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EXAM 4 MENTAL HEALTH
Delirium & Dementia
| Question | Answer |
|---|---|
| Delirium | Syndrome that involves a disturbance of consciousness accompanied by change in cognition. Usually develops over a short period, sometimes in a matter of hours , and fluctuates, or changes, throughout the course of the day |
| Delirium Symptoms | Difficulty paying attention, easily distracted, disoriented, and may have sensory disturbances such as illusions, misinterpretations, or hallucinations. Sleep disturbances, changes in psychomotor activity and emotional issues such as anxiety, fear, irritability, euphoria, or apathy. |
| Causes of Delirium | Physiological or Metabolic - hypoxemia, electrolyte imbalance, renal or hepatic failure, hypo/hyperglycemia, dehydration, sleep deprivation, thyroid disturbance, vitamin deficiency, cardiovascular shock, brain tumor, head injury, exposure to gasoline, paint solvents, pesticides. Infections. OR drug related such as intoxication of anticholinergics, lithium, alcohol, sedatives, and hypnotics, or withdraw from drugs or alcohol, or reactions to medications or anesthesia |
| Plan of Care/Nursing Interventions | Maintain nutrition and fluid |
| Nursing Priority | Determine the underlying cause |
| Signs of Cognitive Impairment | Aphasia, the deterioration of language function. Apraxia, the impaired ability to execute motor functions despite intact motor abilities. Agnosia, the inability to recognize or name objects despite intact sensory abilities. Disturbance in executive functioning, which is the ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior |
| Mild Dementia | Forgetfulness, exceeding normal, occasional forgetfulness. Difficulty finding words, frequently loses objects, and begins to experience anxiety about losses. Occupation and social settings are less enjoyable, and person may avoid them. |
| Moderate Dementia | Confusion is apparent, along with progressive memory loss. They can no longer perform complex tasks but remains oriented to person and place. Still recognizes familiar people, but towards the end of this stage they lose the ability to live independently and require assistance because of disorientation to time and loss of information. |
| Severe Dementia | Personality and emotional changes occur. May be delusional, wander at night, forget names of their spouse and children, and required assistance with ADLs. |
| Causes of Dementia | Genetic component of the abnormal APOE gene is known to be linked. Other reasons are infections such as HIV infections or Creutzfeldt-Jakob Disease. |
| Caregiver Role Strain | Identified when the demands of providing care threaten to overwhelm a caregiver. Indications include constant fatigue that is unrelieved by rest, increased use of alcohol or drugs, social isolation, inattention to personal needs, and inability or unwillingness to accept help from others. Can contribute to the neglect or abuse of clients |
| Nursing Interventions | Provide opportunities to reminiscence or recall past events. Minimize environmental changes, provide single step instructions, integrate reminders into conversations, assist with tasks but do not rush, |
| Pharmacological treatment | Cholinesterase Inhibitors such as donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl, Razadyne, Nivalin). And NMDA receptor antagonist memantine (Namenda) |
| Lewy Body Dementia | involves progressive cognitive impairment and extensive neuropsychiatric symptoms as well as motor symptoms. Delusions and visual hallucinations are common. Functional impairments may initially be more pronounced than cognitive deficits. Several risk genes have been identified, and it can occur in families, though that is less common than no family history |
| Vascular Dementia | onset is typically abrupt, followed by rapid changes in functioning |
| Alzheimer's Disease | causes an increasing decline in functioning, including loss of speech, loss of motor function, and profound personality and behavioral changes such as paranoia, delusions, hallucinations, inattention to hygiene, and belligerence. It is evidenced by atrophy of cerebral neurons, senile plaque deposits, and enlargement of the third and fourth ventricles of the brain |
| Frontotemporal Lobar Degeneration | a degenerative brain disease that particularly affects the frontal and temporal lobes and results in a clinical picture similar to that of Alzheimer disease. Early signs include personality changes, loss of social skills and inhibitions, emotional blunting, and language abnormalities. Onset is most commonly 50 to 60 years of age |
| Prion Disease | can trigger normal proteins in the brain to fold abnormally. t involves altered vision, loss of coordination or abnormal movements, and dementia that usually progresses rapidly (a few months). The cause of the encephalopathy is an infectious particle resistant to boiling, some disinfectants, and ultraviolet radiation. Pressured autoclaving or bleach can inactivate the particle. Mad cow disease and kuru are other types |
| HIV Infections | can lead to dementia and other neurologic problems |
| Parkinson's Disease | a slowly progressive neurologic condition characterized by tremor, rigidity, bradykinesia, and postural instability. It results from loss of neurons of the basal ganglia. Dementia has been reported in approximately 25% (mild NCD) to as many as 75% (major NCD) of people with this disease |
| Huntington Disease | an inherited, dominant gene disease that primarily involves cerebral atrophy, demyelination, and enlargement of the brain ventricles. Initially, there are choreiform movements that are continuous during waking hours and involve facial contortions, twisting, turning, and tongue movements. Personality changes are the initial psychosocial manifestations followed by memory loss, decreased intellectual functioning, and other signs of dementia. |
| Traumatic Brain Injury | can cause dementia as a direct pathophysiological consequence of head trauma. The degree and type of cognitive impairment and behavioral disturbance depend on the location and extent of the dementia |
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