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220 Cards in this Set

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mental state characterized by a disturbance of cognition, confusion, excitement, disorient, clouding of consciousness. Hallucinations and illusions are common
delirium
symptoms include diff. in sustaining and shifting attention
delirium
s/s include impaired reasoning ability and impaired level of consciousness; impaired sleep wake cycle
delirium
t or f: delirium begins abruptly
true
duration of delirium lasts is brief: period of ___________
1 week; rarely more than one month
t or f : delirium may transition into a more permanent cognitive disorder e.g. dementia
true
delirium classified accdg to physiological consequences of hypoxia, hypercarbia and hypoglycemia, F/E imbalances, thiamine deficiency, head trauma
delirium due to med. condition
delirium that is attributed to medication s/e or exposure to toxin
substance induced delirium
delirium d/t cannabis, cocaine and hallucionogens
subst- intoxication delirium
loss of previous levels of cognitive, executive and memory funciton in a state of full alertness
dementia
dementia, such as AD in w/c the dementia is the major sign of some organic brain disease
primary dementia
caused by or r/t another disease or condition, such as HIV
secondary dementia
3 characteristics of dementia
a) impaired abstract thinking, judgment and impulse control
b) disregarding social conventions
c) personal hygiene neglect
this language problem happens in severe forms of dementia
aphasia
common sign of dementia
personality change
causes of reversible dementia
CVA, depression, s/e of meds, nutritional deficiencies
t or f : most clients have reversible dementia
f: most clients dementia have irreversible progressive course
inability to carry out motor activities despite intact motor function
apraxia
accounts to 60 to 80 percent of all dementia cases
AD
no apparent decline in memory
stage I dementia
PT becomes aware of the intellectual decline and may feel shame; s/s not observed by others
Stage II: forgetfullness
interference w/ work and becomes noticeable to workers; gets lost driving; interrupted concentration; unable to recall names and words
stage III: mild cognitive decline
forgets major events and personal history: confabulation occurs
stage IV: mild to moderate cognitive decline: CONFUSION
impaired ADLs, forgets close relatives; disoriented to place and time
Stage 5 : early dementia
name of spouse forgotten; recent life events; ADLs need assistance; urinary and fecal incontinence
stage 6: middle dementia
bedfast and aphasic; decubiti; contractures
stage 7: late dementia
creating imaginary events to fill in memory gaps
confabulation
most common CODs on dementia
infection, sepsis, aspiration
dementia that is slow and insidious; progressive and deteriorating
dem. of Alzheimers type
t or f : exact cause of AD is unknown
true
what does glutamate do to AD brains?
leads to overstimulation of NMDA receptors, flooding brain with calcium that results to cell death
feature characteristic of AD brain
plaques and tangles
what are plques made of ?
beta-amyloid protein
what are tangles made of?
tau protein
3 main causes of AD
a) Ach alteration
b) plaques and tangles
c) head trauma
d) genetic factors
group of people who are most likely to develop AD
ppl with down syndrom: extra 21st chromosome
dementia by significant cerebrovascular disease
vascular dementia
how is V.dementia diff from AD
abrupt onset and highly variable course: occurs in STEPS
common psycho-symptom of V.dementia
anxiety from irregular patterns
common neuro signs w/ V. dementia
weakness of the limbs; small stepped gait ; difficulty speaking
etiology of V. dementia
impaired circulation in the brain
individual with v dementia and AD
mixed dementia
repeated head trauma causing dementia
dementia pugilistica
s/s of dementia due to head trauma
emotional lability; dyarthria, ataxia, and impulsivity
60% of Parkinsons patients have this
dem. due to pd
disease that is transmitted by the Mandelian dominant gene w/ damage to basal ganglia and cerebral cortex.
dem due to Huntington's
a profound state of dementia char. by ataxia, ddepression, twitching of the limbs and facial muscles
dem due to huntington's
median duration of dem due to huntingtons
21.4 years
the initial symptom is personality change; resulting from atrophy in the frontal and temporal lobes
Pick's disease
caused by a prion; death w/in a year; involuntary movements; muscle rigidity and ataxia
dem due to Creutzfeldt-jakob disease
other medical conditions causing dementia
hypoglycemia, hypothyroidisnm, pulmonary disease, cardio and hepatic and renal insufficiency, f/e imbalances, frontal temporal lobe lesions, systemic infections; uncontrolled epilepsy, MS
meds inducing persisting dementia
anticonvulsants
intrathecal methotrexate
Toxins inducing persisting dementia
organophosphates
lead
mercury
carbon monoxide
industrial solvents
idiopathic substance presuming to cause dementia; then the diagnosis is...
Unknown Substance Induced persisting Dementia
dementia attributable to more than one cause
Dem due to multiple etiologies
the inability to recall past experiences. the condition may be permanent or temporary depending on etiology
Amnesia
how is amnesia diff. than dementia
there is no impairment in abstract thinking, or judgment,

no disturbance of higher cortical function

and no personality change
t or f : the amnesiac may engage in confabulation to fill in memory gaps
true
Common s/s of amnesia
apathy, lack of initiative and emotional blandness
onset of s/s on amnesiacs (speed)
acute or insidious
how is amnesia diagnosed
transient (< 1 month)

chronic (> 1 month)
gen. medical conditions associated with amnesia
head trauma
CVA
HSV
neoplastic disease
cerebral anoxia
poorly controlled IDDM
surgery in the brain
transient amnestic syndromes may occur from ........
CVA, arrhythmias, migraine, thyroid disorders, epilepsy
meds that induce persisting amnesia
anticonvulsants
intrathecal methotrexate
toxins that induce persisitng amnesia
lead
mercury
co
organophosphates
industrial solvents
nursing assessment on patients with cognitive or neurological disorders should include 5 areas of concern
a) type, frequency and severity of mood swings and rxn
b) cognitive changes
c) orientation to person, place and time and situation
d) appropriate social behavior
what is pseudodementia
depression
Dem or dep?
slow onset
dementia
dem or dep? intact attention and concentration
depression
dem or dep? consistent poor performance of tasks but struggles to perform
dementia
dem or dep? little effort on tasks
depression
dem or dep? appears unconcerned regarding distress
dementia
dem or dep? communicates distress regarding affective behavior
depression
dem or dep? unchanged appetite
dementia
dem or dep? diminished appetite
depression
dem or dep:? no wandering; A and O intact
depression
t or f: evaluation of client with cognitive disorders is based on a series of long term goals instead of short term goals
False: outcomes must be measured in terms of slowing down the problems rather than stopping or curing them
what is the first step in treatment of delirium
determination and correction of the underlying causes
dem or delirium? client may require mechanical or chemical restraint due to agitation and aggression
delirium
what's the percentage of dementia patients have a potentially reversible condition
10 to 15 percent: hypothyroidism, brain tumors, normal pressure hydrocephalus
ACE inhibitor that's been shown to enhance cognitive functioning in individuals with mild to moderate AD
Antilirium (physostigmine)
most commonly used to combat behaviors associated with dementia, although carries EPS risk
Haloperidol (haldol)
meds that inhibit acetylcholinesterase
Tacrine, Donepezil, Rivastigmine, Galantamine
med for moderate to severe AD
Namenda (memantine)
in AD there is a continous influx of _____________ which results in flooding of ______________ in the nerve cells leading due cell death
glutamate: calcium
two meds to slow progression of AD and inhibit acetylcholinesterase
Namenda and Donepezil
antipsychotic meds for clients with dementia
Risperidone, Quetiapine, Ziprasidone, Olanzapine
approx. ___________% of people with _____ suffer from depression
25: AD
med good for depression esp. at bedtime
trazodone
meds to treat severe apathy
dopaminergic agents such as Methylphenidate, Amantadine, Bromocriptine, and bupropion
what's the significant cause of anxiety for clients with early stages of dementia
progressive loss of mental functioning
least toxic and most effective of the antianxiety meds
benzodiazepines:
Oxazepam
Diazepam (Valium)
Lorazepam
Alprazolam
elderly individuals exhibit paradoxical excitement and confusion with these antianxiety drugs
barbiturates
___________problems are common in clients with dementia and intensify as the disease progresses
sleep
meds for sleep problems
benzodiazepines: Dalmane, Restoril, Triazolam

nonbenzodiazepines: Ambien, Sonata, and antidepressant Trazodone
objectives of care for the client experiencing an acute phase of neurological disorder
eliminate etiology
promoting client safety
return to highest possible functioning
objectives of care for the client with a chronic phase of neurological disorder
preserving the dignity
promoting deceleration of s/s
maximize functional capabilities
identify: duration of the disorder is commonly brief
Delirium
identify: client uses confabulation to hide cognitive deficits
Amnestic Disorder
identify: can be caused by a series of small strokes
dementia
identify: commonly reversible
delirium
identify: denial that a problem exists is common
amnestic disorder
identify: reversible in 10-15% if treated before permanent brain damage
dementia
identify: severe migraine headache can cause transient symptoms
amnestic disorder
identify: personality change is common
dementia
identify: illusions and hallucinations are common
delirium
identify: symptoms can occur as a result of cocaine
delirium
identify: s/s can occur as a result of ETOH withdrawal
delirium
=identify: high concentrations of aluminum in the brain have been implicated in the etiology of this disorder
dementia
identify: transient symptoms can occur after ECT therapy
amnestic disorder
dementia due to hypertension
v. dementia
v. dementia exhibits___________________
a fluctuating pattern of deterioration STEPS
Which nursing diagnosis is a priority for pts with v. dementia
Risk for trauma
which is an example of an antidepressant that is given to patients with v. dementia
Amitriptyline
what is the trade name of amitriptyline
Elavil
is a process of knowing, including perception , memory and judgement
cognition
a state of mental confusion / excitement
delirium
the lobe of the brain that is in charge of abstract thinking
parietal lobe
are dementias irreversible?
most of them
what is DAT
dementia of the Alzheimer's type
when a person has dementia due to HIV, what happens when the person develops aids
patient dementia becomes worse
aka pre-senile dementia characterized by frontal and temporal lobe atrophy
dementia due to Pick's Disease
common among older people; done to preserve self esteem; a lot of embellishment
Confabulation
is a process of knowing, including perception , memory and judgement
cognition
a state of mental confusion / excitement
delirium
the lobe of the brain that is in charge of abstract thinking
parietal lobe
are dementias irreversible?
most of them
what is DAT
dementia of the Alzheimer's type
when a person has dementia due to HIV, what happens when the person develops aids
patient dementia becomes worse
aka pre-senile dementia characterized by frontal and temporal lobe atrophy
dementia due to Pick's Disease
common among older people; done to preserve self esteem; a lot of embellishment
Confabulation
2nd most common dementia;often with higher mortality than alzheimer's
v. dementia
most noticeable deficit in the alzheimer's patient upon early onset
memory loss
a severe mental condition w in w/c there is disorganization of the personality, deterioration in social functioning and loss of contact w/ or distortion of reality
psychosis
they do not enjoy close relationships and prefer to be loners. cold and aloof. premorbid condition
Phase I: schizoid personality
social withdrawal; impaired role functioning; peculiar, eccentric, untidy; blunt or inappropriate affect; bizarre ideas; lack of initiative. This phase is highly variable and may last for many years
Phase II: prodromal phase
in the active phase of this disorder, psychotic symptoms are prominent
Phase III: schizophrenia
Diagnostic for schiz: continuous signs of disturbance persist for at least _________ months and may include prodromal or residual symptoms
6 months
if someone is autistic or has another developmental disorder, schizophrenia is a diagnosis only if prominent delusions or hallucinations are also present for at least _______month (s)
one (1)
characterized by periods of exacerbation; usually is followed by an active phase of the illness
Phase IV : Residual Phase
this theory that schizophrenia may be caused by excess of dopamine-dependent neuronal activity in the brain
Dopamine Hypothesis
these class of meds lower brain levels of dopamine by blocking dopamine receptors (e.g. chlorpromazine or haloperidol)
neuroleptics
aka hebephrenic schizophrenia. onsets before age 25. affect is flat or grossly inappropriate
disorganized schiz
schiz that is manifested by stupor or excitement
catatonic schiz
a type of "posturing" or voluntary assumption of bizarre positions
waxy flexibility
_______is manifested by extreme psychomotor agitation
catatonic excitement
SCHIZ characterized by presence of delusions of persecution or grandeur and auditory hallucinations of a single theme
paranoid schizophrenia
schiz that does not meet the criteria of any of the subtypes
undifferentiated schiz
in this schiz, there is continuing evidence of the illness although there are no prominent psychotic symptoms
residual schizophrenia
schiz with the presence of characteristic symptoms combined with the mood disorders (depression or mania)
Schizoaffective disorder
characterized by a sudden onset of psychotic symptoms that may or may not be preceded by a sever psychosocial stressor. lasts at least 1 day but less than a month
Brief Psychotic disorder
onset of prminent psychotic symptoms within 4 weeks; confusion or perplexity at the height of the psych episode; good premorbid social occupational functioning; absence of blunted or flat affect
shizophreniform disorder
characterized by the presence of one or more nonbizarre delusions that persist for at least a month; behavior is not bizarre
delusional disorder
the individual believes that someone usually of a higher status is in love with him or her
erotomanic type
individuals that have irrational ideas regarding their own worth, talent, knowledge or power
grandiose type
individual centers on the idea that the sexual partner is unfaithful
jealous type
individual believes that he is being spied on, poisoned, drugged, harassed, etc.
persecutory type
individual believes that he has some physical defect, disorder or disease
somatic type
essential feature is called "folie a deux" where delusional thinking is imposed on another passive partner
shared psychotic disorder
hallucinations and delusions are attributed to a general medical condition
psychotic disorder due to a general medical condition
hallucinations and delusions are attributable to the effects of a substance
sunstance induced psychotic disorder
_____are false personal beliefs that are inconsistent w/ the person's intelligence or cultural background
delusions
"The FBI has bugged my rooms and intends to kill me"
Delusion of persecution
" I am Jesus Christ"
Delusion of Grandeur
I am being talked about; someone is trying to send me a message through the TV
delusion of reference
Individual believes certain objects or persons have control over his or her behavior
Delusion of control or influence
The doc says I'm not pregnant but I know I am
Somatic Delusion
individual has a false idea that self or part of self, others or the world is nonexistent
Nihilistic delusion
Excessive demonstration of religious behavior
religiosity
extreme suspiciousness of others, their actions, or perceived intentions
paranoia
common in children; believes that thoughts and actions have control over things
magical thinking
thinking characterized in speech in which ideas shift from one unrelated subject to another
associative looseness
inventing of new words that are meaningless to other but have symbolic meaning to the psychotic person
neologisms
individual punches the ground when you said "alright, hit the road"
Concrete thinking
choice of words is governed by sounds
clang associations
random words put together without any logical explanation
word salad
individual is delayed in reaching the point of a communication because of unnecessary and tedious details
circumstantiality
individual never reaches the point of conversation; unrelated topics are introduced
tangentiality
refusal to speak
mutism
individual persistently repeats the same word or idea in response to different questions
perseveration
_____are false sensory perceptions not associated with real external stimuli
hallucinations
the sensation that something is crawling under the skin
formication
false perception of taste
gustatory hallucination
misperceptions or misinterpretations of real external stimuli
illusions
_____describes the behavior associate with an individual's feeling state or emotional tone
affect
at a funeral, individual laughs
inappropriate affect
individual appears to be void of emotional tone
bland or flat affect
individual shows an indifference to or disinterest in the environment
apathy
repeating of words an individual hears
echolalia
imitation of movement by others
echopraxia
a sense of seeing oneself from a distance
depersonalization
______ has to do with impairment in the ability to intiate goal-directed activity
avolition
refers to the existence of opposite emotions toward the same object, person, or situation
emotional ambivalence
focusing inward on a fantasy world, while distorting or excluding the external environement
autism
untidy; lack of personal hygiene
deteriorated appearance
a deficiency of energy
anergia
assuming bizarre inappropriate postures
posturing
common psychomotor behavior of schizophrenics characterized by back and forth motions
pacing and rocking
inability to experience pleasure
anhedonia
____is the retreat to an earlier level of development
regression
a diminution or loss of normal functions; evidence by structural brain abnormalities
negative symptoms
excess or distortion of normal functions; associated with normal brain structures
positive symptoms
a withdrawal inward into one's own fantasy world
autism
does not talk
mutism
stops talking in mid-sentence, tilts head to side and listens
auditory hallucinations
If the FBI finds me here....
persecutory delusion
Get by for anyone just to answer fortune cookies
word salad
Prays, kneels and sings praise the Lord
religiosity
I'm going to the circus. Jesus is God. The cops are here
associative looseness
Laughs when told his mother has died
Inappropriate affect
"they are trying to poison me"
paranoia
If we sweep at night, we are sweeping away good fortune
magical thinking
I'm going to buy me a sprongle
neologism
test test test, I do not jest; we got no rest
clang association
still assumes the position of being taken a blood pressure reading which occured 15 minutes ago
waxy flexibility
An adult thumbsucks after spilling his drink on the floor
regression
When I speak, the whole world listens
delusion of grandeur
type of dementia that exhibits a fluctuating pattern of deterioration
v.dementia
Med for dementia to enhance circulation in the brain
Cyclantelate (cyclan)
priority nusing diagnosis for v.dementia
risk for trauma