CH 14 Flashcards
Delirium
a syndrome
that develops over hours or days, fluctuates over the course
of the day and can persist for months. Changes in mental
status involve problems with attention and consciousness
and several or many additional changes, including altered
sleep—wake patterns.
ACUTE CONFUSION CHARACTERIZED
BY SUDDEN AND TEMPORARY CHANGES IN
COGNITION, ATTENTION, MEMORY AND
PERCEPTION
Common precipitating factors for delirium
surgery, infections, serious illness and physical restraints.
most widely used screening tool in LTC and acute care
Confusion Assessment method
Features of deliriuj according to CAM
Acute onset or fluctuating course: change in mental status
from baseline or onset of abnormal behaviours that tend
to come and go or increase and decrease in severity.
Inattention:
Disorganized thinking:
Altered LOC
3 Subtypes of delirium
Hyperactive
Hypoactive
Mixed (fluctuates bwhyper and hypo)
Examples of nursinginterventions to delirium
Provisions of aids to orientation i.e. clock
Environmental modification (noise reduction)
Psychological support
Protomooion of normal sleeping pattern
etc
\
Dementia medical term
medical term
that includes a group of brain disorders characterized by a
gradual decline in cognitive abilities (e.g., memory, understanding,
judgment, decision-making, communication) and
changes in personality and behaviour.
How many cases of dementia are alzheimers disease
60-80%
Lewey body ementia
part of a group of disorders called
Lewy body diseases, which also includes Parkinson disease
and Parkinson disease with dementia.
Account for 15-20% of dementia diagnoses
How many Stages of AD
7
Anosognosia,
Anosognosia,
which is the diagnostic term for lack of awareness, is assessed
by having the person who is being evaluated and a
family member or caregiver independently answer questions
related to the person’s behaviours and daily activities
behavioural
and psychological symptoms of dementia (BPSD)
Agitation
Psychiatric symptoms: delusions, hallucinations
e Personality changes,
Mood disturbance
Causes of delirium
UNKNOWN, THOUGHT TO BE
DISTURBANCES IN THE NEUROTRANSMITTERS
WITH MULTIFACTORIAL CAUSES
Predisposing
Things that exist that increase risk for something (age)
Precipitating
More spontaneous risk factors (pain, surgery, contitpation, urinary retention etc.)
3 types of delirium
Hyperactive, hypoactive, mixed
How important is delirium
A medical emergency
Consequences of delirium
Longer hospital stays
Higher rate of LTC residency
Short and long term functional impairment
Development of or worsening of dementia
What can delirium do to dementia
exacerbate it
Nursing assessment for delirium
Assess and treat predisposing factors
Keep individual safe until delirium is resolved
CAM
Confusion assessment method
- Diagnosis tool for delirium
1 Acute onset/fluctuating course
2 Inattention
3 Disorganized thinking
4 Altered LOC
Pharmacological intervention for delirium
Not recommended BC medication can cause it in the first place
Limit the use of psychoactive meds
Discontinue Non-essential medications
Non-pharm interventions for delirium
Physiological stability/reversible cause
Environmental (Create a stress free environment)
Education (teaching them what they need to do)
Get them to work with you
Communication
Treatment of delirium focused on
Possible contributing factors
Safety to address function and behaviour changes
Managing aggravating factors that might worsen the delirium
Key parts of deleirum
Sudden
Acute
Predisposing factors
Key features of dementia
Aphasia, apraxia (Cant do the action with their body that they intend), agnosia (recognition problems), disturbances in executive functioning (act do cycle)
Types of dementia
Alzheimer
Vascular
Lewy Body
Frontotemporal
Cause of demntiia
Damage TO OR LOSS OF NERVE CELLS AND THEIR
CONNECTIONS IN THE BRAin
Most dementia is
Alzheimers
Alzheimers
Requires a genetic component
60-80% of dementia
Insidious disease (happens and progresses quickly)
Cannot be officially diagnosed until post Morten autopsy
Vascular dementia
Dying blood vessels leading to brain death
11-18%
stroke (CVA)
heart disease
Lewy body dementia
15-20% (grouped with parkinsons)
similar symptoms to alzheimers
Very insidious
Functional consequences of dementia
Various
Loss of personhood/self-worth
Feel isolated and depressed
Difficult to recognize and/or acknoledge
Initial and ongoing assessment
MMSE
Behaviour and psych symptoms of dementia
Important treatment for people with dementia
Routine
Regular faces
Regular location
Nursing assessment for dementia
MMSE
Behaviour and pscyh symptoms of dementia
Nursing diagnosis to individualize interventions
Dementia interventions
Pharmacological intervention
Non pharm interventions
Pharmacological interventions for dementia
Most meds can stabilize disease etiology and progression and mange symptoms
Alzheimer’s disease does have specific meds
Undrrelying cardiac factors for vascular dementia can be treated
Non pharm interventions for dementia
- EDUCATION
- ENVIRONMENTAL MODIFICATION
- COMMUNICATION SKILLS
- ALTERNATIVE THERAPIES FOR DEMENTIA (mobilize)
KNOW SUMMAR OF IMPAIRED condition delirium and dementia
Primary characteristics
- RAPID CHANGE IN MENTAL STATUS
- DEVELOPS IN HOURS TO DAYS
- SYMPTOMS FLUCTUATE
- PREVENTABLE AND TREATABLE
- NURSING CARE FOCUSED ON RISK
FACTORS AND SYMPTOMS
Primary intervention for management of delirium
Reducing noise and placing familiar objects in the client’s environment
Open ended questions for people with dementia?
No, maintain good eye contact and relaxed and smiling is more important
A brain with vessel occlusions is suffering from what kind of dementia
Vascular
How to best tell someone to react to alzheimers
Yes, progression is usually fairly fast, you might want to start making plans.
???
Sudden onset of delirium should first be investigated in what
Medications or infections
Lewy body dementia characterized by
The presence of abnormal proteins in the brain (lewy bodies) that eventually damage the neurons in the brain
people are highly sensitive to anticholergenic medications even in low doses
Can progress quickly if environment is changed or if infection or condition occurs as well
Frontotemporal degeneration (dementia)
Major cause of young onset dementia
Stage 2 of dementia
Age associated memory impairment (normal)
