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106 Cards in this Set

  • Front
  • Back
*common in older adults
*lower mood tone, difficulty thinking, somatic changes precipitated by guilt and/or feelings of loss
Depression increases...
with medical illness
Different types of depression
minor, major, adjustment disorder, bipolar, SAD, dysthymia
What are characteristics of depression?
depressed mood, loss of interest and pleasure, decrease in energy, change in sleep pattern, anxiety, loss of or excessive appetite, crying, agitation, loss of libido
What is the most common emotional disorder in older adults
Some suicide risk factors
depression, family history, lack of support systems
What are some consequences of depression?
amplification of pain, delayed recovery, worsening of medical symptoms, risk of physical illness, alcoholism, cognitive impairment, increased utilization of healthcare resources, malnutrition, increased rates of suicide
Who has the highest rates of completed suicide
white men
People with these illnesses commonly commit suicide
cancer, stroke, quadripilegics, chronic illness, Diabetes
What does a Geriatric Depression Score over 5 suggest?
Depression and follow up
What are some assessment instruments for depression?
geriatric depression scale, hamilton rating, Zungself rating, Cornell scale
What are some illness associated with depression in elders?
hypothyroidism, CHF, GI malignancy, DJD, CVA, alzheimers, Parkinsons, anemia, vitamin deficiencies, systemic malignancies
What are some interventions for depression
safety, monitor nutrition, elimination, sleep and comfort, focus on enhancing physical function, activity, and social support, and pleasant events
Is depression natural in old age?
What is SIG E CAPS for depression?
sleep patterns, interests/ loss of pleasure, guilt, energy, concentration, appetite changes, psychomotor changes, suicide
acute confusion with rapid onset (hours to days) that is REVERSIBLE
*disturbance in teh ability to concentrate, maintain attention, language distrubance (slurred, rambling), perceptual disturbances often with paranoia that worsens at night, often prodromal phase with anxiety, restless, insomnia and disturbing dreams
What can happen in delirium?
full recovery or progression to stupor and death
What does delirium put you at risk for?
longer hospital stays, falls, more institutions, more nursing and home care
What do the agitated behaviors of delirium usually lead to
physical and chemical restraints
Some risk factors for delirium
advanced age >80, dementia, severe illness, comordity, alcohol, depression, sensory impaired, dehydration, infection, polypharmacy (over 4 meds), previous episode
what are common causes of delirium in older hospitalized patients?
medication, pain, dehydration, infection, electrolyte and metabolic disturbance
What are variables which predispose to delirium
vision impaired, severe illness, preexisting cognitive impairment, dehydration, present on admission, use of physical restraints, bladder cath, more than 3 meds added, iatrogenic effect
What are 3 subtypes of delirium
hyperactive, hypoactive, mixed
Hyperactive delirium
increased psychomotor activity, such as rapid speech irritability and restlessness: easily recognized and treatment is sought
Hypoactive delirium
present with slurred slow speech, lethargy, decreased alertness, apathy, behavior is not disruptive so its often missed
Mixed delirium
behavior shifts between hyper and hypo: during hyper phase people may think the behavior has improved
Assessing delirium
history and physical, (did they use alternative therapies), mini cog, digit span (20 backwards), days/months backward, WORLD backward, test of attention, current meds, lab chemistries, O2 sat, thyroid function, cultures, drug levels, UA, EKG, CXR, B12, folate level
Delirium Prevention
immunization, community support, early diagnosis and treatment, careful use of meds, pain control, identify risk factors
Managing delirium
prompt treatment, discontinue meds, nutrition and hydration, supportive environment, consolidate nighttime care, noise reduction, communication, cognitive enhancement
What is better choice for delirium in older adult: Haldol or Ativan
ativan, because haldol can cause extrapyramidal symptoms
Some meds for delirium
haldol, ativan, risperdol, zyprexa, geodone IM, benzodiazepines, lorazepam
What are main dementias?
alzheimers, vascular dementia, dementia with Lew bodies
What may help dementias?
cholinesterase inhibitors and N-ethyl d-aspartate antagonists
Who has more dementia: male or female
20-30% of those with dementia have..
vascular or combination of alzheimers with vascular dementia
Causes of vascular dementia
HTN, stroke, etc
What is diagnosis of dementia
decline in 2 or more areas of cognitive functioning: memory and one of others (aphasia, apraxia, agnosia)
difficulty speaking
difficulty with movement
inability to know specific objects
Dementia usually beings after
age 60
Dementia is...
progressive and irreversible
60-70% of dementia have...
What occurs in dementia?
brain cells are destroyed, which affects memory, thinking and behavior which then interferes with work, hobbies, and social life
What is the 6th leading cause of death
10% of people over 65 have?
50% of people over 90 have
What occurs with the brain in dementia
accumulation of proteins in the brain, causing neurofibrillary tangles
*cortex shrivels up
*hippocampus shrinks
*ventricles grow
What occurs in dementia when the cortex shrivels
damages areas for thinking, planning and remembering
What occurs in dementia when then hippocampus shrinks?
it is the area for new memories, so you cannot form new memories
What are risk factors for dementia?
advanced age/family, mild cognitive impairment, genetics, family history, female, environment, head injury, low education, lower occupational status, alcohol abuse, lack of mental stimulation
What are risks for vascular dementia?
stroke, hypertension, high LDL, hyperlipidemia, older age, male, smoking
What is one of the earliest symptoms of AD?
impairment of smell function
What may a person with A.D. be unable to smell?
leather, clove, menthol, strawberry, pineapple, soap, smoke, lemon, lilac, natural gas (egg odor added)
What is genotyping for dementia
APOE gene, has 3 alleles APOE 2, 3, & 4
Definition of dementia
clinical syndrome of cognitive deficits that invovles both memory and a disturbance in at least one other area of cognition that is commonly associated with changes in function and behavior
most common forms of dementia
alzheimers and vascular
Agitation in dementia
excessive verbal or motor activitiy
Motor agitation in dementia
irritable, restless, resisting assitance even when needed, pacing, hyperactivity, wandering, assaultiveness, threatening gestures, spitting, and physical destructiveness
Verbal agitation in dementia
verbal abuse, beligerance, screaming, swearing, expressions of anger
What is cognition affected in dementia
orientation x 3, memory (register, retain or recall info), attention and concentration, thinking, language (receive and express message), praxis function (direct and coordinate movement)
What is some behavior in dementia?
disruptions, agitation, aggression, anxiety, disinhibitions, delusion, hallucination, insomnia, decreased energy, weight loss/gain, mood changes, feeling helpless, decreased initiation, lack motivation
Goals for dementia patients
delay progression, delay functional decline, promote quality of life, control symptoms, promote dignity
What should you do for nursing strategies in dementia?
rule out everything else
physical exam, medication review, labs (to check for reversible conditions like thyroid, b 12, cbc, syphilis, hiv), treate underlying pathology, monitor effectiveness of meds, assure adequate rest, nutrition, fluid, elimination, pain control, and comfort
What is treatment for dementia?
treat cognitive symptoms, treat behavioral disturbances, and educational interventions
How do you treat dementia cognitive symptoms
acetylcholinesterase inhibitors, NMDA receptor antagonist, stroke prevention
how do you treat dementia behavioral disturbances?
antipsychotices, benzodiazepines, selected TCAs
Some meds for dementia
Ach-1 inhibitors: aricept exelon, gonex, reminyl (mild to moderate): slow cogitive decline and may slowly improve symptoms and may delay onset new symptoms
S/E of Ach-1 inhibitors
GI, diarrhea most common
When is namenda used?
moderate to severe dementia; can be add on to initial start
*blocks glutamate, which is the main excitatory NT in areas of memory and cognition
What is a goal in behavior of dementia
reduce overstimulation, know that basic human needs may trigger behavior disturbance
delirium is often caused by?
underlying condition such as UTI, med toxicity
What may antipsychotic meds do?
reduce agitation
What may antidepressants do?
help symptoms of depression
What is lewis body dementia?
prominent psych symptoms, cognitive deterioration and parkinsonian features, distinct psychotic behavior, such as visual hallucinations
Some goals in dementia
avoid use of restraints, treat comorbidities, provide symptom management
Nonpharm interventions dementia
activity therapy, bright light and white noise, psychosocial program, environmental designs for safety, massage, prosthesis for sensory impaired, simulated presence therapy, structured daily activity, activities that promote fatigue at bedtime, bedtime routines, strategies to promote positive behaviors, use personal history as able, maintain routine alternate rest with activities, slow down, speak clearly, eye contact, cue person to do as much for self as possible, modify environment, monitor for symptoms of personal distress
What are some ways to promote positive behaviors in dementia?
identify environmental triggers, medical conditions, caregiver conflict, limit stimuli, respect space, distract, redirect
Strategies for safe and therapeutic environment
avoid overstimulation or understimulation, name tags, wander gaurd, medic alert bracelet, eliminate environment hazards, provide snesory cues to promote cognition, safety
Strategies to promote quality end of life care
advance directive, promote communication early in disease
is confusion a normal part of aging?
How can you ensure adequate comfort in dementia
food, eliminatio, etc.
What should you realize as a nurse in different behaviors
every behavior has a reason, needs not met
Which is reversible: delirium or dementia
What is cause of delirium
cause of dementia
increases risk dementia
family history, increased age, CV disease
Treatment for delirium
immediate care to fix the physical cause
What is most important in wandering
Some good things to do for wandering?
wristbands, prevention
How to assess delirium in older adults with dementia
risk factors, baseline, assess every shift, perception, elimination
Prevent delirium in dementia patients
treat/prevent infections, pain control, sensory aids, therapeutic environment, education of family, nutrition, decrease risk factors, prevent dehydration
When is delirium fatalistic?
if physical cause is unfixed
Some common behaviors in dementia
aggression, questioning, throwing things, sleep disturbance, agitation, paranoia, forgetting to eat/bathe, sundown syndrome
What is sundown
acting differently at night
What is very important with mental disturbances
what is a way to assess nutrition in dementia
Some things to assess in eating?
sloppy, able to chew, bring cup to mouth, need help or eat alone, sit up, open packages, need supervision, check amount of food able to eat, if they have remnants after, if tired after, hydration
Do feeding tubes help in dementia near end of life?
there is no evidence that feeding tubes help!
What can you do to check for aspiration?
cookie swallow test
Lewis body dementia
in cortex, plaque/tangles in hippocampus, like Parkinsons
Important in lewis body dementia
safety, physical therapy and occupational therapy
Interventions for difficulty eating in dementia
decrease distractions, show how to physically eat, involve family, familiar foods or comfort foods, out of bed to eat, weight, eating is social, but must be supervised
Alzheimers behaviors
irritable, depression, decrease movement, reorientation necessary, use scrapbook or crossword puzzles to help
Cause and behavior is different between
alzheimers and lewis body dementia
What are some activities for alzheimers patients?
go to the zoo, make a collage, music specific to their age, help with meal prep, folding washclothes, old movies