An acute organic mental disorder characterized by confusion, disorientation, restlessness, clouding of the consciousness, incoherence, fear, anxiety, excitement, and, often, illusions; hallucinations, usually of visual origin; and, at times, delusions.
Occurs over a short period of time, rapid onset, always secondary to another condition, once the underlying condition is corrected the client should have complete recovery.
Define dementia (chronic confusion).
A progressive organic mental disorder characterized by chronic personality disintegration, confusion, disorientation, stupor, deterioration of intellectual capacity and function, and impairment of control of memory, judgment, and impulses.
Develops over a period of time, 80-95% are irreversible froms, 5-20% are reversible & are secondary to a pathological process, 70% aoe of the Alzheimer's type.
Define Amnestic disorder.
characterized by loss in both short term and long term memory, sufficient to cause some impairment in the person's functioning.
Secondary to an underlying cause.
Define mild cognitive impairment (MCI).
Client's have problems with memory, language, and other initial cognitive functions that are severe enough to be noticable by others but not severe enough to affect daily lives. Normal cognitive function at one end and cognitive impairment on the other end.
Define depression.
An abnormal emotional state characterized by exaggerated feelings of sadness, melancholy, dejection, worthlessness, emptiness, and hopelessness that are inappropriate and out of proportion to reality.
Difficulty concentrating, forgetfulness, inattention, LOC (level of consciousness) not altered, lethargy, lack of motivation, poor sleep.
Delirium can occur:
More frequently in elderly, postoperative, drugs, cardiovascular disease, CHF, children with a fever.
Symptoms of delirium:
Disturbances in consciousness,thinking, memory, attention, perception, develop over a short period of time, fluctuates during the day, progressive disorientation to time and place.
Common causes of dementia:
Infections-fever, UTI
Postoperative-due to anastesia
Metabolic abnormalities-dehydration
Hypoxic conditions-< O2
Drug and alcohol withdrawal
Drug intoxication
Polypharmacy
Nursing concerns with dementia:
Assisting with proper health management to eradicate the underlying cause
Preventing physical harm due to confusion, agression, or electrolyte and fluid imbalances
Use supportive messures to relieve distress
Nursing Dx of dementia:
Risk for injury
Fluid volume dficit
Acute confusion
Sleep pattern disturbances
Impaired verbal communication
Self care deficit
Impaired social interaction
What are the 2 types of etiology of dementia?
Neurodegenerative
Vascular
Examples of neurodegenerative:
Alzheimer's disease
Lewy body disease
Lou Gehrig's disease (ALS)
Parkinson's disease
Huntington's chorea disease
Examples of vascular:
Ischemic
Hypoxic
Multiinfarct
Hemorrhagic
Brain lesions (caused by cardiovascular disease)
Types of dementia:
Alzheimer's
Pick's
Creutzfeldt-Jakob
Multiinfarct
Parkinson's
Korsakoff's
Huntington's
Pick's disease:
rare senile dementia that occurs in middle age
Creutzfeldt-Jakob: (mad cow)
related to an infectious agent or virus (is not contagious)
Korsakoff's syndrome:
Vitamin B1 dificiency and usually associated with chronic alcoholism
Huntington's chorea disease:
hereditary disorder with mental and physical deterioration leading to death
Primary dementia:
is not reversible, progressive, not secondary to any other disorder
Secondary dementia:
result of some other pathological process
Pseudodementia:
mimics dementia
drug toxicity
metabolic disorders
infections
nutritional dificiencies
Pseudodementia---
important to do a complete history and physical of client
Usually do a EEG, ECG, Cat Scan
Usually run lab tests: CBC, B12, Thyroid, Chem panel
Risk factor for Alzheimer's:
advanced age
down syndrom
head injury
cardiovascular disease-factors:HTN, obesity, smoking, high cholesterol
Causes of Alzheimer's:
Unknown however several hypotheses:
Neurochemical changes-< in acetyltransferase which is needed to sythesize the neurotransmitter acetylcholine.
Genetic defects-mutations of genes 21, 14, and especially 19.
Abnormal proteins-beta amyloid & proteins in the brains of the deceased.
Pathological changes of Alzheimer's:
neurofibrilary tangles-composed of protein in the neurons in the hippocampus(part of brain responsible for short term memory)
senile plaques-degenerative neuron material-# of plaques is related to the degree of dementia
granulovascular degeneration-filling of brain cells with fluid and granulation
What are the 4 signs of Alzheimer's?
Aphasia
Apraxia
Agnosia
Mnemonic disturbance
Define aphasia.
loss of language ability
at first hard to find the right word then deminishing into babbling
Define apraxia.
loss of purposeful movement (motor activity)
getting dressed and walking
Define Agnosia.
loss of sensory ability to recognize objects
sounds (hearing-not relating the doorbell ring to needing to answer the door)
visual (recognition of family and friends)
Define mnemonic disturbance.
loss of memory
recent events (short term) the deminishment of long term memory
Cognitive assessment tools for Alzheimer's:
MMSE-Mini-mental state examination
Clock drawing test
Geriatric depression scale
Functional assessment (Katz)
MMSE-Mini-mental state examination:
takes 5-10 minutes
ask about 30 questions evaluating orientation, registration, attention span, language recall, perception
Clock drawing test
to detect progression of cognitive decline
it is quick and checks decline over a period of time
Geriatric depression scale:
Detects depression that may contribute to dementia asking a series of yes or no questions.
Functional assessment (Katz)
Assesses the ability to perform their ADL's
Aids in care planning and determining if client needs to be institutionalized
What are the stages of Alzheimer's disease?
Mild (Early)
Moderate (Middle)
Severe (Late)
Mild (Early) stage:
average of 2-4 years
-recent memory loss
-affecting job performance
-forget to pay the bills
-hard time doing routine chores
-trouble finding familiar places
-mood and personality changes
Moderate (Middle) stage:
average of 2-10 years
-> memory loss and confusion
-hard to think logically
-sun downing
-need suporvision
Severe (Late) stage:
1-3 years
-institutionalized
-loss of bowel/bladder
-cannot take care of themselves
-cannot communicate
-put a lot of things in their mouths
Nursing Dx for Alzheimer's:
Risk for injury
Impaired verbal communication
Self-care deficit
Chronic confusion
Disturbed sleep pattern
Imbalanced nutrition
Caregiver role strain
What are the 3 classifications of Alzheimer's drug interventions?
anti-alzheimer's
antidepressants
antipsychotics
What anti-alzheimer's drugs are used for mild to moderate Alzheimer's disease?
Cognex - BID - causes liver damage
Aricept - QD
Exelon - QD
Razadyne - QD
What anti-alzheimer's drug is used for middle to late stages of AD?
Namenda - may be used in combination the the other antialzheimer's drugs
- binds to the MNDA receptor and helps slow down neuronal death
What antideppressants are used for AD?
SSRI's include:
celexa, zoloft, prozac, wellbutrin
What antipsychotics are used for AD?
Risperdal, Zyprexa, Seroquel ****when giving these meds to geriatrics-start low & go slow****
used when there are behavioral disorders that we aren't able to manage otherwise
- strikout, threat to themselves & others
What are some drug interventions for AD and the reasoning for use or disapproval?
Experimental drugs:
-Vitamin E- showed to slow the disease process in those who took 20000IU QD, but > bleeding risks so a max of 400IU is recommended however, this doesn't seem to slow the process.
-Estrogen- has fallen out of favor & some that that it actually speeds up the progression of AD
-Anti-inflammatory- NSAID's- unproven & not recommended due to GI bleeding and cardiovascular & renal toxicity.
-Ginko biloba-not recommended due to risk of bleeding
What is not considered a causitive agent in delirium?
A. Elevated blood urea nitrogen levels
A nursing dx appropriate for a client with AD, regardless of the stage, would be?
D. Risk for injury
The daughter of a patient with early familial AD asks how AD can be detected. The nurse describes early warning signs of AD, including
B. having no memory of preparing a meal and forgetting to serve or eat
A patient with AD has a nursing dx of disturbed thought processes related to effects of dementia. An appropriate nursing intervention for the patient is to
D. maintain familiar routinesof sleep, meals, drug admin, and activities
Which event would a client with early AD have greatest difficulty remembering?
D. what th client ate for breakfast
A 69 year old client is admitted to the hospital with a UTI and a positive bacterial sepsis. The client is disoriented and has a disturbed sleep-wake cycle. The nurse administers a MMSE to differentiate among various cognitive disorders, primarily because,
B. delirium can be reversed by treating the underlying cause
Which of the following clients is most at risk for developing delirium?
A. a 78 year old man admitted to the medical unit with complications related to heart failure
Creutzfeldt-Jacob disease is characterized by
C. memory impairment, muscle jerks, and blindness
A major goal of tx for the client with AD is to
C. maintain client safety
The early stage of AD is characterized by
D. memory problems and mild confusion
Which of the following statements accurately describes mild cognative impairment?
B. caused by variety of factors and may progress to AD
The clinical dx of dementia is based on
C. patient history and cognative assessment
Vascular dementia is associated with
C. cognitive changes secondary to cerebral ischemia
Dementia is defined as
D. syndrome characterized by cognitive dysfunction and loss of memory
Define frontotemporal dementia.
Pick's disease, a type of frontotemporal dementia, is a rare brain disorder characterized by disturbances in behavior, sleep, personality, and eventually memory. The major distinguishing characteristic between these disorders and AD is marked symmetric lobar atrophy of the temporal and/or frontal lobes. The disease is relentless in its progression, which may ultimately include language impairment, erratic behavior, and dementia. Because of the strange behavior associated with Pick's disease and frontotemporal dementia, psychiatrists often see these patients first. There is no specific treatment. The diagnosis can be confirmed at autopsy.
