Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
59 Cards in this Set
- Front
- Back
|
Describe characteristics of delirium?
SS:? |
1.acute confused state.occur at any age,reversible
2.disturbed sleep/wake cycle -memory impairment -disorientation -altered perceptions(H&Ds) -vivid dreams,fantasies -agitation -no sleep -seizure -emotional disturbance:fear -impaired concentration/atten |
|
|
causes of delirium?
I? |
infectious:
-encephalitis meningitis syphilis HIV Pneumonia Pyelonenephritis high fever |
|
|
W?
|
withdrawal
alcohol sedative hypnotics opioids |
|
|
A?
|
acute metabolic acidosis/alkalosis
electrolyte disturbance hepatic failure renal failure hypoalbuminemia |
|
|
T:
|
trauma
heat stroke post operative burns fractures prolonged immobilization |
|
|
C?
|
CNS abnormality
abscess, hemorrhage ICP seizures stroke tumors vasculitis |
|
|
H?
|
Hypoxia:
anemia, carbon monoxide poisoining hypotension heart failure resp failure |
|
|
D?
|
deficiencis
vit B12 niacin thiamine |
|
|
E?
|
Endocrinopathies
adrenal d.o throiditis uncontrolled DM |
|
|
A:
|
acute vascular
hypertensive encehalopathy shock vasculitis cns-SLe lupus |
|
|
T?
|
toxins/drugs:
medications anticholinergin agents pesticides solvents |
|
|
H?
|
heavy metals:
lead manganese mercury |
|
|
3 cognitive components of delirium?first component
|
A.perception:
B.thinking:fragmented/disorganized,unable to reason judge,abstract or solve probles:executive function c.memory:cannot retain/recall |
|
|
second component of delirium(attention & wakefulness)
|
A.alertness or vigilance
B.selectiveness:ability to focus on certain stiumli at will c.directiviness:direct mental process D.more sleepy durin the day and awake at night |
|
|
third component of delirium(psychomotor behavior)
|
A.hyperactive or hypoactive
B.speech can be slurred or disjointed C.tremors/choreiform movements(spasmodic or irregular) |
|
|
Delirium?
|
acute
consciousness fluctuates atten:varies short lived,reversible develops rapidly link to recent source medical emergency:ro cause |
|
|
dementia?
|
progressive
declines more steady atten:stable insidious process profound loss/impairmnt n intelligence usually organic cause:ACH deficit, GABA high,DA high |
|
|
Dementia characteristics:
|
global cognitive impairmet,
judgement,insight,language,tasking,recognition and personality changes |
|
|
dementia executive functioning is ?
|
decrease:cant plan,organize,sequence and abstract.Pts are concrete,loss of intellectual functioning
|
|
|
features of dementia?
|
memory impairmnet
altered judgemnt altered affect spatial disorientation sundowners syndrome predisposition to delrium |
|
|
disease may destroy neurons which secrete acetylcholine(insidious decline in learning & memory)?
|
Alzheimer's dementia
|
|
|
Name the symptoms of alzheimer's dementia?
|
1.agraphia
2.agnosia 3.alexia 4.anomia 5.aphasia 6.apraxia 7.Mnemonic disturbances |
|
|
loss of language
|
aphasia
|
|
|
decreased ability to remember words
|
anomia
|
|
|
inability to express thoughts in writing
|
agraphia
|
|
|
inability to understand written language
|
alexia
|
|
|
loss of motor abilities
|
apraxia
|
|
|
loss of ability to recognize objects
|
agnosia
|
|
|
memory loss (immediate -recall-short term-longterms stores?
|
Mnemonic disturbances
|
|
|
risk factors of alzheimer disease?
|
-advanced age:one in 26 at age 65:2 out 4 after age 85
-female -head trauma -fam hx of alzhe/trisomyal (down syndrome) |
|
|
The onset of alzheimer disease is insidious and course of disease progresses throug 4 stages, name the stages?
|
1.forgetfullness Lasts 1-3yr
2.confusion lasts 2-10yrs 3.ambulatory dementia lasts 5-15yrs 4.end stage lasts 8-10+years |
|
|
The goals of collaborative management include?
|
-ensure all ADL and nutritional needs are met
-adhere to med tx -prov/asse/tx for physi prob -ensure safety -safe environment:home,hosp, |
|
|
Mini mental state exam use on the DAT pts includes?
|
1.orientation:time,place,person
2.registration:name 3 common objects wait 1 sec to say each,then ask pt to repeat all 3 3.attention and calculation:serial 7's test,count back from 100 in decrements of 7 4.recall:ask for 3 common objects named during registration 5.language: |
|
|
drug therapy to assist the pt in early stages of DAT to maintain memory and orientation?
|
galantamine(Reminyl)
donepezil(Aricept) rivastigmine(Exelon) tacrine(Cognex) |
|
|
lewy bodies found in the cerebral cortex.Parkinson's and EPS may occur. visual hallucinations,fluctuation cognition.May appear with co-morbidly with AD?
|
Dementia with lewy bodies
|
|
|
abrupt onset and episodic with multiple
remissions,focal neurologic signs(one sided weakness)motional outbursts,stepwise decline in intellectual functioning,hx of HTN,DM or CVD? |
vascular dementia
|
|
|
imbalance b/w DA and ACH.
Most client with dementia have parkinson's? |
parkinson disease
|
|
|
a dominantly inherited DZ which is a progressive,& degenerative disorder characterized by both motor and cognitive decline?
|
Huntington's disease
motor dysfunction:chorea:quick,jerky,purposeless,involuntary movmts. -avg life span: 15 yrs -tx with CoQ10 |
|
|
rare,cerebral atrophy,runs in fam.SS?
|
Picks disease
SS:talkative,lighthearted,gaiety,anxiety,hyperattention or inertia,emotional dullness or lack or initiative.Progresses to memory and language |
|
|
transmissible degenerative cell destruction in the cerebral cortex. SS?
|
Creutzfeldt-Jakob disease
SS: ataxia,myoclonic jerks,visual and neurological abnormalities.Caused by prion (proteinoceous particle)New variant is mad cow disease:jerky tremors,fall over |
|
|
alcohol induced persisting amnestic d.o a disturbance of S.T. memory due to damage to the hippocampus?
|
Korsakoff's syndrome:often present with confabulation
|
|
|
alcoholic encephalopathy a neurological disease characterized by ataxia, 6th cranial nerve palsy,nystagmus,and confusion.TX with?
|
Wernickes encephalopathy
-tx with thiamine |
|
|
Mimics dementia, usually hx of depression, name the SS of pseudodementia?
|
-abrupt onset
-clinical course rapid -c/o cognitive failures -impaired attention/memory -apathy(lack of feeling/inter -self-neglect -no c/o of depression |
|
|
Mini mental status:
25/30 indicates? What pts would have the most difficulty with immediate recall and drawing pentagons? |
-mild cogitive impairment
-alzheimer pts |
|
|
Elderly pt spend most of their time in what stage of sleep?
|
stage 4
|
|
|
How does sundowning effect the DAT pt?
|
increases confusion at night when stimuli is low
|
|
|
Psychiatric symptoms due to AD?
|
psychosis
depression altered circadian rhythms agitation anxiety |
|
|
which meds increase anticholinergic effects and are detrimental for the elderly?
|
TCAs
|
|
|
which medication should not be used with older pts due to strong alpha blockage?
|
thorazine
|
|
|
orthostatic hypotension is more common than EPS in what pts?
|
elderly
|
|
|
What size dosage should the elderly be given of FGA antipsychotics to manage their symptoms?
|
small doses (crumb) prefferably haldol
|
|
|
Why is atypical contraindicated with elderly to control agitation? what meds should be used for acute agaitation?
|
b/c new warning of increased mortality.
continous use of BDZs may cause antegrade amnesia & increase fall risk -Lorazepam (ativan) used for acute agitation |
|
|
Name other psychiatric problems other than dementia in the elderlY?
|
-mood d/o: elation hyperactivity(mania),elation to depression
-depression: due to losses,mult med problems,isolation,neglect, -suicide:High risk Men>50y/o,widowed,divorced, caucasians.low socio economic status |
|
|
what d/o due to loss, change ,relocation,dependence,loss of autonomy,retirement,illness and financial stress.Maladaptation occurs within 3 months of the stressor and has not persisted longer than 6 months?
|
adjustment d/o can occur with elderly
|
|
|
what d/o common in elder due to somatic complaints,rigid thinking,and behavior,insomnia,fatigue,hostility,resltlessness,confusion,and increased dependence:use SSris
|
anxiety d/o
|
|
|
power and control,protective,somatic,comforting and persecution?
|
delusional d.o
|
|
|
ETOH can cause nutritional deficits?
|
Substance related d.o
|
|
|
frequent awakenings,increased total time awake and take longer to fall asleep?
|
disorders of sleep/arousal
|
|
|
multiple unresolved losses from the past?
|
dysfunctional grief
|
