317 Final Flashcards
Delirium is sometimes
Reversible
According to the American psychiatric Association what are the four components of delirium?
Disturbance of consciousness
Change in cognition
Fluctuation
Caused by a medical condition
How can delirium be prevented?
By recognition of high risk patients.
Routine screening for delirium is part of a comprehensive nursing care for
Elderly
CHARACTERISTICS of Delirium
Rapid onset Altered level of consciousness Erratic lucidity and somnolence Disturbed attention Disorganized thinking Sleep-wake cycle is affected
CHARACTERISTICS of Delirium
Rapid onset Altered level of consciousness Erratic lucidity and somnolence Disturbed attention Disorganized thinking Sleep-wake cycle is affected
Three types of delirium
Hyperactive
Hypoactive
Mixed
Delirium risk factors (6)
Old age
Pain
Dementia
Surgery
Medications
Psychosocial/environment changes
Delirium CAUSES (6)
Drug toxicity interaction
Infection process
Metabolic and endocrine disorders
CNS lesion
New disease process
Changes in chronic illness
Because of delirium, it is important to measure baseline prior to admission for patients with
Dementia
4 components of CAM
Mental status altered from baseline
Inattention
Disorganized thinking
Altered level of consciousness
Nursing interventions for delirium (7)
Provide eye glasses and hearing aids Avoid restraints Avoid psychotherapeutic drugs Avoid excessive stimulation Adequate lighting Calm reassuring person Provide familiar objects
Another delirium intervention includes removing “tethers.” For example
IVs and catheters
Some more delirium interventions…
Evaluate medications
Pain management
Increase physical activity
Oxygen
Evaluate medications for
Discontinue of “unnecessary” or high risk medications.
What practical forms of increased physical activity help with delirium?
Walking
PT
What is the suspected cause of sundowning?
Changes in circadian rhythm
Reversible causes of dementia (7)
Thyroid disease Vitamin B12 deficiency Depression Tumors Infections Vasculitis Normal pressure hydrocephalus
Non-reversible dementias
Frontaltemporal
Lewy Body
Creutzfeld-Jakob
Huntington’s
Vascular
20% of dementia cases
Vascular dementia
Vascular dementia it was once called
Muti-infarct dementia
Caused by death of nerve cells from poor blood flow
Vascular dementia
Which disease has unknown cause and cure?
Alzheimer’s
Changes in the brain in Alzheimer’s Disease
Death of neurons
Amyloid/neuritic senile plaques
Neurofibrillary tangles
Reduced brain weight
ApoE4 is an allele linked to
Alzheimer’s
MMSE score of greater than or equal to 21
Mild Alzheimer’s
Personality change is what stage of Alzheimer’s?
Mild stage
May be able to maintain ADLs with minimal assistance
Mild stage
MMSE score 10-20
Moderate Alzheimer’s
With severe Alzheimer’s the patient is unable to (3)
Communicate
Smile
Hold head up
Which stage of Alzheimer’s involves incontinence?
Severe stage
MMSE less than or equal to 9
Severe Alzheimer’s
Alzheimer’s diagnosis
Health history Physical exam Neurological/MMSE Monitoring symptoms across time Blood studies and urinalysis Electrocardiogram CT scan
Alzheimer’s drugs types
Cholinesterase inhibitors
Memantine (nemenda)
3 leading causes of death in Alzheimer’s patients
Cardiac arrest
Pneumonia
Sepsis
CNS changes affect the patients ability to interpret
Pain
Assessing pain in dementia patients (4)
Attempt self report
Observe behaviors
Attempt analgesic trial
Use best practice tools from Hartford
What is used for assessing pain in patients with dementia?
PAINAD scale
In terms of pharmacokinetics, there is no significant change in quantity absorbed, but the time to onset or peak may be
Delayed
In the elderly, SQ tissue
Decreases
In the elderly, connective tissue
Increases
Possible decreased absorption via (2)
Injections
Topical/transdermal
Changes to the drug distribution increase risk for
Adverse drug reactions
Why do renally excreted drugs build up in the elderly?
They are not eliminated fast enough
Which type of drug has dehydration side effects in the elderly?
Anti-cholinergic
Urinary retention
Cardiac arrhythmias
Increased fall risk
Delirium/hallucinations/agitation
Caused by what drug type?
Anticholinergic
All the negative side effects of anti-cholinergic drugs are worse in patients with
Dementia
List of 48 medications not recommended for anyone greater than 65 years old
Beer’s Criteria
5 common drug types on Beer’s List
Anticholinergic
Antipsychotics
Tricyclics antidepressants
Barbiturates
Benzodiazepines
MMSE score lower than 24 is associated with
Difficulty managing medications
What should the patient know about their medications? (7)
Name Dosage Time of day How Why Side effects Meds borrowed or not used?
Interventions to decrease ADE’s (4)
Educating patients and caregivers
Decrease number of medications
Alternative therapies
Set up a pill box system
Symptoms of pain in elderly (4)
Confusion
Restlessness
Fatigue
Aggression
Why might a patient avoid pain management?
Fear of addiction
Think pain is a normal part of aging
Fear of being labeled as a bad patient
Don’t believe pain is manageable
Why might the nurse avoid pain management?
Lack of typical signs and symptoms
Lack of assessment
Misinformation about addiction
Pain is a normal part of aging
Sleep interventions (7)
Rituals Relaxation techniques Decrease caffeine Avoid alcohol Bedtime snacks Physical activity Adequate sun
Homeopathic sleep interventions like…
Chamomile
What is a last resort sleep intervention?
Hypnotics/sleep medications
The chemical disruption of neurotransmitters like norepinephrine and serotonin
Depression
Risk factors for depression (6)
Psychosocial stressors/loss
Medical conditions
Functional impairments
Lack of social support
Adverse medication effects
Alcohol
Hormonal changes suspected in elderly depression (4)
Elevated cortisol levels
Altered growth hormone
Altered response to thyroid hormone
Serotonin
Surprising hallmark of major depression
Psychomotor agitation or retardation
Depression is often chronic and recurrent in people with
CV disease
Depression can occur after a
Stroke
Cognitive impairments such as loss of focus can occur because of
Depression
This is why depression is often an antecedent to
Dementia
Stroke in the ???? Side of the brain is associated with?????
Left, depression
What 2 assessment tools are used for depression?
PHQ2
GDS
Demographics/risk for depression
Advanced age
Living alone
Male
Caucasian
Hoplessness
Substance abuse
Evaluate medications and alcohol as contributors to
Depression
Basic things to improve depression
Diet
Nutrition
Patient education
Referral to support groups
It is important for the nurse to not only treat the patient, but also the
Caregiver
Some ways to help the caregiver (4)
Support groups
Community resources
Respite
Family counseling
Medicare for those under 65 if
Long term disability
End stage renal disease
