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58 Cards in this Set
- Front
- Back
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What are COGNITIVE DISORDERS?
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- A group of conditions characterized by disruption of thinking, memory, processing and problems solving
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What are RISK FACTORS for Alzheimer's Disease?
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- Advanced age
- Family history - Head trauma |
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What is DELIRIUM?
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- RAPID onset over a short period of time (hours to days)
- Caused SECONDARY to another medical condition, such as infection, or substance abuse - REVERSIBLE if diagnosis and treatment are PROMPT |
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What are signs and symptoms of delirium?
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- IMPAIRMENTS in: memory, ability to focus, impairments may FLUCTUATE throughout the day
- LOC is usually altered - Personality change is RAPID - May have perceptual disturbances |
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What is DEMENTIA?
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- Gradual DETERIORATION of FUNCTION over months or years
- Exact ONSET IS DIFFICULT TO DETERMINE - Generally caused by a CHRONIC disease, such as Alzheimer's, or is the RESULT of chronic alcohol abuse (WERNICKE or Korsakoff) - May be caused by PERMANENT trauma, such as head injury - Irreversible and progressive |
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What are the signs and symptoms of dementia?
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- IMPAIRMENTS in memory, judgment, ability to focus, and ability to calculate; impairments DO NOT CHANGE throughout the day
- LOC is altered - Personality change is GRADUAL |
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What are some causes of dementia?
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- Alzheimer's disease: progressive deterioration in function due to neurotransmitter deficiency
- Vascular disease: due to significant cerebrovascular disease - HIV/AIDS: related to brain infections with a range of symptoms from acute delirium to profound dementia |
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What are some causes of dementia?
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- Head trauma: intellectual and memory difficulties after the trauma
- Parkinson's disease: loss of nerve cells and progressive decrease in dopamine activity - Huntington's disease: genetically transmitted disease, in which profound ataxia occurs within 5-10 years of onset - Creutzfeldt-Jakob disease: transmissible agent, known as the "slow" virus; clinical course is rapid with progressive deterioration and death within 1 year - Dementia due to a general medical condition: can be due to an endocrine condition, pulmonary disease, hepatic or renal failure, uncontrolled epilepsy |
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What is Korsakoff's syndrome?
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- A type of progressive dementia caused by thiamine deficiency, usually occurring due to LONG TERM ALCOHOL ABUSE
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What are the stages of Alzheimer's?
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- Stage I, forgetfulness
- Stage II, confusion - Stage III, ambulatory dementia - Stage IV, end stage |
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What is the functional dementia scale?
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- Shows the client's ability for self care, extent of memory loss, mood changes, degree of danger to self or others
- Determine safety measures NEEDED for client |
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What are some defense mechanisms in cognitive disorders?
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- DENIAL: both the client and family members may refuse to believe that changes are taking place, even if they are obvious
- CONFABULATION: client make make up stories about events or activities that they don't remember - PERSEVERATION: client will avoid answering questions by repeating phrases or behavior |
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What are some nursing interventions for clients with cognitive disorders?
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- ENSURE environmental safety, lower bed, removal of scatter rugs
- Provide support to caregivers - Recommend support groups and respite care - Establish a ROUTINE; provide CONSISTENCY in caregivers |
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When do development and behavioral actions become pathologic?
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- Are NOT age appropriate
- Deviate from cultural norms - Create deficits or impairments in adaptive functioning |
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What are pervasive developmental disorders (PDD)?
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- Severe impairment in social interaction and communication skills, stereotypical behaviors, interests and activities
- Client may be easily frustrated, impulsive and angry - These disorders include: AUTISM and ASPERGER'S |
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What is AUTISM?
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- Abnormal brain function, affection, logic and reasoning
- IMPAIRED COMMUNICATION: language delay, echolalia, failure to imitate - IMPAIRED SOCIAL INTERACTIONS: lack of responsiveness and interest in others, avoidance of contact - Stereotypical behaviors: rigid adherence to routines, BIZARRE behaviors, finger flapping, clapping, hand biting, swaying, head banging - Usually observed before 3 years of age |
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What is AUTISM?
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What is ASPERGER'S DISORDER?
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- Occurs later in childhood, usually when the child enters school
- Later onset than autism, with LESS COGNITIVE or LANGUAGE DELAY |
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What are BEHAVIOR DISORDERS?
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- Behavioral problems usually occur in school, church, home, or recreational activities
- For children, behaviors will worsen in situations that require sustained attention - These disorders include: attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder |
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What is ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)?
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- Key symptoms include: inattention and hyperactivity
- Difficult to diagnose before age 4 |
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What is oppositional defiant disorder?
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- Recurrent pattern of antisocial behaviors: negativity, disobedience, hostility, DEFIANT behaviors
- BEHAVIORS USUALLY SEEN AT HOME, DIRECTED TOWARD A PERSON BEST KNOWN - Patient has a low tolerance threshold - Patient will NOT see themselves as defiant - GENERALLY DO NOT VIOLATE THE RIGHTS OF OTHERS - CAN DEVELOP INTO A CONDUCT DISORDER |
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What is a CONDUCT DISORDER?
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- Most common reason for psychiatric referral of children
- May occur in males and females living in rural areas - Contributing factors: parental rejection and neglect, lack of supervision, parent history of psychological illness |
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What are the manifestations of conduct disorder?
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- LACK of remorse or care of the feelings of others; bullies, threatens and intimidates others, physically cruel to others and/or animals, belief that AGGRESSION IS JUSTIFIED
- Learning disorders or impairments on cognitive function |
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What are ANXIETY DISORDERS?
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- Anxiety and worry are a part of normal life, but they become an anxiety disorder WHEN:
*Child has difficulty moving to a higher developmental level due to anxiety *Anxiety is so serious, child is unable to function normally at home, school, and other areas of life - Anxiety disorders include: separation anxiety and PTSD - May progress to a PANIC DISORDER |
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What are some nursing interventions for the child with PDD (pervasive developmental disorders?
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- Use one on one interactions
- Identify desired behaviors and REWARD them - ROLE MODEL social skills, role play situations that involve conflict - Encourage verbal communication - Limit self stimulating and ritualistic behaviors by PROVIDING ALTERNATING PLAY ACTIVITIES - FOCUS on the family and child's strengths, not just the problem - Provide short and clear explanations |
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What are some nursing interventions for the child with a SEVERE behavior problem?
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- Identify issues that result in power struggles
- Assist child in developing coping mechanisms - Encourage child to participate in group and family therapy |
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What is SUBSTANCE ABUSE?
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- Repeated use of chemical substances, leading to clinically significant impairment over a 12 month period
- Inability to perform normal duties at home, school and work - Continued use of substance despite problems |
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What is SUBSTANCE DEPENDENCE?
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- Repeated use of chemical substances, leading to a clinically significant impairment over a 12 month period
- Tolerance; symptoms of withdrawal, substance taken in larger amounts or for longer periods than intended |
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What is TOLERANCE?
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- A need for HIGHER and HIGHER doses of a substance to achieve the desired effect (such as requiring larger amount of alcohol)
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What is WITHDRAWAL?
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- Stopping or reduction of intake that results in specific physical and psychological symptoms such as tremors and headaches
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What is ADDICTION?
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- Loss of control due to participation in the dependency, whether dependency is a substance or process
- Participation in this dependency continuing despite associated problems - GOAL: COMPLETE ABSTINENCE, although relapse is common - DENIAL PREVENTS PROBLEM FROM OBTAINING HEALP |
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What are some drugs of ABUSE?
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- CNS depressants: alcohol, barbiturates, benzodiazepines and opioids
- CNS stimulants: methamphetamine, cocaine and caffeine |
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What is alcohol (ethanol)?
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- Most common drug of abuse in the US
- Poses the greatest withdrawal dangers - A laboratory blood alcohol concentration (BAC) of 0.08% is CONSIDERED LEGALLY INTOXICATED, for adults operating automobiles in every US state - Death could occur from acute toxicity levels that are GREATER THAN 0.35% - Effects of excess: altered judgment, poor motor skills, decreased LOC - CHRONIC USE: cardiovascular damage, liver damage, GI bleeding |
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What is withdrawal from high degree of alcohol dependence?
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- Can be life threatening and require hospitalization
- Symptoms: abdominal cramping, vomiting, INCREASED HR, INCREASED BP, INCREASED TEMP, TONIC-CLONIC SEIZURES |
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What are DELIRIUM TREMENS (DT)?
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- Most SERIOUS SYMPTOM OF ALCOHOL WITHDRAWAL
- Symptoms: severe disorientation, psychotic symptoms (delusions and hallucinations), severe HTN, cardiac dysrhythmias, delirium, may progress to death |
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What is the CAGE method for data collection of alcohol abuse (ethanol)?
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- CAGE acronym
- C: has anyone told you to CUT down on alcohol? - A: have people ANNOYED you by criticizing you for drinking/using drugs? - G: have you ever felt GUILTY for drinking/using drugs? - E: have you ever taken an EYE-OPENER to steady your nerves to get rid of a hangover? |
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How do you manage alcohol withdrawal?
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- Administration of BENZODIAZEPINES to maintain VS within normal limits, will decrease risk of seizures and intensity of symptoms
- Administration of adjunct medications: carbamazepine (Tegretol), clonidine (Catapres), propanolol (Inderal) - Provide seizure precautions |
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How do you MAINTAIN alcohol abstinence?
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- DISULFIRAM (Antabuse): daily PO medication that is a type of AVERSION THERAPY
- Inform client the DANGER of drinking alcohol (will cause respiratory depression, N/V) and to AVOID products with alcohol - NALTREXONE (ReVia): OPIOID antagonist that suppresses the craving and pleasurable affects of alcohol (may be given by monthly IM injections if client can't keep up with daily medication) - Acamprosate (Campral): DECREASES UNPLEASANT effects resulting from abstinence such as anxiety and restlessness |
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What is NICOTINE?
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- Intended effects: relaxation and decreased anxiety
- HIGHLY TOXIC, but acute toxicity is seen only in children - Long term effects: respiratory disease, cardiovascular disease, irritation to oral mucous membranes - Abstinence syndrome: irritability, craving, nervousness, increased appetite, difficulty concentrating |
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How do you manage nicotine withdrawal?
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- BUPROPION (Zyban): decreases nicotine craving and symptoms of withdrawal
- May cause DRY mouth (encourage client to chew on gum or hard candy) - Nicotine replacement therapy: nicotine gum, nicotine patch (DO NOT USE > 6 MONTHS) |
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What are the intended effects of OPIOIDS?
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- RUSH OF EUPHORIA, relief from pain, PUPIL CONSTRICTION, CONSTIPATION
- Toxic effects: decreased respiration and LOC, may cause death - Naloxone (NARCAN), is used as antidote to relieve overdose - ABSTINENCE SYNDROME: sweating, weakness, nausea, rhinorrhea, DILATED PUPULS, bone pain and muscle spasms (will only last 7-10 days, NOT life threatening) |
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How do you manage OPIOID WITHDRAWAL?
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- METHADONE (DOLOPHINE) is a PO OPIOID that REPLACES the OPIOID to which the client is addicted
- METHADONE PREVENTS abstinence syndrome and removes need to obtain illegal drugs - Methadone is used for withdrawal and long term maintenance - Dependence is transferred to methadone |
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What are Barbiturates?
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- The intended effect of barbiturate drugs are sedation and decreased anxiety
- Toxic effects: respiratory depression and decreased LOC, which may be fatal |
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What are some names of barbiturate drugs?
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- Pentobarbital (Nembutal)
- Secobarbital (Seconal) - Amobarbital (Amytal) - Phenobarbital (Luminal) |
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What are the intended effects of benzodiazepines?
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- Intended effects: decrease anxiety, sedation
- Toxic effects: increased drowsiness, life threatening hypotension - ANTIDOTE: flumazenil (Romazicon), used as an IV to relieve overdose |
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What are some examples of benzodiazepines?
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- Valium (Diazepam)
- Ativan (Lorazepam) |
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What are the intended effects of amphetamines?
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- Intended effects: increased energy, dilated pupils
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What are the intended effects of cocaine?
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- Intended effects: rush of euphoria and pleasure, increased energy
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What are the intended effects of cannabis?
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- Intended effects: euphoria, sedation and hallucinations
- Causes AMOTIVATION SYNDROME (apathy) |
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What are the inhalants?
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- These drugs include: amyl nitrate, nitrous oxide, and solvents which are "sniffed", often by young children or teenagers
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What are the intended effects of psychedelics?
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- Intended effects: heightened sense of self, and altered perceptions
- May have PANIC attacks, FLASHBACKS (visual disturbances or hallucinations), may occur intermittently for years |
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What are some examples of non-substance related dependency?
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- Dependency to all behaviors
- Also called process addictions - Abused processes include: *Gambling *Sexual behaviors *Shopping and spending money *Internet use |
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What is a DUAL DIAGNOSIS?
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- Client has both a MENTAL ILLNESS as well as a SUBSTANCE or PROCESS abuse
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What does CODEPENDENCY MEAN?
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- Common behavior by the significant other/family/friends of the substance or process abuser that allows the individual to continue the substance or process behavior
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What are some nursing interventions regarding substance abuse?
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- Nurse must assess own feelings regarding abuses
- Use open ended questions - Assess client's DATE OF LAST SUBSTANCE USE/COMPULSIVE BEHAVIOR - SAFETY is the primary focus during acute stage of abuse |
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What does PALLIATIVE care mean?
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- Palliative care: management approach for end of life issues that PREVENTS, RELIEVES, REDUCES and/or eases the symptoms of the disease
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What is HOSPICE case used for?
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- Care is provided for the terminally ill client as well as the family
- Uses an interdisciplinary approach, PRIORITY is symptom control - Hospice care can be given within 6 months of expected death |
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What are the 5 stages of dying? (Kubler-Ross)
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1. Denial
2. Anger 3. Bargaining 4. Depression 5. Acceptance |
