Delirium and Dementia

Question 1

Delirium definition and cause

Answer 1

Acute confusion characterized by sudden and temporary changes in cognition, attention, memory, and perception. Develops in hours to days.

Cause: unknown, thought to be disturbances in the neurotransmitters

Question 2

Risk factors for delirium

Answer 2

Predisposing factors (may lead to disease, vulnerability already exists in the person)
- advanced age, dementia, depression, a functional dependency, polypharmacy

Precipitating factors (create the onset of the disease, new factor happened before having the disease)
- surgery, infection, serious illness, restraints

Question 3

Types of delirium

Answer 3

Hyperactive - agitation, hallucinations, restlessness, hyperactivity

Hypoactive - lethargy, decreased motor activity

Mixed - fluctuation between hyperactive and hypoactive

Question 4

Nursing Assessment for Delirium

Answer 4

• assess and treat predisposing factors
• keep Pt safe until delirium is resolved
• CAM (confusion assessment method) where diagnosis requires feature 1 (acute onset or fluctuating course), feature 2 (inattention), and either feature 3 (disorganized thinking) or feature 4 (altered LOC)

Question 5

Delirium intervention

Answer 5

Pharmacological intervention
- not recommended, discontinue nonessential meds, benzodiazepines/psychotropic meds (for delirium associated with alcohol withdrawal)

Nonpharmacological intervention
- physiological stability
- giving the client low-dose oxygenation and maintaining fluid and electrolyte balance
- environmental
- education
- communication

Question 6

Dementia definition and cause

Answer 6

Definition: Irreversible loss of cognitive functioning. Develops in months to years. Progressive, terminal.
- key features: Aphasia, apraxia (not able to perform certain actions despite desire and physical ability), agnosia (unable to recognize objects/people/sounds)

Cause: damage to or loss of nerve cells and their connections in the brain

Question 7

4 Types of Dementia

Answer 7

Alzheimer - has genetic component, plaque in brain, diagnosed in a scan, 5-10 years for full progression (60-80% of all dementia)

Vascular - death of nerve cells from diseased BVs, progress can be delayed (11-18% of all dementia)

Lewy body - fluctuations in cognitive symptoms, aphasia, hallucinations, hemisensory, hemiparesis

Frontotemporal - one or both frontal lobes are degenerating, loss of communication (ex. brain trauma related dementia from sports)

Question 8

Nursing Assessment for Dementia

Answer 8

• Mini-Mental State Examination (MMSE)
• Behaviour and Psychological symptoms of dementia (BPSD)

Question 9

Dementia interventions

Answer 9

Pharmacological interventions
- most medications to stabilize disease etiology and progression, manage symptoms
- no Alzheimer’s disease specific medications

Nonpharmacological interventions
- education
- environmental modification
- communication skills
- alternative therapies for dementia

Question 10

Dementia interventions

Answer 10

Pharmacological interventions
- most medications to stabilize disease etiology and progression, manage symptoms
- no Alzheimer’s disease specific medications

Nonpharmacological interventions
- education
- environmental modification
- communication skills
- alternative therapies for dementia