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DELIRIUM
- 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
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DEMENTIA
- 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
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STAGES OF ALZHEIMER'S DISEASE
- 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
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DEFENSE MECHANISMS IN COGNITIVE DISORDERS
- 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
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AUTISM
- 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
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ASPERGER'S DISORDER
- Occurs later in childhood, usually when the child enters school
- Later onset than autism, with less cognitive or language delay
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ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
Key Symptoms include: Inattention & Hyperactivity
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OPPOSITIONAL DEFIANT DISORDER
- Behaviors usually seen at home & directed toward person best known
- Generally do not violate the rights of others
- Can develop into conduct disorder
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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
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NURSING INTERVENTIONS FOR THE CHILD WITH PDD
- 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
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SUBSTANCE DEPENDENCE
- 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
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ALCOHOL (ETHANOL)
- 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%
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DELIRIUM TREMENS (DTs)
Symptoms: all of the previous symptoms plus severe disorientation, psychotic symptoms (ex delusions & hallucinations ), severe hypertension, cardiac dysrhytmias, delirium; may progress to death
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DATA COLLECTION FOR ALCOHOL (ETHANOL) ABUSE
- 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
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MANAGING ALCOHOL WITHDRAWAL
Provide Seizure Precautions
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MAINTAINING ALCOHOL ABSTINENCE
- 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
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OPIOIDS
- 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
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BARBITURATES
- The names of some common ones (and brand names) include:
- Pentobarbital (Nembutal)
- Secobarbital ( Seconal)
- Amobarbital (Amytal)
- Phenobarbital (Luminal)
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BENZODIAZEPINES
- 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
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CANNABIS
- Intended Effects: Euphoria, Sedation, Hallucinations
- Causes Amotivational Syndrome (Apathy), red eyes, Compulsive eating/laughing, impaired memory (long term use)
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PSYCHEDELICS
- Intended Effects: Heightened sense of self & altered Perceptions
- May have panic attacks, flashbacks (visual disturbances or hallucinations) which can occur intermittently for years
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SUBSTANCE ABUSE & DEPENDENCY
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
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CARE OF THOSE WHO ARE DYING &/OR GRIEVING
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
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HOSPICE CARE
- 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
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CRISIS MANAGEMENT
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
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SUICIDE
- 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)
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