What are some Behavior, Speech and CNS assessments for delirium?
Poor impulse control, withdrawn or agitated
Dull or Rapid and pressured
Anemia, Ischemia, Hypoglycemia, Lack of Vitamin B, Endocrine disorders, toxicity from alcohol or drugs, trauma or infections
What are some affect, Cognition, Interpersonal Relationships and physical assessments for Delirium?
Range from apathy to irritability, Labile emotions, laughing or sad, Bizarre behavior at night/Sundowner's
Sleep disturbance and tremors, Picking at clothes or the air
Disorganized thinking, Rambling speech and decreased ability to maintain and shift attention, thinking/memory/attention/perception are disturbed
Visual hallucinations/altered perception are common
Families are anxious and frightened
What are some Delirium interventions?
Eliminate cause of delirium
Monitor LOC continually
Reorient with each interaction - introduce self and call client by name
Use short, simple, concrete phrases
Keep the room well lit
Have client use assistive devices (hearing aids/glasses)
Clarify reality while justifying emotions/feelings
When a patient is having Delirium you want to treat the ________ _______ before trying to treat the Delirium.
When a patient is having Delirium you want to treat the UNDERLYING CAUSE before trying to treat the Delirium.
What are some cultural considerations when dealing with Dementia?
Increased risk for Latin Americans and African Americans
EUROPE & ASIA:
Japanese, Italians and thos from Hong Kong are at increased risk
Inc with clients with previous head injuries
Inc with clients with relatives that have AD
Increased in lower educational and socioeconomic levels
Early onset of Dementia is rare (5%), and it is related directly to the ________ gene.
Early onset of Dementia is rare (5%), and it is related directly to the ALZHEIMER'S gene.
There are 2 etiologies for Dementia, the first one is Neurofibrillary tangles, what does it do?
Twisted Fibrils inside the neuron that disrupt cellular processes and eventually kill the cell
There are 2 etiologies for Dementia, the second one is Plaques, what does it do?
It is the quantity of plaques in relation to the person's age that is signifigant
Widened sulci and narrowed gyri
Alzheimer's affects what? (3 things)
Repair process of Neurons in the brain
When a patient has Alzheimer's it causes what 3 things?
Difficulty carrying out ADL's
There are 4 stages of AD, what are they?
What are some characteristics of Stage 1 (Mild AD)?
Short term memory loss
Uses memory aids such as lists and routines
Aware of the problem
Depression is common
NOT diagnosable at this stage
What are the characteristics of Stage 2 (Moderate AD)?
Progressive Memory Loss
Withdrawn from social activities
Decline in instrumental ADL's
(Money management, cooking, driving)
Fears of "losing" his/her mind
Symptoms worsen with physical/emotional stress
What are some characteristics of Stage 3 (Moderate/Sever AD)?
Willingness to bathe, grooming, choosing clothing, toileting, communication, reading/writing
Loss of reasoning ability
Depression resolves as they become unaware of loss
Usually institutionalized or need care 24-7
What are characteristics of Stage 4 (Late/End Stage)?
Family recognition/self recognition disappears
Forgets how to eat, swallow, chew, wt loss
24-7 Care required
Return to infantile reflexes and ultimately death
DEATH USUALLY SECONDARY TO INFECTION OR CHOKING
What are 7 warning signs of AD?
Asking same ? over and over
Repeating same story, word for word
Forgetting how to do activities tha twere previously done with ease:
cook, make repairs, play cards
Losing one's ability to pay bills or balance one's checkbook
Getting lost in familiar surroundings
Neglect to perform personal hygeine
Relying on someone else close to them to make decisions or answer questions that they used to handle
What is another disorder that mimics Dementia?
What are some causes of Pseudodementias?
Infections (UTI, Pnemonia)
Depression (MOST COMMON)
What does Donazepil (Aricept) do?
Improves Cognitive funcion
Improving cholinergic function by inhibiting acetylcholinesterase
What is the inital dose for Donazepil (Aricept) and then what do you increase it to?
5mg for 4-6 weeks
What are some Side Effects of Dementia Meds (Cholinesterase Inhibitors)?
What do you want to teach about Dementia Meds (Cholinesterase Inhibitors)?
Taking after breakfast may lessen side effects
How to monitor pulse
That is DOES NOT CURE, only slows down the disease
What are some Multisciplinary interventions for Dementia?
New Nerve Growth
What are some alternative therapies for Dementia? LOTS OF THEM
Green tea, grape seed extract, deepest color fruits & veggies
Omega-3 Fish Oil
Salmon, mackerel, sardines
Keep nerve cells flexible
May be preventative in women (not useful for existing)
Improves cell membrane flexibility, caution in people with cardiac history
Found in soybeans & eggs
Increased risk for bleeding
What are some behavior assessments for Dementia?
Unable to do Complex Tasks
Frightened by their confusion
Attempt to cover up symptoms
Need assistance dressing
IE: lipsmacking, pacing
Disoriented at days' end, oriented during the day
What are some assessments for Affect for Dementia?
Mild stage: Anxiety & depression occur
Moderate Stage: Inc lability of emotions (rage/irritability)
Severe Stage: Person becomes unresponsive to environment
What are some cognition assessments for dementia?
Decrease in Concentration
unable to make judgements
Language skills begin to deteriorate
Mod AD: Memory Loss (recent and Remote)
Confabulation: Filling in gaps with imaginary information
Misidentification Syndrom: Familiar people are unfamiliar
Aphasia - Unable to understand language
Agraphia - Unable to read or write
Agnosia - Unable to recognize familiar people or situations
Alexia - Unable to tell what to do with a frying pan, toothbrush, telephone
What are some perception assessments for Dementia?
Visual Hallucinations are MOST common
What is being unable to understand language?
What is it when you are unable to read or write?
What is it when you are unable to recognize familiar people or situations?
What is it when you are unable to tell what to do with a frying pan, toothbrush, telephone etc?
What are some Dressing and bathing interventions for AD?
Have pt perform task to their capacity
Always have pt wear own clothes
use clothing w/ elastic/velcro buttons
Label clothing w/name
Give step by step instructions
If resistant to self care come back later and try again
What are some nutrition interventions for AD?
Monitor food and fluid intake
Offer finger foods
Weigh pt once a week
During hyperorality make sure pt doesn't eat non-food items
What are some bowel/bladder function interventions for AD?
Begin bowel and bladder training early
start with bladder control
Evaluate use of diapers
Label bathroom door as well as other rooms
What are some sleep interventions for AD?
Keep room well lit b/c pt may be awaken and scared
Maintain calm atmosphere during day
Order non barbituates if neccessary
If meds are indication consider neuroleptics
Avoid the use of restraints
What are the 5 A's for Alzheimer's?