Exam 2 NUR 2459 Study Guide – Spring 2022/2023 Material will include topics from Module 4 through Module 6

Module 04 – Nursing Interventions for Clients Exhibiting Cognitive Dysfunction and Substance-Related Conditions Ch. 22 - Neurocognitive Disorders Ch. 23 - Substance-Related and Addictive disorders Topics: -Drug and Drug Related Disorders- substances with intoxication and withdrawal symptoms ● Substance use disorders are complex diseases of the brain characterized by craving, seeking and use regardless of consequences. ● A substance use disorder is a pathological use of a substance that leads to a disorder of usage. Symptoms fall into four groups. ○ Impaired control ○ Social impairment ○ Risk, use ○ Physical effect ● It is important for all nurses regardless of practice specialty area to develop an understanding of the complex disease of substance use disorders. ○ Addiction:A compulsive or chronic requirement. The need is so strong as to generate distress (either physical or psychological) if left unfulfilled. ○ Intoxication: A state of disturbance in cognition, perception, behavior, level of consciousness, judgment, and other functions that is directly attributable to the effects of a psychoactive drug. It may be marked by a physical and mental state of exhilaration and emotional frenzy or lethargy and stupor. ○ Withdrawal: The physiological and mental readjustment that accompanies the discontinuation of an addictive substance. ○ Tolerance: the increased need to have a drug or substance as use becomes more apparent. The increased amount of a drug to produce its intended effect. -Delirium: is characterized by a disturbance in attention and awareness and change in cognition that develops rapidly over a short period. -Dementia: a mental disorder involving functional decline in multiple cognitive areas, including memory along with behavioral and psychological symptoms. -Alzheimer’s Stages (1-7 be able to identify) ● Stage 1- No apparent symptoms: In the first stage of the illness, there is no apparent decline in memory despite changes that are beginning to occur in the brain. A positron emission tomography (PET) scan can be used to detect these changes. ● Stage 2- Forgetfulness: The individual begins to lose things or forget names of people. Losses in short-term memory are common. The individual is aware of the intellectual decline and may feel ashamed, becoming anxious and depressed, which in turn may worsen the symptoms. Maintaining an organization with lists and a structured routine provides some compensation. These symptoms often are not noticed by others and do not interfere with the individual’s ability to work or live independently. ● Stage 3- Mild cognitive decline: In this stage, there are changes in thinking and reasoning that interfere with work performance and become noticeable to coworkers. The individual may get lost when driving his or her car. Concentration may be interrupted. There is difficulty recalling names or words, which becomes noticeable to family and close associates. A decline occurs in the ability to plan or organize. ● Stage 4- Mild to Moderate cognitive decline:At this stage, the individual may forget major events in personal history, such as his or her child’s birthday; experience declining ability to perform tasks, such as shopping and managing personal finances; or be unable to understand current news events. He or she may deny that a problem exists by covering up memory loss with confabulation. Depression and social withdrawal are common. At this stage, the individual requires some assistance to maintain safety. ○ Confabulation: the client may make up stories when questioned about the events or activities they do not remember. ■ Ex: If one asked about their favorite childhood activity, they may make up something totally irrelevant to their life, as they cannot remember their childhood that well. ● Stage 5- Moderate cognitive decline: At this stage, individuals lose the ability to independently perform some ADLs, such as hygiene, dressing, and grooming, and require some assistance to manage these tasks on an ongoing basis. They may forget addresses, phone numbers, and names of close relatives. They may become disoriented about place and time, but they maintain knowledge about themselves. Frustration, withdrawal, and self-absorption are common. ● Stage 6- Moderate to severe cognitive decline: At this stage, individuals may be unable to recall the name of their spouse or may misidentify people.Disorientation to surroundings is common, and the person may be unable to recall the day, season, or year. The person is unable to manage ADLs without assistance. Delusions often become apparent, such as maintaining the belief that one must go to work even though the person is no longer employed. Urinary and fecal incontinence are common. Sleeping becomes a problem. Psychomotor symptoms include wandering, obsessiveness, agitation, and aggression.Communication becomes more difficult, with increasing loss of language skills. Institutional care is usually required at this stage. ○ Sundowning: A phenomenon in neurocognitive disorder in which the symptoms of aggression, delusions,agitation, and disorientation seem to worsen in the late afternoon and evening. ■ Ex: a client may start to hit and kick staff near the evening time because of not being able to remember their names or how to do certain tasks. ● Stage 7- Severe cognitive decline: In the end stages of AD, the individual is unable to recognize family members, is commonly confined to bed, and is aphasic. Problems of immobility, such as decubiti and contractures, may occur. Care of the client with Neurocognitive disorders (Alzheimer’s, Delirium, Types of NCD, NMS) Delirium: ● Characterized by a disturbance in attention and awareness and a change in cognition that develops rapidly over a short period. ● Symptoms will begin abruptly, and will usually last 1 week or until the cause is eliminated. ● Risk Factors: ○ Medical/Surgical/Neurological ■ Systemic infections ■ Febrile illness or hyperthermia ■ Metabolic disorders, such as electrolyte imbalances, hypercarbia, hypoglycemia, or hyponatremia ■ Hypoxia and chronic obstructive pulmonary disease (COPD) ■ Hepatic failure or renal failure ■ Head trauma ■ Seizures ■ Migraine headaches ○ Age ■ Brain abscess or brain neoplasms ■ Stroke ■ Nutritional deficiency ■ Uncontrolled pain ■ Burns ■ Heat stroke ■ Orthopedic and cardiac surgeries ■ Social isolation ■ Emotional stress- depression ■ Physical restraints ■ Admission to an intensive care unit ■ People older than 65 years are high risk ■ Falls ■ Elder abuse ○ Substance Intoxication ○ Substance Withdrawal ○ Medication Induced ■ Anticholinergics ■ Antihypertensives ■ Corticosteroids ■ Anticonvulsants ■ Cardiac glycosides ■ Analgesics ■ Antineoplastic agents ■ Antiparkinson drugs ■ H2-receptor antagonists ■ Polyph