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dementia
pn 141 test 2 book: burke pg: 496
| Question | Answer |
|---|---|
| Def of alzheimers disease | a progressive, irreversable deterioration of the brain. it is characterized by a gradual loss of intellectual functioning. |
| what is the most common type of dementia | alzheimers disease |
| the development of AD increases with _________ | age |
| AD: genetic deficits on what chromosomes are associated with it | 1,14,19 and 21 |
| what are the four pathologic changes seen in the brains of AD clients | loss of nerve cells, reduced brain size, presence of neurofibrillary tangles, neuritic plaques |
| AD: what causes plaque formation | a protein substance called amyloid |
| AD: the neurofibrillary tangles and plaque lead to what | altered nerve impulse transmission |
| AD: altered nerve pulse transmission results in loss of what | memory and cognition |
| AD: Acetylcholine, a neurotransmitter, is decreased. what is this essential for | memory |
| AD: what lobe of the brain is effected first | the frontal lobe |
| AD: how is it stages | according to pt symptoms and abilities |
| AD: what is the first s/s | memory loss |
| AD: does it develop slowly or quickly | slowly |
| AD: STAGE 1- how long is it | 2-4 years |
| AD: STAGE 1- what happens in this stage | short term memory loss (forgetting names and locations of things), attempts to cover up memory loss, has difficulty learning new info and making decisions, decreased attention span, angry and depressed |
| AD: STAGE 2- how long is it | approximately 2-12 years |
| AD: STAGE 2- what happens in this stage | unable to remember names of family, lost in familiar locations, easily agitated, difficulty using objects reading and writing, cannot follow a convo, bad personal hygeine, unable to make decisions, unsteady gait, sundowning, wanders |
| AD: STAGE 3- how long is it | approx. 1-4 years |
| AD: STAGE 3- what happens in this stage | can't recognize self or others, inability to communicate, has delussions and hallucinations, bowel and bladder incontinence |
| DEF of sundowning syndrome | behavior characterized by increased agitation, disorientation to time, and wandering during the afternoon and evening |
| complications of dementia | PNA, dehydration, malnutrition, falls |
| how does death frequantly occur | PNA secondary to aspiration |
| diagnostic tests: how does it begin | by first ruling out other caueses for s/s (infection etc) |
| diagnostic tests: why is a cbc ordered | to ruelout infection,pna, hypothyroidism, malnutrition |
| diagnostic tests: what is the only definitive method of dx | postmortem exam of the brain |
| diagnostic tests: ecg- what may it show | slowed brain wave pattern in late stages |
| diagnostic tests: MRI & CT: what will that show | decreased brain size in late stages |
| diagnostic tests: PET scan: what can that show | reduced glucose levels in affected areas of the brain |
| diagnostic tests: mini mental status exam (MMSE): what will that show | loss of memory and other cognitive skills over time |
| meds: cholinesterase inhibitor drugs: what do they do | block the breakdown of acetylcholine, seems to slow the cognitive decline and in some clients imprive reasoning and memory |
| meds: cholinesterase inhibitor drugs: names | tactrine hydrochloride (Cognex), donepezil (aricept) rivastigmine (exelon) |
| meds: cholinesterase inhibitor drugs: adverse effects | liver toxicity (monitor liver function) |
| meds: memantine (Ebixa): what does it do | bloack glutamate to protect the brain cells |
| meds: memantine (Ebixa): when is it used | late stages of AD |
| meds: why is (fluoxetine) prozac given | to treat depression |
| meds: why are risperidone (risperdal) and haloperidol (Haldol) given | to control behavioral s/s |
| how does ginkgo help | it can improve memory |
| ginkgo should be avoided in pts who take what meds; why? | anticoagulants; it increases bleeding |
| why are boundaries set in by placing red or yellow tape on the floor for pt w/ AD | older adults can see red and yellow better |
| difference between dementia and delerium | dementia: chronic, irreversable, progressive, elderly. delerium: acute any age, sudden |
| delerium: who gets it more male or FM | male |
| delerium: risk factors | sex, age, acute illness, dementia, real failure, mult meds, ETOH, depression, pain |
| delerium: causes | infection, meds, eTOH, drugd, CV, psot op, neoplasms, trauma, metabollic |
| delerium: s/s | short lived confusion (<1 wk-month), usually temporary, disorianted, misinterpretation of surroundings, environment, hallucinations |
| delerium: are tehy distracted | yes |
| delerium: Nx Dx for it | risk for injury, disturbed thought process, sleep disturbance, communication, family coping |
| delerium: goals of Tx | address cause of confusion, during episode keep safe, comfort, relieve anxiety, assess status of caregiver |
| def of dementia | memory impairement along with problems in other cognitive areas (apraxia, agnosia, aphasia) |
| Dementia: goals of care | maintain the highest level of fucntioning possible, preserve independance |
| Dementia: causes that are reversible | hypothyroid, depression, Vit D def |
| def of apraxia | familiar movements and routines (loss of) |
| Dementia: what happens to executive functioning | there is impaired reasoning, planning, sequencing, initiating |
| Vascular dementia: cause | CV diseas, stroke, mult TIAs |
| Vascular dementia: whith what cause is the onset gradual ; sudden | TIAs, CVA |
| Vascular dementia: risk factors | stroke, HTN, CV disease, DM, Males, AA, smokers |
| Vascular dementia: what increases their risk for falls | unsteady gate |
| Alzheimers: what does MCI stand for | mild cognitive impairement |
| Alzheimers: s/s of MCI | ST memory loss, intact daily function, a little more than the typical forgetfulness |
| what labs are done to rule out other Dx | thyroid, Vit B, infection and metabollic, CT/MRI |
| meds: HAldol (haloperidol)- class | antipsychotic med |
| meds: HAldol (haloperidol)- use | psychotic disorders, hyperactivity, dementia |
| meds: HAldol (haloperidol)- adverse effects | EPS, akathisia, dystonia, TD, drowsiness, HA, dry mouth, orthostatic hypotension |
| med: risperidone (risperdal): class | antipsychotic |
| med: risperidone (risperdal): use | psychotic disorders, |
| med: risperidone (risperdal): side effects | agitation, dizziness, nervouseness, akathisia, constipation, fever wt gain |
| meds: whatare the antipsycotics given | haldol, seroquel, rsperdal, zyprexa |
| meds: what is the most significant adverse reaction | extrapuramidal effects (adverse muscle movements, parkisins liek s/s,)- reversable w/ lower dose |
| meds: adverese effect of antipsychotics: Tardive dyskinesia (TD) effect what is it | a sydrome of irreverable involuntary dyskinetic movements (mouth, jaw and tongue)non reversable |
| meds: adverese effect of antipsychotics: what are they | TD, EPS, anticholenergic (constipation anddry mouth), wt gain, dislipid, arrythm, DM,orthoHTN, sedation |
| meds: adverese effect of antipsychotics: concerns with ortho hypotN | falls |
| meds: what does cholinesterase inhbitors do | acetylcholine is the transmitter in the cholinergic neuropathway, ppl with early Dementia experience degeneration of these, this med thus inhibits the breakdown and slows neural distruction (slow down mem. loss, inproves cognitive function, decreases delu |
| meds: cholinesterase inhbitors - use | mild to mod Dementia |
| meds: cholinesterase inhbitors - names | donezpil (aricept), galantamine (razadyne), rivastigmine (exelon) |
| meds: cholinesterase inhbitors - adverse effects | anorexia, N/V, D, dizziness and HA |
| meds: cholinesterase inhbitors - nursing considerations | don't stop abbruptly b/c s/s return, liver studies, 6-12 months for full effect, |
| meds: what do NMDA receptor blockers do | thought to work by decreasing the excitabilty of neurotransmission |
| meds: what are NMDA receptor blockers used for | mod to severe dementia |
| meds: what are NMDA receptor blockers names | memantine (namenda) |
| meds: what are pluses to NMDA receptor blockers | better tolerated |
Created by:
jmkettel
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