NURS 406 Psychology Test 2_2020 | NURS406 Psychology Test 2_Graded A

NURS 406 Psychology Test 2_2020 Neurocognitive Disorders: - Cognition: conscious mental activity; allows one to be aware of oneself - Thinking, understanding, learning, remembering, attention, problem solving, memory, orientation, etc. Delirium: acute cognitive impairment with multiple causes 1. Info: a. If delirium is acute, you can cure it -- you just need to get to the underlying causes. b. A syndrome NOT a disease c. Short term, REVERSIBLE if underlying cause is identified 3-6 months d. Problem with attention -- they’re going to be “out of it” and it can fluctuate. Moments where they’re lucid, and then they’re all over the place. HIGHLY INATTENTIVE e. ABRUPT ONSET f. Can last for hours or weeks, in others it can last months. Want to look at if they’re on polypharmacy -- could it be from that? g. IT’S AN EMERGENCY. IT’S SERIOUS AND SHOULD BE TREATED AS AN EMERGENCY. HIGH RISK OF MORTALITY IF NOT CAUGHT. h. 1 year mortality as high as 40-50%. Shown as a sign of progression with terminal illness. i. Not as aware of their environment, also has problems with memory and orientation. j. It’s often overlooked or mistaken for dementia or other mental illnesses k. Effects geriatrics more, very common in post op geriatrics l. CATCH IT EARLY TO TREAT AND PREVENT MORTALITY 2. Causes: a. Rapid onset: Head injury could cause delirium (could have a brain bleed which is underlying) b. Slow onset: systemic or metabolic illness (patients that are constipated can retain urine at risk for UTI aka INFECTION) c. We want to think illness and infection, fluid and electrolyte imbalances including hyponatremia, hypoxia and ischemia d. Sensory overload or underload on the environment (example -- no windows, don’t know time) e. Stress 3. Predisposing factors: a. Usually over 65 years old, but can happen at any age b. More common in men c. History of delirium d. Depression e. Sleep deprivation f. Pre-existing cognitive impairment: dementia, brain damage, depression g. Dehydration, malnutrition h. Functional dependence -- dependence with their ADLs (going to the bathroom) i. Visual/and or hearing impairment j. Polypharmacy k. Alcohol/Drug abuse -- people who present with delirium due to alcohol dependence is a TRUE EMERGENCY ICU care. 4. Post op Delirium a. Could be due to stress of surgery b. Post op pain c. Pain meds d. Infection e. Fever f. Blood loss 5. Symptoms: a. Confusion (fluctuates, can have periods of lucidity) b. Can be presented as hyperactive OR hypoactive c. Clouding of consciousness d. Disturbance of attention develops rapidly over a period of time e. Most symptoms resolve between 3-6 months f. They can hallucinate and seem psychotic/incoherent/disorganized g. Could be emotionally labile (happens post op!) h. You can be very quiet and still be delirious i. They have physical symptoms, since there’s an underlying cause (infection, medication, hypoxia) j. Autonomic instability: diaphoresis, tachycardia, flushed face, elevated BP, dilated pupils 6. Treatment GOAL: a. FIND out what’s wrong b. Close MONITORING. c. Intervene early d. REVERSE the cause! 7. DELIRIUM MNEMONIC (causes) a. Drugs b. Electrolyte abnormalities c. Low O2 sats (hypoxia) d. Infection e. Reduced sensory input f. Intracranial issues (if head injury/brain bleed) g. Urinary or renal retention h. Myocardial Biggest difference between dementia and delirium? In dementia, you won’t have a change in consciousness but in delirium it can be labile. (changeable and altered to cure) What questions would you ask to see if it’s dementia or delirium? Talk to family member! You need background baseline info. Dementia: chronic cognitive impairment differentiated by cause, not symptom patterns; slow progression ● A progressive impairment of cognitive functions ● No fluctuation in consciousness; consistently bad ● With dementia, you have brain atrophy, aka = brain cells are dying. ● Progressive, irreversible ● Types of dementia: alzheimers and vascular dementia (Can happen from long term substance use) 1. Signs of impairment: a. Trouble with ADLs b. Impaired abstract thinking, judgement, problem solving, organization, unkempt appearance c. Combativeness/Agitated d. Aphasia (loss of language ability) e. Apraxia (loss of purposeful movement without motor impairment) i. Can’t perform once familiar tasks f. Agnosia (loss of sensory ability to recognize objects or sounds) i. Put a quarter in hand, can’t tell you what it is g. Confabulation (memory error, no intent to deceive or lie) i. Almost like a defense, it’s not true but they’re trying to fill in the blanks ii. It’s not that they’re trying to deceive you h. Apathy (no emotion), depression i. Disorientation, getting lost i. Risk for dementia: leaving the house, fire, leaving stove on 2. Types of Dementia: a. Alzheimer’s: - most common i. Degenerative progressive neuropsychiatric disorder that has cognitive impairment, emotional and behavioral changes, physical and functional decline, ultimately death. ii. Onset: slow and insidious iii. Types of Alzheimer’s: 1. Early onset (65 years old and young -- RAPID progression) 2. Late onset (older than 65) -- more common iv. Epidemiology/Risk: 1. 1/10 older than 65. 2. Higher in African Americans and Latinos than in whites 3. Sixth leading cause of death among older adults 4. Familial link in early onset (when they get it in their 40s)