FNP Board Review: Problems of Older Adult (Fitzgerald) 100% Correct Answers | Verified | Latest 2024 Version

FNP Board Review: Problems of Older Adult (Fitzgerald) 100% Correct Answers | Verified | Latest 2024 Version ____________ is a sudden state of rapid changes in brain function reflected in confusion, changes in cognition, activity, and level of consciousness. - Delirium ____________ is a slowly developing impairment of intellectual or cognitive function that is progressive and interferes with normal functioning - Dementia T/F: Delirium is precipitated by an underlying acute cause, such as acute illness whereas a dementia has a variety of causes - True With dementia there are psychomotor changes _______(early or late) in the disease - Late What is important (related to medications) to look at when assessing a patient with delirium? - The last medication added or dose adjusted What are some problematic medications in the elderly related To delirium? - Systemic Anticholinergics -TCA - FIRST-generation antihistamines (diphenhydramine) - antipsychotics (Haldol) - Opioids - Benzodiazepines - Alcohol Which electrolyte disturbance in particular could cause delirium? - Hyponatremia Reasons for hyponatremia in the elder? - Elder kidney can not conserve sodium plus we give elders lots of hyponatremia causing medications like thiazides What are the most common infections in the elderly that can cause delirium? - UTI (#1) , CAP (#2) Delirium Mnemonic - Drugs Emotional Electrolyte Low PO2 Lack of Drugs Infection Retention Reduced sensory input Ictal or postictal state Undernutrition Metabolic Myocardial Problems Subdural Hematoma Delirium mnemonic - •Drugs—When any medication is added or dose is adjusted. Particularly problematic medications include anticholinergics (tricyclic antidepressants [TCAs], firstgeneration antihistamines), neuroleptics (haloperidol, others), opioids (in particular, meperidine), longacting benzodiazepines (diazepam, clonazepam), and alcohol. •Emotional (mood disorders, loss); Electrolyte disturbance, especially hyponatremia. •Low PO2 (hypoxemia from CAP, COPD, PE, MI); Lack of drugs (withdrawal from alcohol, other habituating substances). •Infection—Urinary tract infection and communityacquired pneumonia (the most common delirium trigger). •Retention of urine or feces; Reduced sensory input (blindness, deafness, darkness, change in surroundings). •Ictal or postictal state—Alcohol withdrawal is a common reason for an isolated first seizure in an older adult. •Under- nutrition—Protein/calorie, vitamin B12, or folate deficiency, dehydration including postoperative volume disturbance. •Metabolic (poorly controlled diabetes mellitus, undertreated or untreated hypothyroidism or hyperthyroidism); Myocardial problems (myocardial infarction, heart failure, dysrhythmia). •Subdural hematoma—Can be as a result of relatively minor head trauma to brain atrophy, fragile vessels. Metabolic reasons for delirium - Poorly controlled diabetes Undertreated hypo or hyper thyroid T/F: Either gender over age 80 most commonly present with dysthymia and confusion in ACS - True What was the first "name" for pernicious anemia? - Megaloblastic mania Most dementia is ______-type dementia - Alzheimer's type 20% of dementia is ______-type dementia - Vascular 5% of dementia is ______-type dementia - Parkinson's Miscellaneous causes of dementia - HIV Dialysis encephalopathy Neurosyphilis Normal pressure hydrocephalus Lewy body disease Frontotemporal dementia T/F: About 30% with Alzheimer's type dementia also have vascular dementia - True To slow AD decline use Vitamin _____, ________ IUs twice daily - Vitamin E, 1000 IUs BID An alternative to vitamin E, 1000 IUs daily use ____________ at 5mg BID. - Selegiline In mild to moderate stage dementia disease the use of the __________inhibitors is considered to be the mainstay of treatment - Cholinesterase What are the names of some cholinesterase inhibitors? - Donepezil (Aricept) Rivastigmine (Exelon) Galantamine (Razadyne) Cholinesterase inhibitors have a clear but minor and time limited benefits by increasing the availability of ___________. At the same time this small effect is clinically significant - acetylcholine What medications are approved in moderate to severe AD - N-methyl-D aspartate receptor antagonist memantine (Namenda) Cholinesterase inhibitor Donepezil (Aricept) Which drugs are most commonly prescribed if environmental manipulation fails to eliminate agitation or psychosis in the person with dementia - Second generation antipsychotics What are the risks for second generation antipsychotics in the elderly with dementia - Stroke and cardiovascular events Second generation antipsychotics worsen _________