Basic Assessment & Core Distinctions
This condition is defined as an ACUTE disturbance of cognition manifested by short term confusion and clouded consciousness that is considered reversible
Delirium
This standardized tool is used by the nurse specifically to identify delirium
CAM- Confusion Assessment Method
Alzheimer's disease is characterized by the presence of these two pathological features in the brain
amyloid plaques and tau tangles
Lewy Body dementia is identified by the AVP triad: Alertness, Visual hallucinations (detailed), and what else?
Parkinsonism Motor features
This life threatening emergency presents with very high fever, tachycardia, and "lead pipe" muscle rigidity after an antipsychotic dose
Neuroleptic Malignant Syndrome
What is the antidote?
Before administering Donepezil the nurse must check this vital sign
Pulse/ Heart rate. If apical is below 60 then hold the medication.
What is something the nurse should do when a client is stuck on one thing over and over
Discourage rumination
focus on environmental modification, validation, and sensory distraction rather than trying to reason with or logically correct the person
Pseudodementia is a condition where cognitive impairment does this to a NCD....
This question is weird: what does it look like sorta disguised as a NCD
MIMICS dementia but it is actually elderly depression
Rapid onset- a few weeks
Treat antidepressants and anxiolytics (Buspirone)
In this mental illness, an elderly client will often answer "I don't know" to memory questions and verbalize distress about their failing memory
Pseudodementia (Depression)
These two physical assessments must be performed before medicating aa client for new onset agitation to rule out life threatening physiological causes?
Blood sugar and pulse ox
This type of NCD shows a "stepwise" progression where function remains stable for months and then drops sharply after a new vascular event
Vascular Neurocognitive Disorder
Because these clients often retain insight into their declining function, the nurse must screen for this safety concern at every contact?
Suicidal Ideation
While typical antipsychotics carry a high risk of movement side effects (EPS), Atypical antipsychotics carry a higher risk for this group of symptoms including weight gain and high blood sugar
Metabolic Syndrome
This is the primary therapeutic goal of medications Memantine (NMDA) receptor antagonist for neurocognitive disorders
Slowing the decline (not the cure)
So does Cholinesterase inhibitors
Donenpezil, Galantamine, Rivastigmine
To prevent a combative self-protection response, a nurse should always approach a confused client from this direction and at eye level
Approach from the front and within eye level
Unlike the onset of Alzheimer's, the onset of symptoms in pseudodementia is usually....
Rapid. Takes a few weeks and often after a major loss
These people are overwhelmed and upset. They choose to not do things (lose willpower) despite knowing how or remain oriented to time and place
Unlike delirium, which is acute, this general term describes an irreversible, slow decline in the ability to remember or think that is NOT a normal part of the aging process
Neurocognitive Disorder Dementia
This clinical finding is a hallmark of delirium, where a client might be lethargic in the morning but hyperalert and shouting by the evening.
In this specific NCD, behvaior and personality changes like disinhibition or crude remarks predominate while memory often remains intact early on.
Frontotemporal NCD
Describe the physical findings of Parkinson's Disease
tremor, rigidity, and slowness
Clients taking Clozapine must have a WBC and absolute neutrophil count monitored because of the risk of what fatal condition?
Agranulocytosis
This electrolyte imbalance is a significant risk for older adults starting SSRI antidepressants and presents as new confusion or weakness
Hyponatremia
To protect the dignity of a client with disinhibition who is undressing in public, the nurse should first do what?
Redirect the client privately, and escort them to their room
(True or False) Clients with pseudodementia often showcase the severity of their symptoms more as the day goes on.
False. The symptom severity actually gets better as the day progresses
This specific daily symptom pattern involves severity that gets better as the day progresses, which points to depression rather than neurocognitive disorder.
Pseudodementia
What is a big safety risk we worry about with those who are experiencing derlirium?
Elopement
The primary distinction between mild and major NCD:
in major NCD the cognitive decline of the client affects the client's what?
Interferes with their independence to complete ALDs
These are the usual causes of death to someone with Huntington's Disease
Pneumonia, choking, and heart failure
Remember these people are very very liable and won't remember even having any mood swings
This specific extrapyramidal symptom involves painful neck spasms or tongue protrusion occurring within hours of starting therapy.
acute dyskinesia
This medical emergency involves hyperreflexia, twitching, and a high fever in a client taking two or more serotonergic medications/ alternative medication
Serotonin Syndrome.
What is the IV antidote?
State some physical care needs we can do that falls under patient centered care
Monitor neuro status, measures to promote sleep, provide aids (glasses, dentures, hearing aids), provide safe environment, ensure adequate intake, discourage caffeine, discourage nicotine, encourage physical activity- (moderate and never close to bedtime)
A client presents with their memory mostly intact, no confabulation, answers "I don't know" to many assessment questions, and doesn't present with any progressive deficits. What level of effort would you predict they would put forth for task performance?
Very little effort. They know how but they don't want to do things. They know something is wrong but they still answer "I don't know"
Overwhelmed and upset!
A client with neurocognitive disorder often uses this defense mechanism, inventing detailed but untrue stories to fill in memory gaps
Confabulation
What is something a nurse can do to help a patient from experiencing delirium in the ICU?
Write information on the whiteboard to help keep them oriented
This phenomenon, characteristic of Stage 4 Alzheimer's involves symptom severity that worsens specifically as the day progresses?
Sundowning
At what age does the onset of Huntington's Disease usually occur?
35-50
Baranski gave us a tip for this medication: Quetiapine
This is an atypical antipsychotic; what is it great for?
Making voices QUIET
When a benzodiazepine causes an older adult with a NCD to become more agitated and combative instead of calm, it is called this:
Paradoxical response
Name some ways to cognitively support clients under patient centered care
consistent caregivers, approach from the front, cover or remove mirrors, encourage physical activity, do not argue, discourage rumination, use calm reassuring tone, reinforce reality, frequent reorientation, do NOT challenge delusions, use positively worded phrases, limit complex decisions making.
This is the most important distinction for families: unlike irreversible dementia, pseudodementia symptoms usually do this with proper treatment
IMPROVE!
SSRI: Sertraline and Paroxetine (hyponatremia and serotonin syndrome)
Tricyclic: Nortiptyline
Benzodiazepine: Lorazepam (over sedation and dependence)
Nonbenzodiazepine: Buspirone