mental health nursing -3 year nursing ,unit on delirium and dementia

1. By Karishma Singh Rajput

2. Introduction
 These disorder were previously identified as organic
mental disorder and syndrome . With the publication
of the DSM –IV the name was changed .
 These disorders constitute of large and growing public
health problems. Scientists estimates 4.5 million
people currently have Alzheimer’s diseases , the most
common type dementia .
 The objective is to provide these individual with
diginity and quality of life they deserve .

3. Delirium
 Delirium is characterized by disturbance of
consciousness a change in cognition that develop
rapidly over short period of time .
 Delirium can be defined as mental state characterized
by a disturbance of,
 cognition,
 excitement,
 confusion,disorientation,hallucination and illusions
are common .

4. ICD CLASSIFICATIONOF DELIRIUM
 F05 –DELIRIUM NOT INDUCED BY ALCOHOL AND
OTHER PSYCHOACTIVE SUBSTANCES
 F05.0- DELIRIUM ,NOT SUPERIMPOSED ON
DEMENTIA ,SO DESCRIBED.
 F05.1- DELIRIUM ,SUPERIMPOSED ON DEMENTIA
 F05.8-OTHER DELIRIUM
 F05.9- DELIRIUM ,UNSPECIFIED

5. Causes
 Delirium due to general medical condition
 Substance induced delirium
 Substance intoxication
 Substance withdrawal
 Multiple etiologies .
 Other causes includes – head trauma ,metabolic
thiamine deficiency, vascular –hypertensive and etc.

6. Clinical features
 Disorientation to time and place .
 Mental confusion
 Impairment of recent memory
 Sleep may fluctuate between hypersomnolency and
insomnia .
 Psychomotor activity may fluctuate between agitated
,purposeless movements .
 Emotional instability manifested by – fear, anxiety ,
anger ,euphoria or apathy .

7. Cont…
 Various emotion includes – crying, cursing, muttering,
And etc .
Autonomic manifestations – tachycardia ,sweating ,
flushed face , dilated pupils .

8. Duration of illness
 From 1 week – 1 month

9. Treatment
 Identify the cause and treat the cause .
 Symptomatic treatment
 Additional attention should be given to fluid and
electrolyte status , hypoxia , anoxia , and diabetic
problems .

10. Dementia
 Dementia can be classified as primary or secondary .
Dementia is not a disease by itself ,but rather a group
of symptoms that are caused by various disease
conditions . If it is severe , it will interfere with a
person’s daily functioning . The word dementia is
derived from 2 latin word ‘de’ ,means apart or away
and ‘mens’ or mentis means mind .

11. Definition
 A/c to Marry Townsend dementia is defined by loss of
previous level of cognitive, executive and memory
function in a state of full alertness.
Or
A/c to wikipedia – the progressive decline in cognitive
functions due to damage or disease in brain beyond,
what might be expected from normal agings.

12. ICD CLASSIFICATION
 F00-09 ORGANIC ,INCLUDING SYMPTOMATIC
MENTAL DISORDER .
 F01-VASCULAR DEMENTIA
 F02- DEMENTIA IN OTHER DISEASES CLASSIFIED
ELSEWHERE
 F03- UNSPECIFIED DEMENTIA.
 F04-ORGANIC AMESIC SYNDROME ,NOT INDUCED BY
ALCOHOL AND OTHER PSYCHOACTIVE SUBSTANCES.
 F06-OTHER MENTAL DISORDER DUE TO BRAIN
DAMAGE AND DYSFUNCTION AND TO PHYSICAL
DISEASE

13. Etiologies
 Common causes:-
 Degenerative disease
 Fronto temporal lobar degeneration
 Toxic reaction
 Senile dementia.
 Less common causes:-
 Parkinson’s disease
 Down syndrome
 Metal poisoning
 Hypoglycemia .

14. Clinical manifestation
 Abstract thinking
 Judgement
 Impulse control
 Social conduct are often disregarded
 Language may or may not be affected
 Aphasia
 Personal appearance and hygiene
 Some individual may have difficulty naming objects
 Personality change
 Apraxia

15. Diagnosis
Ct scan and MRI
Neuropsychological testing
Geropsychologist
Mini mental status examination
Assessment of daily activity

16. Etiological factors implicated the
development of delirium and
dementia
Biological factors Exogenous factors
Hypoxia
Nutritional deficiencies
Metabolic disturbance
Endocrine dysfunction
Cardiovascular disease
Primary brain disorder
Infection
Intracranial neoplasm's
Congential defects
Birth trauma
Cranial trauma
Volatile inhalant
Heavy metals
Substance abuse
Other medications

17. Treatment modalities
 Validation therapy
 Reality orientation training
 Cognitive and behavioral intervention remotivation
therapy

18. Nursing diagnosis
 Risk for trauma related to impairments in cognitive
and psychomotor functioning
 Distrubed thought process related to cerebral
degeneration evidenced by confusion and inaccurate
interpretation of the enviroment .
 Self care deficit related to memory deficits evidenced
by inability to fulfill ADLs

19.  Plan nursing care as above mentioned nursing
diagnosis.

20. Dementia of the Alzheimer’s type
 Several causes have been described for the syndrome
of dementia but dementia of the alzheimer’s type
accounts for 50-60 percent of all cases . The
progressive nature of symptoms associated with DAT
has been described according to stages .
 It includes 7 stages .

21. Cont…
 Stage -1 – no apparent symptoms
 Stage -2-forgetfulness
 Stage -3- mild cognitive decline
 Stage -4- mild to moderate cognitive
 Stage -5- moderate cognitive decline early dementia
 Stage -6- moderate to severe cognitive decline middle
dementia.
 Stage -7- severe cognitive decline ;late dementia

22. Cont…
 Stage 1- in this first stage of the illness there is no
apparent decline in memory
 Stage -2- the individual begins to lose things or forget
names of people . Losses in short term memory are
common . The individual is aware of the intellectual
decline and may feel ashamed ,becoming anxious and
depressed ,which in turn may worsen the symptoms .
 Stage -3- in this stage ,there is interference with work
performance ,which becomes noticeable to coworkers .
The individual may get lost when driving his or her car.

23. Cont…
 Stage -4-at this stage ,the individual may forget major
events in personal history ,such as his or her own
child’s birthday . He or she, may deny that a problem
exists by covering up memory loss with confabulation .
 Stage -5 – in this early stages of dementia ,the
individual loses the ability to perform some ADL .
 Stage -6- at this stage the individual is unable to recall
recent major life events or even the name of his or her
spouse . Symptoms seems to worsen by sundowning .
 Stage -7-in this end stage of DAT ,the individual is
unable to recognize family members.

24. Etiologies
 A/c TO DSM –IV
 Dementia of the alzhemier type
 Vascular dementia
 Dementia due to hiv diseases
 Dementia due to head trauma
 Dementia due to parkinson’s disease.
 Dementia due to huntington disease.
 Dementia due to pick’s diseases
 Dementia due to crutzfeldt jakob ,general medical
conditions ,multiple etiologies.
 Substance induced persisting dementia .

25. NEUROTRANSMITTERS
 A decrease in the neurotransmitters acetylcholine has
been implicated in the etiology of alzheimer’s disease
.cholinergic sources arises from brainstem and the
basal forebrain and basal forebrain to supply areas of
the basal ganglia ,thalamus ,limbic
structure,hippocampus , and cerebral cortex .