MOOD AND NEUROCOG

What is a neurocognitive disorder?

A condition that affects how the brain thinks, remembers, makes decisions, communicates, or performs everyday activities.

Remember: Neuro = brain. Cognitive = thinking.

How do neurocognitive disorders affect a client's overall health?

They can cause memory loss, confusion, unsafe behavior, difficulty communicating, and loss of independence. Some clients eventually need 24-hour supervision.

Remember: Brain problems → difficulty with everyday life.

What are the main causes and risk factors for neurocognitive

• Brain conditions: stroke, brain injury, Parkinson's, Huntington's.

• Brain diseases: Alzheimer's, Lewy body disease, frontotemporal dementia.

• Medical problems: heart disease, low oxygen, metabolic disorders.

• Infections: HIV, meningitis, encephalitis.

• Alcohol, drugs, and certain medications.

• Genetics and family history.

Remember: Brain, body, infections, substances, and genes.

What is the difference between delirium and dementia?

• Delirium: Sudden confusion, symptoms change throughout the day, often reversible.

• Dementia: Slow decline in memory and thinking, gradually worsens, usually permanent.

Remember: Delirium = sudden. Dementia = slow.

What are the 3 D's in neurocognitive assessment?

• Delirium: Sudden confusion, often reversible.

• Depression: Mood disorder that can be treated with medication and therapy.

• Dementia: Gradual decline in thinking and memory.

Remember: Delirium = sudden; Depression = mood; Dementia = progressive.

What is delirium?

A sudden change in attention, awareness, and thinking that usually develops over hours to days.

Remember: Sudden brain confusion.

What causes delirium?

Infections, medication effects, alcohol or drug withdrawal, dehydration, electrolyte imbalances, low oxygen, blood sugar problems, head injury, surgery, and sleep deprivation.

Remember: Look for something that suddenly changed in the body.

What is the I WATCH DEATH mnemonic for delirium causes?

• I = Infection

• W = Withdrawal

• A = Acute metabolic problems

• T = Trauma

• C = CNS problems

• H = Hypoxia

• D = Deficiencies

• E = Endocrine problems

• A = Acute vascular problems

• T = Toxins/drugs

• H = Heavy metals

Who is at increased risk for delirium?

Older adults, especially those who are hospitalized, recovering from surgery, living in nursing facilities, or receiving end-of-life care. Younger people can also develop delirium.

What are the signs and symptoms of delirium?

• Sudden confusion and poor attention.

• Restlessness or extreme sleepiness.

• Hallucinations or paranoia.

• Rambling or unclear speech.

• Sleep problems.

• Tremors, sweating, and fast heart rate.

• Severe cases may involve seizures.

Remember: Delirium = sudden confusion + changing behavior.

Why can delirium become worse at night?

Fewer environmental cues and changes in the sleep-wake cycle can make confusion worse.

What tests may be ordered for a client with delirium?

Blood chemistry tests, urinalysis, vitamin B12 levels, and liver function tests to help identify the cause.

Remember: Find what is making the brain confused.

What is the priority treatment for delirium?

Find and treat the underlying cause. For example, treat an infection or correct dehydration or electrolyte problems.

Remember: Fix the cause → improve confusion.

What is the nurse's priority when caring for a client with delirium?

Keep the client safe, assess changes in consciousness and behavior, look for possible causes, and report sudden changes.

How should the nurse communicate with a client experiencing delirium?

Use a calm voice, short sentences, simple directions, and gentle reminders about where they are and what is happening.

Remember: Calm, simple, and reassuring.

What is dementia?

A gradual decline in thinking, memory, and other brain abilities that affects a person's independence.

How does dementia progress?

It may begin with mild forgetfulness and gradually progress to difficulty with everyday activities and the need for constant supervision.

What brain abilities can dementia affect?

• Executive function: Planning and decisions.

• Complex attention: Staying focused.

• Learning and memory: Remembering information.

• Language: Speaking and understanding.

• Perceptual-motor ability: Performing tasks.

• Social cognition: Understanding appropriate behavior.

Remember: Plan, focus, remember, speak, do, socialize.

What does impaired executive function look like?

Difficulty planning activities, multitasking, organizing appointments, or making decisions.

What does impaired complex attention look like?

The client becomes easily distracted, takes longer to complete tasks, or struggles when several things happen at once.

What does impaired memory look like?

Forgetting recent information, misplacing objects, repeating questions, or forgetting names.

What does impaired language look like?

Difficulty finding words, naming objects, understanding instructions, or expressing thoughts.

What does impaired perceptual-motor ability look like?

Difficulty performing familiar physical tasks or using objects correctly.

What does impaired social cognition look like?

Poor judgment, inappropriate behavior, or difficulty understanding other people's feelings.

What is Alzheimer's disease?

A progressive brain disease that causes gradual memory loss and problems with thinking and everyday activities.

Remember: Alzheimer's = memory decline that gets worse.

What is vascular dementia?

Cognitive decline related to problems with blood flow to the brain, including strokes. The decline may happen in steps.

Remember: Vascular = blood vessels.

What is Lewy body dementia?

A type of dementia involving changes in thinking, visual hallucinations, Parkinson-like movement problems, and REM sleep behavior problems.

Remember: Lewy = seeing things + movement problems + changing alertness.

What is frontotemporal dementia?

A progressive disorder affecting the frontal and temporal parts of the brain, causing personality, behavior, judgment, and sometimes language changes.

Remember: Frontotemporal = behavior and personality changes.

What is the difference between Alzheimer's and frontotemporal dementia?

• Alzheimer's: Memory problems are especially important.

• Frontotemporal dementia: Behavior, personality, and judgment changes are especially important.

What are important signs of Lewy body dementia?

Repeated visual hallucinations, changes in alertness, Parkinson-like symptoms, REM sleep behavior problems, and sensitivity to antipsychotic medications.

What is sundowning?

When a client with dementia becomes more confused, restless, or agitated later in the day or at night.

Remember: Sun goes down → confusion goes up.

What is apraxia?

Difficulty performing a familiar action or task.

What is agnosia?

Difficulty recognizing familiar objects or people.

What is confabulation?

Filling in memory gaps with information that is not accurate.

What is perseveration?

Repeating the same word, thought, or action over and over.

What are neologisms?

Made-up words that other people may not understand.

Flashcard 37. What are the three major nursing priorities for neurocognitive disorders?

1. Keep the client safe.

2. Manage symptoms.

3. Connect the client and family with resources.

Remember: Safety → symptoms → support.

. What should the nurse assess in a client with dementia?

Memory, thinking, mood, hallucinations, communication, ability to complete daily activities, physical symptoms, and safety.

What home safety measures are important for dementia?

Remove hazards and sharp objects, prevent wandering, use locks and safety rails, check smoke detectors, and supervise cooking and other risky activities.

What inpatient safety measures help clients with dementia?

Good lighting, handrails, grab bars, glasses and hearing aids, identification bracelets, and minimizing unnecessary restraints.

Why should the nurse avoid unnecessary restraints in confused clients?

Restraints can increase agitation and create additional safety problems.

What nonmedication treatments are discussed for dementia?

Music therapy, reminiscence therapy, massage, pet therapy, personal care assistance, education, and support groups.

Remember: Comfort, memories, activities, and support.

What is reminiscence therapy?

Helping clients recall familiar memories and past experiences to provide comfort and improve mood.

What are important personal care interventions for dementia?

Use easy-to-wear clothing, allow independence when possible, help with bathing and dressing, and provide simple choices.

what nutrition interventions are important for dementia?

Monitor food and fluid intake, provide finger foods when helpful, check for food pocketing, and weigh the client weekly.

What is the MIND diet?

A diet combining Mediterranean and DASH eating patterns, discussed in the slides as a nutritional approach for brain health.

What is the nurse's role in supporting caregivers?

Provide education, emotional support, safety information, community resources, and respite care suggestions.

Remember: Care for the caregiver, too.

When should the nurse contact Adult Protective Services?

When the client is experiencing suspected abuse or is living in an unsafe environment that requires protective intervention.

How does the nurse apply the nursing process to dementia?

• Assess: Check memory, behavior, physical needs, and safety.

• Analyze: Identify the biggest risks.

• Plan: Create a safe, individualized care plan.

• Implement: Provide safety measures, treatment, and support.

• Evaluate: Recheck cognition, behavior, medication effects, and caregiver stress.

How does the nurse know neurocognitive care is effective?

The client is safer, symptoms are better managed, medication is taken correctly, and caregiver needs are addressed.

ashcard 51. What is a mood disorder?

A mental health condition that causes major changes in emotions, such as severe sadness or unusually high mood and energy.

Flashcard 52. How can mood disorders affect overall health?

They can affect sleep, eating, energy, thinking, relationships, work, daily activities, and personal safety

Flashcard 53. What factors can contribute to mood disorders?

Genetics, changes in brain chemistry, stress, loss, trauma, hormonal changes, medical conditions, medications, and substance use.

Flashcard 54. What medical conditions are associated with depressive symptoms in the slides?

Parkinson's disease, Huntington's disease, traumatic brain injury, and hypothyroidism.

Flashcard 55. What is major depressive disorder?

Severe depression that causes persistent low mood or loss of interest and interferes with everyday functioning.

Flashcard 56. What is persistent depressive disorder (dysthymia)?

A long-lasting form of depression described in the slides as milder than major depression.

ashcard 57. What is postpartum depression?

Depression that occurs after childbirth and can develop during the first year after giving birth

Flashcard 58. What is premenstrual dysphoric disorder (PMDD)?

Severe mood symptoms that occur before menstruation.

Flashcard 59. What is substance-induced depression?

Depressive symptoms caused by a medication, substance use, or withdrawal.

Flashcard 60. What is bipolar disorder?

A mood disorder involving episodes of depression and unusually elevated or irritable mood.

Remember: Bipolar = mood highs and lows.

Flashcard 61. What is mania?

A period of unusually high or irritable mood and increased energy that can cause risky behavior and poor judgment.

Flashcard 62. What is hypomania?

A milder form of mania.

Remember: Hypo = less severe.

Flashcard 63. What is bipolar I disorder?

Bipolar disorder involving at least one full manic episode.

Remember: Bipolar I = full mania.

Flashcard 64. What is bipolar II disorder?

Bipolar disorder involving hypomania and depression, without a full manic episode.

Remember: Bipolar II = hypomania + depression.

Flashcard 65. What is cyclothymic disorder?

A long-term pattern of milder mood highs and lows that lasts at least two years.

Remember: Cyclothymia = mild mood cycling.

What are the symptoms of major depression?

Use SIG E CAPS:

• S = Suicidal thoughts

• I = Interest decreased

• G = Guilt

• E = Energy decreased

• C = Concentration decreased

• A = Appetite changes

• P = Psychomotor changes

• S = Sleep changes

Also remember depressed mood.

What are the DSM-5 symptom requirements for major depressive disorder in the slides?

At least five symptoms during the same two-week period, including depressed mood or loss of interest, with a change from previous functioning.

Flashcard 68. What are the common symptoms of mania?

Excessive energy, fast talking, decreased need for sleep, overactivity, overspending, poor judgment, and risky behavior.

Remember: Mania = too much energy, too little sleep.

How can mania affect the client's physical health?

Excessive activity and lack of sleep can interfere with rest, eating, and daily self-care.

Flashcard 70. How do depression and mania differ?

Depression	Mania
Low energy	High energy
Sad or empty mood	Elevated or irritable mood
Loss of interest	Increased activity
May sleep too much or too little	Decreased need for sleep
Difficulty concentrating	Racing or confused thoughts

Why can bipolar II be mistaken for major depression?

Because depression may be the main complaint, while hypomania may go unnoticed.

What are the nurse's main concerns when assessing mania?

Risky behavior, poor judgment, lack of sleep, inadequate nutrition, and client safety.

What are the nurse's main concerns when assessing depression?

Suicidal thoughts, hopelessness, inability to perform daily activities, poor nutrition, sleep changes, and medication adherence.

What are the main medication groups used for mood disorders?

SSRIs, SNRIs, TCAs, MAOIs, mood stabilizers, and second-generation antipsychotics.

What are SSRIs and which examples are listed?

Antidepressants that affect serotonin.

Examples: Fluoxetine, sertraline, escitalopram.

Nursing: Monitor suicidal thoughts and serotonin syndrome. Full effect may take 4–6 weeks.

What are SNRIs and which examples are listed?

Antidepressants that affect serotonin and norepinephrine.

Examples: Venlafaxine, duloxetine.

Nursing: Monitor blood pressure and symptoms related to stopping the medication

What are TCAs and which examples are listed?

Older antidepressants, including amitriptyline and nortriptyline.

Nursing: Watch for sedation, anticholinergic effects, and dangerous heart effects in overdose.

What are MAOIs and which examples are listed?

Antidepressants including phenelzine and tranylcypromine.

Nursing: Teach clients to avoid tyramine-rich foods because of the risk of hypertensive crisis.

Remember: MAOI + tyramine = dangerous blood pressure rise.

What are mood stabilizers and which examples are listed?

Medications used to help control mood changes, including lithium and valproic acid.

0. What is the therapeutic lithium range listed in the slides?

0.6–1.2 mEq/L.

Nursing: Monitor lithium levels, kidney function, and thyroid function.

What second-generation antipsychotics are listed for mood disorders?

Olanzapine and quetiapine.

They can be used for acute mania and psychotic depression.

Nursing: Monitor for metabolic problems.

What is important patient teaching about antidepressants?

Antidepressants may take 4–6 weeks to have their full effect. Clients should take them as prescribed and report worsening mood or suicidal thoughts.

Remember: Antidepressants take time.

What is cognitive behavioral therapy (CBT)?

Therapy that helps clients change unhelpful thinking patterns and behaviors.

Remember: Change thoughts → change behaviors.

What is electroconvulsive therapy (ECT)?

A treatment using controlled electrical stimulation of the brain, discussed in the slides for depression that has not responded to treatment.

. What is transcranial magnetic stimulation (TMS)?

A treatment that uses magnetic pulses to stimulate areas of the brain. The slides note that it does not require anesthesia.

. What is vagus nerve stimulation (VNS)?

A treatment involving a device implanted in the chest to stimulate the vagus nerve.

What is deep brain stimulation (DBS)?

A procedure in which electrodes are placed in the brain to stimulate specific areas.

What nursing interventions help clients experiencing mania?

Provide a safe environment, promote rest, offer high-calorie finger foods, monitor behavior, and support medication adherence.

Remember: Mania = safety, food, sleep.

hat nursing interventions help clients experiencing depression?

Build trust, listen without judgment, assess suicide risk, encourage nutrition and sleep, support daily activities, and monitor treatment.

What screening tools for depression are listed?

• PHQ-9: Nine-question depression screening tool.

• Beck Depression Inventory: 21-item depression assessment.

Why is culturally sensitive nursing care important for mood disorders?

Clients may fear judgment, losing relationships, employment problems, or other negative consequences if they discuss mental health symptoms.

Nursing: Listen respectfully, show empathy, and avoid stigma.

What is suicidal ideation?

Thoughts about suicide or ending one's life.

What is a suicide attempt?

Self-directed, potentially harmful behavior carried out with some intent to die that does not result in death.

What are important suicide warning signs?

• Talking about wanting to die.

• Feeling hopeless or trapped.

• Withdrawing from others.

• Saying goodbye.

• Giving away possessions.

• Making final arrangements.

• Engaging in dangerous behavior.

Remember: Hopelessness + goodbye behaviors = serious warning signs.

Suicide Assessment Five-Step Evaluation and Treatment.

• Identify risk factors.

• Identify protective factors.

• Ask about suicidal thoughts, plans, behavior, and intent.

• Determine risk level and interventions.

• Document findings and follow-up.

What should the nurse ask when assessing suicide risk?

Ask directly about suicidal thoughts, whether the client has a plan, access to the method, previous behavior, and intent.

what is the nurse's priority for a client at immediate risk of suicide?

Protect the client from harm. Follow the required observation and safety precautions, remove dangerous objects, and immediately notify the appropriate care team.

What inpatient suicide safety precautions are described?

Depending on the risk level and orders, use one-to-one observation or 15-minute checks and remove potentially dangerous items such as belts, shoelaces, sharp objects, and other contraband.

What should the nurse do for a client at risk of suicide in an outpatient setting?

Assess thoughts, plans, and access to dangerous methods; create a safety plan; encourage reporting worsening thoughts; and arrange urgent intervention for immediate danger.

Why is therapeutic communication important for suicidal clients?

Trust and nonjudgmental listening help clients feel comfortable sharing suicidal thoughts so the nurse can assess risk and provide support.