Delirium and dementia Flashcards
what is the most common affective disorder of old age
depression
what is depression often confused with?**
why?
dementia there is (can be) a cognitive decline that is related to apathy
are changes in cog ability, excess forgetfulness or modd swings a normal part of aging?
no It may be treatable mental condition.
what can cause changes in mental status**
• Changes in mental status may be related to alt in diet and fluid electrolyte imbalance, fever, low oxygen levels assoc w cardio and pulm diseases
when does depression often occur**
• Depression in o adults is often following major illness or loss and or r/t chronic pain or illness. May be secondary to med interaction or an undiagnosed condition
signs of depression**
• Signs: sleep disturbances, feelings of guilt or worthlessness, appetitie disturbances, restlessness, impaired attention span, dec memory or concentration, fatigue, sadness, suicidal ideation
reasons that depression and mental status should be assessed and monitored?
how would you do this?
-inc risk of suicide in caucasian men and men over 90
MMSE and geriatric depression scale
what should you do if pt has depression and a physica illness
• if pt has medical illness + depression the depression mustn’t be overlooked as it can impede recovery
why is depression often not treated?
is it responsive?
• Depression is often untreated d/t it not being identified but it is very responsive to Tx.
Tx of depression that is mild
May involve Tx of the underlying conditions causing the depression
• Mild depression Tx: exercise, bright lighting, inc interaction, cog therapy, reminiscence therapy
• Major depression:antidepressants, short term psychotherapy (esp in combination) are effective for o adults
Tx of major depression
tx of life threatening depression
• Major depression:antidepressants, short term cpsychotherapy (esp in combination) are effective for o adults
if life threatening use electroconvulsive therapy
meds for depression and what to watch for
• New meds can work well eg tricyclic antidepressants. Meds w anticholinergic, cardiac, orthostatic effects etc and any interactions should be used w care d/t falls and hypotensive events
how log can it take for symptoms to diminish (depression)
what should nurse do?
• May take 4-6 weeks for symptoms to diminish. Nurses should offer support during this time
which habits in older adults may influence/be influenced by depression
concerns with this
alcohol and drug abuse
• may be r/t depression
• inc incidence in o aduts. They often deny it and it remains hidden.
• alcohol abuse is v dangerous in o adults d/t age related changes in renal and liver fx as well as high risk of interactions w prescription meds
delirium aka
what is it and when does it often occur
• often termed acute confusional state
common and life threatening complication for the hospitalized older adult and most freq complication of hospitalization
delirium starts with ______ and progresses to _______
• starts w confusion and progresses to disorientation
is delirium treatable and preventable
often preventable
usually treatable
how is delirium broken down
hypoalert-hypoactive
hyperalert-hyperactive
-mixed hypo hyper
which types of delirium are hardest to Dx and which is easier
- hyperalert/hyperactive pts may demand more attention from the nurse and are easier to Dx
- recognition of delirium in the mixed type may be difficult
- pts w hypoalert-hypoactive type of delirium have higher mortality rates and even poorer outcomes of care as the delirium is often not recog and treated
signs symp of delirium**
• signs/symp: pts may experience altered LOC ranging from stupor (hypoalert-hypoactive) to excess activity (hyperalert-hyperactive) or a combo of the two (mixed)
o thinking is disorganized, attention span is short. May have hallucinations, delusions, fear, anxiety, paranoia
o acute symptoms: agitiation, disorientation, fearfulness-should be reported immediately
what is delirium often mistaken for?**
what is helpful in differentiating them
• delirium is often mistaken for dementia-its good to know pts usual mental status and whether changes are abrupt (delirium) or long term (dementia)
DSM criteria for dementia
Disturbance of consciousness (reduced clarity of awareness) with reduced ability to focus, sustain, or shift attention
Change in cognition (memory, disorientation, language) or the development of a perceptual disturbance not better accounted for by pre-existing dementia
Disturbance develops over short time period and tends to fluctuate over course of day
non modifiable risk factors for delirium**
previous cog impairment
age
what does delirium often occur secondary to aka modifiable risk factors**
delirium occurs 2ary to many things including: o physical illness o med or alcohol toxicity o dehydration o fecal impaction o malnutrition o infection o head trauma o lack of environmental cues o sensory deprivation or overload o fluid and electrolyte disorders
Her notes • Dementia • Polypharmacy • Fever/infections: UTI, Sepsis • Medical illness • Electrolyte imbalances • Renal disease • Hypoxia • Sx (cardiac, AAA (aortic abd aneurysm) • Alcohol abuse or withdrawal • Look for meds w CNS effects • Institutionalization
why is delirium a medical emergency
• d/t acute and unexpected onset of symp. It is a harbinger of acute medical illness. and unknown cause
delirium is a medical emergency
• if delirium isn’t recognized or treated it can result in permanent irreversible brain damage or death
-it can inc the risk of falls
course of delirium**
• course=acute onset, hypoalert-hypoactive, mixed, hyperalert-hyperactive
