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26 Cards in this Set
- Front
- Back
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Delerium |
Characterized by a disturbance in level of awareness and change in cognition or thought process.
Develops rapidly over a short period. |
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Neurocognitive Disorder |
Impaired thinking, reasoning, memory, learning, speaking |
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Primary NCDs |
Those in which the disorder itself is the major sign of some organic brain disease not directly related to any other organic illness (e.g. Alzheimer's) |
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Secondary NCDs |
Caused by or related to another disease or condition (e.g. HIV disease or cerebral trauma |
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Symptoms of NCDs |
-Impairment exists in abstract thinking, judgment, and impulse control -Conventional rules of social conduct are disregarded -Personal appearance and hygiene are neglected -Language may or may not be affected -Personality change is common |
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Causes of Reversible NCDs |
-Stroke -Depression -Side effects of medications -Nutritional deficiencies -Metabolic disorders |
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Progression of disease process of NCDs |
-Aphasia: trouble expressing or comprehending thoughts/commands -Apraxia: Unable to perform purposeful movement, muscles don't function right. -Irritability and moodiness, with sudden outbursts over trivial issues -Inability to care for personal needs independently -Wandering away from the home -Incontinence |
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Stages of Alzheimer's Disease |
Stage 1. No apparent symptoms Stage 2. Forgetfulness Stage 3. Mild cognitive decline Stage 4. Mild-to-moderate cognitive decline Stage 5. Moderate cognitive decline Stage 6. Moderate-to-severe cognitive decline Stage 7. Severe cognitive decline |
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1. Hospitalized and diagnosed in the 4th stage of NCD due to Alzheimer’s disease, a client, when asked about the previous evening, describes a wonderful evening spent on a cruise. Which symptom is the client exhibiting? a) Aphasia b) Confabulation c) Delirium d) Apraxia |
Correct answer: B Confabulation is a behavioral reaction to memory loss in which the client fills in memory gaps with information about events that have not occurred. During the 4th stage of Alzheimer’s dementia, a client will use confabulation in an effort to maintain self-esteem. |
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2. A client is newly diagnosed with second stage NCD due to Alzheimer’s disease. Which cognitive change would a nurse observe? a) Memory disturbance b) Confabulation c) Apraxia d) Inability to plan or organize |
Correct answer: A In the second stage of the illness, losses in short-term memory are common and the individual may begin to lose things or forget names of people. It’s at this stage that a diagnosis may be considered. |
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Vascular NCD |
Occurs as a result of significant cerebrovascular disease
More abrupt onset than is seen in association with Alzheimer's disease and the course is more variable
Etiology: hypertension, cerebral emboli, cerebral thrombosis |
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Frontotemporal NCD |
-Occurs as a result of shrinking of the frontal and temporal anterior lobes of the brain -Previously called Pick’s disease -Exact cause is unknown, but genetics appears to be a factor |
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NCD due to traumatic brain injury |
-Amnesia is the most common neurobehavioral symptom following head trauma -Repeated head trauma can result in dementia pugilistica with symptoms of Emotional lability Dysarthria: uncoordinated movement Ataxia: unsteady gait/balance Impulsivity |
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NCD due to Lewy body disease |
-Similar to Alzheimer’s disease, but progresses more rapidly -Appearance of Lewy bodies in the cerebral cortex and brainstem -Progressive and irreversible -May account for 25 percent of all NCD cases |
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NCD due to Parkinson's disease |
Caused by a loss of nerve cells located in the substantia nigra and a decrease in dopamine activity
Cerebral changes in NCD due to Parkinson’s disease sometimes resemble those of Alzheimer’s disease |
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NCD due to HIV infection |
-Caused by brain infections with opportunistic organisms or by the HIV-1 virus directly -Symptoms may range from barely perceptible changes to acute delirium to profound cognitive impairment |
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Substance-induced NCD |
-Occurs as a result of reactions to, or the overuse or abuse of, substances such as -Alcohol -Inhalants -Sedatives, hypnotics, and anxiolytics -Medications that cause anticholinergic side effects -Toxins, such as lead and mercury |
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NCD due to Huntington's Disease |
-This disease is transmitted as a Mendelian dominant gene -Damage occurs in the areas of the basal ganglia and the cerebral cortex -The client usually declines into a profound state of dementia and ataxia -Average course of the disease is based on age at onset, with juvenile-onset and late-onset having the shortest duration |
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NCD due to Prion disease
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-The disorder is attributable to prion disease (e.g., Creutzfeldt-Jakob disease or bovine spongiform encephalopathy) -Onset of symptoms typically occurs between ages 40 and 60 years; course is extremely rapid, with progression from diagnosis to death in less than 2 years -Five to 15 percent of cases have a genetic component |
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3. Which statement is true about vascular dementia? a) Vascular dementia is reversible. b) Vascular dementia is characterized by plaques and tangles in the brain. c) Vascular dementia involves a gradual, progressive cognitive deterioration. d) Vascular dementia involves a variable pattern of cognitive functioning. |
Correct answer: D In vascular dementia, clients suffer the equivalent of small strokes that destroy many areas of the brain. The pattern of deficits is variable, depending on which regions of the brain have been affected. |
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Pharmaceutical agents for cognitive impairment |
Donepezil (Aricept) |
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Pharmaceutical agents for agitation, aggression, hallucinations, thought disturbances, and wandering |
Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) Haloperidol (Haldol)
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4. A client has recently been diagnosed with mild to moderate NCD due to Alzheimer’s disease. Which medication would the nurse expect the physician to order for this client’s cognitive impairment? a) Nortriptyline (Pamelor): Antidepressant b) Zaleplon (Sonata): Used for sleep c) Donepezil (Aricept): Used for cognitive impairment d) Quetiapine (Seroquel): Used for agitation |
Correct answer: C Donepezil is used to improve cognition in clients diagnosed with mild to moderate dementia associated with Alzheimer’s disease. Its action improves cholinergic function by inhibiting acetlycholinesterase. |
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Pharmaceutical agents for depression
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-SSRIs: Often considered first-line due to favorable side effect profile -Tricyclic antidepressants: Often avoided due to anticholinergic and cardiac side effects -Trazodone (Desyrel): Good choice for clients with insomnia -Dopaminergic agents: Helpful in treatment of severe apathy |
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Pharmaceutical agents for anxiety (should not be used routinely for prolonged periods)
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Chlordiazepoxide (Librium) Alprazolam (Xanax) Lorazepam (Ativan) Oxazepam (Serax) Diazepam (Valium) |
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Pharmaceutical agents for sleep disturbances (for short-term therapy only) |
Flurazepam (Dalmane) Temazepam (Restoril) Triazolam (Halcion) Zolpidem (Ambien) Zaleplon (Sonata) Ramelteon (Rozerem) Eszopiclone (Lunesta) Trazodone (Desyrel) Mirtazapine (Remeron) |
