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360 LS2 > Delirium/Dementia/Depression > Flashcards

Delirium/Dementia/Depression Flashcards

1
Q

What is Delirium?

A

acute neuropsychiatric syndrome

  • inattention
  • acute cognitive dysfunction
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2
Q

Is Delirium preventable?

A

30-40% is preventable and can be reversed

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3
Q

Delirium can be the only sign of which medical illnesses?

A

A-SIP

  • Abdominal infection
  • sepsis
  • Intra-cerebral event
  • Pneumonia
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4
Q

what are the 3 things Delirium is independently associated with…?

A
  1. rates of death
  2. institutionalization
  3. functional disability
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5
Q

Consequences of Delirium

A
  1. institutionalization
  2. prolonged hospitalization
  3. Death
  4. increased costs
  5. functional impairment
  6. psychological stress
  7. long-term cognitive impairment
  8. full recovery
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6
Q

What are the non-modifiable risk factors of Delirium

A
  1. Dementia or cognitive impairment
  2. male sex
  3. advancing age (>65)
  4. delirium, stroke, falls, neurological disease or gait disorder
  5. chronic renal or hepatic disease
  6. multiple comorbidities
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7
Q

What are the modifiable risk factors of Delirium

A
  1. medication
  2. pain
  3. emotional stress
  4. environment
  5. sustained sleep deprivation
  6. surgery
  7. immobilization
  8. sensory impairment
  9. acute neurological diseases
  10. intercurrent illnesses
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8
Q

List 5 causes of Delirium?

A

DELIRIUM or I WATCH DEATH

  • Dementia
  • Electrolyte disorders
  • liver, lung, heart, kidney, brain
  • Infection
  • Rx drugs
  • injury, pain, stress
  • Unfamiliar environment
  • Metabolic
  • Infection
  • Acute metabolic
  • Trauma
  • withdrawl
  • CNS pathology
  • Hypoxia
  • Deficiency
  • Endocrine
  • toxins, drugs
  • acute vascular
  • Heavy metals
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9
Q

How is Delirium presented (psychomotor behaviours)?

A

develops over hours to days

  • Hyperactive - agitated
  • Hypoactive - zoned out, sleepy, difficult to arouse
  • Mixed - hyper and hypoactive
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10
Q

Mention 5 clinical features of Delirium.

A
  1. Inattention
  2. Disorganized thinking
  3. altered LOC
  4. altered sleep cycle
  5. psychomotor disturbances
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11
Q

Why do we not notice delirium?

A
  1. we assume incorrectly that in older adults cognitive impairments are normal and therefore we dont look for changes
  2. we dont think about the time course
  3. we underestimate the severity of the condition and the consequences
  4. we believe delirium always means agitation whereas hypoactive form is most common
  5. we rarely use formal assessment methods
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12
Q

When does DSD (delirium superimposed on dementia) take place?

A

when the person has pre-existing dementia and develops delirium

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13
Q

what are the 2 scales available to assess delirium

A
  1. CAM

2. Delirium rating scale

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14
Q

nursing assessment for delirium…

A
  1. history of dementia or chronic cognitive decline
  2. history of cognitive impairment
  3. gather additional details
    - symptoms : what symptoms
    - patterns/frequency: when and under what conditions
    - Course : has it changed
    - Onset : when it started
    - Duration: how long has it lasted
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15
Q

state 5 things nurses should assess for in delirium

A
  1. LOC
  2. sleep/wake cycle
  3. thought process
  4. memory
  5. perception
  6. orientation/attention
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16
Q

How does CAM scale work

A
  1. acute onset and fluctuating course
  2. inattention
  3. disorganized thinking
  4. altered LOC
    (1+2+ 3/4)
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17
Q

How is Delirium managed

A
  1. Treat causes:
    - take a thorough history
    - Xray/CT
    - ECG
    - Urine analysis/culture
    - Blood work
  2. Non-pharmacologic
    - therapeutic communication
    - reduce internal stressors
    - reduce external stressors
    - involve family/caregiver in the plan
    - promote patient safety
    - control disruptive behaviours- diversion activities, music
  3. pharmacologic
    - medications to treat symptoms like agitation
    - medication review
18
Q

How to prevent delirium or what are the principles of prevention

A
  1. prevent sleep deprivation
  2. provide nutrition and fluid intake
  3. early mobilization
  4. minimize use of psychoactive drugs
  5. adaptive methods (wear glasses and hearing aids)
  6. orientation and therapeutic activities
19
Q

what are the targeted interventions for delirium

A
  1. reduce incidence of delirium

2. reduce duration of delirium

20
Q

What are the 3 main differences between Dementia and Delirium
and what is the similarity

A

Differences:
1. Dementia is chronic and slowly-pregressive
Delirium is acute and rapidly progressive

  1. Dementia is non-reversible
    Delirium is reversible
  2. Dementia cannot be diagnosed in a patient with Delirium
    Delirium can be diagnosed in a patient with Dementia

Similarity: they both have multiple underlying etiologies

21
Q

what are the 3 things you’d check to ensure the person has dementia

A
  1. evidence for significant cognitive decline from baseline in one or more cognitive domains- complex attention, executive function, learning, memory, language, perceptual-motor or social cognition
  • concern of the individual or an informant or clinician informing about the significant decline
  • a neuropsychological assessment or another type of qualified assessment documenting the impairment in cognitive functioning
  1. the cognitive deficits interfere w/ independence in everyday activities (IADLs)
  2. cognitive deficits don’t occur only in context of a delirium and are not better explained by another mental disorder.
22
Q

List 5 risk factors of Dementia

A
  1. alcohol
  2. increasing age
  3. depression
  4. smoking
  5. high cholesterol, diabetes, family history
23
Q

what are some normal age related changed in memory

A
  1. emphasis on relevance
  2. increase in processing time
  3. increased distractibility
24
Q

10 warning signs of dementia

A
  1. memory loss affecting day to day activities
  2. difficulty performing familiar tasks
  3. problems with language
  4. disorientation in time
  5. impaired judgement
  6. problems with abstract thinking
  7. misplacing things
  8. changes in mood and behavior
  9. changes in personality
  10. loss of initiative
25
Q

What are the 4 characteristics of dementia

A
  1. global impairment
  2. decline in functioning over time
  3. severity of impairment
  4. normal consciousness
26
Q

what are the 6 types of Dementia

A
  1. Alzheimer dementia (AD) >60%
  2. Vascular dementia (VaD)
  3. Parkinson Dementia
  4. Frontotemporal Dementia (FTD)
  5. Lewy body dementia (LBD)
  6. Mixed dementia, dementia related to HIV or alcohol
27
Q

3 stages of Dementia

A
  1. Mild:
    - mostly independent, may require little help with IADLs
    - misplacing things, forgetful
    - word finding difficulty
    - judgement can be impaired
  2. Moderate:
    - increased confusion
    - greater memory loss, may not recall personal info.
    - worsening judgement
    - help with ADLs
    - changes in sleep patterns, behavior and personality
  3. Severe:
    - inability communicate (can speak)
    - 24 hr care
    - decline in physical abilities
    - incontinence
    - difficulty walking, eating, swallowing
28
Q

state 5 nursing interventions for dementia

A
  1. reduce distractions
  2. give time to communicate, dont rush
  3. dont correct the patients
  4. give simple instructions
  5. follow a set routine
29
Q

What are the screening tools used in Dementia

A
  1. Mini Cog + Clock drawing
  2. MMSE
  3. MoCA
30
Q

importance of screening tools

A
  1. improve communication with interprofessional team
  2. helps to teach students and colleagues
  3. monitor changes over time
  4. solve clinical problems and plan appropriate interventions
  5. standardized assessment
31
Q

what are the advantages and disadvantages of Mini Cog

A

advantages:

  • less affected by language, ethnicity and education level
  • detect a variety of different dementia
32
Q

what are the advantages and disadvantages of MMSE

A

Advantages:

  • screen for perception, memory and language
  • available in many languages

Disadvantages:

  • affected by language, education level and ethnicity
  • needs to be adjusted for education level
  • does not measure executive function
  • screening test not diagnostic
33
Q

what are the advantages and disadvantages of MoCA

A

Advantages:

  • brevity
  • simplicity
  • reliability to measure AD
  • measures for executive functioning

Disadvantages:

  • takes longer
  • needs multiple other screening tools to detect and diagnose for dementia
34
Q

7 A’s of Dementia

A
  1. Amnesia : loss of memory
  2. Agnosia: loss of recognition
  3. Aphasia: loss of language
  4. Apraxia: loss of purposeful movement
  5. Apathy: no interest in initiation
  6. Altered perception: loss of visual acuity
  7. Anosognosia: no knowledge of the disease
35
Q

what is BPSD

A

behavioral and psychological symptoms of dementia . also known as responsive behaviors
- physical agression
- verbal aggression
- false beliefs
- delusions
- hallucinations
which poses risk of harm to the patient and the caregivers

36
Q

what are the interventions of Responsive behaviors or BPSD

A
  • find out whats causing their behaviour
  • person centered care= REAP - relationship, environment, abilities, personhood
  • non-pharmacological interventions
  • pleasant events as distractions
37
Q

what is depression

A

It is misdiagnosed, underdiagnosed and under-rated illness in older adults

second leading cause of disability worldwide in older adults.

Symptoms: characterized by low mood and loss of interest in activities and difficulty with sleeping, appetite, energy, concentration, suicidal ideals

38
Q

Which one is worst at night?

a) delirium
b) dementia
c) depression

A

Dementia

39
Q

what are the interventions for Depression

A
  1. medications
    - antidepressants
    - medication for associated agitation and/or psychosis
  2. supportive care
  3. ECT
40
Q

which one is the most effective intervention for depression

  1. ECT
  2. antidepressants
  3. supportive care strategies
  4. Therapeutic communication
  5. medication for associated psychosis and/or agitation
A

ECT

41
Q

how would you support a person in depression

A
  1. listening
  2. understanding that the behavior is due to an illness and recovery is more complicated
  3. offering reassurance

360 LS2 (1 decks)

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