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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
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delirium
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symptoms include diff. in sustaining and shifting attention
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delirium
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s/s include impaired reasoning ability and impaired level of consciousness; impaired sleep wake cycle
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delirium
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t or f: delirium begins abruptly
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true
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duration of delirium lasts is brief: period of ___________
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1 week; rarely more than one month
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t or f : delirium may transition into a more permanent cognitive disorder e.g. dementia
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true
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delirium classified accdg to physiological consequences of hypoxia, hypercarbia and hypoglycemia, F/E imbalances, thiamine deficiency, head trauma
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delirium due to med. condition
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delirium that is attributed to medication s/e or exposure to toxin
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substance induced delirium
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delirium d/t cannabis, cocaine and hallucionogens
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subst- intoxication delirium
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loss of previous levels of cognitive, executive and memory funciton in a state of full alertness
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dementia
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dementia, such as AD in w/c the dementia is the major sign of some organic brain disease
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primary dementia
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caused by or r/t another disease or condition, such as HIV
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secondary dementia
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3 characteristics of dementia
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a) impaired abstract thinking, judgment and impulse control
b) disregarding social conventions c) personal hygiene neglect |
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this language problem happens in severe forms of dementia
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aphasia
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common sign of dementia
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personality change
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causes of reversible dementia
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CVA, depression, s/e of meds, nutritional deficiencies
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t or f : most clients have reversible dementia
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f: most clients dementia have irreversible progressive course
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inability to carry out motor activities despite intact motor function
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apraxia
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accounts to 60 to 80 percent of all dementia cases
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AD
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no apparent decline in memory
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stage I dementia
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PT becomes aware of the intellectual decline and may feel shame; s/s not observed by others
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Stage II: forgetfullness
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interference w/ work and becomes noticeable to workers; gets lost driving; interrupted concentration; unable to recall names and words
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stage III: mild cognitive decline
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forgets major events and personal history: confabulation occurs
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stage IV: mild to moderate cognitive decline: CONFUSION
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impaired ADLs, forgets close relatives; disoriented to place and time
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Stage 5 : early dementia
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name of spouse forgotten; recent life events; ADLs need assistance; urinary and fecal incontinence
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stage 6: middle dementia
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bedfast and aphasic; decubiti; contractures
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stage 7: late dementia
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creating imaginary events to fill in memory gaps
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confabulation
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most common CODs on dementia
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infection, sepsis, aspiration
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dementia that is slow and insidious; progressive and deteriorating
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dem. of Alzheimers type
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t or f : exact cause of AD is unknown
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true
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what does glutamate do to AD brains?
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leads to overstimulation of NMDA receptors, flooding brain with calcium that results to cell death
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feature characteristic of AD brain
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plaques and tangles
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what are plques made of ?
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beta-amyloid protein
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what are tangles made of?
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tau protein
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3 main causes of AD
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a) Ach alteration
b) plaques and tangles c) head trauma d) genetic factors |
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group of people who are most likely to develop AD
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ppl with down syndrom: extra 21st chromosome
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dementia by significant cerebrovascular disease
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vascular dementia
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how is V.dementia diff from AD
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abrupt onset and highly variable course: occurs in STEPS
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common psycho-symptom of V.dementia
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anxiety from irregular patterns
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common neuro signs w/ V. dementia
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weakness of the limbs; small stepped gait ; difficulty speaking
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etiology of V. dementia
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impaired circulation in the brain
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individual with v dementia and AD
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mixed dementia
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repeated head trauma causing dementia
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dementia pugilistica
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s/s of dementia due to head trauma
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emotional lability; dyarthria, ataxia, and impulsivity
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60% of Parkinsons patients have this
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dem. due to pd
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disease that is transmitted by the Mandelian dominant gene w/ damage to basal ganglia and cerebral cortex.
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dem due to Huntington's
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a profound state of dementia char. by ataxia, ddepression, twitching of the limbs and facial muscles
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dem due to huntington's
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median duration of dem due to huntingtons
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21.4 years
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the initial symptom is personality change; resulting from atrophy in the frontal and temporal lobes
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Pick's disease
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caused by a prion; death w/in a year; involuntary movements; muscle rigidity and ataxia
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dem due to Creutzfeldt-jakob disease
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other medical conditions causing dementia
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hypoglycemia, hypothyroidisnm, pulmonary disease, cardio and hepatic and renal insufficiency, f/e imbalances, frontal temporal lobe lesions, systemic infections; uncontrolled epilepsy, MS
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meds inducing persisting dementia
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anticonvulsants
intrathecal methotrexate |
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Toxins inducing persisting dementia
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organophosphates
lead mercury carbon monoxide industrial solvents |
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idiopathic substance presuming to cause dementia; then the diagnosis is...
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Unknown Substance Induced persisting Dementia
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dementia attributable to more than one cause
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Dem due to multiple etiologies
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the inability to recall past experiences. the condition may be permanent or temporary depending on etiology
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Amnesia
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how is amnesia diff. than dementia
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there is no impairment in abstract thinking, or judgment,
no disturbance of higher cortical function and no personality change |
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t or f : the amnesiac may engage in confabulation to fill in memory gaps
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true
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Common s/s of amnesia
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apathy, lack of initiative and emotional blandness
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onset of s/s on amnesiacs (speed)
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acute or insidious
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how is amnesia diagnosed
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transient (< 1 month)
chronic (> 1 month) |
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gen. medical conditions associated with amnesia
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head trauma
CVA HSV neoplastic disease cerebral anoxia poorly controlled IDDM surgery in the brain |
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transient amnestic syndromes may occur from ........
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CVA, arrhythmias, migraine, thyroid disorders, epilepsy
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meds that induce persisting amnesia
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anticonvulsants
intrathecal methotrexate |
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toxins that induce persisitng amnesia
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lead
mercury co organophosphates industrial solvents |
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nursing assessment on patients with cognitive or neurological disorders should include 5 areas of concern
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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 |
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what is pseudodementia
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depression
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Dem or dep?
slow onset |
dementia
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dem or dep? intact attention and concentration
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depression
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dem or dep? consistent poor performance of tasks but struggles to perform
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dementia
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dem or dep? little effort on tasks
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depression
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dem or dep? appears unconcerned regarding distress
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dementia
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dem or dep? communicates distress regarding affective behavior
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depression
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dem or dep? unchanged appetite
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dementia
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dem or dep? diminished appetite
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depression
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dem or dep:? no wandering; A and O intact
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depression
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t or f: evaluation of client with cognitive disorders is based on a series of long term goals instead of short term goals
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False: outcomes must be measured in terms of slowing down the problems rather than stopping or curing them
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what is the first step in treatment of delirium
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determination and correction of the underlying causes
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dem or delirium? client may require mechanical or chemical restraint due to agitation and aggression
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delirium
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what's the percentage of dementia patients have a potentially reversible condition
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10 to 15 percent: hypothyroidism, brain tumors, normal pressure hydrocephalus
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ACE inhibitor that's been shown to enhance cognitive functioning in individuals with mild to moderate AD
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Antilirium (physostigmine)
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most commonly used to combat behaviors associated with dementia, although carries EPS risk
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Haloperidol (haldol)
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meds that inhibit acetylcholinesterase
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Tacrine, Donepezil, Rivastigmine, Galantamine
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med for moderate to severe AD
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Namenda (memantine)
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in AD there is a continous influx of _____________ which results in flooding of ______________ in the nerve cells leading due cell death
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glutamate: calcium
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two meds to slow progression of AD and inhibit acetylcholinesterase
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Namenda and Donepezil
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antipsychotic meds for clients with dementia
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Risperidone, Quetiapine, Ziprasidone, Olanzapine
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approx. ___________% of people with _____ suffer from depression
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25: AD
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med good for depression esp. at bedtime
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trazodone
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meds to treat severe apathy
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dopaminergic agents such as Methylphenidate, Amantadine, Bromocriptine, and bupropion
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what's the significant cause of anxiety for clients with early stages of dementia
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progressive loss of mental functioning
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least toxic and most effective of the antianxiety meds
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benzodiazepines:
Oxazepam Diazepam (Valium) Lorazepam Alprazolam |
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elderly individuals exhibit paradoxical excitement and confusion with these antianxiety drugs
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barbiturates
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___________problems are common in clients with dementia and intensify as the disease progresses
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sleep
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meds for sleep problems
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benzodiazepines: Dalmane, Restoril, Triazolam
nonbenzodiazepines: Ambien, Sonata, and antidepressant Trazodone |
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objectives of care for the client experiencing an acute phase of neurological disorder
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eliminate etiology
promoting client safety return to highest possible functioning |
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objectives of care for the client with a chronic phase of neurological disorder
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preserving the dignity
promoting deceleration of s/s maximize functional capabilities |
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identify: duration of the disorder is commonly brief
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Delirium
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identify: client uses confabulation to hide cognitive deficits
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Amnestic Disorder
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identify: can be caused by a series of small strokes
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dementia
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identify: commonly reversible
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delirium
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identify: denial that a problem exists is common
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amnestic disorder
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identify: reversible in 10-15% if treated before permanent brain damage
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dementia
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identify: severe migraine headache can cause transient symptoms
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amnestic disorder
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identify: personality change is common
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dementia
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identify: illusions and hallucinations are common
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delirium
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identify: symptoms can occur as a result of cocaine
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delirium
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identify: s/s can occur as a result of ETOH withdrawal
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delirium
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=identify: high concentrations of aluminum in the brain have been implicated in the etiology of this disorder
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dementia
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identify: transient symptoms can occur after ECT therapy
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amnestic disorder
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dementia due to hypertension
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v. dementia
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v. dementia exhibits___________________
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a fluctuating pattern of deterioration STEPS
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Which nursing diagnosis is a priority for pts with v. dementia
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Risk for trauma
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which is an example of an antidepressant that is given to patients with v. dementia
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Amitriptyline
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what is the trade name of amitriptyline
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Elavil
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is a process of knowing, including perception , memory and judgement
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cognition
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a state of mental confusion / excitement
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delirium
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the lobe of the brain that is in charge of abstract thinking
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parietal lobe
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are dementias irreversible?
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most of them
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what is DAT
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dementia of the Alzheimer's type
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when a person has dementia due to HIV, what happens when the person develops aids
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patient dementia becomes worse
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aka pre-senile dementia characterized by frontal and temporal lobe atrophy
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dementia due to Pick's Disease
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common among older people; done to preserve self esteem; a lot of embellishment
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Confabulation
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is a process of knowing, including perception , memory and judgement
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cognition
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a state of mental confusion / excitement
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delirium
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the lobe of the brain that is in charge of abstract thinking
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parietal lobe
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are dementias irreversible?
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most of them
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what is DAT
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dementia of the Alzheimer's type
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when a person has dementia due to HIV, what happens when the person develops aids
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patient dementia becomes worse
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aka pre-senile dementia characterized by frontal and temporal lobe atrophy
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dementia due to Pick's Disease
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common among older people; done to preserve self esteem; a lot of embellishment
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Confabulation
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2nd most common dementia;often with higher mortality than alzheimer's
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v. dementia
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most noticeable deficit in the alzheimer's patient upon early onset
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memory loss
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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
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psychosis
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they do not enjoy close relationships and prefer to be loners. cold and aloof. premorbid condition
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Phase I: schizoid personality
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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
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Phase II: prodromal phase
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in the active phase of this disorder, psychotic symptoms are prominent
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Phase III: schizophrenia
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Diagnostic for schiz: continuous signs of disturbance persist for at least _________ months and may include prodromal or residual symptoms
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6 months
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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)
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one (1)
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characterized by periods of exacerbation; usually is followed by an active phase of the illness
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Phase IV : Residual Phase
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this theory that schizophrenia may be caused by excess of dopamine-dependent neuronal activity in the brain
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Dopamine Hypothesis
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these class of meds lower brain levels of dopamine by blocking dopamine receptors (e.g. chlorpromazine or haloperidol)
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neuroleptics
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aka hebephrenic schizophrenia. onsets before age 25. affect is flat or grossly inappropriate
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disorganized schiz
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schiz that is manifested by stupor or excitement
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catatonic schiz
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a type of "posturing" or voluntary assumption of bizarre positions
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waxy flexibility
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_______is manifested by extreme psychomotor agitation
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catatonic excitement
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SCHIZ characterized by presence of delusions of persecution or grandeur and auditory hallucinations of a single theme
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paranoid schizophrenia
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schiz that does not meet the criteria of any of the subtypes
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undifferentiated schiz
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in this schiz, there is continuing evidence of the illness although there are no prominent psychotic symptoms
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residual schizophrenia
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schiz with the presence of characteristic symptoms combined with the mood disorders (depression or mania)
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Schizoaffective disorder
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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
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Brief Psychotic disorder
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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
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shizophreniform disorder
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characterized by the presence of one or more nonbizarre delusions that persist for at least a month; behavior is not bizarre
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delusional disorder
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the individual believes that someone usually of a higher status is in love with him or her
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erotomanic type
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individuals that have irrational ideas regarding their own worth, talent, knowledge or power
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grandiose type
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individual centers on the idea that the sexual partner is unfaithful
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jealous type
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individual believes that he is being spied on, poisoned, drugged, harassed, etc.
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persecutory type
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individual believes that he has some physical defect, disorder or disease
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somatic type
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essential feature is called "folie a deux" where delusional thinking is imposed on another passive partner
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shared psychotic disorder
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hallucinations and delusions are attributed to a general medical condition
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psychotic disorder due to a general medical condition
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hallucinations and delusions are attributable to the effects of a substance
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sunstance induced psychotic disorder
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_____are false personal beliefs that are inconsistent w/ the person's intelligence or cultural background
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delusions
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"The FBI has bugged my rooms and intends to kill me"
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Delusion of persecution
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" I am Jesus Christ"
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Delusion of Grandeur
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I am being talked about; someone is trying to send me a message through the TV
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delusion of reference
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Individual believes certain objects or persons have control over his or her behavior
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Delusion of control or influence
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The doc says I'm not pregnant but I know I am
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Somatic Delusion
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individual has a false idea that self or part of self, others or the world is nonexistent
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Nihilistic delusion
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Excessive demonstration of religious behavior
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religiosity
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extreme suspiciousness of others, their actions, or perceived intentions
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paranoia
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common in children; believes that thoughts and actions have control over things
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magical thinking
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thinking characterized in speech in which ideas shift from one unrelated subject to another
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associative looseness
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inventing of new words that are meaningless to other but have symbolic meaning to the psychotic person
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neologisms
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individual punches the ground when you said "alright, hit the road"
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Concrete thinking
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choice of words is governed by sounds
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clang associations
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random words put together without any logical explanation
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word salad
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individual is delayed in reaching the point of a communication because of unnecessary and tedious details
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circumstantiality
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individual never reaches the point of conversation; unrelated topics are introduced
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tangentiality
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refusal to speak
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mutism
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individual persistently repeats the same word or idea in response to different questions
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perseveration
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_____are false sensory perceptions not associated with real external stimuli
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hallucinations
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the sensation that something is crawling under the skin
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formication
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false perception of taste
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gustatory hallucination
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misperceptions or misinterpretations of real external stimuli
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illusions
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_____describes the behavior associate with an individual's feeling state or emotional tone
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affect
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at a funeral, individual laughs
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inappropriate affect
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individual appears to be void of emotional tone
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bland or flat affect
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individual shows an indifference to or disinterest in the environment
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apathy
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repeating of words an individual hears
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echolalia
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imitation of movement by others
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echopraxia
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a sense of seeing oneself from a distance
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depersonalization
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______ has to do with impairment in the ability to intiate goal-directed activity
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avolition
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refers to the existence of opposite emotions toward the same object, person, or situation
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emotional ambivalence
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focusing inward on a fantasy world, while distorting or excluding the external environement
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autism
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untidy; lack of personal hygiene
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deteriorated appearance
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a deficiency of energy
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anergia
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assuming bizarre inappropriate postures
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posturing
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common psychomotor behavior of schizophrenics characterized by back and forth motions
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pacing and rocking
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inability to experience pleasure
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anhedonia
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____is the retreat to an earlier level of development
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regression
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a diminution or loss of normal functions; evidence by structural brain abnormalities
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negative symptoms
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excess or distortion of normal functions; associated with normal brain structures
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positive symptoms
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a withdrawal inward into one's own fantasy world
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autism
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does not talk
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mutism
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stops talking in mid-sentence, tilts head to side and listens
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auditory hallucinations
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If the FBI finds me here....
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persecutory delusion
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Get by for anyone just to answer fortune cookies
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word salad
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Prays, kneels and sings praise the Lord
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religiosity
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I'm going to the circus. Jesus is God. The cops are here
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associative looseness
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Laughs when told his mother has died
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Inappropriate affect
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"they are trying to poison me"
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paranoia
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If we sweep at night, we are sweeping away good fortune
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magical thinking
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I'm going to buy me a sprongle
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neologism
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test test test, I do not jest; we got no rest
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clang association
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still assumes the position of being taken a blood pressure reading which occured 15 minutes ago
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waxy flexibility
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An adult thumbsucks after spilling his drink on the floor
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regression
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When I speak, the whole world listens
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delusion of grandeur
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type of dementia that exhibits a fluctuating pattern of deterioration
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v.dementia
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Med for dementia to enhance circulation in the brain
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Cyclantelate (cyclan)
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priority nusing diagnosis for v.dementia
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risk for trauma
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