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40 Cards in this Set
- Front
- Back
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What does the Mini-Cog test? What does the test include?
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Tests registration, recall and executive function. Determines if pt could have dementia.
Three item recall: listen and remember 3 unrelated words and then (after clock) repeat back AND clock drawing test (11:10) |
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How is the mini-cog scored? What do the scores mean?
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unsuccessful recall of all 3 items - dementia
successful recall of all 3 items - no dementia recall of 1-2 items with abnormal clock - dementia recall of 1-2 items with normal clock - no dementia |
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What are the limitations of the mini-cog?
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visual impairment
hearing impairment inability to draw clock d/t physical impairment |
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What is the CAM? How often is it used?
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Determines change in cognition/LOC. Documented and assessed at every shift.
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What are the four features of delirium? What features must be present to identify delirium?
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1. Mental status change from baseline (acute onset or fluctuating changes)
2. inattention 3. disorganized thinking 4. altered LOC (could be depression if only this) #1, #2 and either #3 or 4 |
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What is the Pittsburg Sleep Index? How does the scoring work?
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A subjective (self-reported) measure of sleep. Can be used for initial assessment or for comparison to previous measurements. Score of 5+ indicates poor sleep quality
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What specific questions are asked to determine if a pt has delirium or dementia?
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?? Need to talk about this one.
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What are the differences between delirium and dementia?
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Delirium can be fatal if missed, medical emergency
Delirium is an acute process and an indicator of a pathology that is being missed >> death within 6 mo Dementia is a gradual decline in function and memory Dementia has no cure When diagnosing dementia, must r/o delirium and depression Pseudodementia masks depression in older adults (Complete Geriatric Dementia Screen) |
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What are the normal age-related changes in a person's sleep?
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sleep diminishes
decreased deep sleep more frequent arousals (nocturnal awakenings), stay awake longer during arousals daytime napping and somnolence sleep latency = takes longer to fall asleep problems with jet lag Dec circadian rhythm responses |
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There is a direct correlation between REM disorders and what?
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PTSD
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How is insomnia defined?
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difficulty falling asleep for at least one month with impairment in daytime functioning
Transient: lasts a few nights Short term: less than a mo Chronic: one month or longer |
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What are the risk factors for insomnia?
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psychological, medical or environmental conditions
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What is restless leg syndrome (RLS)?
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sensorineurological disorder - unpleasant leg sensations (crawling, tingling) and need to move legs
affects sleep similar to akathesia worsening of symptoms at night |
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How prevalent is RLS?
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10 - 20% over age 65
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What is secondary RLS?
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may result from medical conditions with iron deficiency.
Interventions: - dopamine agonist may help by transporting DA in the brain. - iron supplements - assess pt for anemia, assess diet for Fe deficiency, look at labs and H&H |
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What is sleep apnea? What would you expect to see (symptoms) in a person with sleep apnea?
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complete cessation of respiration during sleep; stop breathing
Sx: - Episodes are terminated by a brief awakening - gasping and choking - loud periodic snoring - poor memory and intellectual functioning |
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What is the most common form of sleep apnea?
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obstructed sleep apnea
70% men, 56% women obstructed by: collapse of hypopharynx, enlarged tonsils, deviated septum |
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What are the risk factors for developing sleep apnea? (9)
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Increasing age
short, thick neck circumference male anatomic abnormalities of upper airway family history excess wt EtOH and sedative use smoking HTN |
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How is sleep apnea assessed?
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polysomnography - sleep study
examine nasal and pharyngeal airways for lesions/obstruction obtain report from partner about sleep behaviors medical review |
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Interventions for sleep apnea (6)
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weight loss
avoidance of EtOH and sedatives smoking cessation avoid supine sleep counseling regarding impaired judgement, driving CPAP |
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What is PLMS?
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Associated with restless legs syndrome
Flection of the toe or ankles > causes cramping and painful voluntary movements Nocturnal myoclonus movements Repeated rhythmical extensions of the big toe and dorsiflexion of the ankle Contributing factors: increase in BMI; caffeine and tobacco use; sedentary lifestyle Currently determining if Obesity is a culprit |
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What is the cause of RLS and PLMS?
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More common in women than men
May be due to impairment in dopamine transport in the substantia nigra due to decreased intracellular iron Antidepressants and neuroleptics can aggravate RLS > These can cause EPS > ensure to monitor and be sure that the right dossing is being given |
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What is the TX for RLS and PLMS?
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Oral iron supplementation for people with serum iron levels lower than 45ug/L
Dopamine receptor agonists (pramipexole, ropinirole) Gabapentin (Neurontin); has less of an effect over the course of treatment Warm baths and exercise |
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What are some non-pharm interventions for sleeping d/o?
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Small glass of milk
Small turkey sandwich - Tryptophan Something with protein or tryptophan Cognitive behavioral therapy; meditation; yoga Exercise during the day; daytime light, nighttime dark Comfortable bed; no TV in bedroom; control noise Routine bedtime and wake-up 7 days a week Dietary restrictions of caffeine, alcohol, spicy foods, fluid intake in the evening hours Light bedtime snack if hungry with protein, tryptophan |
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What are some pharmacological issues for older adults related to sleep d/o?
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Sedatives and hypnotics, benzodiazepines should be avoided in older adults with sleep problems
Increased risk for cognitive impairment and falls, decline in functional status Reserve meds for when non-pharm alternatives do not work Control pain: Chronic arthritic pain would be tolerated better if small doses of medication are given throughout the day |
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What are the 4 "A's" of dementia?
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Aphasia: inability to produce or comprehend language
Apraxia: loss of ability to execute or carry out learned purposeful movements; lose the ability to move any more Agnosia: inability to recognize objects, persons, sounds, shapes, and smells; Confabulation Agraphia: inability to write |
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Describe four medications used for dementia and their MOA.
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1. Aricept (Donepezil): used to help pts improve memory after ECT, prescribed at all stages (Acetylcholinesterase inhibitor)
2. Razadyne (Galantamine): for mild to moderate stages (Acetylcholinesterase inhibitor) 3. Exelon (Rivastigmine): mild to moderate stages, available as transderm patch (Acetylcholinesterase inhibitor) 4. Namenda (Memantine HCl): moderate to severe stages, used earlier if in combination with other drugs (glutamate pathway modifier - block overstim of Glu which contributes to neurodegeneration, NT involved with learning and memory) |
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List nursing interventions for dementia
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Implement interventions according to the patient’s level of functioning
Always institute safety measures Assess the caregiver’s needs and concerns Provide family, caregiver education and support Review and coordinate community resources, respite services Monitor for medication side effects Assess for depression Assess for malnutrition and dehydration Monitor for adequate nutritional and fluid intake Assess for pain Assess for constipation and fecal impaction Assess for pressure ulcer risk Collaborate with team members Monitor laboratory results Perform an environmental assessment with necessary adaptation Communicate simply and directly in a calm manner; reassure Use distraction to ensure safety Monitor and maintain physical health Provide for social interaction according to tolerance Small, frequent meals Use of clocks, calendars, personal items Providing patients with a routine or task that can be mimicked to comfort the patients Combativeness is when the nurses request medications from the MDs |
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How to manage an agitated pt?
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Assess for underlying cause: delirium superimposed on dementia
Evaluate patterns of behavior: timing of procedures, meds, therapies Review all medications for adverse reactions or drug-drug interactions No FDA-approved meds for management of agitation in dementia Adverse outcomes with use of antipsychotics and anxiolytics |
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What are the four goals of pharmacologic management of agitation?
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1. minimize aitation
2. maintain function 3. low dose 4. short-term use |
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What are some non-pharm strategies for managing agitation?
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Include family, significant others in care process
Approach patient in a calm manner Communicate clearly and slowly Provide reassurance and consistency Modify the environment to calm the patient Divert attention through beneficial activities Place on toileting schedule Ensure relief from pain, hunger, thirst Avoid physical restraints |
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Relationship of pain in the client with dementia?
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??
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What is sundown syndrome? What are some nursing interventions?
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Increase in confusion and agitation around late afternoon to nightfall
Can resemble delirium Reduced attention, impaired sleep/waking patterns, disturbed psychomotor behavior Identify physiologic factors, such as thirst, hunger, pain, elimination needs Reduce environmental stimuli, increase lighting Offer reassurance, companionship, rest |
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What is mild cognitive impairment?
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Mild cognitive impairment (MCI) is the stage between normal forgetting and the development of AD: problems with thinking and memory do not interfere with everyday activities; person is aware of forgetting; not everyone with MCI develops AD
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What are the sx of mild cognitive impairment?
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forgetting recent events or conversations; difficulty performing more than one task at a time & solving problems; taking longer to perform more difficult tasks
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What are the difficulties in caring for the client with delirium superimposed on dementia?
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Difficult to recognize due to overlapping symptoms
Difficult to ascertain baseline mental status Clinicians may attribute s/s of delirium to a worsening of dementia Challenges: - Recognition of condition - Patients with Parkinson’s dementia (Lewy body) often have fluctuating cognition, referred to as “Pseudodelirium” - Assume delirium until it is ruled out - Know your patient’s medical history - Communicate and collaborate with the healthcare team to manage complexity of care |
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How do you manage wandering in the client with dementia?
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??
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Ways to prevent delirium. (8)
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1. Prevent nosocomial infections
2. Maintain fluid and electrolyte balance 3. Avoid specific meds that pose risks to the older adult 4. Remedy nutritional deficiencies 5. Correct sensory deficits: use assistive devices 6. Reorient patient 7. Promote mobilization (may see improvement in Katz score) 8. Perform range of motion exercises |
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What are some treatment/nursing interventions for delirium?
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Remove unnecessary catheters, tubes
Implement a toileting schedule Provide familiar objects; family visits Non-pharmacologic sleep protocol Pain assessments and relief from pain Institute fall precaution measures Provide sunlight Decrease sensory overload/note deprivation Offer food and fluids as tolerated and prescribed After ambulating there is evidence of improving CAD scores and the patient can become more oriented |
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What are the features of an effective sleep hygiene plan?
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?? Sleep hygiene? Is that a thing?
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