N1 Exam 1 reviewer

Dementia ­ refers to various organic disorders that progressively affect cognitive functioning. ­ Dementia is chronic and usually develops gradually ­ Most people think of AD when dementia is mentioned, but dementia may also occur more suddenly following a stroke or other vascular event ­ vascular dementia, this form is often related to hypertension, and is the second most common type of dementia ­ many people have a form of mixed dementia consisting of two or more types ­ Of the dementias that affect older adults, Alzheimer’s disease (AD) is the most common degenerative neurologic illness and the most common cause of cognitive impairment o It is irreversible and progresses from deficits in memory and thinking skills to an eventual inability to perform basic self-care o usually occur in a person’s mid-60s o the formation of amyloid plaques and tangles of tau proteins have an impact on the brain structure and function in older adults with AD o progressively serious and ultimately fatal disorder o In mild or early AD, forgetfulness and impaired judgment may be evident. becomes progressively more confused o forgetting family and becoming disoriented in familiar surroundings o requires constant supervision and care, often in a long-term care facility o There is no effective medical treatment for AD at this time ­ Often, a medical or nursing intervention can trigger a sequence of adverse events in a frail older adult = cascade iatrogenesis o example of cascade iatrogenesis: an episode of confusion and wandering at night may lead to a fall that results in a hip fracture. During the resulting hospitalization, the insertion of an indwelling catheter can precipitate a urinary tract infection that requires use of an antibiotic and possibly the development of antibiotic-resistant organisms. ­ common problem in patients with dementia is sundowning syndrome, in which an older adult habitually becomes confused, restless, and agitated after dark. ­ Fulmer SPICES tool = not a tool specifically used for the assessment of dementia or delirium, it provides information on hospitalized older adults that may assist in preventing and detecting common complications. o alerts nurses to quickly identify interventions to individualize an older adult’s care. o S—Sleep disorders o P—Problems with eating or feeding o I—Incontinence o C—Confusion o E—Evidence of falls o S—Skin breakdown