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PMHNP ancc Chapter 12 Neurocognitive Exam 2023
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PMHNP ancc Chapter 12 Neurocognitive Exam 2023
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By: pensiaernest • 1 year ago
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PMHNP ancc Chapter 12 Neurocognitive Exam 2023when do cognitive disorders occur - Answer- any age. the very young and very old often
have multiple health needs older adults usually have more than one chronic illness and psy. disorders can be co-morbid
etiology of cognitive disorders - Answer- a complex general medical condition resulting in changes in multiple domains including memory, interpersonal relationships, and behavior. can result from injury, medical condition, substance abuse, reaction to a medication, other injected agents or a combination of these
Delirium is a - Answer- syndrome, not a disease
Subtypes of delirium - Answer- hyperactive, agitated hypoactive, lethargic slowed mixed, cycles between hyperactive and hypoactive
etiology of delerium - Answer- general medical condition substance induced physical health problems medication sleep deprived
incidence of delirium - Answer- highest in hospitalized older adults
70-87% older adults in ICU
60% of Nursing home residents
25% with cancer 80% terminally ill nearing death
1 year mortality rate of pt with delirium - Answer- 40%
risk factors for delerium - Answer- age multisystem medical illness
substance abuse
vision or hearing impairment past episodes brain disorder or cognitive impairment
screening for delirium - Answer- Confusion Assessment Method (CAM)
Delirium Index (DI)
NEECHAM Confusion Scale
Mini-Cog presentation of delrium - Answer- rapid change from baseline, waxs and wanes
Key findings for delirium - Answer- disturbance of consciousness develops over a short period of time fluctuates during the day several of day and night is common
impaired recent and intermediate memory
agitated type -- purposeless, random action resolves in hours to days if sx are discovered and treated sooner, resolves sooner, can last 3-6 months
physical exam finding for delirium - Answer- tremors.. poor coordination,
urinary incontinence, myoclonus, nystagmus. asterixis (flapping of the wrist), increase muscle tone and reflex
mental status exam fiindings for delerium - Answer- disheveled, highly inattentive,
speech- impaired, rambling, incoherent, slurring affect- rapid unpredictable changes from lethargic to agitate without precipitation mood-difficult to elicit
thought process- disorganized, distractable illusions common, hallucination usually visual and accompanied by illusions
disoriented --!st sx to appear
memory, judgment, concentration, abstraction all grossly impaired
diagnositc work-up for delerium - Answer- serum chemistry, CBC, thyroid function, syphilis, HIV, urinalysis. chest x-ray, UDS
EEG
Pharmacological Treatment for delerium - Answer- symptomatic tx. agitation and psychosis -Haldol, atypical antipsychotic, anxiolytic,
non-Pharmacological Treatment for delerium - Answer- monitor for safety needs, determine reality orientation frequently, pay attention to basic needs -hydration, nutrition. the client should neither by sensory deprived or overstimulated helpful to have familiar things in the room
delerium mnemonic - Answer- Drugs
Electrolyte abnormality Low o2 saturation Infection Reduced sensory Intracranial Urinary or renal retention Myocardial
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