Delirium and Dementia Flashcards
Three DS of cognitive impairment in Older adults
- Delirium
- Dementia
- Depression
What is Delirium
is Acute confusion characterized by sudden and temporary changes in cognition, attention, memory and perception
- Cause: unknown, thought to be disturbances in the
Neurotransmitters with multifactorial causes. - Predisposing and precipitating risk factors: Ex. advanced age, depression, polypharmacy, chronic medical condition, alcoholism
Delirium Prevalence
- 22% IN COMMUNITY-LIVING PEOPLE
- 15% TO 70% IN LONG-TERM CARE RESIDENTS
- 11% TO 33% UPON ADMISSION TO HOSPITAL
* + 5% TO 35% DELIRIUM DEVELOPING AFTER ADMISSION - 80% OR MORE IN INTENSIVE CARE SETTINGS
Types of Delirium
- Hyperactive
- Hypoactive
- Mixed
Hyperactive delirium
Agitation, hallucinations, restlessness, and hyperactivity
Hypoactive delirium
lethargy, decreased motor activity
Mixed delirium
Fluctuation between hyperactive and hypoactive
Functional Consequences of Delirium
- Delirium is a medical emergency
- Longer hospital stays
- Higher rate of LTC residency
- Short and long-term functional impairment
- Development of or worsening of Dementia
Why is delirium unrecognized in LTC?
Delirium is often unrecognized in long-term care (LTC) because its symptoms, such as confusion, agitation, or lethargy, can be mistaken for normal aging, dementia, or other chronic conditions.
Nursing assessment for Delirium
- Assess and treat predisposing factors (pre-existing factors)
- Keep individual safe until delirium is resolved
Most Common Nursing assessment for Delirium
CAM (The Confusion assessment method): The diagnosis of delirium by CAM requires the presence of feature 1 and 2 and either 3 or 4
- FEATURE 1: ACUTE ONSET OR FLUCTUATING COURSE
- FEATURE 2: INATTENTION
- FEATURE 3: DISORGANIZED THINKING
- FEATURE 4: ALTERED LEVEL OF CONSCIOUSNESS
Delirium Intervention
- Pharmacological intervention
- Non-pharmacological intervention
Pharmacological Intervention for Delirium
- Pharmacological treatment of delirium is not recommended
- Review Patient medication
- Limit use of psychoactive medication to specific symptoms
- Discontinue nonessential medications
& BENZODIAZEPINES/PSYCHOTROPIC MEDICATIONS ARE USED FOR
DELIRIUM ASSOCIATED WITH ALCOHOL WITHDRAWAL
Non-pharmacological intervention for Delirium
- Physiological stability/reversable cause
- Environmental
- Education
- Communication
Treatment of Delirium is focused on
- Possible contributing factors
- Safety to address function and behavioral changes
- Managing aggravating factors that might worsen the Delirium
What is Dementia
Is an Irreversible loss of cognitive functioning
- Key features: Aphasia (difficulty speaking), apraxia (unable
to perform tasks or movements when asked),
Agnosia (neurological disorder on
recognition), Disturbances in executive
functioning (unable to think or plan)
Cause: Damage to or loss of nerve cells and their connections in the brain
Risk Factors: Mis-management of diabetes, depression,
Types of Dementia
- Alzheimer (Most dementia is Alzheimer’s, genetic components)
- Vascular (diseased blood vessels, dying blood vessels in the brain,
leads to brain death,) (Hypertension, Stroke, Cardiovascular
disease cause Vascular dementia) - Lewy body (presence of abnormal proteins)
- Frontotemporal (frontal and temporal lobes damaged/lost)
Dementia Prevalence
- CHALLENGING TO DETERMINE
* DEMENTIA IS A GROUP OF DISEASES, EACH WITH DIFFERENT
MANIFESTATIONS AND COMBINATIONS OF SYMPTOMS
* SPECIFIC DEMENTIAS MAY NOT BE IDENTIFIED UNTIL AFTER
DEATH - ALZHEIMER’S DISEASE ACCOUNTS FOR 60% TO 80% OF DEMENTIA
- VASCULAR DEMENTIA 11% TO 18% (22% - 34% WITH AD)
- LEWY BODY AND PARKINSON DISEASE 15% - 20%
Functional Consequences of Dementia
- FUNCTIONAL CONSEQUENCES VARY AMONG
INDIVIDUALS - LOSS OF PERSONHOOD AND SELF-WORTH
- FEEL ISOLATED AND DEPRESSED
- MAY BE DIFFICULT TO RECOGNIZE AND/OR
ACKNOWLEDGE
Nursing assessment of Dementia
- INITIAL & ONGOING ASSESSMENT
* MMSE (Mini-mental state examination)
* BEHAVIOUR AND PSYCHOLOGICAL SYMPTOMS OF
DEMENTIA (BPSD) - NURSING DIAGNOSIS TO INDIVIDUALIZE INTERVENTIONS
Dementia Intervention
Pharmacological intervention
Non-pharmacological intervention
Pharmacological Intervention for Dementia
- MOST MEDICATIONS FOR DEMENTIA ARE TO STABILIZE
DISEASE ETIOLOGY AND PROGRESSION, AND MANAGE
SYMPTOMS - ALZHEIMER’S DISEASE DOES HAVE SPECIFIC MEDICATIONS
- UNDERLYING CARDIAC FACTORS FOR VASCULAR DEMENTIA
CAN BE TREATED - ADVERSE EFFECTS ARE COMPLEX TO RESOLVE
Non-pharmacological interventions for Dementia
- EDUCATION
- ENVIRONMENTAL MODIFICATION
- COMMUNICATION SKILLS
- ALTERNATIVE THERAPIES FOR DEMENTIA
The Nursing Process for those with Dementia
- ASSESSMENT
* FACTORS AFFECTING QUALITY OF LIFE - PLANNING
* FOR QUALITY OF LIFE AND FUNCTION - DIAGNOSIS
* FUNCTION, COGNITION, BEHAVIORAL,
CAREGIVER - INTERVENTIONS
* INTERPROFESSIONAL (P. 269 THERAPIES) - EVALUATION
* QUALITY OF LIFE
Delirium 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
Dementia Primary Characteristics
- SLOW CHANGE IN MENTAL STATUS
- DEVELOPS IN MONTHS TO YEARS
- SYMPTOMS PROGRESS
- DEMENTIA IS TERMINAL
- NURSING CARE FOCUSED ON SAFETY,
CAREGIVER STRAIN AND QUALITY OF LIFE
Which nursing interventions is priority for the management of delirium?
Question 1Select one:
a.
Giving the client a clock, a watch and calendars to provide the client with temporal orientation
b.
Reducing noise and placing familiar objects in the client’s environment
c.
Giving the client low-dose oxygenation and maintaining his or her fluid and electrolyte balance
d.
Providing psychological support through cognitive and social stimulation
Giving the client low-dose oxygenation and maintaining his or her fluid and electrolyte balance
Which exemplify appropriate communication techniques for dealing effectively with people with dementia?
Question 2Select one:
a.
Ask open-ended questions so the person feels he or she can make choices.
b.
When the person forgets something, remind him or her not to forget next time.
c.
Maintain good eye contact and use a relaxed and smiling approach.
d.
For people in the later stages of Alzheimer disease, talk as you would to a child.
Maintain good eye contact and use a relaxed and smiling approach.
A nurse develops a plan to addressing dementia-related behaviors in an older adult with dementia. All of the following interventions should be included in this plan except?
Question 3Select one:
a.
Maintain a clutter-free environment.
b.
Place pictures of familiar people in every visible places.
c.
Test the client’s memory with each conversation.
d.
Implement regular rest periods.
e.
Lay out clothing in the order in which the items are to be donned.
Test the client’s memory with each conversation
An 80-year-old client was referred to a neurologist after several months of worsening cognitive deficits and has subsequently been diagnosed with Alzheimer disease. Which statement by the nurse to the client’s family demonstrates appropriate use of terminology.
Question 4Select one:
a.
“Even though your parent is demented, we will do all we can to promote his quality of life.”
b.
“It’s very difficult and stressful when a loved one becomes senile.”
c.
“This form of organic brain syndrome is a common health problem in the ninth decade of life.”
d.
“We always try our best to foster wellness in persons who have dementia.”
“We always try our best to foster wellness in persons who have dementia.”
A client was diagnosed 3 years ago with a cognitive impairment, a condition that worsened over the next several months and which culminated in his recent death. An autopsy revealed numerous infarcted brain regions resulting from vessel occlusions. This client most likely suffered from which type of dementia?
Question 5Select one:
a.
Vascular dementia
b.
Lewy body dementia
c.
Alzheimer disease
d.
Frontotemporal degeneration
a.
Vascular dementia
A long-time resident of an assisted living facility has just been diagnosed with Alzheimer disease. A nurse who provides care at the facility has remarked to a colleague, “It’s a real shame, but at least she’ll never know what’s happening to her.” Which fact should underlie the colleague’s response?
Question 6Select one:
a.
Certain types of dementia are occasionally marked by older adults’ awareness of their disease.
b.
An awareness of dementia is an indication that the condition is either latent or resolving.
c.
Many persons with dementia are acutely aware of the fact that they are experiencing a cognitive deficit.
d.
Older adults with Alzheimer disease and other dementias rarely have insight into their cognitive deficits.
Many persons with dementia are acutely aware of the fact that they are experiencing a cognitive deficit.
A gerontological nurse has been providing ongoing care for an older adult who has a diagnosis of dementia. Which goal should the nurse prioritize when conducting ongoing assessment of this client?
Question 7Select one:
a.
Determining whether the client has Alzheimer disease, Lewy body dementia or frontotemporal lobe dementia
b.
Identifying factors affecting the client’s functioning and quality of life
c.
Identifying strategies that can be used to cure the client’s dementia
d.
Identifying genetic or lifestyle factors that may have contributed to the client’s dementia
Identifying factors affecting the client’s functioning and quality of life
A 74-year-old client is diagnosed with mild Alzheimer disease. He has no other noted health issues. When speaking with the nurse, he expresses concern regarding the progression of his disease. Which statement by the nurse is most appropriate?
Question 8Select one:
a.
As you have no other health issues, the progression is usually gradual.
b.
We never know how fast Alzheimer disease will progress.
c.
Yes, progression is usually fairly fast, you might want to start making plans.
d.
The medications stop the progression of the disease.
Yes, progression is usually fairly fast, you might want to start making plans.
A nurse councils a care partner of a client with dementia. The care partner states, “He fights me when I try and bath him; he hasn’t had a shower in 2 months!” Which response by the nurse is most appropriate?
Question 9Select one:
a.
“I would just put him in there, he needs to be clean.”
b.
“I hear your frustration. What other ways have you tried to assure he is clean?”
c.
“He wants to feel he has a choice. How do you get him to shower?”
d.
“Whatever worked before should work now.”
“I hear your frustration. What other ways have you tried to assure he is clean?”
A nurse assesses a 91-year-old client in long-term care healing from bilateral broken legs caused in a fall. Today, the client developed new onset confusion and combativeness. Which set of factors must the nurse investigate as possible sources of this mental status state?
Question 10Select one:
a.
Medication interactions, urinary tract infection
b.
Social separation, positional pain
c.
Loneliness, immobility
Medication interactions, urinary tract infection
