T4 MENTAL HEALTH #3a

• Rapid Onset over a short Period of time (hours to days)
• Caused secondary to another medical condition, such as infection, or to substance abuse.
• Reversible if Dx & Tx are prompt

• S/S OF DELIRIUM:
• Impairments in: Memory, judgment, ability to focus, & ability to calculate, Impairments fluctuate throughout the day Level of Conciousness is usually altered Personality change is Rapid

• Gradual Deterioration of function over months or years; exact onset is difficult to determine
• Irreversible & Progressive

• S/S OF DEMENTIA
• Impairments in Memory , judgment, ability to focus, & ability to Calculate; Impairments do not change throughout the day
• Personality change is Gradual

• CAUSES OF DEMENTIA
• Alzheimers Disease- progressive deterioration in function due to neuro transmitter deficiency most prevalent form of dementia & characterized by memory loss, deficits in thought process, & behavioral changes in 4 stages
• Vascular Disease - due to significant cerebro vascular disease & caused by multiple infarcts in the cortex
• HIV/AIDS - r/t to brain infections with a range of symptoms from acute delirium to profound dementia
• Head Trauma - intellectual & Memory difficulties after the Trauma
• Parkinson's Disease - loss of nerve cells & progressive decreasein Dopamin activity Huntington's Disease - geneticaly transmitted disease in w/c a profound state of dementia ataxia occurs within 5-10 years of onset
• Creutzfeldt-Jakob Disease - aka Mad Cow Disease - transmissible agent known as "slow" virus clinical course is rapid with progressive deterioration & death within 1 year
• Korsakoff's Syndrome - progressive dementia caused by thiamine deficiency, usually occuring due to long term alcohol abuse
• Dementia - due to a general medication condition

• Stage I, Forgetfulness - short term memory loss, decrease attention span, subtle personality changes, mild cognitive, difficulty with depth perception
• Stage II, Confusion - obvious memory loss, impaired judgment, confabulation, wandering, sundowning, irritability & agitation, intensifications of symptoms when client is stressed, fatigued, or in new environment depression r/t awareness of decrease capacities
• Stage III, Ambulatory Dementia - loss of reasoning ability, increasing lossof expresive language, loss of ability to perform ADLs, more withdrawn
• Stage IV, End Stage - impaired or absent, cognitive, communication &/or motor skills, bowel & bladder incontinence, inability to recognize family members or self in the mirror

• DATA COLLECTION
• Use the Functional Dementia Scale, a tool that shows the clients ability for self care, the extent of memory loss, mood changes & the degree of danger to self & others

• Denial - both the client & family members may refuse to believe that changes are taking place, even when obvious Confabulation - client may make up stories about events or activities that she may not remember
• Perseveration - Client avoids unswering questions by repeating phrases or behavior

• Nursing Interventions:
• Ensure environmental safety, lowered bed, removal of scatter rugs
• Provide support to caregivers, recommend support groups & respite care
• Establish a routine; ensure all caregivers apply the routine; provide consistency in caregivers

• Impaired Communication - language delay. echolalia, failure to imitate
• Impaired Social Interactions - lack of responsiveness & interests in others. Avoidance of contact, lack of eye to eye contact, failure to cuddle or be comforted, avoidance of touch, lack of friendship.
• Stereotypical Behaviors - rigid adherence to routines, bizarre behaviors such as hand or finger flapping, clapping, rocking, swaying, head banging, hand biting, preoccupation with certain repetitive activities
• Usually observed before 3 years of age

• Occurs later in childhood, usually when the child enters school
• Later onset than autism, with less cognitive or language delay

Key Symptoms include: Inattention & Hyperactivity

• Behaviors usually seen at home & directed toward person best known
• Generally do not violate the rights of others
• Can develop into conduct disorder

Lack of remorse or care for the feelings of others; bullies, threatens, & intimidates others; physically cruel to others and/or animals, belief that aggression is justified

• Use one on one interactions
• Identify desired behaviors & reward them
• Role Model social skills, role play situations that Involve conflict
• Limit self stimulating & ritualistic behaviors by providing alternative play activities

• Tolerance - a need for higher & higher doses of a substance to achieve the desired effect, such as requiring larger amounts of alcohol to feel euphoric
• Withdrawal - Stopping or reduction of intake that results in specific physical & psychological s/s such as tremors headaches & other symptoms when alcohol is not available

• A Laboratory Blood Alcohol Concentration (BAC) of 0.08% is considered legally intoxicated for adults operating automobiles in every U.S. state
• Death could occur from acute toxicity in levels > 0.35%

Symptoms: all of the previous symptoms plus severe disorientation, psychotic symptoms (ex delusions & hallucinations ), severe hypertension, cardiac dysrhytmias, delirium; may progress to death

• C - has anyone ever told you that you should CUT down on your dringking/drug use
• A - have people ANNOYED you by criticizing you for drinking/using drugs
• G - have you ever felt GUILTY for drinking/using drugs
• E - have you ever taken an EYE-OPENER to steady your nerves or get rid of hangover

Provide Seizure Precautions

• Disulfiram (Antabuse) is a daily oral medication that is a type of Aversion Therapy
• Inform client of danger of drinking alcohol & to avoid products with Alcohol

• Intended effects: rush of euphoria, relief from pain, pupil constriction, constipation
• Abstinence Syndrome: sweating, rhinorrhea, piloerection, tremors, irritability, severe, weakness, nausea, vomiting, dilated pupils, muscle & bone pain, muscle spasms (self limiting in 7-10 days, not life threatening

• The names of some common ones (and brand names) include:
• Pentobarbital (Nembutal)
• Secobarbital ( Seconal)
• Amobarbital (Amytal)
• Phenobarbital (Luminal)

• Intended Effects: dec. anxiety & sedation
• Toxic Effects: Inc. drowsiness & sedation, life threatening hypotension (rare) resp. depression
• An Antidote, Flumazenil (Romazicon), is used IV to relieve overdose

• Intended Effects: Euphoria, Sedation, Hallucinations
• Causes Amotivational Syndrome (Apathy), red eyes, Compulsive eating/laughing, impaired memory (long term use)

• Intended Effects: Heightened sense of self & altered Perceptions
• May have panic attacks, flashbacks (visual disturbances or hallucinations) which can occur intermittently for years

Dual Diagnosis - clients has both a mental illness, as well as a substance or process abuse

• Nursing Interventions:
• Assess Chemical Use: Date of last substance use/compulsive behavior

Palliative Care is a management approach for end of life issues that prevents, relieves reduces, &/or erases the symptoms of the disease without compromising medical interventions

• Care is provided for the terminally ill client as as the family
• Uses an interdisciplinary approach, priority is symptom control
• Hospice services may be provided in a facility or at home
• Hospice Care can be given within 6 months of expected death; family bereavement services

Crisis - acute, time limited (4-6 weeks) event in which the client experiences an emotional response that cannot bemanaged with the clients normal coping mechanisms

• Basis of Crisis Intervention
• Assisting the client to regain a normal level of functioning, psychologic equilibrium

• Suicide is the intentional act of killing oneself
• Suicide ideation is having thoughts about committing suicide
• Parasuicide is inflicting a nonlethal injury to oneself with the intent to die or commit bodily harm (suicidal gestures)