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What is delirium?
- An acute condition brought one or more conditions that have altered brain functioning
- Reduction in cerebral functioning
- Main s/sx – sudden disturbance in consciousness or cognition
Underlying causes of delirium
- Infection (Usualy UTI)
- Allergic reaction
- Vitamin deficiency
- Drug toxicity (may be aggressive)
- Drug interactions
- Food supplement toxicity (ginseng?)
Nursing Assessment of Cognitive Disabilities
- Identify normal
- Past and present health status
- Description of onset, duration, range and intensity of symptoms
- Presence of chronic physical illness, dementia, depression, etc
- Lab values
- Medication history/use
Nursing Diagnosis for Cognitive imparement
- Acute confusion
- Disturbed thought processes
- Disturbed sensory perception
- Ineffective coping
- Acute pain
- Risk for infection
- Disturbed sleep pattern
- Interrupted family processes
Planning-Interventions and Outcomes
- --Low beds, guard rails, and careful supervision
- --Adequate lighting
- Maintaining fluid and electrolyte balance
- Frequent interaction
- Correction of underlying physiologic alteration
- Resolution of confusion
- Family member verbalization of understanding
- Prevention of injury
A clinical syndrome involving reduced intellectual functions with impairment in memory, language, visiospacial skills and cognition.
Different than delirium in that dimentia is slower onset, will be chronic, is progressive and irreversible.
Various forms of dementia
- Alzheimer’s Disease
- Lewy body disease: halucinations of inanimate objects. Will get worse with psychotropic drugs
- Parkinson’s disease: degenerative
- Subdural hematoma
- Normal pressure hydrocephalus
- Focal brain atrophy syndrome
- Creutzfeldt Jakob disease: Mad cow disease.
what is Agnotia?
Inability to identify common objects
Risk factors for dementia
check out these websites
What is the difference between CVA dementia and Alziemer's?
What are the early signs of Alzeimer's
- Early stage
- Mild decline
- Short-term memory deficit
- Forgets names and places that are familiar
How would this impact the caregivers??
What are the signs of moderate decline with Alzeimer's?
- Clear cut deficits
- Pt and others become more aware of problems
- Pt gets lost in familiar settings
- May develop behavioral problems such as:
- --mood swings
What are the signs of advanced Alzeimer's?
- Severe loss of function due to cognitive disability
- Loss of ability to move and speak
- Death from sepsis or pneumonia
What are some functional nursing interventions for the patient with demential/alzeimer's?
- Maintain safe environment
- Driving and occupational issues
- Long term financial and legal planning
- Will made out prior to the moderate stage
- Assign Power of Attorney
- Eligibility for pension/benefits
- As disease progresses evaluate environmental and placement choices
- Referral/resources: Alzheimer’s Association;
- Community Resources; Referral to Allied health personnel
What are some behavior nursing interventions for the patient with demential/alzeimer's?
- Decrease number of choices pt has to make
- Organize/start activities that the pt is able to continue or complete
- Will not eat
- Decrease distractions
- Offer one food at a time
- Offer finger foods/colorful foods
- Identify/Fix precipitants
- Look for pain/infection
- Cannot/will not sleep
- Exercise early in the day
- Decrease daytime napping
- Adjust light and warmth
- Regular exercise
- Safe place to wander
- Use of complex locks
- Provide safe return bracelet/ ID
What is "FOCUSED" treatment?
Nursing interventions for depression
Primary Intervention -Involves actions that promote health and decrease the likelihood of depression. Preventative.
Secondary – the nurse’s response to the client who experiences acute symptoms of depression
Tertiary - Restorative or rehabilitative functions
Symptoms associated with depression which require nursing interventions:
- Physical Needs
- Unable to perform own ADL’s (May need assistance and motivation to do so)
- Decreased appetite
- GI distress
Evaluation of interventions addressing depression
- Prevention of injury
- Patient's Verbalization of feelings/thoughts/concerns
- Affect of alternative therapies
- Changes in patient's behaviors
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