Csn Mental Health Mental Health Of The Elderly And Care Of Clients With Impaired Cognition

Front 1

Cognition refers to all human thought processes affecting...?

Back 1

1. Memory
2. Comprehension
3. Judgment/reasoning
4. Affect
5. Attention/concentration
6. organization

Front 2

What are some causes of impaired cognition?

Back 2

Head trauma
Organ failure
Toxicity
Metabolic disturbances
Medications
Other: stress, fever, pain, sleep deprivation, environmental

Front 3

DELIRIUM VS DEMENTIA

What are the onsets?

Back 3

Delirium: rapid development

Dementia: gradual and insidious development

Front 4

DELIRIUM VS DEMENTIA

What are the durations?

Back 4

Delirium: Brief duration of 1 month or less

Dementia: Long, with progressive deterioration

Front 5

DELIRIUM VS DEMENTIA

What is the course?

Back 5

Delirium: More nocturnal exacerbations

Dementia: Stable progression of symptomatology

Front 6

What are cognition changes found in delirium?

Back 6

disorientation
aimless activity
memory deficit
inability to pay attention
incoherent speech
perceptual disturbances (illusions)

Front 7

What are some examples of delirium?

Back 7

AZ pt with severe infection
metabolic disturbances
drugs
postop surgery
hypoxic states
fever (children)
Alcohol intoxication/withdrawl

Front 8

What are the stages of AZ?

Back 8

1. Forgetful/mild (pt knows)
2. Confused/moderate (others know)
3. Demented/Severe (totally dependent)

Front 9

What are the characteristics of the forgetful/mild stage of AZ?

Back 9

1. Depression
2. Slight recent memory loss, decreased ability to concentrate and make decisions
3. Lack of spontaneity
4. Should be able to complete most MSA

Front 10

What are the characteristics of the confused/moderate stage of AZ?

Back 10

1. Gradual memory (remote) loss and cognitive impairments
2. More inappropriate behaviors (putting milk in cabinet; wandering at night)
3. Self-care deficits-frustrating (may not be able to put on socks)

Front 11

What are the characteristics of the demented/severe stage of AZ?

Back 11

1. Can't recognize caregiver
2. Verbal and motor skills lost (bedridden, needs same routine)

Front 12

What are the risk factors for Vascular Dementia?

Back 12

Cerebrovascular disease (blood flow blockage)
-diabetes
-atherosclerosis
-hypertension

Front 13

What are the characteristics of Lewy Body Dementia?

Back 13

-Has similar symptoms to both AZ &PD
-Gait problems
-Delusions
-violent/aggressive behavior

Front 14

What is Huntington's disease?

Back 14

-Hereditary; autosomal dominant chromosone 4
-Adult onset, progressive
-Wasting of cerebral cortex and basal ganglia
-Mostly problems with executive functioning

Front 15

What are the characteristics of Huntington's disease?

Back 15

-Depression is an early sign (apathy, anxiety, irritability, suicidal, OC traits, impulsivity, psychosis)
-Chorea movements (uncontrolled, involuntary movements with head, trunk and limbs)
-Deficits in executive tasks (attention, concentration, planning, multitasking)

Front 16

What are the early s/s of AIDs Dementia?

Back 16

-depression and behavioral changes
-decreased concentration and organizing thoughts
-psychomotor retardation
-weakness in lower extremities (virus increases in basal ganglia)

Front 17

What are the late s/s of AIDs dementia?

Back 17

-hallucinations
-confusion
-disorientation
-tremors
-seizures
-mutism
-coma

Front 18

What are some treatments for demented conditions?

Back 18

- Medical work up (labs & cognitive tools)
- CSF (HIV)
- CT
-MRI

Front 19

What some cognitive tools used to treat demented conditions?

Back 19

- MSA (mini mental status assessment)
- clock test
- specific dementia tests

Front 20

What are some nursing care for communication with a demented pt?

Back 20

-simple limited choices/sentences; yes or no
- Allow time to respond (may have receptive or expressive aphasia, alexia, or agraphia)
- use visual and tactile cues; gesturing
- refer to objects by name (helps w/memory)
- Reminiscence therapy (group that reminiscence on past history)
- Avoid "why" and "don't" questions
-Be friendly, nonthreatening and nonjudgmental/avoid criticism i.e. Lunch is ready vs Do you want to eat now?

Front 21

How to prevent behavior problems in demented pts?

Back 21

-reinforce appropriate behavior
- balance sleep and rest
- prevent fatigue
- regular exercise
- use of music

Front 22

What are some ways to keep the mind healthy in the nursing home?

Back 22

- fine and gross motor activities (OT, PT)
- celebrate occasions
- day room activities
- Mind stimulating activities i.e. bridge, crossword puzzles, games

Front 23

What are some basic care needs that must be met?

Back 23

- Elimination (monitor, keep routine)
- Bathing (room & water temperature)
- Oral care
-Nutrition (don't rush)
-pt at risk for dehydration and malnutrition
-pt at risk for aspiration (thicken foods, look for
pocketed food)
- watch for hoarding of food

Front 24

DEF
Fluctuating behavior

Back 24

agitated, apathetic, wanders

Front 25

DEF
Apraxia

Back 25

difficulty performing motor tasks i.e. brushing teeth, combing hair

Front 26

DEF
Disturbance in executive functioning

Back 26

planning, organizing and sequencing information

Front 27

DEF
Aphasia

Back 27

language disturbance; unable to find the word they want to use

Front 28

DEF
Agnosia

Back 28

failure to recognize or identify objects and sounds

Front 29

What are meds used to treat dementia?

Back 29

- Antiviral (HIV)
-Antidepressants
- Anticonvulsants (Depakote, Tegretrol) - used for impulsivity, agressive/assulting behavior
- Antipsychotics (Risperdal)
- Cholinesterase Inhibitors (Aricept, Exelon patch, Razadyne) decreases ACh