test 5 psy well being

therapy; technique used to improve quality of life in confused older adults; older adults to gain more accurate understanding; info about time, place, and person; useful in early stages

reality orientation

loss of sensory ability to recognize objects

agnosia

diminished or lost ability to read or write

agraphia

creation of stories or answers in place of actual memories to amintain self esteem 

confabulation

short term onset; acute confusional; potentially reversible cognitive impairment

delirium

progressive deteoration cognitive functioning and global impairment of intellect with no changes in consciousness

dementia

loss of ability to plan or problem solve

executive function

false sensory stimuli; real to the person; 5 senses

hallucinations

urge to touch everything; regressing back into child like ways

hypermetamorphosis

urge to put things in your mouth 

hyperorality 

state of extraordinary alertness; increased agitation

hypervigilance 

misinterpretation of something that is actually there

illusions

persistent repetition of the same word or idea in response to different questions

preseveration

aka nocturnal delirium; characterized by confusion, agitation, disruptive actions that occur in the late afternoon or evening; common when they aren't living at home
ex: nursing home, hospital

sundown syndrome 

what cuases of delirium infections?

UTI, penumonia

causes of delirium: withdrawal?

alcohol

causes of delirium: acute metabolic disorders?

hyperthyroidism

causes of delirium: trauma?

surgery

causes of delirium: CNS pathology

MS, epilepsy, brain disorders 

causes of delirium: hypoxia?

near drowning, strangulation, suffication

causes of delirium deficiencies

v, iron, electrolytes

causes of delirium: endocrinopathies?

diabetes

causes of delirium: acute vascular

anemias, liver problems, HPS

causes of delirium: toxins

botulism

causes of delirium: heavy metals

led, mercury

four cardinal features of delirium:

a) rapid acute onset
b) fluctuating course of inattention (LOC changes)
c) disorganized thinking
d) disturbance in LOC

delirium is ________________ if you can find the underlying cause and treat it early

reversible

the most prevalent form of dementia; progressive brain disorder marked by impaired memory and thinking skills; personality changes, cognitive changes, functional changes, and altered stress threshold

alzheimers disease

causes of Alzheimer's disease:

a) neuronal loss
b) neurofibrillary tangles
c) amyloid plaques
d) brain atrophy
e) genetics

may feel as if he/she is having memory lapses; forgetting familiar words or location of everyday objects; trouble remembering names when meeting new people; losing or misplacing valuable things

mild alzheimers disease

increased trouble planning and organizing; moody/withdrawn; unable to recall phone # or address; "what day is it?"; need help choosing appropriate clothing; tend to wander and get lost

moderate alzheimers disease

remote memory is pretty much gone; remembers own name; needs help dressing/bathing/toileting; muscles grow rigid; loss of ability to carry on a conversation; swallowing eventually becomes impaired; very vulnerable to infection; they will soon pass away from complications in this disease

severe alzheimers disease

treats moderate to severe Alzheimer's; no evidence that it modifies underlying disease
side effects: dizziness, agitation, constipation, confusion, etc

NMDA antagonist
Memantine (Namenda)

-regulates glumate activity by blocking NMDA receptors
treats moderate to severe Alzheimer's currently stabilized on a combination of memantine and donepezil
side effects: dose-related, nausea, diarrhea, vomiting, etc

NMDA receptor antagonist/ cholinesterase inhibitor
Memantine/Donepezil (Namzaric)

Exelon ,Exelon patch (cholinesterase inhibitor) patch is approved for mild/moderate Parkinson's disease

rivastigmine

most common; Aricept (cholinesterase inhibitor)
approved for severe Alzheimer's disease; PO administer

donepezil

meds that increase avaliable acetyocholine

Cholinesterase inhibitors:
-donepezil
-rivastigmine
-galantamine

used to treat depression:
SSRIs (Selective Serotonin Reuptake Inhibitors)

1) citalopram (Celexa)
2) escitalopram (Lexapro)
3) fluoxetine (Prozac)
4) paroxetine (Paxil)
5) sertraline (Zoloft)

used to treat anxiety: DO NOT GIVE TO ELDERLY

lorazepam ATIVAN

Atypical (antipsychotics) give z-track!!!

1) aripiprazole (Abilify)
2) olanzapine (Zyprexal)
3) quietiapine (Seroquel)
4) risperidone (Risperidol)
5) ziprasidone (Geodon)

when their mood switches
Anticonvulsants

1) carbamazepine (Tegretol)
2) valproic acid (Depakote)

therapy; technique used to improve quality of life in confused older adults; gain more accurate understanding; useful in early stages

reality orientation

based upon affirmation of person's feelings and adoption of a nonjudgmental approach on part of caregiver; validating persons emotions can help resolve some past conflicts; emphasis on going with the person to his/her own reality

validation therapy 

involves discussion of past activities, events, or experiences with another person/group; person-centered care; emphasizes respect and valuing the individual as a full member of society; factors that support or deny personhood

reminisce therapy

communication strategies:

-pleasant, smile, good eye contact
-do not use sarcasm
-use short, simple sentences
-slow directions
-approach patient from front

nutritional strategies:

-serve smaller meals several times per day
-finger foods work well with wanderers
-beverage supplements (Ensure shakes

toileting strategies:

take to bathroom every 2 hours to promote continence

services that may be avaliable:

-adult day care
-NACOLG
-home health
-physical therapy
-mental health services
-occupational therapy
etc

loss of movement

apraxia

loss ability to speak cannot develop words

aphasia