassurance, Reorient (as approp); visible cues; familiar surroundings;Limit stimuli;Sleep, rest
How does Oxygen play a role in delirium Depleted oxygen over time can cause delirium (think of cardio vascular disease and decreased oxygen)
Memory impairment along with problems in other cognitive areas, such as apraxia (skilled movements), agnosia (familiar objects, people), aphasia (communication), and executive function Dementia
apraxia Impaired skilled movements; The loss of the ability to execute or carry out learned purposeful movements,[1] despite having the desire and the physical ability to perform the movements.
agnosia Impaired to recoginize familiar objects, people; a general term for a loss of ability to recognize objects, people, sounds, shapes, or smells;
aphasia Impaired communication: a disorder that results from damage to portions of the brain that are responsible for language.
Dementia affects Executive function in what way? Impaired ability to think at a higher level.
Goals for pts who have dementia? Maintain highest functioning ability Preserve independence as long as possible
List some causes of dementia? Alzheimer’s disease Vascular Lewy Body (sim movements, visual illus, co-exist) Parkinson’s Picks disease Huntington’s disease HIV/AIDS Nutritional Imbal Hydrocephalus Reversible – Hypothyroid, Depression, Vit D def
Can you treat dementia with haladol? Yes
Is Dementia slow onset or long onset? It is slow onset that progressess slowly.
Does dementia affect short term memory? Yes, dementia patient short term memory is affected first, but eventually long term memory loss does happen as disease progresses.
Dementia characteristics 7th leading cause of death in US; 4-5 mil now, triple by 2050; Chronic, Slow progressive decline ;Alters affect ;Impairs intellectual function
List some dementia characteristics of impairment. Impaired problem solving;Short/longterm memory decline;Disorientation;Apraxia (familiar movement,routines);Agnosia (recognition);Executive dysfxn (impaired higher level thinking);Impaired reasoning, planning, sequencing, initiating (examples)
What is vascular dementia? It could be from Cerebrovascular Disease; multiple Strokes;Sudden onset (3mo); Mult. TIAs;Gradual; Unrecognized by pt?, yet still damage to brain tissue?
List some risk factors that could cause vascular dementia. Stroke* HTN, Cardiovasuclar disease, DM Males > Females African Amer. Smokers
List some impairments commonw with vascular dementia Abnormal Executive Fxn;Diff. with tasks that require conscious control and planning; Diff. organization, solving complex problems (more than with AD);Stepwise development (signif decline then stability); Walking/Gait (Vascular);
What is dementia Alzheimers disease? Progressive, irreversible deterioration of the brain ;Course varies (8-10 - 20yrs); Aspiration; Pneumonia;Most common dementia
What age population does Alzheimers affect? Age it affects(doubles every 5yrs >65) 1 in 10>65 (10%) 1 in 2>85 (50%)
MCI – Mild Cognitive Impairment This is not an actual dx of dementia; it involves Short-term memory loss;Intact daily fxn
Treatment for MCI Tx- Calendar, memos, etc; can live alone...cue cards to help them to remember.
Does MCI stabilize or progress? Sometimes it stabilizes...while other times it does progress to Alzheimers.
Stage 1 of Alzheimers lasts 2-4yrs
Stage 1 of Alzheimers Short tem memory loss Disorientation – time / place Language, word loss Concentration, Abstract thinking Difficulty with familiar routines, misplacing items Alert, sociable Mood, personality
Stage 1 of Alzheimers - Subtle, Family compensates? It generally starts out as forgetfulness, or misplacing things...it's very subtle in that family and patient just sort of brush it off as forgetfulness.
Stage 1 of Alzheimers..forgetfulness interfering with daily living...withdrawing? Generally, people in stage 1 AD are functioning and getting around...but sometimes forget where they are or misplace things.
Stage 2 of AD- characteristics This is the Longest of the stages; they get lost in familiar places; they are unable to recognize faces, names; they often have Illusions; Easily irritated, Paranoia, Depression, Sleep Sundowning, Unable to follow conversations, Language deficits, writin
Stage 2 of AD - other characterisitics Difficulty with simple tasks (ADLs) Loss abstract thinking Agnosia (objects) Apraxia (routines) Gait changes Score low on the MMSE
Stage 3 of AD - characteristics Unable to recognize others;self Decline & impaired verbalization; Incontinence;Unable to care for self (forgetful);Delusions; Complications (pneumonia, dehyd, nutrition, falls, behavior)
Assessing and dgx dementia and delirium- history You are going to ask about History (family);Medical Meds (last dose, etc); Drugs &/or ETOH consumption; Environment (hazards)
Assessing and dgx dementia and delirium - lab testing They will want to do further tests to rule out other by looking aat Thyroid;Vit B;Infection or Metabolic;CT /MRI
Assessing and dgx dementia and delirium - other testing Cognitive Tests – (MMSE) and assessing if their ability to meet ADLs
Nursing care for treating pt with AD or delirium who has a disturbed Thought Process Nurse should try to reorient prn (clocks, calendars);
With regards to nsg dgx of Disturbed Thought Process at what stage is re-orienting not useful? Stage 1 pt can be reoriented, with clocks, calendars, cue cards...stage 2 or 3 it is not helpful
Disturbed thought process for AD or Delirium - some helpful tips You'll want to Address hallucinations (i.e.“..you are at the hospital..”) also 1:1 time is helpful
Disturbed thought process for AD or Delirium - offering consistent routines This would include Same care-giver, Family members.
Assess nonverbals help with? Non verbals help with identify triggers...what causes them to get agitated (maybe they start getting restless when they have to go pee)
Nursing care for Dementia or delirium pt- why provide calm & quiet environment? This helps pt reorient & reduce anxiety (within their ability);Soft lighting, Soft music is calming; hearing aids cuz they afraid of hearing things; ltd distractions;Familiar pictures, objects
Nursing care for delirium pt - what things can you do to provide a quiet and calm environment? To reduce anxiety avoid physical restraints; confrontation;Simple, direct phrases; Identify self; Call them by their name;Redirect, Diversion
Nursing care for dementia and delirium pt- Self care defecit Encourage participation & allow for adequate time; Demo how to use equipment; provide Visual cues; Modify clothing (velcro)& lay out;
Nursing care for dementia and delirium pt- considering Self care defecit, list other methods to compensate for loss and how would this help? Reduce confusion by Limit choices- foods, clothing; Provide Finger foods cuz they are easier to pick up; encourage fluids; Break tasks into steps so they are not overwhelmed; Frequent toileting cuz they lose bladder control- reduces incontinence
Nursing care for dementia and delirium pt- what are strategies you could use to reduce the risk of injury? Limit clutter; avoid re-arranging room; Handrails that they can hold onto for support;skid-proof surfaces (Shoes, glasses, walkers, etc) to avoid falls;Routine fall assessment; provide Night lights; Monitor meds that affect balance
Nursing care for dementia pt- ways to avoid injury Personal alarms, door locks detect if pt is moving about; Avoid physical restraints as these will increase agitation- have Family members help out with the dementia pt;1:1 time; allow frequent toileting (Urgency is common with elderly- leading to accident
Monitor behavior & agitation of a dementia pt. Doing this will help Identify/prevent triggers; Face client, call by name, calm voice;Identify self, simple explanations Yes/No questions; Redirect if possible.
Why does redirection work for the elderly? Redirection usually works for dementia pts b/c they have short term memory (unable to learn new things)
Nursing care for some one who has sleep disturbed patterns. Limit distractions;low lights, calm environment Keep awake during daytime hrs Dementia pts often have reversed sleep patterns
Nursing care for someon who has a knowledge defecit rt meds. Antipsychotic Meds (severe agitation) Haldol (Haloperidol) Risperidal (Risperidone) Zyprexa (Olanzapine) Seroquel (Quetiapine fumate)
What are nursing considerations before administering antipsychotic meds? Priority is to redirect the pt and document that you tried preventing to give meds- these sort of drugs are considered a form of restraint.
When do you determine giving antipsychotic meds? YOu assess Behavioral and Psychological S/S and if they demonstrate Agression,screaming, cursing, agitation, wandering Anxiety, depression, or delusions
What are side effects of Haladol Extrapyramidal Effects (EPS,TD), wt gain, anticholenergic s/s (constip, dry mouth), sedation
Pt has been given haladol and you notice that he is involuntarily shaking and jerking. What do you need to do? The pt needs to be taken off this med...haladol has a side effect that causes involuntary movement.
what are nursing considerations when taking haladol? Pt is at risk for Ortho Hypotn and should be assessed for Falls; This is an antiCholenergic med that causes Dry Mouth, constipation, urinary retention; haladol causes Sedation increasing the risk for Falls and Social isolation
what do diabetics need to consider when taking Haladol? Diabetics may need to increase insulin.
T or F. Some patients who require insulin while taking haladol aren't necessarily diabetic. True- pts who are given haladol may still need to take insulin even if they aren't diabetic.
Another nursing consideration if pt is recieving haladol is mood and behavior- why? This needs to be assessed as behavior and mood are the reason why they are taking the drug.
What if a pt has urinary retention and they seem agitated. Do you put them on haladol right away? You should proceed with caution before administering haladol. Urine retention may mean they have a UTI, which could have adverse effects on mood and behavior.
Acetylcholinesterase Inhibitor is an arocept inhibitor and N-methyl-D aspartate receptor antag are drugs used on later stages of dementia. Poss. Combo of both; nurse should set Realistic Expectations and note that AD is progressive & these drugs will not completely stopped/reverse s&s of AD.
Acetylcholinesterase Inhibitor N-methyl-D aspartate receptor antag treats behavior of a pt that show which s&s? Tx behavioral s/s also Psychosis, depression, and agitation
Cholinesterase Inhibitors - what does it treat? tx of MILD to MOD symptoms; Improve Cog Fxn and Delay Behavior s/s
Cholinesterase Inhibitors- brand names of these drugs Donezpil (Aricept)*** QD is used first, and then Rivastigmine (Exelon) is the second most common of this class of drugs. lantamine (Razadyne) is the least given because it causes liver damage.
Cholinesterase Inhibitors actions: This med Slows the breakdown of acetylcholine; it helps to slows memory loss & decline and Improve cognitive fxn (ADLs); as well as Decrease/delay agitation & delusions
Cholinesterase Inhibitors sideeffects: GI – N/V/D, bradycardia, sleep chngs
Cholinesterase Inhibitors - nursing considerations Don’t stop abruptly (s/s will return rapidly -behave); Liver studies if patient is taking(razadyne);it takes 6-12 months to eval full effect; can start taking it once MMSE < 12 little effect
Cholinesterase Inhibitors- nursing goal Improve cognitive function and behavior;maintain where they are at; majority of people taking this drug will see an improvement.
Which drug do give along side of Arocept? Namenda
NMDA Receptor Blockers - Memantine (Namenda); Actions: This med is used for the Tx mod to severe dementia; Temporary improvement of Cognitive and Behave s/s; (vascular dementia)
NMDA Receptor Blockers - side effects SE: Better tolerated – Fatigue, dizziness, HA, constipation
Created by: Wends1984