ch 29 - care of individuals with neurocognitive disorders Flashcards
3 Ds of cognitive impairment
depression
delirium
dementia
ONSET
- delirium
- depression
- dementia
DELIRIUM: sudden
DEPRESSION: recent, can be chronic
DEMENTIA: slowly over years
PSYCHOMOTOR ACTIVITY
- delirium
- depression
- dementia
DELIRIUM: increased/decreased/mixed
DEPRESSION: variable, agitation/retardation
DEMENTIA: normal (maybe apraxia or agnosia)
ORIENTATION
- delirium
- depression
- dementia
DELIRIUM: impaired, fluctuates
DEPRESSION: usually normal
DEMENTIA: impaired, may confabulate
SPEECH
- delirium
- depression
- dementia
DELIRIUM: incoherent, slow/rapid, repeating phrases
DEPRESSION: maybe slow
DEMENTIA: difficulty finding words
AFFECT
- delirium
- depression
- dementia
DELIRIUM: variable, maybe frightened/disturbed
DEPRESSION: flat
DEMENTIA: slowed response, maybe labile
RF delirium
- underlying cognitive impairment
- functional impairment
- depression
- acute illness
- sensory impairment
precipitating factors delirium
- meds
- procedures
- restraints
- sleep deprivation
- foley cath
- pain
causes delirium (DELIRIUM)
Dementia Electrolytes Lungs, liver, heart, kidney, brain Infection Rx polypharmacy, psychotropics Injury, pain, stress Unfamiliar environment Metabolid
2 assessments for delirium
mini cog
CAM
nonpharmacological Tx delirium (HELP)
address:
- cognitive impairment
- sleep deprivation
- dehydration
- immobility
- visual/hearing impairments
tips for preventing delirium
- sensory enhancement
- mobility enhancement
- pain management
- simple communication
- family at bedside
- sleep enhancement
- adequate O2
- minimize medical devices/procedures
tips for talking to pt with delirium
- speak slowly
- be calm and patient
- face person and keep eye contact
- smile
- one step directions, tell person what you want them to do
nursing interventions for pts with dementia
- accept pts reality
- maximize ability to make choices
- meaningful activities and relationships
difficulty finding words
anomia
