NURS 211: Exam 3 Qs and As
Cognition - ✔✔the mental action or process of acquiring knowledge and understanding through
thought, experience, and the senses.
Delirium def - ✔✔state of disturbed consciousness and altered cognition with a rapid onset occurring
over hours or a few days
Neurocog disorders (dementia) - ✔✔Cog impairment not dementia
Focal cognitive
Intellectual disabilities
Learning disabilities
Scope of cognition - ✔✔Cognitive impairment--> Basic Cognitive Functioning --> Higher order cognitive
functioning
Consequences of Cognitive impairment - ✔✔-Increased risk for injury
-Complicates disease mgmt
-Decreased functional ability including capacity for independent living and normal social interaction
-Increased need for assistive services
-Financial hardship
-Caregiver burden
Risk factors for cognitive impairment - ✔✔-Most at risk- aging adult
-Individual risk factors
--Personal behaviors
--Environmental exposures
--Congenital or genetic disorder
-Health related conditions
-Physical disability and reduced mobility
,Assessment for Cognition - ✔✔Routine observations (health care providers)
Pt self report
Report by family or others
Cognitive exam
Consciousness is FIRST step
level of consciousness - ✔✔Awake→ Drowsy→ Lethargic→ Obtunded→ Stupor→ Coma
Cognition interview/health hx - ✔✔-Speech pattern (difficulty forming words or saying what is meant)
-Appropriate responses to questions
-Memory, Logic, Judgement
-Brain trauma or disease, substance abuse, current medications, exposure to hazards (environmental or
occupational)
-Headaches, behavior changes, seizures, changes in memory or mental function
Cognition: General appearance abnormal - ✔✔Slumped posture
Slow movements while walking
Dragging feet
Dress not appropriate for weather, age, etc.
Poor Hygiene
Cognition: Behavior abnormal - ✔✔Lethargic, obtunded
Disoriented (note whether time, place or person)
Flat expression
Quality of speech
Trouble recalling words
,Blocking
Distorted speech
Disconnected sentences
Loose associations
Confabulation
MMSE (Mini Mental State Examination)- - ✔✔A standardized cognitive assessment tool
Provides 11 cognitive tasks
The lower the score, the more severe the impairment
Below 27 should be sent for further evaluation
Mini-cog - ✔✔Word recall - short term memory
Clock drawing-level of executive functioning
Confusion Assessment Method (CAM) - ✔✔Requires features 1 and 2 and either 3 or 4:
1. Acute change in mental status and fluctuating course - Hours to Days
2. Inattention
3. Disorganized thinking
or
4. Altered level of consciousness
Amnesia - ✔✔short-term memory deficit
Anomia - ✔✔forgetting names of persons or things
Impaired ability to name places or objects; may have difficulty with sentence repetition, although
comprehension and expression abilities are basically intact
, Agnosia - ✔✔forgetting the purpose of familiar items
Apraxia - ✔✔forgetting how to perform activities
Sundowning - ✔✔when the individual shows symptoms of acute confusion, disorientation,
hallucinations, and mood swings during late day into night, often occurs.
Aphasia - ✔✔mute
Language impairment at the conceptual level; may have difficulty with production or comprehension of
language or both
apathy - ✔✔a lack of feeling, emotion, or interest
Cognitive Dx test - ✔✔lab (r/o), neuroimaging, MRI(intracranial tumors, infarcts (VD), Frontotemporal
lobe atrophy), Neuropsychometric testing
Acute (delirium) - ✔✔Transient, usually reversible, cause of cerebral dysfunction. Wide range of
neuropsychiatric abnormalities and exhibited as a hyperactive or hypoactive state
-Mistaken for dementia or depression
-Decreased attention span, waxing or waning type of confusion
Acute (delirium) etiology - ✔✔Decreased levels ach
Exists b/w cholinergic and dopaminergic activities
Excess dopaminergic activity occurs
Disruption of cortisol and beta-endorphin circadian rhythms
Exogenous glucocorticoids
Acute (delirium) risk factors - ✔✔Following general surgery; especially orthopedic surgery
Intensive care units, which commonly have no windows and constant fluorescent lighting night and day
that can be disorienting to the elderly patient
Cognition - ✔✔the mental action or process of acquiring knowledge and understanding through
thought, experience, and the senses.
Delirium def - ✔✔state of disturbed consciousness and altered cognition with a rapid onset occurring
over hours or a few days
Neurocog disorders (dementia) - ✔✔Cog impairment not dementia
Focal cognitive
Intellectual disabilities
Learning disabilities
Scope of cognition - ✔✔Cognitive impairment--> Basic Cognitive Functioning --> Higher order cognitive
functioning
Consequences of Cognitive impairment - ✔✔-Increased risk for injury
-Complicates disease mgmt
-Decreased functional ability including capacity for independent living and normal social interaction
-Increased need for assistive services
-Financial hardship
-Caregiver burden
Risk factors for cognitive impairment - ✔✔-Most at risk- aging adult
-Individual risk factors
--Personal behaviors
--Environmental exposures
--Congenital or genetic disorder
-Health related conditions
-Physical disability and reduced mobility
,Assessment for Cognition - ✔✔Routine observations (health care providers)
Pt self report
Report by family or others
Cognitive exam
Consciousness is FIRST step
level of consciousness - ✔✔Awake→ Drowsy→ Lethargic→ Obtunded→ Stupor→ Coma
Cognition interview/health hx - ✔✔-Speech pattern (difficulty forming words or saying what is meant)
-Appropriate responses to questions
-Memory, Logic, Judgement
-Brain trauma or disease, substance abuse, current medications, exposure to hazards (environmental or
occupational)
-Headaches, behavior changes, seizures, changes in memory or mental function
Cognition: General appearance abnormal - ✔✔Slumped posture
Slow movements while walking
Dragging feet
Dress not appropriate for weather, age, etc.
Poor Hygiene
Cognition: Behavior abnormal - ✔✔Lethargic, obtunded
Disoriented (note whether time, place or person)
Flat expression
Quality of speech
Trouble recalling words
,Blocking
Distorted speech
Disconnected sentences
Loose associations
Confabulation
MMSE (Mini Mental State Examination)- - ✔✔A standardized cognitive assessment tool
Provides 11 cognitive tasks
The lower the score, the more severe the impairment
Below 27 should be sent for further evaluation
Mini-cog - ✔✔Word recall - short term memory
Clock drawing-level of executive functioning
Confusion Assessment Method (CAM) - ✔✔Requires features 1 and 2 and either 3 or 4:
1. Acute change in mental status and fluctuating course - Hours to Days
2. Inattention
3. Disorganized thinking
or
4. Altered level of consciousness
Amnesia - ✔✔short-term memory deficit
Anomia - ✔✔forgetting names of persons or things
Impaired ability to name places or objects; may have difficulty with sentence repetition, although
comprehension and expression abilities are basically intact
, Agnosia - ✔✔forgetting the purpose of familiar items
Apraxia - ✔✔forgetting how to perform activities
Sundowning - ✔✔when the individual shows symptoms of acute confusion, disorientation,
hallucinations, and mood swings during late day into night, often occurs.
Aphasia - ✔✔mute
Language impairment at the conceptual level; may have difficulty with production or comprehension of
language or both
apathy - ✔✔a lack of feeling, emotion, or interest
Cognitive Dx test - ✔✔lab (r/o), neuroimaging, MRI(intracranial tumors, infarcts (VD), Frontotemporal
lobe atrophy), Neuropsychometric testing
Acute (delirium) - ✔✔Transient, usually reversible, cause of cerebral dysfunction. Wide range of
neuropsychiatric abnormalities and exhibited as a hyperactive or hypoactive state
-Mistaken for dementia or depression
-Decreased attention span, waxing or waning type of confusion
Acute (delirium) etiology - ✔✔Decreased levels ach
Exists b/w cholinergic and dopaminergic activities
Excess dopaminergic activity occurs
Disruption of cortisol and beta-endorphin circadian rhythms
Exogenous glucocorticoids
Acute (delirium) risk factors - ✔✔Following general surgery; especially orthopedic surgery
Intensive care units, which commonly have no windows and constant fluorescent lighting night and day
that can be disorienting to the elderly patient
