Exam 2 NUR 2459 Study Guide – Winter 2021
Exam 2 Study Guide
We will continue to build on ALL of the first exam insights further advancing our knowledge,
skills and attitudes with communication, ethics, Legal, therapies, barriers, boundaries, safety
considerations, Patients’ rights, HIPPA, defense mechanisms, communication techniques
(therapeutic communication), dosage and calculation, and etc…
New Material will include topics from week 4 through week 6
Care of the client with Neurocognitive disorders (Alzheimer’s, Delirium, Types of NCD, NMS)
Delirium: is characterized by a disturbance in attention and awareness and change in cognition
that develops rapidly over a short period.
Differentiating delirium from dementia can be a difficult process, but failure to recognize
delirium and the cause can delay appropriate treatments causing serious consequences.
m
er as
Examples of causes: Systematic infections, Febrile illness, Head trauma, Seizures, Migraine
headaches, Stroke, Electrolyte imbalance, Post-operative state.
co
eH w
Symptoms: Disorganized thinking (rambling speech, irrelevant, pressured, incoherent)
Shifting attention, Very distractible, Lack of focused attention, Disorientation, Impairment of
o.
rs e
recent memory, Misperceptions of the environment, Illusions, hallucinations
o State of awareness my range from hypervigilance to stupor.
ou urc
o Sleep may fluctuate between hypersomnolence and insomnia.
o Psychomotor activity may fluctuate between agitated, purposeless movements to a state
o
resembling catatonic stupor.
aC s
Emotional instability may be manifested by anxiety, fear, irritability, anger, euphoria or apathy.
vi y re
These emotions may be evidenced by crying, calling for help, muttering and moaning.
Autonomic symptoms: Tachycardia, Sweating, Flushed face, Dilated pupils, Elevated blood
pressure
Onset of the symptoms is usually quite abrupt and duration is usually brief (1 week – rarely 1
ed d
month)
ar stu
TX: Antipsychotic (low-dose) haloperidol (Haldol) Benzodiazepine (lorazepam or diazepam)
B1 IV for thiamine deficiency and electrolyte imbalance. Supplemental oxygen. Decrease
stimulation, Have family stay with client, Verbally orient to time, place and situations several
is
times daily, Place in room close to the nursing station. Etc.
Dementia: a mental disorder involving functional decline in multiple cognitive areas, including
Th
memory along with behavioral and psychological symptoms. Dementias are classified according
to the cause or areas of neurological damage.
Stages of Alzheimer’s disease
sh
o Stage 1- No apparent symptoms
o Stage 2- Forgetfulness
o Stage 3- Mild cognitive decline
o Stage 4- Mild to Moderate cognitive decline
■ confabulation
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https://www.coursehero.com/file/81594684/Exam-2-NUR-2459-Study-Guidedocx/
, o Stage 5- Moderate cognitive decline
o Stage 6- Moderate to severe cognitive decline
■ sundowning
o Stage 7- Severe cognitive decline
How the brain changes: An overabundance of structures called plaques and tangles appear
in the brain of individuals with Alzheimer’s disease.
■ Amyloid Plaques are made of amyloid protein. This clumps together and form between
nerve cells causing neuronal destruction.
■ Tangles are formed from a cellular protein called tau protein. Strands of protein become
tangled together, interfering with neuron transport.
■ Brain atrophy
TX: galantamine (Razadyne)-cholinesterase inhibitor – mild to moderate
■ donepezil (Aricept)-cholinesterase inhibitor-- all stages
■ rivastigmine (Exelon)—all stages
■ memantine (Namenda)—moderate to severe
m
er as
■ donepezil and memantine (Namzaric)—moderate to severe
co
Symptoms: Confabulation, Preservation, Agraphia, Aphasia, Apraxia, Agnosia, Auditory agnosia,
eH w
Hyperorality, Hypermetamorphesis ,Sundowning
It is important that that what the individual is saying is heard, and that the caregiver listen and
o.
rs e
understand the frustration shown.
ou urc
Interventions: Orient to time and place. Keep environment safe. Assist the client with
ambulation and ADL’s. Remain calm and undemanding and avoid pressing the client when
he/she is refusing. Dance and movement therapy. Music (of the client’s past)
o
aC s
vi y re
Care of the client with Substance Misuse, Drug and Alcohol and addictive related psychiatric
problems
Substance-related and Addictive Disorders: Substance use disorders are complex. Symptoms fall
ed d
into four groups.
ar stu
o Impaired control
o Social impairment
o Risk, use
is
o Physical effect
Th
It is important for all nurses regardless of practice specialty area to develop an understanding of
the complex disease of substance use disorders.
Weed: intoxication: impaired motor coord. Euphoria, anxiety, sensation of slowed time,
impaired judgement, social withdrawl.
sh
Withdrawal: anger, aggression, anxiety, irritability, sleep difficulty, decreased appetite,
restlessness, depressed mood, physical symptoms.
Opioid: intoxication: psychomotor retardation, Drowsiness, slurred speech, altered mood,
impaired memory and attention, Bradycardia, Hypotension, hypothermia, meiosis (pinpoint
pupils) , intense drowsiness, coma.
This study source was downloaded by 100000835664478 from CourseHero.com on 11-05-2021 11:17:20 GMT -05:00
https://www.coursehero.com/file/81594684/Exam-2-NUR-2459-Study-Guidedocx/
Exam 2 Study Guide
We will continue to build on ALL of the first exam insights further advancing our knowledge,
skills and attitudes with communication, ethics, Legal, therapies, barriers, boundaries, safety
considerations, Patients’ rights, HIPPA, defense mechanisms, communication techniques
(therapeutic communication), dosage and calculation, and etc…
New Material will include topics from week 4 through week 6
Care of the client with Neurocognitive disorders (Alzheimer’s, Delirium, Types of NCD, NMS)
Delirium: is characterized by a disturbance in attention and awareness and change in cognition
that develops rapidly over a short period.
Differentiating delirium from dementia can be a difficult process, but failure to recognize
delirium and the cause can delay appropriate treatments causing serious consequences.
m
er as
Examples of causes: Systematic infections, Febrile illness, Head trauma, Seizures, Migraine
headaches, Stroke, Electrolyte imbalance, Post-operative state.
co
eH w
Symptoms: Disorganized thinking (rambling speech, irrelevant, pressured, incoherent)
Shifting attention, Very distractible, Lack of focused attention, Disorientation, Impairment of
o.
rs e
recent memory, Misperceptions of the environment, Illusions, hallucinations
o State of awareness my range from hypervigilance to stupor.
ou urc
o Sleep may fluctuate between hypersomnolence and insomnia.
o Psychomotor activity may fluctuate between agitated, purposeless movements to a state
o
resembling catatonic stupor.
aC s
Emotional instability may be manifested by anxiety, fear, irritability, anger, euphoria or apathy.
vi y re
These emotions may be evidenced by crying, calling for help, muttering and moaning.
Autonomic symptoms: Tachycardia, Sweating, Flushed face, Dilated pupils, Elevated blood
pressure
Onset of the symptoms is usually quite abrupt and duration is usually brief (1 week – rarely 1
ed d
month)
ar stu
TX: Antipsychotic (low-dose) haloperidol (Haldol) Benzodiazepine (lorazepam or diazepam)
B1 IV for thiamine deficiency and electrolyte imbalance. Supplemental oxygen. Decrease
stimulation, Have family stay with client, Verbally orient to time, place and situations several
is
times daily, Place in room close to the nursing station. Etc.
Dementia: a mental disorder involving functional decline in multiple cognitive areas, including
Th
memory along with behavioral and psychological symptoms. Dementias are classified according
to the cause or areas of neurological damage.
Stages of Alzheimer’s disease
sh
o Stage 1- No apparent symptoms
o Stage 2- Forgetfulness
o Stage 3- Mild cognitive decline
o Stage 4- Mild to Moderate cognitive decline
■ confabulation
This study source was downloaded by 100000835664478 from CourseHero.com on 11-05-2021 11:17:20 GMT -05:00
https://www.coursehero.com/file/81594684/Exam-2-NUR-2459-Study-Guidedocx/
, o Stage 5- Moderate cognitive decline
o Stage 6- Moderate to severe cognitive decline
■ sundowning
o Stage 7- Severe cognitive decline
How the brain changes: An overabundance of structures called plaques and tangles appear
in the brain of individuals with Alzheimer’s disease.
■ Amyloid Plaques are made of amyloid protein. This clumps together and form between
nerve cells causing neuronal destruction.
■ Tangles are formed from a cellular protein called tau protein. Strands of protein become
tangled together, interfering with neuron transport.
■ Brain atrophy
TX: galantamine (Razadyne)-cholinesterase inhibitor – mild to moderate
■ donepezil (Aricept)-cholinesterase inhibitor-- all stages
■ rivastigmine (Exelon)—all stages
■ memantine (Namenda)—moderate to severe
m
er as
■ donepezil and memantine (Namzaric)—moderate to severe
co
Symptoms: Confabulation, Preservation, Agraphia, Aphasia, Apraxia, Agnosia, Auditory agnosia,
eH w
Hyperorality, Hypermetamorphesis ,Sundowning
It is important that that what the individual is saying is heard, and that the caregiver listen and
o.
rs e
understand the frustration shown.
ou urc
Interventions: Orient to time and place. Keep environment safe. Assist the client with
ambulation and ADL’s. Remain calm and undemanding and avoid pressing the client when
he/she is refusing. Dance and movement therapy. Music (of the client’s past)
o
aC s
vi y re
Care of the client with Substance Misuse, Drug and Alcohol and addictive related psychiatric
problems
Substance-related and Addictive Disorders: Substance use disorders are complex. Symptoms fall
ed d
into four groups.
ar stu
o Impaired control
o Social impairment
o Risk, use
is
o Physical effect
Th
It is important for all nurses regardless of practice specialty area to develop an understanding of
the complex disease of substance use disorders.
Weed: intoxication: impaired motor coord. Euphoria, anxiety, sensation of slowed time,
impaired judgement, social withdrawl.
sh
Withdrawal: anger, aggression, anxiety, irritability, sleep difficulty, decreased appetite,
restlessness, depressed mood, physical symptoms.
Opioid: intoxication: psychomotor retardation, Drowsiness, slurred speech, altered mood,
impaired memory and attention, Bradycardia, Hypotension, hypothermia, meiosis (pinpoint
pupils) , intense drowsiness, coma.
This study source was downloaded by 100000835664478 from CourseHero.com on 11-05-2021 11:17:20 GMT -05:00
https://www.coursehero.com/file/81594684/Exam-2-NUR-2459-Study-Guidedocx/
