Neurocognitive Disorders (NCDs)
What is the most common primary NCD?
Alzheimer's Disease
True or False: The onset of delirium is slow, occurring over months to years.
False
Delirium is an acute, short-term, and reversible state that comes on quickly. The onset of dementia is slow.
Making lists to avoid forgetting is recommended in this stage.
Stage 2 - Very Mild
When caring for clients with NCDs or delirium, which nursing task should be prioritized?
A. Ensure belongings are within reach
B. Initiate suicide precautions
C. Teach relaxation techniques
D. Administer lorazepam TID
A. Ensure belongings are within reach
Safety is always the priority nursing problem, but specific safety precautions differ depending on the diagnosis and client. The priority nursing problem when caring for a client with delirium or an NCD is risk for (accidental) injury (as opposed to suicide, homicide, medication toxicity, etc. that may be common with other diagnoses). Teaching relaxation techniques would not be very effective with these clients. Lorazepam is a benzodiazepine, it should only be used PRN and should be avoided if possible in the elderly.
An acute disturbance of cognition, causing confusion and disorientation, is called this
Delirium
True or False: Individuals with primary NCDs can achieve remission.
False
Primary NCDs (Alzheimer's, Lewy Body Disease, Vascular Dementia, etc.) are chronic, progressive processes that get worse over time.
Secondary NCDs are caused by chronic medical conditions (e.g., AIDS, Parkinson's Disease, etc.) so they are also non-curable.
Your client was recently admitted to the hospital for delirium. After ensuring safety, what assessment should the nurse complete next?
Assess for underlying causes of delirium (so that we can quickly identify & treat the cause)
Your client cannot recall what he did for his birthday yesterday, so he reports that he went to disneyland with his grandkids. What stage is this behavior seen in?
Stage 4 (this is confabulation)
You hear your client with Lewy Body Dementia yelling from down the hall. Upon entering his room, he states that there are birds in his room that will not leave. Which response is most appropriate?
A. "That's not possible. Are you sure?"
B. "You must be hallucinating, there are no birds in here"
C. "Don't worry, the birds cannot hurt you"
D. "That sounds very frightening, but I don't see any birds in here"
D. "That sounds very frightening, but I don't see any birds in here"
A progressive, irreversible decline in cognitive ability is called this
Dementia or Neurocognitive Disorder (NCD)
List three symptoms or findings associated with NCDs
Common symptoms: impaired impulse control, impaired judgment, concrete thinking, neglected hygiene/appearance, behavioral disinhibition, social misconduct, speech/language abnormalities, personality changes, paranoia, mood swings, apathy, apraxia, incontinence, agitation, sundowning, etc.
Acute withdrawal of this substance can lead to delirium if not treated effectively.
Alcohol
We treat acute alcohol withdrawal with benzodiazepines (e.g., lorazepam, diazepam, chlordiazepoxide, etc.) to prevent delirium tremens (DTs)
While your client is talking with her son, you notice that she keeps referring to her neighbor as "Tom", but his name is "John". What NCD stage is your client likely in?
Stage 5 - moderately severe
Which of the following medications has a black box warning specific to elderly clients?
A. Bupropion
B. Olanzapine
C. Duloxetine
D. Lamotrigine
B. Olanzapine
Olanzapine is a 2nd gen/atypical antipsychotic. All antipsychotics have a black box warning for increased risk of death when given to elderly clients with dementia-related psychosis.
Your 68-year-old client developed confusion, disorientation, and sleep disturbances after beginning a new medication.
True or False: This condition is likely short-term and reversible
True
This medication is given in the early stages of dementia, while this medication is given in moderate and later stages of dementia (classes or individual medications okay).
Early: Donepezil, Rivastigmine, etc. (acetylcholinesterase inhibitors)
Later: Memantine (NMDA receptor antagonist)
List two causes of delirium
Common causes include: infection, substance intoxication/withdrawal, medications, liver failure, kidney failure, COPD exacerbation/hypercarbia, stroke, seizures, head trauma, etc.
Getting lost driving may occur in this stage, while sundowning occurs in this stage.
Stage 3 (getting lost driving)
Stage 6 (sundowning)
Which nursing interventions are appropriate for a client with a neurocognitive disorder (NCD)?
A. Turn on a cartoon when the client is anxious
B. Offer the client as many choices as possible
C. Speak slowly and allow more time for tasks
D. Change up their activities to prevent boredom
C. Speak slowly and allow more time for tasks
The inability to carry out purposeful movement is called this
Apraxia
List three causes/types of NCDs
Common causes/types of NCDs
Alzheimer's Disease/Dementia
Lewy Body Disease/Dementia
Vascular Dementia
Frontotemporal Dementia
HIV/AIDS (secondary NCD)
Parkinson's Disease (secondary NCD)
Huntington's Disease (secondary NCD)
Traumatic brain injury (secondary NCD)
List three symptoms of delirium
Symptoms include: confusion, disorientation, distractability, waxing and waning mental status, sleep disruptions, illusions, hallucinations, memory impairment, speech difficulties, behavioral changes (mood swings, misconduct, agitation, etc.)
List each stage with the corresponding number and severity/title
■Stage 1: No apparent symptoms
■Stage 2: Very mild
■Stage 3: Mild
■Stage 4: Moderate
■Stage 5: Moderately severe
■Stage 6: Severe
■Stage 7: Very severe
Your client with Alzheimer's Disease became restless upon awakening from a nap and is now demanding to see his wife who passed away 6 years ago. Which intervention(s) is/are appropriate at this time? Select all that apply.
A. Try to reorient the client to time and place
B. Escort the client to group therapy
C. Show the client photos of his children and ask him to tell you about them
D. Administer haloperidol
E. Take the client for a short walk
F. Turn all of the lights off and help him back to bed
A. Try to reorient the client to time and place
C. Show the client photos of his children and ask him to tell you about them
E. Take the client for a short walk
Your client has been taking risperidone for agitation for about three years. Which behavior should the nurse monitor for?
A. The client taking a higher dose than prescribed
B. Muscle rigidity of the jaw and neck
C. Involuntary movements
D. Extremely high blood pressure
C. Tardive dyskinesia