NUR 114 Delirium and Dementia 2020 - EXAM II Flashcards
involves a change in cognition in which there is an abrupt onset of confusional state involving:
- disturbances of consciousness
- change in cognition
- develops over a short period of time
- fluctuates during the day
- always secondary to another condition
- complete recovery can occur
Delirium acute confusion
disorientation worse at night and early morning
sundowning
errors in perception and interpretation of real sensory stimuli
illusions
both visual and tactile false sensory stimuli
hallucinations
- labile mood swings
- agitation and/or mood swings
- hypervigilance (constantly alert or scanning room)
- increase pulse, increase BP, flushed, sweating and dilated pupils
symptoms of delirium
a common tool utilized to assess acute onset confusion. an assessment tool that is specific for delirium. The assessment takes less than 5 minutes. very helpful in noting change in cognition. a delay in treatment can have serious consequences
Confusion Assessment Method (requires feature 1 and 2 and either 3 or 4)
Feature 1 acute onset and fluctuating course
Feature 2 inattention
Feature 3 disorganized thinking
Feature 4 altered level of consciousness
directed toward and identifying and treating any underlying cause
medical management
direct towards patient safety
nursing implementations
communicate in simple and concrete phases.
- use reality-oriented aid (clocks, calendars)
- maintain the same staff, if possible
- encourage family members to be supportive
planning and implementing in regards to delirium
- progressive loss of cognitive function
- impairment in memory w/o impairment in consciousness
- difficulty w/ memory, thinking and comprehension
- majority are irreversible
- most common cause is Alzheimer’s disease (Alzheimer’s is a subtype of dementia)
Dementia (Chronic Confusion)
stage of alzheimer’s disease that is characterized by forgetfulness and possible depression. can be easily passed off and not easily recognized. some lost of energy, more difficult time learning new things. simple tasks become more difficult.
stage 1 (mild)
stage of alzheimer’s disease that is characterized by confusion, disorientation is evident, memory gaps, self care gaps, apraxia, and labile mood. Client’s confusion about recent event grow, and memory gaps become more noticeable. loved ones become aware of the problem during this stage. There may be changes in personality as well, client becomes more irritable, agitated, more aggressive, and there will be gaps in self-care. They may deny that anything is wrong and thus have behavioral issues.
stage 2 (moderate)
stage of alzheimer’s disease that is considered severe and is the point in which the client can’t identify familiar objects or people. advanced agnosia and apraxia.
stage 3 (severe)
trouble remembering words
anomia
trouble with language
aphasia
loss of purposeful movement
Apraxia
does not recognize objects
agnosia
there is no definitive test for Alzheimer’s other than an autopsy but a history of _____ is what is used to diagnose someone
symptoms
cholinesterase inhibitors that increase acetylcholine levels to slow down progression of AD. acetylocholine aids in memory. used to treat mild to moderate Alzheimer’s. can stabilize the client for about 6-12 months.
side effects: headaches, dizziness, diarrhea, loss of appetite
donepezil
rivastigime
galantamine
Drug intoxications/withdrawals
Infections
Metabolic disorders—fluid &
electrolyte imbalances, hypoxia,
hypo/hyperglycemia
Drugs—CNS depressants, digitalis,
lithium, steroids, benzodiazepines
Neurological diseases—head trauma, seizures
Cancer—primary or metastatic lesions
Psychosocial stressors—sensory deprivation/overload, relocation, pain, immobility, sleep deprivationcauses of delirium
errors in perception and interpretation of real sensory stimuli
illusions
(visual and tactile): false sensory stimuli
hallucinations
delirious patients require what kind of environment ?
a very simple environment (safe and reduce stimulus environment)
type of dementia that is irreversible, progressive, and not secondary to any other disease.
Primary Dementia
type of dementia that is a result of another pathologic process. (ex: AIDS related dementia)
Secondary Dementia
Advancing age Gender Ethnicity Family history Vascular issues Head injury/repeated trauma
Risk factors for Alzheimer’s Diease
end stage Alzheimer’s. The client is total care and experience hyperorality (obsessing with chewing on things), hypermetamorphosis, and agraphia (inability to write and understand written information).
Stage 4 (late) of Alzheimer’s
makes up stories to preserve own self esteem
confabulation
giving the same answer regardless of the question
preservation
N-methyl-D-aspartate receptor antagonist blocks the uptake of glutamtate.
side effects: dizziness, constipation and headache.
memantine (protoype)
