Mental Health- Test 2 Chapter 17

Front 1

Cognitive Disorders

-Interventions for patients with cognitive disorders are: (3)

Back 1

focused on protecting patient dignity,

preserving functional status, &

promoting well-being

Front 2

Delirium:
-characterized by:
-when does it develop?

Back 2

a disturbance of consciousness and a change in cognition
-that develop over a short period of time

Front 3

Delirium:

comorbidity

-when would recovery occur?

Back 3

always secondary to another physiological condition and is a transient disorder (short lasting)

-if the underlying condition is corrected, complete recovery should occur


-secondary to medical conditions

Front 4

Delirium:

major causes are: (3)

Back 4

-nervous system diseases, (alzheimers, MS, parkinsons, muscular distrophy, stroke, brain cancer/tumors, head ache)

systemic disease (cardiac failure) --hypertension, diabetes, AIDS, arthritis, MS

and either intoxication or withdrawal from a chemical substance

Front 5

Delirium:

-can occur in children but more frequently in older adults – what are the common causes in an older adult?

Back 5

surgery,
introduction of meds,
UTIs,
cerebrovascular disease,
CHF,
pneumonia,
fevers

PICS FUC

Front 6

Delirium:

-factors that predispose someone to delirium: (3)

Back 6

existing cognitive impairment (esp on admission to hospital),

low functional autonomy,

polypharmacy (esp. benzodiazepines, narcotic analgesics, anticholinergics)

Front 7

Delirium:

treatment:

Back 7

-entire medical team need to determine what the underlying cause is and treat it, then delirium will resolve

Front 8

Delirium:

onset?
etilogy?

Back 8

-abrupt onset (happens suddenly)
-always something that causes it to happen

Front 9

Delirium / Assessment

-pts with delirium may appear withdrawn, agitated, or psychotic.
-what is another symptom they may experience?

Back 9

-sundowning –symptoms and problem behaviors become more pronounced in the evening (can occur in dementia and delirium)

Front 10

Delirium:

-how is their ability to focus?
-what may the nurse have to do?

Back 10

-the ability to focus, sustain, or shift attention is impaired,




questions may be repeated

Front 11

Delirium:
-diffiiculty with what?

-when do disorentation and confusion the worst?


what makes the patient very fearful?

Back 11

-difficulty with orientation (usually intact to the extent of one’s identity)
-disorientation and confusion are a lot worse at night and early morning


disorentation

Front 12

Delirium:
nursing assessment includes observations of

Back 12

-1) cognitive and perceptual disturbances,
2) physical needs
3) moods and physical behaviors

Front 13

Delirium:

-4 cardinal features

Back 13

-acute onset
-fluctuating course (there may be periods during the day where their LOC or orientation is intact and other moments where it is not)
-inattention (can’t tend to what your saying) thinking is disorganized
-consciousness is disturbed (hypervigilant, agitated, very alert, lethargic)

Front 14

Delirium:

-main emotional experience is

Back 14

fear

Front 15

Delirium:

what does anything going on in the enviornment cause?

Back 15

-anything going on in the envt causes an exaggerated response

Front 16

Delirium:

illusions, hallucinations, delusions - what is common?

Back 16

-illusions are common (telephone cord is a snake)

-hallucinations (visual hallucinations –schizo=auditory)

Front 17

Delirium:Cognitive and Perceptual Disturbances

give example of each

Back 17

-cognitive: memory deficits


-perceptual: perception is the processing of information about one’s internal and external envt (illusions and hallucinations are ex)

Front 18

Delirium:Cognitive and Perceptual Disturbances

false sensory stimuli –

Back 18

hallucinations

Front 19

Delirium:Cognitive and Perceptual Disturbances

errors in perception of sensor stimuli (the stimuli is a real object in the envt but it is misinterpreted, usually as an object of the patient’s projected fear) can be explained and clarified

Back 19

illusion

Front 20

Delirium:Cognitive and Perceptual Disturbances

Hallucinations
-2 most common

Back 20

visual hallucinations are common in delirium and tactile hallucinations may also be present –ex: seeing spiders crawling over the bed, or feeling bugs crawling on their bodies (auditory hallucinations occur more often in schizophrenia)

Front 21

Delirium:Cognitive and Perceptual Disturbances

-delirium pts are most often aware that something is very wrong “my thoughts are all jumbled”
True or False

Back 21

true

Front 22

Delirium: Physical needs
-the person with delirium has trouble processing stimuli in the environment and confusion magnifies the problem, nurses should make the physical environment as

Back 22

simple and clear as possible (clocks and calendars can help w/ orientation to time) (eyeglasses, hearing aids, lighting can help interpret the envt more accurately

Front 23

Delirium: Physical needs -autonomic signs are present, such as:

Back 23

(tachycardia, sweating, flushed face, dilated pupils, elevated BP) are often present

Front 24

Delirium: Physical needs

hypervigilance, which means?

Back 24

-hypervigilance (pts are extraordinarily alert, eyes constantly scan the room, difficulty falling asleep or may be actively disoriented and agitated throughout the night)

Front 25

Delirium: Physical needs

the nurses 2 goals are:

Back 25

-safety is a priority (restraint can be necessary) for months they can remember being tied down for months. so we want to restrain as the last resort. (delirium)
-monitoring that anxiety and trying to keep it at a level where physical behavior of agitation is not pronounced and safety is not a risk

Front 26

Delirium: Physical needs

what is 1 way the nurse can lower anxiety?

Back 26

- meet with the pt on a regular basis (not when they are totally out of it) they can help reduce anxiety

Front 27

Delirium
-in finding the underlying cause, what should the nurse make sure to check?

Back 27

- medications need to be assessed b/c they can cause delirium (interactions, new medications)

Front 28

Delirium: Mood and Physical Behaviors

tell me about their mood swings and physical behaviors?

Back 28

-individuals moods and physical behaviors may change w/in a short period (moods may swing back and forth among fear, anger, anxiety, euphoria, depression, apathy)

Front 29

Delirium: Mood and Physical Behaviors

what is often accompanied by physical behaviors associated with feeling states

Back 29

–liable moods

Front 30

Communication w/ someone who is delirious

-how should you approach them?
-what should you say?

Back 30

-approach pt from the front, they need to see you

-say their name “john” each time you are initiating contact

-let them know who you are “I’m amy, I’m your nurse”

Front 31

Communication w/ someone who is delirious

-what should you always inform them of?

-what tone of voice should you use?

Back 31

-inform them of what’s going to happen “I am going to take your BP”

-maintain a clear, calm, low voice, use as few words as possible (they can’t take in much)

Front 32

Diagnosis of delirium patient

-people can perceive the envt in a distorted way and objects are often misperceived
-people and objects may be misinterpreted as threatening or harmful and pts can act on these misinterpretations

(main issue is ________)

Back 32

safety
---what else is always present???


RISK FOR INJURY

Front 33

Outcomes of delirium patient

overall outcome is that the delirious pt will

Back 33

-return to the premorbid level of functioning

Front 34

Delrium
-is COMPELTE recovery possible?

Back 34

-if the underlying disorder is corrected, complete recovery is possible.

Front 35

Delrium

if the underlying disorder is not corrected and persists, what can result?

Back 35

irreversible neuronal damage can occur

Front 36

Delirium
-nursing concerns/interventions can center on:

Back 36

-preventing physical harm due to confusion, aggression, electrolyte and fluid imbalance
-identifying the cause
-eradicate the underlying cause
-relieve distress
-acute delirium pt should never be left alone

Front 37

Evaluation
-long term outcome criteria for pt experiencing delirium include
(3)

Back 37

-pt will remain safe
-pt will be orientated to time place and person by discharge
-underlying cause will be treated and ameliorated

Front 38

Interventions for delirium management

-assist with needs related to:

-what about the envt/stimuli

-how many nurses should meet with the pt?

Back 38

nutrition, elimination, hydration, & personal hygiene

remove stimuli that create misperception (pictures/tv)


meet with the pt 1 on 1 (family too)

Front 39

-defined as:

progressive deterioration of cognitive functioning and global impairment of intellect with no change in consciousness

Back 39

dementia

Front 40

Dementia

-manifested by difficulty with (3)

Back 40

memory, thinking, comprehension

Front 41

-______ is the most common cause of dementia in older adults

Back 41

Alzheimer’s disease

Front 42

-defined as:

a progressive brain disorder marked by impaired memory and thinking skills

Back 42

Alzheimer’s disease

Front 43

-defined as:

marked by progressive deterioration in intellectual functioning, memory, ability to solve problems and learn new skills, decline in the ability to perform ADL

Back 43

-dementia --

Front 44

-defiend as:

a progressive deterioration of personality accompanied by impairment in judgment

Back 44

dementia

Front 45

dementias can be classified as primary or secondary

what is primary?

Back 45

-primary is irreversible, progressive, and not secondary to any other disease

-Alzheimer’s and vascular dementias are primary, progressive, and irreversible

Front 46

dementias can be classified as primary or secondary

what is secondary?

Back 46

-occurs as a result of some other pathological disease (metabolic, nutritional, neurological)

Front 47

primary or secondary dementia

-Alzheimer’s

Back 47

primary

Front 48

primary or secondary dementia

vascular dementias

Back 48

primary

Front 49

primary or secondary dementia

AIDS related dementia is an example

Back 49

secondary

Front 50

primary or secondary dementia

-other dementias can result from viral encephalitis, pernicious anemia, folic acid deficiency, and hypothyroidism

Back 50

secondary

Front 51

primary or secondary dementia
-korsakoff’s syndrome, caused by thiamine (vit b) deficiency, which can be associated with prolonged, heavy alcohol ingestion

Back 51

secondary

Front 52

-majority of dementia is Alzheimer’s --2nd kind is

Back 52

cerebrovascular (strokes in the brain)

Front 53

Alzheimer’s Disease

etiology:

Back 53

unknown


-biological factors: neuronal tangles
-genetic factors: family history
-envt factors: increasing age, down syndrome, and head injury, cardiovascular disease (high BP, high cholesterol, low levels of vitamin folate)

Front 54

- four defense mechanisms that people with early Alzheimer’s use in an attempt to cover their loss of memory in order to protect their self-esteem are:

Back 54

-denial –
-confabulation-
-perseveration-
-avoidance of questions-

Front 55

Alzheimer’s Disease defense mechanisms

denial is the _______

Back 55

-–unconscious protective defense against the terrifying reality of losing one’s place in the world

Front 56

Alzheimer’s Disease defense mechanisms

avoidance of questions to maintain:

Back 56

-- to maintain self-esteem unconsciously in the face of severe memory deficits

Front 57

Alzheimer’s Disease defense mechanisms

perseveration, is the:

Back 57

repetition of phrases or behavior, seen with stress,

Front 58

Alzheimer’s Disease defense mechanisms

confabulation, is the:

Back 58

creation of stories or answers in place of actual memories to maintain self esteem, it’s unconscious

Front 59

Alzheimer’s Disease defense mechanisms

-when someone is losing their memory/thinking clearly/make decisions, it’s a terrifying experience when they know it’s happening. .therefore they engage in denial for what reason??

Back 59

for fear of losing their mind

Front 60

Alzheimer’s Disease defense mechanisms

make something up / making up an answer. it’s not lying. it’s not conscious.

Back 60

confabulation

WHY DO THEY DO IT???



it’s a way to be able to answer and protect their self-esteem.

Front 61

Alzheimer’s Disease defense mechanisms

stuck on 1 thought/concept/word and you’re repetitive about it. can’t let it go.

--that intensifies under stress

Back 61

-perserveration:

Front 62

Alzheimer’s Disease defense mechanisms

avoidance of questions: why do they do this?

Back 62

cuz they can’t answer them, they might change the subject or divert you

Front 63

primary vs secondary dementia

slow onset

Back 63

primary

Front 64

primary vs secondary dementia

marked by a number of deficits
-inability to do ADLs
-memory
-judgement
-mood and personality changes

Back 64

primary

Front 65

primary vs secondary dementia

irreversible

Back 65

primary

Front 66

cardinal symptoms observed in AD/dementia

amnesia

Back 66

-or memory impairment: initially the person has difficulty remembering recent events..gradually deterioration progresses to include both recent and remote memory

Front 67

cardinal symptoms observed in AD/dementia

aphasia:

Back 67

- loss of language ability (initially the person has problems finding the correct word, then is reduced to a few words, and finally reduced to babbling)

Front 68

cardinal symptoms observed in AD/dementia

apraxia:

Back 68

-: loss of purposeful movement in the absence of motor or sensory impairment (apraxia of gait, person loses the ability to walk) apraxia of dressing, person is unable to put clothes on properly

Front 69

cardinal symptoms observed in AD/dementia

agnosia:

Back 69

- loss of sensory ability to recognize objects (lose ability to recognize familiar sounds (auditory agnosia=such as the door bell, telephone, car horn, and can extend to glass, pencil, toothbrush, even their own body parts or family members

Front 70

cardinal symptoms observed in AD/dementia

disturbances in executive functioning:

Back 70

- (planning, organizing, abstract thinking) –degeneration of neurons in the brain –they are cells that contain memories receive sights and sounds, cause hormones to secrete, produce emotions, command muscles into motion

Front 71

cardinal symptoms observed in AD/dementia

loss of language ability (maybe in the beginning they have a hard time finding the right word but in the later stages, the ability to communicate is gone (might be mute)

Back 71

aphasia

Front 72

cardinal symptoms observed in AD/dementia

not able to dress themselves, walk independently

Back 72

apraxia

Front 73

cardinal symptoms observed in AD/dementia

please pass be the broccoli is what I would say / person with dementia would say “please pass me that thing that looks like a tree” they may want cranberry juice “please pass me that red stuff I like to drink”

Back 73

agnosia

Front 74

cardinal symptoms observed in AD/dementia

not able to do finances

Back 74

disturbance in executive functioning

Front 75

Diagnostic tests for dementia

-________needs to be assessed for

Back 75

depression

Front 76

Diagnostic tests for dementia

-depression occurs in the ____ stage
-depression is common in the ____stage
-after the ______stage, the persons mind is too far gone to feel the loses the deperssion

Back 76

-depression occurs in the 1st stage
-depression is common in the 2nd stage
-after the 2nd stage, the persons mind is too far gone to feel the loses the depression

Front 77

Diagnostic tests for dementia


-_________is the most common disorder that gets missed when someone has dementia

Back 77

-depression is the most common disorder that gets missed when someone has dementia

Front 78

Guidelines for communication w/ people with dementia

-when you talk with a person, choose a topic that is meaning full for them

what is a key way to communicate with patients?

Back 78

(reminiscence is key way to communication with pts)

-playing music from their era
-TV or movies from their era

Front 79

Guidelines for communication w/ people with dementia

what should the nurse avoid?

Back 79

-avoid orientation, ?s, and probing

Front 80

Guidelines for communication w/ people with dementia

-when they are verbally aggressive, what should the nurse do?

Back 80

distract them and talk about a familiar object


going along with validation or going along* (lets say you want the pt to eat in the dining room with other people but the pt becomes agitated and says he needs to get dressed b/c I have my daughters wedding) what do you do? “lets eat and then go get dressed” ----you go along with what the pt is saying, validating w/ what they are experiencing/thinking and do not challenge them. maybe you could say “how nice you are going to your daughters wedding! lets get something to eat and then go get dressed”

Front 81

Managing behavior / dementia

-______is more useful intervention when someone has dementia

Back 81

distraction

-distract them from w/e seems to be upsetting them

Front 82

Managing behavior / dementia

what is the nurses motor
"going along with _____ and:

-limit what?

-don't take them where?

Back 82

-going along with validation and going along

-limit the # of choices (don’t overwhelm them)

-don’t take them into an unfamiliar situation (keep it as familiar as possible)

Front 83

Managing behavior / dementia


agitation and combativeness is often managed with:

Back 83

-medication (any antipsychotics)

-recent research talks about sudden cardiac death and that a whole cardiac workup is necessary

Front 84

dementia

-any ________ can present a risk of cardiac death to the elderly (3 deaths for every 1000 pts ..the higher the dose, the higher the risk of sudden death)

Back 84

antipsychotic

Front 85

dementia

-they don’t find that the cardiac risks are relative to children (_______ is what needs to be controlled because your setting them up for cardiac death)

Back 85

weight gain

Front 86

Alzheimer’s

is progressive and often leads to death (3 ex)

Back 86

-it’s progressive
-often leads to death (malnutrition, infection, choking)

Front 87

Alzheimer’s

-_____ stage of Alzheimer’s is the hardest for family members

Back 87

-last stage of Alzheimer’s is the hardest for family members

Front 88

Alzheimer’s

-main intervention:

Back 88

preserving their dignity
HOW DO YOU DO THAT??





(not asking ?s that they can’t answer)

Front 89

Alzheimer’s
Implementation (2)

Back 89

-positive regard
-maintaining dignity

Front 90

Health teaching and health promotion of cognitively impaired patients/families

-family members need to know what to expect regarding the course of the disease


- the most important learning need that families have who are caring for family a member with dementia:

Back 90

where to get help (professional counseling and education regarding the process and progression of the disease) **test**

Front 91

Health teaching and health promotion of cognitively impaired patients/families

-research says what exercise can help prevent dementia?

-what other things can you tell the family to do to prevent dementia?

Back 91

-240 minutes (4 hours) a week of aerobic exercise a week can prevent dementia


-memory strategies when older

Front 92

Dementia & Delirium

-priority nursing diagnosis is

Back 92

“risk for injury”

Front 93

Dementia & Delirium


-nursing diagnosis for family?

Back 93

-what about for family for dementia or Alzheimer’s “knowledge deficit about the disorder” or “caregiver role strain”

Front 94

Pharmacological
AD
-is there a cure?

Back 94

-no cure for AD
-5 drugs approved by the FDA to slow the progression

Front 95

-deficiency of ___________ has been linked to AD, medications aimed at preventing its breakdown

what medication has been developed to help?

Back 95

acetylcholine





(cholinesterase inhibitors)All cholinesterase inhibitors have the positional to cause nausea, diarrhea, and vomiting.

Front 96

Pharmacological / AD

-all the dedication is aimed at increasing __________

Back 96

-all the dedication is aimed at increasing Acetylcholine

Front 97

-antipsychotics (conventional and atypical) are no longer indicated for dementia-related psychosis b/c they are associated with what?


-overall outcome for treatment are to promote (what 2 things)

Back 97

increased risk of death

the persons optimal level of functioning and to delay further regression whenever possible