CH 14 Flashcards by Joseph Nesbitt

Delirium

a syndrome
that develops over hours or days, fluctuates over the course
of the day and can persist for months. Changes in mental
status involve problems with attention and consciousness
and several or many additional changes, including altered
sleep—wake patterns.

ACUTE CONFUSION CHARACTERIZED
BY SUDDEN AND TEMPORARY CHANGES IN
COGNITION, ATTENTION, MEMORY AND
PERCEPTION

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Common precipitating factors for delirium

surgery, infections, serious illness and physical restraints.

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most widely used screening tool in LTC and acute care

Confusion Assessment method

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Features of deliriuj according to CAM

Acute onset or fluctuating course: change in mental status
from baseline or onset of abnormal behaviours that tend
to come and go or increase and decrease in severity.
Inattention:
Disorganized thinking:
Altered LOC

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3 Subtypes of delirium

Hyperactive
Hypoactive
Mixed (fluctuates bwhyper and hypo)

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Examples of nursinginterventions to delirium

Provisions of aids to orientation i.e. clock
Environmental modification (noise reduction)
Psychological support
Protomooion of normal sleeping pattern

etc
\

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Dementia medical term

medical term
that includes a group of brain disorders characterized by a
gradual decline in cognitive abilities (e.g., memory, understanding,
judgment, decision-making, communication) and
changes in personality and behaviour.

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How many cases of dementia are alzheimers disease

60-80%

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Lewey body ementia

part of a group of disorders called
Lewy body diseases, which also includes Parkinson disease
and Parkinson disease with dementia.

Account for 15-20% of dementia diagnoses

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How many Stages of AD

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Anosognosia,

Anosognosia,
which is the diagnostic term for lack of awareness, is assessed
by having the person who is being evaluated and a
family member or caregiver independently answer questions
related to the person’s behaviours and daily activities

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behavioural
and psychological symptoms of dementia (BPSD)

Agitation
Psychiatric symptoms: delusions, hallucinations
e Personality changes,
Mood disturbance

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Causes of delirium

UNKNOWN, THOUGHT TO BE
DISTURBANCES IN THE NEUROTRANSMITTERS
WITH MULTIFACTORIAL CAUSES

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Predisposing

Things that exist that increase risk for something (age)

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Precipitating

More spontaneous risk factors (pain, surgery, contitpation, urinary retention etc.)

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3 types of delirium

Hyperactive, hypoactive, mixed

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How important is delirium

A medical emergency

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Consequences of delirium

Longer hospital stays
Higher rate of LTC residency
Short and long term functional impairment
Development of or worsening of dementia

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What can delirium do to dementia

exacerbate it

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Nursing assessment for delirium

Assess and treat predisposing factors

Keep individual safe until delirium is resolved

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CAM

Confusion assessment method
- Diagnosis tool for delirium

1 Acute onset/fluctuating course
2 Inattention
3 Disorganized thinking
4 Altered LOC

Pharmacological intervention for delirium

Not recommended BC medication can cause it in the first place

Limit the use of psychoactive meds

Discontinue Non-essential medications

Non-pharm interventions for delirium

Physiological stability/reversible cause
Environmental (Create a stress free environment)
Education (teaching them what they need to do)
Get them to work with you
Communication

Treatment of delirium focused on

Possible contributing factors
Safety to address function and behaviour changes
Managing aggravating factors that might worsen the delirium

Key parts of deleirum

Sudden Acute Predisposing factors

Key features of dementia

Aphasia, apraxia (Cant do the action with their body that they intend), agnosia (recognition problems), disturbances in executive functioning (act do cycle)

Types of dementia

Alzheimer Vascular Lewy Body Frontotemporal

Cause of demntiia

Damage TO OR LOSS OF NERVE CELLS AND THEIR CONNECTIONS IN THE BRAin

Most dementia is

Alzheimers

Requires a genetic component 60-80% of dementia Insidious disease (happens and progresses quickly) Cannot be officially diagnosed until post Morten autopsy

Vascular dementia

Dying blood vessels leading to brain death 11-18% stroke (CVA) heart disease

Lewy body dementia

15-20% (grouped with parkinsons) similar symptoms to alzheimers Very insidious

Functional consequences of dementia

Various Loss of personhood/self-worth Feel isolated and depressed Difficult to recognize and/or acknoledge

Initial and ongoing assessment

MMSE Behaviour and psych symptoms of dementia

Important treatment for people with dementia

Routine Regular faces Regular location

Nursing assessment for dementia

MMSE Behaviour and pscyh symptoms of dementia Nursing diagnosis to individualize interventions

Dementia interventions

Pharmacological intervention Non pharm interventions

Pharmacological interventions for dementia

Most meds can stabilize disease etiology and progression and mange symptoms Alzheimer's disease does have specific meds Undrrelying cardiac factors for vascular dementia can be treated

Non pharm interventions for dementia

* EDUCATION * ENVIRONMENTAL MODIFICATION * COMMUNICATION SKILLS * ALTERNATIVE THERAPIES FOR DEMENTIA (mobilize)

KNOW SUMMAR OF IMPAIRED condition delirium and dementia

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

Primary intervention for management of delirium

Reducing noise and placing familiar objects in the client's environment

Open ended questions for people with dementia?

No, maintain good eye contact and relaxed and smiling is more important

A brain with vessel occlusions is suffering from what kind of dementia

Vascular

How to best tell someone to react to alzheimers

Yes, progression is usually fairly fast, you might want to start making plans. ???

Sudden onset of delirium should first be investigated in what

Medications or infections

Lewy body dementia characterized by

The presence of abnormal proteins in the brain (lewy bodies) that eventually damage the neurons in the brain people are highly sensitive to anticholergenic medications even in low doses Can progress quickly if environment is changed or if infection or condition occurs as well

Frontotemporal degeneration (dementia)

Major cause of young onset dementia

Stage 2 of dementia

Age associated memory impairment (normal)