Dementia and Delirium Flashcards
what is delirium
-acute
-days to wks
-course is fluctuating
-consciousness, impaired fluctuates
-attention and memory, inattentive, poor memory without marked inattention
-affect variable
-
what is dementia
- onset: insidous
- month to years duration
- course is slowly progressive
types of dementia
- static or fixed
- slowly progressive
- rapidly progressive
symptoms of dementia
- memory loss
- inability to learn or remember new information
- difficulty with planning and organization
- difficulty with coordination & motor function
- personality changes
- intabliity to reason
- incontinence
- dishibitoin
- poor insight or judgment
- aggression
- repetitive behavior
- paranoia
- agitation
- hallucinations
- difficulty communicating
- repetive aphasia
- expressive aphasia
what is repetitive aphasia
cannot understand what is said
what is expressive aphasia
cannot express themselves verbally
who is at risk for dementia
unmodifiable risk factors:
- Age >65 dementia is not a normal process of aging
- postive family history (for specific types)
- female (most likelu to live longer)
who is at risk for dementia
unmodifiable risk factors:
- Age >65 dementia is not a normal process of aging
- postive family history (for specific types)
- female (most likely to live longer)
Drugs for dementia
- Acetylcholinestarse inhibitors
- NMDA receptor antagonists
- Symptom management: Risperidone, Haloperidol
Acetylcholinesterase inhibitors for dementia
ex .donzepil: Aricept
- works by increasing the levels of aceytlcholine by inhibiting the enzyme which destorys it (cholinesterase)
- useful for -mild to moderate Alzheimers disease. is ineffective in later stages due to destruction of receptor sites in the later stages of disease. Best preventative effect if treatment starts early
- goal of treatment: to increase function in 3 domains- ADLS, behaviour and cognition
N-Methyl-D-Asparate (NMDA) recpetor antagonists for dementia
ex. memantine, Ebixa
- works by blocking stimulation of these receptors is thought to be part of the disease process of Alzhiemers. Blocking may help reduce the cognitive decline.
- useful for: Mild-Moderate Alzheimer disease
risperidone for symptom managment of dementia
useful for schizophrenia, mania, aggression,
risperidone for symptom management of dementia
useful for schizophrenia, mania, aggression, or psychosis associated with dementia
halperidol for symptom management of dementia
haloperidole used for acute psychosis of schizophrenia and mania or agitation, provides a tranquilizing affect
how to identify Dementia
- Medical history & physical exam
- Lab & diagnostics to rule out treatable causes
- CT head
- MRI
- Neurphyscholigical tests
cognitive assessment tools
-Mini mental status examination (MMSE): takes 10 minutes, tests memory, orientation, and arithmetic good for obtaining a baseline to follow changes in cognition over time . sometimes used in conjuction with other tests to differntiate dementias
-Montreal Cognitive assesment MOCA:
takes 10 minutes, availbe in 35 languages, more sensitive then the MMSE especially designed to help diagnose cases of mild dementia
Nursing management:
- support cognitive function
- promote physical activity
- promote independence in self care activities
- reduces anxiety and agitation
- improving communication
- providing socialization and intimacy
- promote adequate nutriton
- promote balanced activity and rest
- supporting home and community based
Nursing management:
- support cognitive function
- promote physical activity
- promote independence in self care activities
- reduces anxiety and agitation
- improving communication
- providing socialization and intimacy
- promote adequate nutrition
- promote balanced activity and rest
- supporting home and community based
what is delerium
an acute confusional state that is common, serious, often preventable, usually treatable
what does delirium look like?
- a disturbance of consciousness
- a change cognition
- the disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day
what is important to remember about delirium
prevention is an intervention:
- discontinuation of inapropriate or unnecessary medications
- early detection and managment of post-operative complications
- early mobilization
- ensuring adequate nutritional intake
- health proffesionals education on delirium and its prevention
- minimizing the use of restraints
- regulating bowel/bladder function: avoid indwelling catheters
- use of sensory aids
- pain control
- ensuring normal sleep patterns
