Cognitive, Organic, and Neurodevelopmental Disorders - Cheat Sheet
Your 30-minute exam survival guide. Master the delirium vs. dementia distinction, Alzheimer's nursing care priorities, and neurodevelopmental disorder management for the PRC Board of Nursing NLE.
DELIRIUM vs. DEMENTIA (THE CORE COMPARISON)
Important facts
- Delirium onset: SUDDEN (hours to days); Dementia onset: GRADUAL (months to years)
- Delirium course: FLUCTUATING, worse at night (sundowning); Dementia course: STABLE day-to-day, progressive over time
- Delirium consciousness: ALTERED/CLOUDED; Dementia consciousness: CLEAR (until very late stage)
- Delirium attention: GROSSLY IMPAIRED (hallmark — cannot sustain focus); Dementia attention: relatively preserved early
- Delirium reversibility: USUALLY REVERSIBLE once cause treated; Dementia reversibility: USUALLY IRREVERSIBLE
- Common delirium causes: Infection (UTI, pneumonia), electrolyte imbalance, hypoxia, hypoglycemia, dehydration, medications, drug/alcohol withdrawal, post-anesthesia, pain
- A patient WITH dementia can ALSO develop delirium (superimposed acute confusion) — investigate for medical cause immediately
- Memory loss pattern — Delirium: all cognitive functions affected; Dementia: RECENT memory impaired FIRST, remote memory preserved longer
- Delirium = MEDICAL EMERGENCY; Dementia = chronic disease requiring supportive care
- Single strongest discriminator for bedside nursing: SUDDEN CHANGE = suspect delirium; GRADUAL CHANGE = expected dementia progression
Key definitions
Delirium
Example
85-year-old develops confusion over 6 hours due to UTI; confusion clears when UTI is treated.
Acute, reversible confusional state caused by an underlying medical problem; a medical emergency requiring cause identification.
Dementia
Example
60-year-old gradually loses memory over 2 years; Alzheimer's-type pathology.
Chronic, progressive, irreversible decline in cognitive functioning (memory, language, judgment) from a baseline.
Diagrams to know
- Timeline showing delirium onset (acute vs. gradual for dementia)
- Mental status fluctuation pattern in delirium (hour-to-hour changes) vs. stable decline in dementia
DELIRIUM: NURSING MANAGEMENT & PHARMACOLOGY
Important facts
- PRIORITY NURSING ACTION: Identify and treat the underlying medical cause (infection, metabolic disturbance, medication toxicity)
- Monitor vital signs, oxygenation (SpO2), fluid balance, glucose, and electrolytes continuously
- Provide CALM, ORIENTED environment: clock, calendar, familiar objects, adequate lighting to reduce sundowning
- Ensure patient SAFETY: side rails, fall precautions, frequent monitoring
- MINIMIZE sedatives (worsen confusion); use antipsychotics (e.g., haloperidol) only for dangerous agitation at lowest dose
- Reorient frequently and reassure patient; use simple, clear communication
- Assess for drug interactions and polypharmacy (major delirium cause in elderly)
- Monitor hydration and nutrition; prevent aspiration
- Review medications — stop unnecessary drugs, adjust doses for renal/hepatic impairment
- Reassurance and frequent orientation are non-pharmacologic cornerstones
Key definitions
Sundowning
Example
Patient alert and oriented in morning; becomes confused and combative by 6 PM without a specific trigger.
Worsening of confusion and agitation in late afternoon/evening; seen in both delirium and dementia but is HALLMARK of delirium.
Diagrams to know
- Delirium cause-and-effect flowchart (identify cause → treat cause → resolution of delirium)
- Environmental modifications checklist (lighting, noise, orientation aids)
DEMENTIA & ALZHEIMER'S DISEASE
Important facts
- Alzheimer's = most common cause of dementia (60–80% of cases); irreversible neurodegeneration with beta-amyloid plaques and neurofibrillary tangles
- The 4 A's: Aphasia, Apraxia, Agnosia, Amnesia (classic Alzheimer's findings)
- Sundowning: increased confusion/agitation late afternoon/evening (manage with light exposure, reduced evening stimulation)
- Memory loss sequence: Recent memory FIRST → intermediate → remote memory (late stage)
- Disease course: mild (independent with reminders) → moderate (requires supervision) → severe (total dependence, non-verbal, bedridden)
- PRIORITY NURSING INTERVENTION: SAFETY (prevent wandering, falls, burns, injuries)
- Use structured, consistent routine; avoid sudden changes; provide familiar objects and people
- Communication: short, simple sentences; one instruction at a time; face patient; allow response time
- Early disease: gentle reorientation is helpful; ADVANCED disease: validation therapy (acknowledge feelings, do NOT argue facts) is MORE therapeutic than correction
- Support activities of daily living (ADLs) with cueing and assistance; maintain nutrition, hydration, mobility
Key definitions
Aphasia
Example
Patient unable to name common objects (pen, cup) or follow multi-step commands.
Loss or impairment of language (speaking, understanding, reading, writing).
Apraxia
Example
Patient cannot button shirt, brush teeth, or write even though hands are strong.
Inability to perform learned, purposeful motor tasks despite intact motor strength and sensation.
Agnosia
Example
Patient does not recognize spouse's face; fails to identify familiar objects by sight.
Inability to recognize or interpret sensory stimuli (objects, faces, sounds) despite intact sensory pathways.
Amnesia
Example
Patient cannot recall breakfast (5 min ago) but remembers childhood clearly.
Memory loss; in Alzheimer's, recent (short-term) memory fails FIRST, remote memory preserved longer.
Confabulation
Example
Patient claims to have just returned from work (in reality, retired 10 years); believes it sincerely.
Filling memory gaps with invented information presented as fact; patient unaware it is false.
Perseveration
Example
Patient repeats same question every 2 minutes; hums same tune continuously.
Repetition of words, phrases, or actions beyond appropriate; inability to shift mental set.
Diagrams to know
- Alzheimer's disease stages (mild, moderate, severe) with cognitive/functional decline
- The 4 A's of Alzheimer's and their clinical examples
- Sundowning management timeline (morning light exposure → afternoon quiet activity → evening calm environment)
ALZHEIMER'S PHARMACOTHERAPY
Important facts
- Cholinesterase inhibitors (donepezil, rivastigmine, galantamine): First-line for MILD-TO-MODERATE Alzheimer's
- Memantine (NMDA antagonist): Used in MODERATE-TO-SEVERE disease; may combine with cholinesterase inhibitor
- CRITICAL: These drugs SLOW progression, do NOT cure or reverse disease
- Nursing monitoring — Cholinesterase inhibitors: watch for BRADYCARDIA, GI upset (nausea, diarrhea, anorexia), vomiting
- Administer cholinesterase inhibitors with food to reduce GI upset
- Monitor heart rate and blood pressure; report bradycardia (HR <50) or syncope
- Memantine: generally well-tolerated; dizziness, confusion possible initially; requires dose titration
- IMPORTANT: Neither class restores lost neurons or reverses damage; benefit is modest slowing of decline
- Educate family: medication does NOT 'fix' Alzheimer's; realistic expectations essential
Key definitions
Cholinesterase Inhibitors
Example
Donepezil (Aricept), rivastigmine (Exelon), galantamine (Reminyl) — all first-line agents.
Drugs that increase acetylcholine by blocking its breakdown; modestly slow cognitive decline in mild-to-moderate Alzheimer's.
NMDA-Receptor Antagonist
Example
Memantine (Namenda) — can be combined with cholinesterase inhibitors.
Drug that blocks glutamate excitotoxicity; used in moderate-to-severe Alzheimer's.
Diagrams to know
- Cholinesterase inhibitor mechanism (increase acetylcholine → improved synaptic transmission in mild disease)
- Disease severity vs. drug choice (mild-to-moderate = cholinesterase inhibitors; moderate-to-severe = memantine ± cholinesterase inhibitor)
ALZHEIMER'S NURSING PRIORITIES & FAMILY SUPPORT
Important facts
- SAFETY IS PRIORITY #1: Prevent wandering (secure/alarmed doors, ID bracelet), falls, burns, poisoning, aspiration, elopement
- Maintain CONSISTENT, STRUCTURED routine; sudden changes provoke agitation and confusion
- Provide FAMILIAR, UNCLUTTERED, SAFE environment; remove hazards (stoves, sharp objects, medications, cleaning supplies)
- COMMUNICATION: Simple, short sentences; one instruction at a time; face the patient; speak slowly; allow response time
- REORIENTATION (early disease) vs. VALIDATION (advanced disease): Reorient if helpful; validate feelings always
- Manage SUNDOWNING: Increase light and activity during day; reduce stimulation and noise in evening; maintain calm bedtime routine
- Support ADLs with cueing, reminders, and hands-on assistance as needed; use simple step-by-step instruction
- Maintain NUTRITION and HYDRATION (swallowing precautions as disease advances); monitor weight; use adaptive eating utensils if needed
- PREVENT IMMOBILITY complications in late stage: Range-of-motion exercises, positioning, skin care, bowel/bladder management
- CAREGIVER SUPPORT is ESSENTIAL: Education about disease, respite care, support groups, community resources, realistic expectations about prognosis
- Document behavioral changes, medication effects, and incident reports per facility protocol per RA 9173 (Nursing Practice Law)
Key definitions
Validation Therapy
Example
Patient states she is waiting for her mother to pick her up (deceased 30 years). Nurse responds: 'I see that's important to you. Let's sit together while you wait,' rather than 'Your mother passed away in 1994.'
Therapeutic approach that acknowledges the patient's emotions and reality without arguing over facts; especially effective in advanced dementia.
Caregiver Strain
Example
Adult daughter providing 24/7 care develops depression, sleep deprivation, and physical illness.
Exhaustion, burden, and stress experienced by family members or caregivers responsible for long-term dementia care.
Diagrams to know
- Hierarchy of Alzheimer's nursing interventions (safety → routine/structure → communication → ADL support → caregiver support)
- Sundowning management flowchart (daytime stimulation → evening calm → consistent bedtime routine)
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD)
Important facts
- ADHD appears in CHILDHOOD and often PERSISTS into adulthood; hereditary component common
- Diagnosis requires symptoms present in MORE THAN ONE SETTING (home AND school, not just one location)
- Symptoms must INTERFERE with functioning and learning; minor fidgeting ≠ ADHD
- Stimulants are FIRST-LINE pharmacotherapy: methylphenidate (Ritalin, Concerta), amphetamine-based meds (Adderall, Dexedrine)
- CRITICAL NURSING POINT: Give stimulants in MORNING (and NOT late in day) to PREVENT INSOMNIA
- Monitor for APPETITE SUPPRESSION and GROWTH/WEIGHT LOSS; administer after meals if possible; monitor height/weight at each visit
- Monitor HEART RATE and BLOOD PRESSURE; report significant increases or irregularities
- Atomoxetine (Strattera) is a non-stimulant alternative for children who cannot tolerate stimulants
- NURSING MANAGEMENT: Provide structured, consistent environment with clear rules and routines; reduce environmental distractions
- Break tasks into SMALL STEPS; give CLEAR, SIMPLE directions; use consistent positive reinforcement and firm, calm limit-setting
- Ensure SAFETY given impulsivity (especially dangerous activities); monitor for medication abuse/diversion potential in adolescents
Key definitions
ADHD
Example
8-year-old boy: easily distracted, cannot sit still in classroom, interrupts constantly, loses homework; same behavior at home.
Neurodevelopmental disorder with persistent pattern of inattention and/or hyperactivity-impulsivity interfering with functioning across multiple settings (home, school).
Inattention
Example
Child cannot focus on homework despite no external distractions; forgets instructions immediately.
Difficulty focusing, sustaining attention, and completing tasks; easily distracted, forgetful, careless mistakes.
Hyperactivity-Impulsivity
Example
Child fidgets constantly, leaves seat during class, always 'on the go,' talks excessively, interrupts others mid-sentence.
Excessive motor activity, inability to remain still, difficulty waiting turns, blurting out answers, interrupting others.
Diagrams to know
- ADHD presentation across settings (home, school, social) and how symptoms interfere with function
- Stimulant medication timeline (morning dose → therapeutic effect during school day → wear-off before bedtime)
AUTISM SPECTRUM DISORDER (ASD)
Important facts
- ASD appears in EARLY CHILDHOOD; characterized by TWO CORE DOMAINS: (1) social-communication deficits AND (2) restricted/repetitive behaviors
- SEVERITY VARIES WIDELY across 'spectrum': some children nonverbal and fully dependent; others highly verbal and independent
- Severity rated on SUPPORT NEEDED (minimal, substantial, very substantial) — NOT on IQ alone
- INSISTENCE ON SAMENESS and ROUTINE is a hallmark feature; sudden changes provoke significant distress
- Social reciprocity is impaired; child may not seek comfort from parents during distress or share joy with others
- Sensory sensitivities common: hypersensitive to sounds, textures, lights, tastes, or smells; may seek sensory input (spinning, rocking)
- NURSING MANAGEMENT: MAINTAIN CONSISTENCY and ROUTINE; prepare child for transitions with warnings and visual supports
- SAFETY FIRST: prevent elopement (runs away), dangerous stimming (head-banging), and behaviors that risk injury
- Reduce OVERWHELMING SENSORY STIMULATION; provide quiet space; use predictable routines and visual schedules
- Communicate at CHILD'S DEVELOPMENTAL LEVEL (not chronological age); use clear, concrete language and visual supports (pictures, written schedule)
- Build on CHILD'S STRENGTHS and interests; use preferred items as positive reinforcement; use consistent reward system
- NO CURE for autism; EARLY BEHAVIORAL INTERVENTION (structured education, speech therapy, occupational therapy) improves outcomes
- Medications treat SPECIFIC symptoms ONLY (aggression, irritability, anxiety) — not autism itself
- Support FAMILY/CAREGIVERS: education about sensory needs, communication style, behavioral strategies, respite care, community resources
Key definitions
Autism Spectrum Disorder
Example
4-year-old: minimal eye contact, echolalic speech, lines up toys obsessively, distressed by routine changes, hypersensitive to sounds and textures.
Neurodevelopmental disorder with persistent deficits in social communication/interaction and restricted, repetitive patterns of behavior; severity ranges widely.
Social Communication Deficit
Example
Child avoids eye contact, does not respond to name, lacks joint attention, has difficulty making friends.
Impaired ability to engage in reciprocal social interaction, understand social cues, and communicate verbally and nonverbally.
Restricted, Repetitive Behavior
Example
Child must follow exact ritual before bed; hand-flaps, spins objects; covers ears at vacuum sound; preoccupied with spinning wheels.
Insistence on sameness and routine, stereotyped movements, intense fixated interests, unusual sensory sensitivities.
Stimming
Example
Hand-flapping, spinning, rocking, humming, line-up toys, spinning objects.
Self-stimulatory behavior (repetitive movement, sound, or action); serves regulatory or self-soothing function.
Diagrams to know
- Autism spectrum severity levels (minimal support needed ↔ very substantial support needed) across social communication and behavior domains
- Transition support tools (visual schedule, countdown timer, social story, verbal warning sequence)
INTELLECTUAL DISABILITY
Important facts
- Intellectual disability = DEFICITS in BOTH intellectual AND adaptive functioning from DEVELOPMENTAL PERIOD (not acquired later)
- Severity based on ADAPTIVE FUNCTIONING and SUPPORT NEEDS, not IQ score alone: mild, moderate, severe, profound
- Common causes: DOWN SYNDROME (Trisomy 21), Fragile X syndrome, FETAL ALCOHOL SYNDROME (prenatal exposure), birth injury/hypoxia, infections (rubella, meningitis), metabolic disorders, lead poisoning
- PREVENTION is KEY nursing role: prenatal care, genetic counseling, newborn screening (PKU, hypothyroidism), injury/infection prevention, lead screening
- NURSING MANAGEMENT: PROMOTE MAXIMUM INDEPENDENCE at person's level; teach self-care and adaptive skills
- Use SIMPLE, CONCRETE, STEP-BY-STEP INSTRUCTION and REPETITION; break tasks into small components; use picture/visual supports
- Ensure SAFETY: protect from injury, exploitation, abuse; supervise medication, finances, healthcare decisions
- Support COMMUNICATION at appropriate level; use simple language, allow extra time; use alternative communication if needed
- Build on STRENGTHS and use positive reinforcement consistently; celebrate small gains
- INVOLVE and EDUCATE FAMILY: realistic expectations, behavioral strategies, community resources, long-term planning, respite care
- Support SOCIAL INTEGRATION and INCLUSION in community activities appropriate to ability level
- Advocate for RIGHTS and DIGNITY per RA 9173 and disability laws; encourage person to participate in decisions affecting care
Key definitions
Intellectual Disability
Example
12-year-old with IQ 45: cannot read, struggles with basic math, requires supervision for toileting and meals, poor social skills.
Neurodevelopmental disorder with onset in developmental period, defined by deficits in BOTH intellectual functioning (reasoning, problem-solving, learning) AND adaptive functioning (communication, self-care, social, practical skills).
Adaptive Functioning
Example
Self-care (eating, hygiene, dressing), communication, money management, following safety rules, employment skills.
Practical, social, and daily-living skills; ability to care for self, communicate, work, and manage daily life independently.
Habilitation
Example
Teaching 16-year-old with intellectual disability to use public transportation, manage money for purchases, basic job skills.
Teaching and training to develop new skills and promote independence and community integration (versus rehabilitation = restoring lost skills).
Diagrams to know
- Intellectual disability severity levels and support intensity needed (mild [minimal support] ↔ profound [total dependence])
- Task breakdown example (simple grooming task broken into 5–7 concrete steps with pictures)
NEURODEVELOPMENTAL DISORDERS: SHARED NURSING PRINCIPLES
Important facts
- ALL neurodevelopmental disorders require EARLY IDENTIFICATION and INTERVENTION for best outcomes
- Common COMPLICATIONS across all disorders: INJURY (from impaired safety awareness or impulsivity), ASPIRATION/NUTRITION problems, CAREGIVER BURNOUT, SOCIAL ISOLATION, BEHAVIORAL CHALLENGES
- FAMILY EDUCATION is CORE: teach behavioral strategies, realistic expectations, medication effects, safety, and self-advocacy
- CONSISTENCY and ROUTINE are therapeutic across all disorders (ADHD, autism, intellectual disability)
- POSITIVE REINFORCEMENT and STRUCTURED LIMIT-SETTING are more effective than punishment
- MULTIDISCIPLINARY APPROACH: collaborate with special education, speech/occupational therapy, behavioral specialists, physicians, social services
- DOCUMENTATION per RA 9173: record behavioral baseline, interventions, response to treatment, incidents, family teaching, and community referrals
- ADVOCACY: support inclusion in school/community, employment, and self-determination appropriate to functioning level
Key definitions
Neurodevelopmental Disorder
Example
ADHD, autism, intellectual disability, developmental coordination disorder.
Disorder with onset in developmental period affecting brain development; results in significant functional limitations.
Diagrams to know
- Neurodevelopmental disorder management framework (early identification → assessment → individualized plan → family/school collaboration → community integration)
Must remember
- DELIRIUM = ACUTE + FLUCTUATING + REVERSIBLE + MEDICAL EMERGENCY; find the cause (infection, electrolytes, hypoxia, drugs, withdrawal). DEMENTIA = CHRONIC + GRADUAL + STABLE + IRREVERSIBLE. A patient WITH dementia can ALSO get delirium (superimposed acute confusion).
- DELIRIUM hallmark = IMPAIRED ATTENTION (cannot sustain focus). DEMENTIA = recent memory FIRST, remote later. Level of consciousness is ALTERED in delirium, CLEAR in dementia (until very late).
- ALZHEIMER'S 4 A's = Aphasia (language loss), Apraxia (cannot do learned tasks), Agnosia (cannot recognize), Amnesia (memory loss). SUNDOWNING is worsening confusion at night.
- ALZHEIMER'S PRIORITY = SAFETY (prevent wandering/falls/burns). Maintain consistent routine. Use VALIDATION (acknowledge feelings) in advanced disease, not repeated correction.
- Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) = MILD-TO-MODERATE Alzheimer's. WATCH for BRADYCARDIA and GI upset (nausea, diarrhea). These drugs SLOW, do NOT cure.
- Memantine (NMDA antagonist) = MODERATE-TO-SEVERE Alzheimer's. Can combine with cholinesterase inhibitor. Generally well-tolerated but requires slow dose titration.
- ADHD: Give stimulants (methylphenidate, amphetamines) IN MORNING ONLY to prevent insomnia. Monitor appetite/growth/HR/BP. Provide structure, clear limits, safe environment for impulsivity.
- AUTISM = social-communication deficits + restricted/repetitive behavior + INSISTENCE ON SAMENESS. MAINTAIN ROUTINE and consistency. Reduce sensory overload. Use visual supports. Early behavioral intervention improves outcomes.
- INTELLECTUAL DISABILITY = deficits in BOTH intellectual functioning AND adaptive functioning from developmental period. Use SIMPLE, CONCRETE, STEP-BY-STEP instruction and repetition. Maximize independence. PREVENT HARM/EXPLOITATION. Educate family.
- KEY NURSING PRINCIPLE across all neurodevelopmental disorders: CONSISTENCY, ROUTINE, STRUCTURE, POSITIVE REINFORCEMENT, FAMILY EDUCATION, and EARLY INTERVENTION are therapeutic cornerstones. Document per RA 9173. Advocate for dignity and inclusion.
Last minute tips
- When you see 'sudden onset confusion with fluctuating consciousness' → think DELIRIUM = MEDICAL EMERGENCY. When you see 'gradual onset progressive memory loss with clear consciousness' → think DEMENTIA = chronic care. Test questions often give a scenario; match the clinical pattern to the correct disorder.
- For Alzheimer's, remember the sequence: RECENT memory fails FIRST (can't recall breakfast), REMOTE memory preserved (remembers childhood). As disease progresses, all cognitive functions decline, but communication/emotion often remain until late stage. Use this to predict what patients CAN and CANNOT do.
- Stimulant medication timing is absolutely critical: If a question asks about a child taking methylphenidate and becoming unable to sleep or has poor appetite, the first thing to ask is: 'When is it being given?' If it's in afternoon/evening, CHANGE to morning. If it's already morning, consider dose reduction or food timing, not stopping the drug.
- For ADHD vs. Autism distinction: ADHD = inattention/hyperactivity/impulsivity (but social skills may be OK). Autism = social communication problems (poor eye contact, no joint attention) + insistence on sameness/stereotyped behavior (hand-flapping, lining up toys, routine). Both can have high IQ; they are different domains.
- In exam scenarios with a parent of a child with intellectual disability asking 'Will my child ever be normal?' or 'Will they outgrow this?', the honest therapeutic answer is: 'No, this is lifelong, but we can teach skills to increase independence and community participation.' Never give false hope; focus on maximizing ability and inclusion.
Comparison tables
DELIRIUM vs. DEMENTIA — THE CRITICAL DISTINCTION
| Feature | Delirium | Dementia |
|---|---|---|
| Onset | SUDDEN (hours to days) | GRADUAL (months to years) |
| Course | FLUCTUATING, worse at night (sundowning) | STABLE day-to-day, slowly progressive |
| Consciousness | ALTERED/CLOUDED (hyperalert, drowsy, or shifting) | CLEAR (until very late stage) |
| Attention (Hallmark) | GROSSLY IMPAIRED; cannot sustain focus | Relatively preserved early; declines late |
| Memory Pattern | All cognitive domains affected | RECENT memory FIRST; remote preserved longer |
| Reversibility | USUALLY REVERSIBLE (treat the cause) | USUALLY IRREVERSIBLE (progressive) |
| Cause | MEDICAL EMERGENCY — find underlying cause | Chronic degenerative disease (Alzheimer's, vascular, Lewy body, frontotemporal) |
| Common Causes | Infection (UTI, pneumonia), electrolyte imbalance, hypoxia, hypoglycemia, dehydration, medications, withdrawal, post-anesthesia, pain | Alzheimer's (60–80%), vascular dementia, Lewy body dementia, frontotemporal dementia; reversible: B12 deficiency, hypothyroidism, normal-pressure hydrocephalus |
| Nursing Priority | Identify and TREAT CAUSE; keep patient SAFE; monitor vitals/oxygenation; maintain orientation | SAFETY (prevent falls/wandering); maintain ROUTINE; simple COMMUNICATION; support ADLs; caregiver support |
| Key Nursing Point | Acute change + altered attention = investigate for medical cause IMMEDIATELY | Gradual change = expected; sudden WORSENING in known dementia = suspect superimposed DELIRIUM |
ALZHEIMER'S DRUGS: INDICATIONS, SIDE EFFECTS, NURSING MANAGEMENT
| Drug Class / Example | Disease Stage | Mechanism | Key Side Effects | Nursing Considerations |
|---|---|---|---|---|
| Cholinesterase Inhibitors (Donepezil, Rivastigmine, Galantamine) | Mild-to-Moderate | Increase acetylcholine by blocking breakdown; improve synaptic transmission | BRADYCARDIA, GI upset (nausea, diarrhea, anorexia), vomiting, syncope | Monitor HR/BP; administer with food; assess for GI symptoms; educate family that benefit is modest slowing, not cure |
| Memantine (NMDA Antagonist) | Moderate-to-Severe | Blocks glutamate excitotoxicity; neuroprotective | Dizziness, confusion, headache (initial); generally well-tolerated | Requires slow dose titration; can combine with cholinesterase inhibitor; monitor for dizziness |
NEURODEVELOPMENTAL DISORDERS: COMPARISON
| Disorder | Core Deficits | Onset | Key Features | Nursing Priority |
|---|---|---|---|---|
| ADHD | Inattention and/or hyperactivity-impulsivity | Childhood (often persists into adulthood) | Symptoms in multiple settings; interferes with school/social functioning; hereditary; responsive to stimulant medication | STRUCTURE and CLEAR LIMITS; stimulants IN MORNING; monitor appetite/growth; provide safe environment for impulsivity |
| Autism Spectrum Disorder | Social-communication deficits + restricted/repetitive behavior | Early childhood | Insistence on SAMENESS/ROUTINE; sensory sensitivities; variable severity (minimal to very substantial support needed); improved with early behavioral intervention | MAINTAIN ROUTINE/CONSISTENCY; reduce sensory overload; simple communication with visual supports; build on STRENGTHS; support family |
| Intellectual Disability | Intellectual functioning AND adaptive functioning (both deficient) | Developmental period | Severity based on SUPPORT NEEDED (not IQ); many causes (Down syndrome, FAS, birth injury); prevention is key nursing role | MAXIMIZE INDEPENDENCE with simple, concrete, repeated instruction; protect from HARM/EXPLOITATION; involve family; promote community integration |
STIMULANT MEDICATIONS FOR ADHD: TIMING & SIDE EFFECT MANAGEMENT
| Side Effect | Why It Happens | Nursing Management |
|---|---|---|
| Insomnia | Stimulant effect if given late in day | GIVE IN MORNING ONLY; NOT after 2 PM; allow medication to wear off before bedtime |
| Appetite Suppression / Weight Loss | Stimulant effect on appetite center | Administer after meals; offer nutritious snacks; monitor height/weight at each visit; consider 'medication holiday' on weekends if weight loss is concerning |
| Increased Heart Rate / Blood Pressure | Sympathomimetic effect of stimulants | Monitor baseline and periodically; assess for palpitations, dizziness; hold dose if HR significantly elevated; educate family about warning signs |
| Behavioral Rebound | ADHD symptoms worsen as medication wears off in afternoon | Anticipate timing; plan afternoon activities to minimize impact; consider dose adjustment; educate family about predictable pattern |
Diagrams
Delirium vs. Dementia: Clinical Decision Tree
Decision tree for rapidly distinguishing delirium from dementia based on onset, consciousness level, and attention. Shows how to identify superimposed delirium in a patient with known dementia.
Alzheimer's Disease: Comprehensive Nursing Management
Mind map showing all major components of Alzheimer's nursing care: safety (primary), environment, communication strategies (reorientation vs. validation), medications, ADL support, sundowning management, and caregiver/family support.
Neurodevelopmental Disorder Management Framework
Framework showing the pathway from identification through assessment, diagnosis-specific management, family education, and ongoing monitoring. Emphasizes that despite different disorders, core principles (structure, family involvement, early intervention, documentation) apply.
Dementia Progression: Cognitive and Functional Decline
State diagram showing the three stages of Alzheimer's disease (mild, moderate, severe) with characteristic cognitive/functional decline and stage-appropriate nursing priorities. Illustrates that management strategies change as disease progresses.