GRCC PN141 dementia and delirium
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| A degenerative neurological disorder that doesn't go away | Dementia
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| Delirium | A degenerative neurological disorder that goes away
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| What is dementia | It is Chronic, Irreversible, Progressive, it affects the Elderly, it leads to impaired cognitive and intellectual fxn
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| What is delirium | It is acute, usually reversible, sudden onset, affects all ages, and is short term
Short term
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| Who is at risk for delirium? | M > F is at greater risk, dementia increases risk for delirium, person with an acute illness, BUN/Crt levels, Mult. Meds
that interact negatively, ETOH consumption, Depression, Pain, lyte imbalance, infection.
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| What causes delirium? | Infection (elderly;Medications; ETOH;Drugs;Cardiovascular disease (O2);Post-operative;Neoplasm; Trauma;Metabolic (fluid imbal, etc);
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| Which degenerative neurological disorder has characteristics of confusion, sudden onset, mood changes and usually only lasts no longer than a month? | Delirium
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| Delirium characteristics | Short lived confusion (<wk-month)
Usually temporary
Disoriented
Misinterpretation of surroundings, environment (sounds, sights, etc)
Hallucinations
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| What response would you expect from a pt who has delirium and seems to be disoriented. | Being disoriented makes them fearful.
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| Often times a pt with delirium will misinterpret their surroundings or environnment | Misinterpreting the environnment resulting in potentially frightening illusions
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| Delirium and hallucinations | Sometimes these patients are misdiagnosed with dementia or depression because they tend to be subdued, quietly confused, disoriented, and apathetic.
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| Characteristics of delirium | Acute onset; Alertness (extremes);
Attention (easily distracted); Orientation (time/place);Memory (short term); Thinking (rambling, unpredictable);Perception (hallucinations, illusions);Psychomotor (hyper to hypoactive)
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| How should a nurse approach a pt who is in a delirious state? | Should approach pt calmly and try to re-orient them. Help them eliminate hallucination and don't pretend you see smae things.
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| Diagnosing and characteristics of delirium | Acute onset; Alertness (extremes);Attention (easily distracted);Orientation (time/place); Memory (short term);Thinking (rambling, unpredictable);Perception (hallucinations, illusions);Psychomotor (hyper to hypoactive)
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| What affects patients alertness if they are experiencing delirium? | They are likely feeling fearful.
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| T or F. Short term memory loss IS a sign of delirium | False
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| Nursing problems | Risk for Injury; Disturbed Thought Process; Sleep Disturbances; Communication; Family coping
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| Nursing goal for treatment of delirium | Address cause of confusion During episodes of confusion: consider Safety,Comfort,and how to Relieve anxiety
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| Nursing goal for caregiver of delirium pt. | Need to continue to assess health and emotional status of Caregiver
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| Nurse assessment and application for a delirium patient should include the following data: | Medication assessment;Pain control; Adeq nutrition, Fluids & Electrolyte bal; Oxygen;Reassurance, Reorient (as approp); visible cues; familiar surroundings;Limit stimuli;Sleep, rest
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| How does Oxygen play a role in delirium | Depleted oxygen over time can cause delirium (think of cardio vascular disease and decreased oxygen)
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| Memory impairment along with problems in other cognitive areas, such as apraxia (skilled movements), agnosia (familiar objects, people), aphasia (communication), and executive function | Dementia
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| apraxia | Impaired skilled movements; The loss of the ability to execute or carry out learned purposeful movements,[1] despite having the desire and the physical ability to perform the movements.
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| agnosia | Impaired to recoginize familiar objects, people; a general term for a loss of ability to recognize objects, people, sounds, shapes, or smells;
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| aphasia | Impaired communication: a disorder that results from damage to portions of the brain that are responsible for language.
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| Dementia affects Executive function in what way? | Impaired ability to think at a higher level.
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| Goals for pts who have dementia? | Maintain highest functioning ability Preserve independence as long as possible
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| List some causes of dementia? | Alzheimer’s disease Vascular Lewy Body (sim movements, visual illus, co-exist) Parkinson’s Picks disease Huntington’s disease HIV/AIDS Nutritional Imbal Hydrocephalus Reversible – Hypothyroid, Depression, Vit D def
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| Can you treat dementia with haladol? | Yes
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| Is Dementia slow onset or long onset? | It is slow onset that progressess slowly.
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| Does dementia affect short term memory? | Yes, dementia patient short term memory is affected first, but eventually long term memory loss does happen as disease progresses.
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| Dementia characteristics | 7th leading cause of death in US; 4-5 mil now, triple by 2050; Chronic, Slow progressive decline ;Alters affect ;Impairs intellectual function
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| List some dementia characteristics of impairment. | Impaired problem solving;Short/longterm memory decline;Disorientation;Apraxia (familiar movement,routines);Agnosia (recognition);Executive dysfxn (impaired higher level thinking);Impaired reasoning, planning, sequencing, initiating (examples)
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| What is vascular dementia? | It could be from Cerebrovascular Disease; multiple Strokes;Sudden onset (3mo); Mult. TIAs;Gradual; Unrecognized by pt?, yet still damage to brain tissue?
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| List some risk factors that could cause vascular dementia. | Stroke* HTN, Cardiovasuclar disease, DM Males > Females African Amer. Smokers
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| List some impairments commonw with vascular dementia | Abnormal Executive Fxn;Diff. with tasks that require conscious control and planning; Diff. organization, solving complex problems (more than with AD);Stepwise development (signif decline then stability); Walking/Gait (Vascular);
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| What is dementia Alzheimers disease? | Progressive, irreversible deterioration of the brain ;Course varies (8-10 - 20yrs); Aspiration; Pneumonia;Most common dementia
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| What age population does Alzheimers affect? | Age it affects(doubles every 5yrs >65) 1 in 10>65 (10%) 1 in 2>85 (50%)
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| MCI – Mild Cognitive Impairment | This is not an actual dx of dementia; it involves Short-term memory loss;Intact daily fxn
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| Treatment for MCI | Tx- Calendar, memos, etc; can live alone...cue cards to help them to remember.
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| Does MCI stabilize or progress? | Sometimes it stabilizes...while other times it does progress to Alzheimers.
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| Stage 1 of Alzheimers | lasts 2-4yrs
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| Stage 1 of Alzheimers | Short tem memory loss
Disorientation – time / place
Language, word loss
Concentration, Abstract thinking
Difficulty with familiar routines, misplacing items
Alert, sociable
Mood, personality
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| Stage 1 of Alzheimers - Subtle, Family compensates? | It generally starts out as forgetfulness, or misplacing things...it's very subtle in that family and patient just sort of brush it off as forgetfulness.
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| Stage 1 of Alzheimers..forgetfulness interfering with daily living...withdrawing? | Generally, people in stage 1 AD are functioning and getting around...but sometimes forget where they are or misplace things.
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| Stage 2 of AD- characteristics | This is the Longest of the stages; they get lost in familiar places; they are unable to recognize faces, names; they often have Illusions; Easily irritated, Paranoia, Depression, Sleep
Sundowning, Unable to follow conversations, Language deficits, writin
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| Stage 2 of AD - other characterisitics | Difficulty with simple tasks (ADLs)
Loss abstract thinking
Agnosia (objects)
Apraxia (routines)
Gait changes
Score low on the MMSE
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| Stage 3 of AD - characteristics | Unable to recognize others;self
Decline & impaired verbalization;
Incontinence;Unable to care for self (forgetful);Delusions;
Complications (pneumonia, dehyd, nutrition, falls, behavior)
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| Assessing and dgx dementia and delirium- history | You are going to ask about History (family);Medical Meds (last dose, etc); Drugs &/or ETOH consumption; Environment (hazards)
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| Assessing and dgx dementia and delirium - lab testing | They will want to do further tests to rule out other by looking aat Thyroid;Vit B;Infection or Metabolic;CT /MRI
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| Assessing and dgx dementia and delirium - other testing | Cognitive Tests – (MMSE) and assessing if their ability to meet ADLs
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| Nursing care for treating pt with AD or delirium who has a disturbed Thought Process | Nurse should try to reorient prn (clocks, calendars);
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| With regards to nsg dgx of Disturbed Thought Process at what stage is re-orienting not useful? | Stage 1 pt can be reoriented, with clocks, calendars, cue cards...stage 2 or 3
it is not helpful
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| Disturbed thought process for AD or Delirium - some helpful tips | You'll want to Address hallucinations (i.e.“..you are at the hospital..”) also 1:1 time is helpful
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| Disturbed thought process for AD or Delirium - offering consistent routines | This would include Same care-giver,
Family members.
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| Assess nonverbals help with? | Non verbals help with identify triggers...what causes them to get agitated (maybe they start getting restless when they have to go pee)
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| Nursing care for Dementia or delirium pt- why provide calm & quiet environment? | This helps pt reorient & reduce anxiety (within their ability);Soft lighting, Soft music is calming; hearing aids
cuz they afraid of hearing things; ltd distractions;Familiar pictures, objects
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| Nursing care for delirium pt - what things can you do to provide a quiet and calm environment? | To reduce anxiety avoid physical restraints; confrontation;Simple, direct phrases; Identify self; Call them by their name;Redirect, Diversion
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| Nursing care for dementia and delirium pt- Self care defecit | Encourage participation & allow for adequate time; Demo how to use equipment; provide Visual cues; Modify clothing (velcro)& lay out;
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| Nursing care for dementia and delirium pt- considering Self care defecit, list other methods to compensate for loss and how would this help? | Reduce confusion by Limit choices- foods, clothing; Provide Finger foods cuz they are easier to pick up; encourage fluids; Break tasks into steps so they are not overwhelmed; Frequent toileting cuz they lose bladder control- reduces incontinence
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| Nursing care for dementia and delirium pt- what are strategies you could use to reduce the risk of injury? | Limit clutter; avoid re-arranging room; Handrails that they can hold onto for support;skid-proof surfaces (Shoes, glasses, walkers, etc) to avoid falls;Routine fall assessment; provide Night lights;
Monitor meds that affect balance
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| Nursing care for dementia pt- ways to avoid injury | Personal alarms, door locks detect if pt is moving about; Avoid physical restraints as these will increase agitation- have Family members help out with the dementia pt;1:1 time; allow frequent toileting (Urgency is common with elderly- leading to accident
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| Monitor behavior & agitation of a dementia pt. | Doing this will help Identify/prevent triggers; Face client, call by name, calm voice;Identify self, simple explanations Yes/No questions; Redirect if possible.
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| Why does redirection work for the elderly? | Redirection usually works for dementia pts b/c they have short term memory (unable to learn new things)
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| Nursing care for some one who has sleep disturbed patterns. | Limit distractions;low lights, calm environment Keep awake during daytime hrs Dementia pts often have reversed sleep patterns
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| Nursing care for someon who has a knowledge defecit rt meds. | Antipsychotic Meds (severe agitation) Haldol (Haloperidol) Risperidal (Risperidone) Zyprexa (Olanzapine) Seroquel (Quetiapine fumate)
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| What are nursing considerations before administering antipsychotic meds? | Priority is to redirect the pt and document that you tried preventing to give meds- these sort of drugs are considered a form of restraint.
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| When do you determine giving antipsychotic meds? | YOu assess Behavioral and Psychological S/S and if they demonstrate Agression,screaming, cursing, agitation, wandering Anxiety, depression, or delusions
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| What are side effects of Haladol | Extrapyramidal Effects (EPS,TD), wt gain, anticholenergic s/s (constip, dry mouth), sedation
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| Pt has been given haladol and you notice that he is involuntarily shaking and jerking. What do you need to do? | The pt needs to be taken off this med...haladol has a side effect that causes involuntary movement.
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| what are nursing considerations when taking haladol? | Pt is at risk for Ortho Hypotn and should be assessed for Falls; This is an antiCholenergic med that causes Dry Mouth, constipation, urinary retention; haladol causes Sedation increasing the risk for Falls and Social isolation
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| what do diabetics need to consider when taking Haladol? | Diabetics may need to increase insulin.
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| T or F. Some patients who require insulin while taking haladol aren't necessarily diabetic. | True- pts who are given haladol may still need to take insulin even if they aren't diabetic.
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| Another nursing consideration if pt is recieving haladol is mood and behavior- why? | This needs to be assessed as behavior and mood are the reason why they are taking the drug.
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| What if a pt has urinary retention and they seem agitated. Do you put them on haladol right away? | You should proceed with caution before administering haladol. Urine retention may mean they have a UTI, which could have adverse effects on mood and behavior.
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| Acetylcholinesterase Inhibitor is an arocept inhibitor and N-methyl-D aspartate receptor antag are drugs used on later stages of dementia. | Poss. Combo of both; nurse should set Realistic Expectations and note that AD is progressive & these drugs will not completely stopped/reverse s&s of AD.
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| Acetylcholinesterase Inhibitor N-methyl-D aspartate receptor antag treats behavior of a pt that show which s&s? | Tx behavioral s/s also Psychosis, depression, and agitation
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| Cholinesterase Inhibitors - what does it treat? | tx of MILD to MOD symptoms; Improve Cog Fxn and Delay Behavior s/s
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| Cholinesterase Inhibitors- brand names of these drugs | Donezpil (Aricept)*** QD is used first, and then Rivastigmine (Exelon) is the second most common of this class of drugs. lantamine (Razadyne) is the least given because it causes liver damage.
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| Cholinesterase Inhibitors actions: | This med Slows the breakdown of acetylcholine; it helps to slows memory loss & decline and Improve cognitive fxn (ADLs); as well as Decrease/delay agitation & delusions
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| Cholinesterase Inhibitors sideeffects: | GI – N/V/D, bradycardia, sleep chngs
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| Cholinesterase Inhibitors - nursing considerations | Don’t stop abruptly (s/s will return rapidly -behave); Liver studies if patient is taking(razadyne);it takes 6-12 months to eval full effect; can start taking it once MMSE < 12 little effect
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| Cholinesterase Inhibitors- nursing goal | Improve cognitive function and behavior;maintain where they are at; majority of people taking this drug will see an improvement.
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| Which drug do give along side of Arocept? | Namenda
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| NMDA Receptor Blockers - Memantine (Namenda); Actions: | This med is used for the Tx mod to severe dementia; Temporary improvement of Cognitive and Behave s/s; (vascular dementia)
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| NMDA Receptor Blockers - side effects | SE: Better tolerated – Fatigue, dizziness, HA, constipation
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