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59 Cards in this Set

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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