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Questions and Answers
What is a primary characteristic of delirium in patients?
What is a primary characteristic of delirium in patients?
Which of the following factors can contribute to the development of delirium?
Which of the following factors can contribute to the development of delirium?
In the context of minor neurocognitive disorders, which statement is true?
In the context of minor neurocognitive disorders, which statement is true?
What distinguishes major neurocognitive disorders from minor ones?
What distinguishes major neurocognitive disorders from minor ones?
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Which of the following accurately describes hallucinations?
Which of the following accurately describes hallucinations?
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Which of the following statements about cognitive impairment in older patients is accurate?
Which of the following statements about cognitive impairment in older patients is accurate?
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What is a common misconception about delirium in relation to cognitive disorders?
What is a common misconception about delirium in relation to cognitive disorders?
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Which cognitive symptom is characterized by the loss of language ability?
Which cognitive symptom is characterized by the loss of language ability?
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What defines confabulation in the context of cognitive disorders?
What defines confabulation in the context of cognitive disorders?
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Which term describes the impaired ability to recognize objects?
Which term describes the impaired ability to recognize objects?
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Which symptom indicates a tendency to drop items or exhibit agitation as light decreases?
Which symptom indicates a tendency to drop items or exhibit agitation as light decreases?
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What is a common risk factor for developing Alzheimer’s disease?
What is a common risk factor for developing Alzheimer’s disease?
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Which term refers to the loss of purposeful movement?
Which term refers to the loss of purposeful movement?
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What is characterized by the tendency to mouth everything?
What is characterized by the tendency to mouth everything?
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Which cognitive impairment involves memory loss without affecting other cognitive functions?
Which cognitive impairment involves memory loss without affecting other cognitive functions?
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Which condition is often associated with disturbances in executive functioning?
Which condition is often associated with disturbances in executive functioning?
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What is a common issue faced when assessing cognitive impairment?
What is a common issue faced when assessing cognitive impairment?
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Which type of medication is classified as a cholinesterase inhibitor?
Which type of medication is classified as a cholinesterase inhibitor?
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What is the primary focus of integrative therapy for patients with cognitive impairment?
What is the primary focus of integrative therapy for patients with cognitive impairment?
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What stage follows anger in Kubler-Ross's five stages of grief?
What stage follows anger in Kubler-Ross's five stages of grief?
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During anticipatory grief, what is primarily mourned?
During anticipatory grief, what is primarily mourned?
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What is NOT typically involved in palliative care for patients with dementia?
What is NOT typically involved in palliative care for patients with dementia?
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Which of these is an example of coping with grief?
Which of these is an example of coping with grief?
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What is the primary difference between grief and major depressive disorder?
What is the primary difference between grief and major depressive disorder?
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Which of the following can be a symptom of grief?
Which of the following can be a symptom of grief?
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Study Notes
Neurocognitive Disorders
- Delirium is a disturbance in attention with abrupt onset, characterized by disorganized thinking, disorientation, anxiety and agitation, poor recall, delusions and hallucinations.
- Delirium is multifactorial with physiological causes like cognitive impairment, immobilization, psychoactive medications, dehydration, infection, sleep deprivation, and visual and perceptual disturbances
- Assessment should include Cognitive assessment sheet, identification of illusions (errors in perception) and hallucinations (false sensory stimuli)
- Do not assume confusion is dementia in the older patient.
- Major Neurocognitive disorders involve a progressive deterioration of cognitive function and global impairment of intellect (dementia) with no change in consciousness.
- Difficulties involve memory, problem solving, complex attention
- Mild does not interfere with ADLs and does not necessarily progress, while Major interferes with daily functioning and independence
- Major Neurocognitive Disorders include Alzheimer's disease, Frontotemporal lobar degeneration, Lewy body disease, Parkinson's disease, Traumatic brain injury, and Cerebrovascular disease.
Alzheimer's Disease
- It is important to distinguish normal forgetfulness from memory deficits in dementia.
- Memory loss in dementia interferes with ADLs.
- Alzheimer's disease progression is categorized as mild, moderate, and severe.
- Symptoms include memory impairment, disturbances in executive functioning, aphasia, apraxia, agnosia, and amnesia.
- It is the most common type of dementia; with late onset and females are affected more.
- Modifiable risk factors include diet, cardiovascular health, head injury, social engagement, and exercise.
Nursing Process: Alzheimer's Disease
- Confabulation or the creation of stories in place of missing memories.
- Perseveration or the repetition of phrases or gestures long after the stimulus is gone.
- Agraphia or diminished ability to read or write.
- Hyperorality or the tendency to put everything in the mouth.
- Sundowning or sundown syndrome; the tendency of mood to drop and agitation to rise as the light of day leaves.
- Assess memory impairment.
- Assess disturbances in executive functioning: problem solving, planning, abstract thinking.
- Assess diminished emotional affect.
- Agnostic testing includes MSE, neuro exam, medication review, and nutrition assessment.
Treatment Modalities: Alzheimer's Disease
- Pharmacotherapy: Medications for cognitive symptoms include cholinesterase inhibitors (Donepezil, Rivastigmine, Galantamine) and NMDA receptor antagonist (Memantine).
- Pharmacotherapy: Medications for behavioral symptoms; none are approved, antipsychotics are used off-label with extreme caution.
- Integrative Therapy: Omega-3 fatty acids and diet.
Chapter 30: Dying, Death and Grieving
- Kubler-Ross Stages of Grieving: Denial and isolation, Anger, Bargaining, Depression, and Acceptance.
- Practice the art of presence with open-ended questions.
- Anticipatory Grief: Future loss is mourned in advance, adjusting life to accommodate the time left and forseeing how the future will be.
- Anger is a common component of anticipatory grief.
Palliative Care for Patients with Dementia
- Anticipate needs.
- Encourage meaningful connections between the patient and loved ones.
- Identify patient goals for care.
- Educate family to minimize aggression during care.
- Manage pain and depression.
- Developmental tasks of dying help people identify what they want to accomplish before death.
Grief
- Grief is the reaction to loss.
- Bereavement is the period after grieving a death.
- Mourning are the things people do to cope with grief.
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Grief vs. Major Depressive Disorder:
- Grief: feelings of emptiness and loss, intense sadness and anger that occurs in waves and gradually subsides, self-esteem intact, reorganization tasks may impact sense of self but thoughts of death may focus on someday reuniting with the deceased.
- Major Depressive Disorder: Feelings of depressed mood, self-esteem involves worthlessness and self-loathing, thoughts of death are focused on ending the pain, may develop a plan for death.
Types of Grieving and Associated Nursing Care
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Complicated Grief: Painful experience after loss that can lead to impairment of relationships and occupational performance.
- Nursing Care: Nursing diagnosis of risk for dysfunctional grieving, respond to grieving, assist with daily functioning.
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Disenfranchised Grief: Grief experience not congruent with socially recognized relationship.
- Nursing Care: Combine support and guidance with individual consideration, virtual support, and psychotherapy.
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Grief Caused by Public Tragedy
- Nursing Care: Acknowledge and validate the grief experienced, encourage self-care activities.
Chapter 31: Older Adults: Mental Health and Aging
- Late-life mental disorders: Major depressive disorder and anxiety disorder.
- Suicide: Suicide is a concern with those experiencing mental illness and older adults.
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Description
This quiz covers key concepts related to neurocognitive disorders, including delirium and major neurocognitive disorders like dementia. It highlights symptoms, assessments, and the importance of distinguishing between confusion and dementia in older patients. Test your understanding of these critical cognitive health issues.
