NUR 2459 Mental & Behavioral Health Nursing

Exam 2 Review Study Guide

(Exam 2 NUR 2459 Study Guide – 2021)

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.

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○ 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.

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● 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, 

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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

■ 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