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154 Cards in this Set
- Front
- Back
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What is the #1 cause of mental change in the elderly?
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bladder infection- they go un-noticed and cause urosepsis, which leads to delirium
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Acute Confusion
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R/T disturbance of cerebral metabolism secondary to (any of the medical causes) AEB abrupt onset of disorientation, restlessness, incoherence, fear.
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Is severe memory loss a normal part of aging?
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No, Memory loss that progresses and significantly interferes with functioning is a sign of dementia.
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With Delirium, why is it important to fix the underlying problem?
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Because delirium can become permanent --> brain damage
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Dementia is characterized by...
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progressive deterioration of the intellectual functioning, memory, and problem solving abilities. In addition, insight and judgment, and moral/ethical behavior decline as well.
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Does delirium happen slowly or suddenly?
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Suddenly
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Primary causes of dementias include...
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Alzheimer’s Disease, Multi-infarct dementia, Pick’s disease, Huntington’s disease, Creutzfeldt-Jakob disease, ansLewy Body Disease
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Secondary causes of dementia include...
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Tuberculosis & other infections of the brain, Trauma, Metal poisoning, Korsakoff’s syndrome, AIDs related dementia
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Huntington’s Disease
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Genetic, autosomal dominant. Avg lifespan 15 yrs after onset, Deterioration of basal ganglia- uncontrolled movements, hallucinations, and delusions. Low GABA and ACh. No cure, can be found with genetic testing.
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Symptoms of Huntington's disease?
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Imbalance of Dopa and Ach (excessive Dopa) causes excessive movement- opposite of Parkinson's, as well as dementia
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How is Huntington's Disease transmitted?
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genetically- only need to inherit 1 gene. 50% chance of children inheriting disease if 1 parent carries Huntington’s (H) gene.
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What is the different effect between inheriting Huntington's from mother or father?
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Father- earlier onset, shorter lifespan
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About what age does Huntington's disease usually come on?
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30-50 (after already had children, too late!! probably passed it on)
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What big ethical question does Huntington's bring up?
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Should there be genetic testing done before having children (in utero) and then making the decision to have the child with disease or terminating the pregnancy
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Creutzfeldt-Jakob disease (CJD)
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deadly w/in 1-2 yrs, Confusion, loss of coordination, become unable to speak or move, mutated prion protein, "spongy brain"
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3 ways to get Creutzfeldt-Jakob disease (CJD)
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Inherited- genetic predisposition,
Acquired- ingest infected brain matter (mad cow) Spontaneous mutation- most common way (85%) |
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Pick’s Disease
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microscopic structures- “Pick’s bodies” are found and neurons “balloon," cannot function. Changes in frontal and anterior temporal lobes. Death w/in 5 yrs
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Symptoms of Pick's Disease
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changes of behavior, personality (apathy, disregard for social norms, loss of functionality), language changes- Eventually person becomes mute.
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What disease is often mistaken for Alzheimer's?
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Pick's Disease
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Lewy Body Disease
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abnormal protein deposits (lewy bodies) that disrupt the brain's normal functioning. Death 5-7 yrs
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Lewy Body Symptoms
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cognitive changes similar to Alzheimer’s Disease, and Parkinson type movement problems.
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Alzheimer’s Disease Cause
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Cause is unknown
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Alzheimer’s Disease accounts for ____% of dementias.
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5060
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Risk for Alzheimer’s disease increases every five years after age ____.
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65
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Risk factor for Alzheimer’s
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Age, heredity, heat disease
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Heart disease interacts with early Alzheimer’s changes to...
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multiply damage to the brain
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Alzheimer’s mechanism of destruction?
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The brain experiences destruction in which neurofibrillary tangles and plaques develop.
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The cardinal symptoms of Alzheimer’s are:
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Aphasia, Apraxia, Agnosia, Memory (Mnemonic)impairment, Disturbances in executive functioning
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Aphasia
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loss of language ability- both expressive and receptive, reading included
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Apraxia
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loss of purposeful movement in the absence of motor or sensory impairment. Not paralysis just cannot purposefully make body do what “you want” even though those movements are physically possible
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Agnosia
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loss of sensory ability to recognize objects- cannot feel a marker and know what it is even though they can physically feel the marker. All senses are affected.
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Memory (Mnemonic)impairment
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gradual loss of both recent and remote memory
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Disturbances in executive functioning
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difficulty with planning, organizing, abstract thinking. Cannot remember to keep appointments, etc.
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Other symptoms of Alzheimer's?
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Confabulation, Perseveration, Agraphia, Hyperorality, Hypermetamorphosis, Avoiding answering questions
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Confabulation
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making up stories to cover gaps in the memory (not intentionally lying- to maintain self-esteem)
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Perseveration
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repetition of phrases or behaviors
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Agraphia
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inability to read or write
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Hyperorality
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the need to put everything in one’s mouth
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Hypermetamorphosis
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touching everything
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Avoiding answering questions
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a way to maintain self-esteem…client “covers up” inability to answer.
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4 stages of Alzheimer's
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Mild: Forgetfulness
Moderate: Confusion Moderate to Severe: Ambulatory dementia Late: End stage |
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Signs of Mild Alzheimer's
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Losses in short-term memory
Loses things by putting them in odd places Uses memory aids Denial of problems common |
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Signs of Moderate Alzheimer's
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Memory losses apparent – forgets address &/or date
ADL’s suffer Problems managing money, legal affairs Mood labile Withdraw from activities Needs day care or in-home assistance |
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Signs of Moderate to Severe Alzheimer's
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Doesn’t recognize family or objects (agnosia)
Forgets how to do activities such as walking, eating (apraxia). Loses control of bowel and bladder Wandering Needs total assistance for all ADLs May need placement in skilled care facility |
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Signs of Late Alzheimer's
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Exhibits hypermetamorphosis & hyperorality
Does not recognize self anymore Forgets how to eat Loses ability to talk & walk Prone to complications of immobility Needs complete care |
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With Alzheimer's The average time from diagnosis to death is __ years, although some people may live up to __.
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10 years,
20 |
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Common Nursing diagnoses for pts with dementia
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Risk for Injury and Chronic Confusion (also Self-care deficit syndrome and Caregiver role strain.)
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Caregiver role strain
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R/T unrelenting or complex care requirements secondary to progressive dementia, AEB depressed feelings, anger, and chronic fatigue
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Managing Alzheimer's
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No cure, drugs used delay decline but not prevent it.
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What type of drugs used for Alzheimer's pts in early to moderate stages?
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Cholinesterase Inhibitors- Aricept, Exelon, and Razadyne- Prevent break down of Ach (needed for memory)- delays worsening of symptoms
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What type of drug is used in Alzheimer's pts in moderate to severe stages?
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Namenda- limits axn (blocks receptors) of glutamate which can be destructive in the brain- protects neurons from being bombarded
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Alz meds- cholinesterase inhibitors
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Aricept, exelon, razadyne- prevent breakdown of ACh- increasing ACH improves cognition and behavior
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Echolalia
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repeats everything said
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Illusions
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errors in perception of sensory stimuli
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Sundowning
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symptoms and problem behaviors that become more pronounced in the evening
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Reminiscence therapy
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treatment to assist dementia patients to remember and increase brain function
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Vascular dementia
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dementia caused by CVA
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Formulate teaching plans for clients and their families to assist them in providing care and making decisions about the care of the client with dementia.
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Give information about community facilities, worry about murder suicide with care takers, must be patient, have to know that they will not get better.
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ETOH level 0.05
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1-2 drinks, Changes in mood/ behavior
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ETOH level 0.10
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5-6 drinks, voluntary actions Clumsy
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ETOH level 0.20
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10-12 drinks, Staggering, emotions labile
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ETOH level 0.30
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15-18 drinks, Confusion, stupor
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ETOH level 0.40
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20-24 drinks, Coma
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ETOH level 0.50
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25-30 drinks, Death d/t respiratory failure
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coping styles used by addicted individuals
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a. Denial, projection, rationalization, all or nothing thinking, conflict minimization, selective inattention, manipulation
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Describe the problem of relapse in the recovery of clients with addictions
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Relapses common during recovery. Goal of relapse prevention is to help the client learn from relapse so that periods of sobriety can be lengthened over time- lapses/relapses are not viewed as total failure
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Discuss three therapeutic modalities used with clients with substance abuse problems
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Support and kindness, set limits, maintain consistency, provide 411 about addiction as a chronic disease, encourage family therapy, reinforce disease concept
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Blackout
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A blackout is a phenomenon caused by the intake of alcohol or other substance in which long term memory creation is impaired or there is a complete inability to recall the past.
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Al-Anon
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support group for spouses and friends of alcoholics
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Alcoholics Anonymous
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self help group for recovering alcoholics
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Co-dependence
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coping behavior prevents from taking care of own needs, preoccupation with thoughts and feelings of other persons
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Denial
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escaping unpleasant realities by ignoring existence
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Detoxification
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treatment for coming off addictive substances to remove physiological effects
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Dual diagnosis
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psychiatric illness with an addiction or substance abuse
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Disulfiram
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antiabuse drug used for treatment of alcoholism causes nausea and vomiting if alcohol is ingested
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Enabling
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helping an addict avoid consequences of addiction
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Flashbacks
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occasional reoccurrence of perceptual disturbances caused by prior hallucinogenic drug use when clean
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Intoxication
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abnormal behavior or psychiatric changes due to use of alcohol or drugs
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Narcan
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medication to counteract narcotic effects
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Polysubstance abuse
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use of more than one drug or substance
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Relapse
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reoccurrence of disorder after period of improvement or returning to addictive substances when clean
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Substance abuse
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excessive use of drugs
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Synergistic effect
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adding effect when more than one med is taken, potentiates effects of one
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Tapering
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gradually becoming smaller
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Tolerance
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physiological decrease in reaction to a drug with repeated administrations of same dose
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Wernicke
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Wernike= acute decrease in thiamin. Causes acute confusion, ataxia, and neuropathy.
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Korsakoff’s
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Korsakoff= chronic decrease in thiamin, causes brain damage which leads to retrograde (from a point backward) and anterograde (from a point forward) amnesia
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Wernicke-Korsakoff’s syndrome
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Wernicke and Korsakoff's are actually one syndrome
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Withdrawal
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negative physiological and psychological reactions that occur when a drug is taken for a long time and is decreased in dose or no longer taken
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Normal process of reward circuit
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“Reward Circuit”- pleasure= release of dopa, Hippocampus & amygdala “remember” the good feeling, “Control center” evaluates & decides whether to repeat axn
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Process of addiction
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Drugs trick reward circuit, strong release of Dopa with drug, depletes Dopa so that "normal" experiences no longer bring pleasure- need for drug then overrides everything due to strong sense of reward
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Recovery is difficult because of the ______ _____ associated with the drug.
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lasting memories (cues in environment stimulate strong cravings)
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50% of individual variation in susceptibility to addiction is _______
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hereditary
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__________ not fully developed in adolescents
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Pre-frontal lobe...= less judgment = more chance of addiction.
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Pain tolerance in cocaine & opioid abusers
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Find in general that general population is much more pain tolerant than abusers; not sure if the person started out pain intolerant or the addiction caused it.
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Good pain tolerant mice
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good analgesia and no reward response – they didn’t like to take opioids for pleasure = good opioid binding.
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Poor pain tolerant mice
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= poor analgesia but loved reward – took opioids happily = poor opioid binding.
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How to ask client's questions about drug use
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Start with the least threatening questions: 1. Use of prescription drugs, 2. Use of over-the-counter drugs, 3. Use of social drugs, 4. Use of recreational drugs
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Why is abstinence from drugs an important response to explore?
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Need to know why – religious convictions or is the client a recovering addict
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Physical signs of addiction
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dilated/constricted pupils, abnormal vital signs, needle marks, tremors, alcohol on breath, confusion, staggering
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Signs a person is intoxicated by CNS depressants
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slurred speech, incoordination, staggering, drowsiness, inhibitions lowered resulting in impulsive sex and aggression, impaired judgment, social and occupational problems.
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Alcohol related problems (medical)
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ulcers, cirrhosis, pancreatitis, esophageal varices, malabsorbtion of vitamins (folic acid, vitamin B1, vitamin B12), cardiomyopathy, myopathies
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Alcohol dulls the “_____ _______” by blocking neurotransmission
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awake centers
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What is the legal level of intoxication in CA?
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.08%
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2 types of alcohol w/drawal
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What is the legal level of intoxication in CA?
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A condition seen in chronic alcoholism is _______ _____ ______
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Wernicke-Korsakoff syndrome
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Wernicke-Korsakoff syndrome
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result of a thiamine deficiency- addicts choose to drinking over eating- malnourished, damage to CNS and PNS
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Wernicke’s disease
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paralysis of eye movements, ataxia (wide based stance and slow uncertain short stepped gait), acute confusion
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The signs and symptoms of Korsakoff’s disease often appears as the _______ is resolving.
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confusion
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Korsakoff’s disease
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Combo antegrade and retrograde amnesia, confabulation is profound- hippocampus damaged D/T long term thiamine deficiency
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Wernicke-Korsakoff syndrome treatments?
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Admin thiamine IV or IM, for the malnutrition give MgSO4, K, and multivites
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DO people bounce back from Wernicke-Korsakoff syndrome?
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Recovery from effects of Wernicke-Korsakoff syndrome vary:
Mortality is 10-20% Full recovery of ocular function usually occurs but 60% may have a persistent, fine horizontal nystagmus 40% recover from ataxia 20% recover from amnestic deficit. |
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Alcohol withdrawal- W/in a few hrs after last drink?
Symptoms peak and disappear ...? |
see symptoms
24-48 hours after last drink |
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What does alcohol withdrawal look like?
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See anxiety, anorexia, insomnia, tremors (shakes), illusions, confusion, increased BP & pulse, seizures
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What environment needs to be provided for alcohol withdrawal?
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Client needs calm, quiet, reassuring atmosphere, frequent reorientation
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For alcohol withdrawal medicate with long lasting __________ to prevent seizures and progression to delirium tremens.
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benzodiazepines (Librium)
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Clonidine
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anti-hypertensive agent
Used to reduce blood pressure in withdrawal Also used to reduce acuity of withdrawal symptoms |
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Naltrexone
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reduces alcohol craving and blocks euphoric effects of opiates
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Antabuse
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causes strong reaction when alcohol ingested; used for people to promote abstinence. MUST AVOID ALL ALCOHOL PRODUCTS
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CIWA-A Assessment
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Tool developed to monitor withdrawal symptoms
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CIWA-A Assessment areas?
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nausea & vomiting, tremors, sweats, anxiety, agitation, tactile/auditory/visual disturbances. Headache, orientation
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How often to use the CIWA-A?
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Every 4 hours during withdrawal
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Alcohol withdrawal Delirium comes on when?
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Starts 2-3 days after last drink
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When pts experience delirium during alcohol withdrawal, is it a medical emergency?
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Yes- Medical emergency, 20% mortality
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How do pts usually die from delirium during alcohol withdrawal
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Death usually due to cardiac problems, aspiration pneumonia, or hyperpyrexia
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Signs & symptoms of alcohol withdrawal delirium
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delirium, disorientation, visual and tactile hallucinations, paranoid delusions, agitation, raised vital signs
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S/S of intoxication of opiates- opium, morphine, heroin
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constricted pupils, decreased respiration, decreased BP, drowsiness, slurred speech, impaired memory and judgment
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Complications of intoxication of opiates
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overdose produces death through depressed respirations, other complications due to impurities in mixture
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Opiates withdrawal signs
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“Flu” – runny nose, aches, chills, fever; cramps, diarrhea, insomnia, diaphoresis, irritability
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Drugs used to treat opiate withdrawal
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methadone, naltrexone, Subutex, Clonidine
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Methadone
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a synthetic drug chemically similar to morphine. Used as heroine replacement for those wanting to stop using heroine. Less sedating, pt can function and live productive life, only admin qday
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Marijuana (MJ) active ingredient
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THC which has mixed depressant and hallucinogenic properties.
INTOXICATION: increased appetite, red eyes |
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s/s of MJ intoxication
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increased appetite, red eyes, detachment, relaxation, euphoria, apathy, impaired memory & judgment.
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s/s of MJ OD
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can cause panic reactions
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s/s of MJ dependence
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associated with with lethargy, anhedonial, difficulty concentrating, memory impairment. This creates problems for kids in school. Also mimics depression.
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5 As of smoking cessation
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Ask, Advise, Assess, Assist and Arrange
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Addictive coping styles tend to be predictable - use ______ _______ to avoid feeling badly about themselves.
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defense mechanisms
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Coping styles
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defense mechanisms, denial, rationalization, All or nothing thinking, selective inattention, conflict minimization, MANIPULATION
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RATIONALIZATION
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justifying illogical ideas, actions, or feelings by developing an acceptable explanation for unacceptable behavior.
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ALL OR NOTHING THINKING
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inability to deal with parts of a situation.
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SELECTIVE INATTENTION
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only paying attention to parts of a situation or conversation.
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CONFLICT MINIMIZATION
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reducing the importance of an issue
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MANIPULATION
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getting people to do what you want.
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Addicts have trouble giving up these coping styles. This interferes with their _______. Old behaviors reinforce _____ ______.
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recovery
addictive lifestyle |
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Nurses Need to examine feelings
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may be intolerant, hardened, or overly involved.
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CODEPENDENCE
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Nurses often come from homes with substance abuse and develop a life style of “saving” others.
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ENABLING
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supporting or denying the seriousness of the client’s substance abuse
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Treat addiction like an _______ not moral failure
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illness
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Treatment programs
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12 step programs, residential therapeutic communities, Intensive outpatient programs, family/marital therapy, long term med treatment
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RESIDENDTIAL THERAPEUTAIC COMMUNITIES
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Betty Ford
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INTENSIVE OUTPATIENT PROGRAMS
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VA
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FAMILY & MARITAL THERAPY
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life is often very dysfunctional due to client’s drug use. Need to rebuild trust & learn to live together. Also must change codependence patterns in family
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Long term medication treatment
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Antabuse, Revia, Subutex
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C.A.G.E.- (Alcohol)
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Have you ever felt....
(like you should) Cut Down Annoyed Guilty Eye opener (wake up in morning needing a drink b4 can function) |
