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29 Cards in this Set

  • Front
  • Back
Cognition refers to all human thought processes affecting...?
1. Memory
2. Comprehension
3. Judgment/reasoning
4. Affect
5. Attention/concentration
6. organization
What are some causes of impaired cognition?
Head trauma
Organ failure
Metabolic disturbances
Other: stress, fever, pain, sleep deprivation, environmental

What are the onsets?
Delirium: rapid development

Dementia: gradual and insidious development

What are the durations?
Delirium: Brief duration of 1 month or less

Dementia: Long, with progressive deterioration

What is the course?
Delirium: More nocturnal exacerbations

Dementia: Stable progression of symptomatology
What are cognition changes found in delirium?
aimless activity
memory deficit
inability to pay attention
incoherent speech
perceptual disturbances (illusions)
What are some examples of delirium?
AZ pt with severe infection
metabolic disturbances
postop surgery
hypoxic states
fever (children)
Alcohol intoxication/withdrawl
What are the stages of AZ?
1. Forgetful/mild (pt knows)
2. Confused/moderate (others know)
3. Demented/Severe (totally dependent)
What are the characteristics of the forgetful/mild stage of AZ?
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
What are the characteristics of the confused/moderate stage of AZ?
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)
What are the characteristics of the demented/severe stage of AZ?
1. Can't recognize caregiver
2. Verbal and motor skills lost (bedridden, needs same routine)
What are the risk factors for Vascular Dementia?
Cerebrovascular disease (blood flow blockage)
What are the characteristics of Lewy Body Dementia?
-Has similar symptoms to both AZ &PD
-Gait problems
-violent/aggressive behavior
What is Huntington's disease?
-Hereditary; autosomal dominant chromosone 4
-Adult onset, progressive
-Wasting of cerebral cortex and basal ganglia
-Mostly problems with executive functioning
What are the characteristics of Huntington's disease?
-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)
What are the early s/s of AIDs Dementia?
-depression and behavioral changes
-decreased concentration and organizing thoughts
-psychomotor retardation
-weakness in lower extremities (virus increases in basal ganglia)
What are the late s/s of AIDs dementia?
What are some treatments for demented conditions?
- Medical work up (labs & cognitive tools)
- CT
What some cognitive tools used to treat demented conditions?
- MSA (mini mental status assessment)
- clock test
- specific dementia tests
What are some nursing care for communication with a demented pt?
-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?
How to prevent behavior problems in demented pts?
-reinforce appropriate behavior
- balance sleep and rest
- prevent fatigue
- regular exercise
- use of music
What are some ways to keep the mind healthy in the nursing home?
- fine and gross motor activities (OT, PT)
- celebrate occasions
- day room activities
- Mind stimulating activities i.e. bridge, crossword puzzles, games
What are some basic care needs that must be met?
- 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
Fluctuating behavior
agitated, apathetic, wanders
difficulty performing motor tasks i.e. brushing teeth, combing hair
Disturbance in executive functioning
planning, organizing and sequencing information
language disturbance; unable to find the word they want to use
failure to recognize or identify objects and sounds
What are meds used to treat dementia?
- Antiviral (HIV)
- Anticonvulsants (Depakote, Tegretrol) - used for impulsivity, agressive/assulting behavior
- Antipsychotics (Risperdal)
- Cholinesterase Inhibitors (Aricept, Exelon patch, Razadyne) decreases ACh