V. Wright Adult i dementia delirium 14 with narativevanessawright
Here are some diagnostic tools that can be used:
- Mini-Mental State Exam (MSE) - 30 point questionnaire; tests orientation, attention, calculation, recall, language, and motor skills.
- Structural imaging tests like MRI and CT scans can show brain shrinkage in areas important for memory and thinking.
- Functional imaging tests like PET and SPECT scans show how well the brain is functioning by detecting glucose metabolism and blood flow. Areas of the brain important for memory and thinking show decreased activity in people with Alzheimer's disease.
- Spinal fluid tests - a sample of cerebrospinal fluid can be analyzed for beta-amyloid and tau protein levels. Elevated tau and beta-
Depression is a common mental disorder that affects mood and can be experienced by elderly individuals. Left untreated, depression can worsen over time and negatively impact quality of life. For seniors, depression is often triggered by difficult life changes like the death of a spouse, loss of independence, or health problems. Treatment options for depression include counseling, support groups, psychotherapy, and medication, which can help most people feel better. It is important to seek help if an older adult is experiencing signs of depression like sadness, fatigue, social withdrawal, appetite changes or sleep disturbances.
This document discusses the treatment of depression in the elderly. It notes that while healthy older adults are not at greater risk of depression than younger adults, risk factors in the elderly include multiple losses, medical illness, and a history of previous depression. Depression is common in elderly patients with medical conditions like stroke, cancer, and heart disease. Treatment includes addressing any underlying medical causes or drugs that may be contributing, starting with low doses of selective serotonin reuptake inhibitors which have fewer side effects in older patients, and considering psychotherapy, electroconvulsive therapy, or mood stabilizers if needed. Close monitoring for side effects and compliance is important when medicating elderly patients.
The correct answer is C. Apnea is not a symptom of depression. It denotes pause or absence of breathing during sleep and is not included in the DSM criteria for depression.
The document discusses symptoms of menopause. It describes common vasomotor symptoms like hot flashes that affect over 50% of menopausal women, as well as psychological, sleep, genitourinary, and sexual symptoms. It provides details on evaluating a patient in menopause through history, physical exam, and screening for risks. It also presents a case study of a patient experiencing hot flashes and discusses appropriate counseling and management.
Alcohol withdrawal delirium, also known as delirium tremens, is a serious and potentially life-threatening condition that can occur when a heavy drinker abruptly stops drinking or significantly reduces their alcohol intake. Symptoms include tremors, seizures, hallucinations, anxiety, and autonomic hyperactivity. Nursing interventions include protecting the patient, monitoring vitals, administering benzodiazepines to reduce agitation and seizures, maintaining fluid and electrolyte balance, and monitoring for complications like pneumonia, liver disease, and hypoglycemia.
This document presents the case of a 27-year-old female who experienced heavy menstrual bleeding, headaches, and loss of consciousness over a year ago and was diagnosed with cerebral venous thrombosis. She underwent VP shunt placement and was discharged with cognitive impairments. On current examination, she has impaired memory, speech, and cognitive functions. A mental status examination found signs of aphasia, dementia, and amnesia. A neurological examination was notable for impaired smell and vision.
V. Wright Adult i dementia delirium 14 with narativevanessawright
Here are some diagnostic tools that can be used:
- Mini-Mental State Exam (MSE) - 30 point questionnaire; tests orientation, attention, calculation, recall, language, and motor skills.
- Structural imaging tests like MRI and CT scans can show brain shrinkage in areas important for memory and thinking.
- Functional imaging tests like PET and SPECT scans show how well the brain is functioning by detecting glucose metabolism and blood flow. Areas of the brain important for memory and thinking show decreased activity in people with Alzheimer's disease.
- Spinal fluid tests - a sample of cerebrospinal fluid can be analyzed for beta-amyloid and tau protein levels. Elevated tau and beta-
Depression is a common mental disorder that affects mood and can be experienced by elderly individuals. Left untreated, depression can worsen over time and negatively impact quality of life. For seniors, depression is often triggered by difficult life changes like the death of a spouse, loss of independence, or health problems. Treatment options for depression include counseling, support groups, psychotherapy, and medication, which can help most people feel better. It is important to seek help if an older adult is experiencing signs of depression like sadness, fatigue, social withdrawal, appetite changes or sleep disturbances.
This document discusses the treatment of depression in the elderly. It notes that while healthy older adults are not at greater risk of depression than younger adults, risk factors in the elderly include multiple losses, medical illness, and a history of previous depression. Depression is common in elderly patients with medical conditions like stroke, cancer, and heart disease. Treatment includes addressing any underlying medical causes or drugs that may be contributing, starting with low doses of selective serotonin reuptake inhibitors which have fewer side effects in older patients, and considering psychotherapy, electroconvulsive therapy, or mood stabilizers if needed. Close monitoring for side effects and compliance is important when medicating elderly patients.
The correct answer is C. Apnea is not a symptom of depression. It denotes pause or absence of breathing during sleep and is not included in the DSM criteria for depression.
The document discusses symptoms of menopause. It describes common vasomotor symptoms like hot flashes that affect over 50% of menopausal women, as well as psychological, sleep, genitourinary, and sexual symptoms. It provides details on evaluating a patient in menopause through history, physical exam, and screening for risks. It also presents a case study of a patient experiencing hot flashes and discusses appropriate counseling and management.
Alcohol withdrawal delirium, also known as delirium tremens, is a serious and potentially life-threatening condition that can occur when a heavy drinker abruptly stops drinking or significantly reduces their alcohol intake. Symptoms include tremors, seizures, hallucinations, anxiety, and autonomic hyperactivity. Nursing interventions include protecting the patient, monitoring vitals, administering benzodiazepines to reduce agitation and seizures, maintaining fluid and electrolyte balance, and monitoring for complications like pneumonia, liver disease, and hypoglycemia.
This document presents the case of a 27-year-old female who experienced heavy menstrual bleeding, headaches, and loss of consciousness over a year ago and was diagnosed with cerebral venous thrombosis. She underwent VP shunt placement and was discharged with cognitive impairments. On current examination, she has impaired memory, speech, and cognitive functions. A mental status examination found signs of aphasia, dementia, and amnesia. A neurological examination was notable for impaired smell and vision.
Geriatrics is a sub-specialty of medicine that focuses on health care of the elderly. It aims to promote health and to prevent and treat diseases and disabilities in older adults.
Complex eating disorder characterized by obsessive pursuit of thinness through dieting with extreme weight loss and disturbance of body image
Anorexia nervosa is typically characterized by
voluntary restriction of food intake ,distorted body image and fear of gaining weight
The document provides an overview of recent updates in schizophrenia research from 2008-2014. It summarizes changes in diagnostic classifications like the DSM-V, research on phenomenology such as delusions and hallucinations, epidemiological aspects including global burden and treatment gaps, neurobiological factors like genetics and imaging research, and interventions including early phase treatments and prevention strategies. The presentation outline indicates it will cover these topics in further depth across multiple slides.
This document summarizes a mental health review meeting that covered several topics: the role of stigma, supporting consumer perspectives, recognizing mental health issues, managing stress, pharmacology updates, and suicide risk factors. Stress from geopolitical issues is impacting both individuals and the health system in New Zealand. Stigma surrounding mental health creates fear, silence and loss of opportunities. Communication is key to supporting consumers in making treatment decisions while managing expectations and concerns about benefits, risks, and side effects of medications. Pharmacists can help by recognizing issues, managing medications properly, and knowing when to involve other supports to help reduce suicide risk.
The document provides an overview of several child and adolescent disorders including pervasive developmental disorders (PDD), attention deficit hyperactivity disorder (ADHD), and eating disorders. It describes the key characteristics and diagnostic criteria for autism, Asperger's syndrome, Rett's syndrome, Down syndrome, ADHD, conduct disorder, anorexia nervosa, bulimia nervosa, and binge eating disorder. It also discusses common assessment findings, treatments, and nursing considerations for managing these conditions.
The document discusses dementia, including its various types, symptoms, diagnostic criteria, assessment methods, and treatment options. It defines dementia as the loss of cognitive and intellectual function without impairment of perception or consciousness. The five major types of dementia are Alzheimer's disease, cerebrovascular disease, Lewy body disease, frontotemporal dementia, and Parkinson's disease with dementia. Assessment involves interviews, examinations, and tests to evaluate cognition, function, and rule out other conditions. Treatment focuses on enhancing quality of life and includes both non-pharmacological and pharmacological approaches.
- Schizophrenia was first described in the 19th century and theories of its causes have evolved over time to include genetic and neurological factors.
- Current understanding points to possible dopamine system imbalance, genetic predisposition, and environmental triggers contributing to symptoms.
- Symptoms are commonly grouped into positive symptoms like hallucinations and delusions and negative symptoms such as flat affect and apathy. Treatment involves medication and other therapeutic approaches.
- Schizophrenia was first described in the 19th century and theories of its causes have evolved over time to include genetic and neurological factors.
- Current understanding points to possible genetic vulnerabilities interacting with environmental influences. Positive symptoms include hallucinations and delusions while negative symptoms involve reduced emotional expression and motivation.
- Treatment involves antipsychotic medications to manage symptoms as well as psychosocial support through family education and community involvement. Ongoing management aims to support functioning while minimizing medication side effects.
Substance abuse disorders are now classified as mental disorders according to the DSM-5. Addiction changes the brain in fundamental ways and causes compulsive drug-seeking behaviors that override the ability to control impulses. Approximately 21.5 million Americans had a substance use disorder in the past year, including alcohol and illicit drugs. Co-occurring mental health and substance use disorders are common, with 7.9 million people having both in the past year. Integrated treatment that addresses both disorders together is most effective for those with co-occurring disorders.
Hypertension, also known as high blood pressure, is a long-standing medical condition where the pressure of blood within the arteries is elevated. This puts increased pressure on the heart to pump blood through the arteries.
The number of hypertension cases is increasing globally, especially in developing countries. It is estimated that 1 in 3 adults worldwide will have high blood pressure by 2025.
High blood pressure has no obvious symptoms in most cases. It can be managed by making lifestyle changes like exercising regularly, quitting smoking, reducing sodium intake, limiting alcohol, maintaining a healthy weight, and reducing stress. Early detection and treatment are important to prevent complications.
Epilepsy In The African American CommunityMyeshi Briley
Epilepsy is a disorder characterized by recurring seizures caused by excessive electrical activity in the brain. Around 350,000 African Americans have epilepsy, and they are more likely to be diagnosed and experience more severe forms than Caucasians. Epilepsy has many potential causes including head trauma, infection, tumors, and genetic factors. During a seizure the brain's electrical activity goes haywire, which can cause loss of consciousness or involuntary muscle movements. Treatment aims to control seizures through medication, surgery, diet changes, or devices like vagus nerve stimulation.
Schizophrenia affects over 222,000 people in England, with half a million experiencing it at some point in their lifetime. Improved services, more research, and better drugs have helped, but also a change in societal attitudes towards mental illness. Positive symptoms include hearing voices and delusions, while negative symptoms include depression. About 1 in 6 people experience a less acute form with heightened environmental awareness. Prevention focuses on reducing cannabis use from a young age through education, talking therapies, and addressing physical health issues since those with schizophrenia die 15-20 years younger. Genetics and life experiences both contribute to schizophrenia risk. Society prioritizes costs of schizophrenia less than other health problems.
10.30.08(a): Schizophrenia and other Psychotic DisordersOpen.Michigan
Slideshow is from the University of Michigan Medical
School's M2 Psychiatry sequence
View additional course materials on Open.Michigan: openmi.ch/med-M2Psych
1. Dementia is defined as a progressive decline in intellectual functioning that interferes with daily life. It is caused by over 60 disorders and is marked by declines in memory, spatial skills, task performance, language, thinking, and math skills.
2. There are two main types of dementia - reversible and irreversible. Reversible dementias can potentially be cured by treating underlying causes, while irreversible dementias like Alzheimer's disease currently have no cure.
3. Delirium is a disturbance of consciousness and cognition that develops over a short period of time, while dementia is a longer-term progressive decline. Delirium has many potential causes and treatments involve treating the underlying medical condition.
This document discusses the assessment and care of patients experiencing behavioral emergencies. It outlines several causes of behavioral changes including medical conditions, substances, and psychological crises. When assessing a patient, EMTs should evaluate their mental status, speech, orientation, and risk of violence. Care involves maintaining distance, encouraging talking, and avoiding threats or arguments. Restraints may be needed if the patient is a danger, and should be done quickly with adequate help while avoiding positional asphyxia. Suicide risk factors and signs are also outlined.
The document provides guidance for conducting a psychiatric history and mental state examination. It outlines 9 sections to cover in the psychiatric history: date, informant, source/reason for referral, patient identifying data, complaint, history of present illness, past illnesses, family history, and personal history. It then describes the components of a mental state examination including appearance/behavior, emotion, thinking, speech, perception, sensorium/cognition, insight, judgement, and impulsivity. Key details are provided on what to assess within each section/component.
Delirium is a common condition affecting approximately 30% of older adult inpatients and anywhere from 10-50% of older patients who have had surgery. It is defined as an acute onset of fluctuating mental status changes, inattention, and either disorganized thinking or altered level of consciousness. Delirium can present as hyperactive, hypoactive, or mixed. The first steps in assessing delirium are to explore potential causes such as infection, pain, constipation through tests like bloodwork and imaging, and to treat the underlying cause. Non-pharmacological interventions like reassurance and redirection are preferred, with medication being a last resort option. It is important to involve nursing, occupational therapy, and other experienced colleagues for
Depression is common, affecting 10% of people at some point in their lives. Risk factors include being female, past depression, chronic illness, and other mental health problems. Symptoms include persistent sadness, loss of interest, changes in appetite or sleep, feeling worthless, and suicidal thoughts. Severity is determined by number of symptoms, from mild (4 symptoms) to severe (7 or more). Diagnosis involves questionnaires like the PHQ-9 or HAD scale. Treatment includes antidepressants like SSRIs or SNRIs and talking therapies such as CBT. Referrals are made for counseling or more specialized therapies.
Emergency Department and Outpatient Senior Healthcare Consultant Coursenomadicnurse
The one day course provided by Piedmont Hospital of ED and outpatient nursing staff on Geriatric Patient care issues. Funded by the HRSA Comprehensive Geriatric Education Grant.
- A neonate presenting as unwell requires prompt assessment and consideration of serious illnesses like sepsis, congenital heart disease, and metabolic disturbances.
- A structured evaluation of vital signs, history, and physical exam can help identify concerning symptoms suggesting an underlying illness and guide appropriate management and investigations.
- Initial management should include empiric antibiotics, fluid resuscitation if needed, and treatment targeted to the suspected condition while consulting pediatric specialists. Ongoing monitoring is needed until the neonate's condition is stabilized.
Geriatrics is a sub-specialty of medicine that focuses on health care of the elderly. It aims to promote health and to prevent and treat diseases and disabilities in older adults.
Complex eating disorder characterized by obsessive pursuit of thinness through dieting with extreme weight loss and disturbance of body image
Anorexia nervosa is typically characterized by
voluntary restriction of food intake ,distorted body image and fear of gaining weight
The document provides an overview of recent updates in schizophrenia research from 2008-2014. It summarizes changes in diagnostic classifications like the DSM-V, research on phenomenology such as delusions and hallucinations, epidemiological aspects including global burden and treatment gaps, neurobiological factors like genetics and imaging research, and interventions including early phase treatments and prevention strategies. The presentation outline indicates it will cover these topics in further depth across multiple slides.
This document summarizes a mental health review meeting that covered several topics: the role of stigma, supporting consumer perspectives, recognizing mental health issues, managing stress, pharmacology updates, and suicide risk factors. Stress from geopolitical issues is impacting both individuals and the health system in New Zealand. Stigma surrounding mental health creates fear, silence and loss of opportunities. Communication is key to supporting consumers in making treatment decisions while managing expectations and concerns about benefits, risks, and side effects of medications. Pharmacists can help by recognizing issues, managing medications properly, and knowing when to involve other supports to help reduce suicide risk.
The document provides an overview of several child and adolescent disorders including pervasive developmental disorders (PDD), attention deficit hyperactivity disorder (ADHD), and eating disorders. It describes the key characteristics and diagnostic criteria for autism, Asperger's syndrome, Rett's syndrome, Down syndrome, ADHD, conduct disorder, anorexia nervosa, bulimia nervosa, and binge eating disorder. It also discusses common assessment findings, treatments, and nursing considerations for managing these conditions.
The document discusses dementia, including its various types, symptoms, diagnostic criteria, assessment methods, and treatment options. It defines dementia as the loss of cognitive and intellectual function without impairment of perception or consciousness. The five major types of dementia are Alzheimer's disease, cerebrovascular disease, Lewy body disease, frontotemporal dementia, and Parkinson's disease with dementia. Assessment involves interviews, examinations, and tests to evaluate cognition, function, and rule out other conditions. Treatment focuses on enhancing quality of life and includes both non-pharmacological and pharmacological approaches.
- Schizophrenia was first described in the 19th century and theories of its causes have evolved over time to include genetic and neurological factors.
- Current understanding points to possible dopamine system imbalance, genetic predisposition, and environmental triggers contributing to symptoms.
- Symptoms are commonly grouped into positive symptoms like hallucinations and delusions and negative symptoms such as flat affect and apathy. Treatment involves medication and other therapeutic approaches.
- Schizophrenia was first described in the 19th century and theories of its causes have evolved over time to include genetic and neurological factors.
- Current understanding points to possible genetic vulnerabilities interacting with environmental influences. Positive symptoms include hallucinations and delusions while negative symptoms involve reduced emotional expression and motivation.
- Treatment involves antipsychotic medications to manage symptoms as well as psychosocial support through family education and community involvement. Ongoing management aims to support functioning while minimizing medication side effects.
Substance abuse disorders are now classified as mental disorders according to the DSM-5. Addiction changes the brain in fundamental ways and causes compulsive drug-seeking behaviors that override the ability to control impulses. Approximately 21.5 million Americans had a substance use disorder in the past year, including alcohol and illicit drugs. Co-occurring mental health and substance use disorders are common, with 7.9 million people having both in the past year. Integrated treatment that addresses both disorders together is most effective for those with co-occurring disorders.
Hypertension, also known as high blood pressure, is a long-standing medical condition where the pressure of blood within the arteries is elevated. This puts increased pressure on the heart to pump blood through the arteries.
The number of hypertension cases is increasing globally, especially in developing countries. It is estimated that 1 in 3 adults worldwide will have high blood pressure by 2025.
High blood pressure has no obvious symptoms in most cases. It can be managed by making lifestyle changes like exercising regularly, quitting smoking, reducing sodium intake, limiting alcohol, maintaining a healthy weight, and reducing stress. Early detection and treatment are important to prevent complications.
Epilepsy In The African American CommunityMyeshi Briley
Epilepsy is a disorder characterized by recurring seizures caused by excessive electrical activity in the brain. Around 350,000 African Americans have epilepsy, and they are more likely to be diagnosed and experience more severe forms than Caucasians. Epilepsy has many potential causes including head trauma, infection, tumors, and genetic factors. During a seizure the brain's electrical activity goes haywire, which can cause loss of consciousness or involuntary muscle movements. Treatment aims to control seizures through medication, surgery, diet changes, or devices like vagus nerve stimulation.
Schizophrenia affects over 222,000 people in England, with half a million experiencing it at some point in their lifetime. Improved services, more research, and better drugs have helped, but also a change in societal attitudes towards mental illness. Positive symptoms include hearing voices and delusions, while negative symptoms include depression. About 1 in 6 people experience a less acute form with heightened environmental awareness. Prevention focuses on reducing cannabis use from a young age through education, talking therapies, and addressing physical health issues since those with schizophrenia die 15-20 years younger. Genetics and life experiences both contribute to schizophrenia risk. Society prioritizes costs of schizophrenia less than other health problems.
10.30.08(a): Schizophrenia and other Psychotic DisordersOpen.Michigan
Slideshow is from the University of Michigan Medical
School's M2 Psychiatry sequence
View additional course materials on Open.Michigan: openmi.ch/med-M2Psych
1. Dementia is defined as a progressive decline in intellectual functioning that interferes with daily life. It is caused by over 60 disorders and is marked by declines in memory, spatial skills, task performance, language, thinking, and math skills.
2. There are two main types of dementia - reversible and irreversible. Reversible dementias can potentially be cured by treating underlying causes, while irreversible dementias like Alzheimer's disease currently have no cure.
3. Delirium is a disturbance of consciousness and cognition that develops over a short period of time, while dementia is a longer-term progressive decline. Delirium has many potential causes and treatments involve treating the underlying medical condition.
This document discusses the assessment and care of patients experiencing behavioral emergencies. It outlines several causes of behavioral changes including medical conditions, substances, and psychological crises. When assessing a patient, EMTs should evaluate their mental status, speech, orientation, and risk of violence. Care involves maintaining distance, encouraging talking, and avoiding threats or arguments. Restraints may be needed if the patient is a danger, and should be done quickly with adequate help while avoiding positional asphyxia. Suicide risk factors and signs are also outlined.
The document provides guidance for conducting a psychiatric history and mental state examination. It outlines 9 sections to cover in the psychiatric history: date, informant, source/reason for referral, patient identifying data, complaint, history of present illness, past illnesses, family history, and personal history. It then describes the components of a mental state examination including appearance/behavior, emotion, thinking, speech, perception, sensorium/cognition, insight, judgement, and impulsivity. Key details are provided on what to assess within each section/component.
Delirium is a common condition affecting approximately 30% of older adult inpatients and anywhere from 10-50% of older patients who have had surgery. It is defined as an acute onset of fluctuating mental status changes, inattention, and either disorganized thinking or altered level of consciousness. Delirium can present as hyperactive, hypoactive, or mixed. The first steps in assessing delirium are to explore potential causes such as infection, pain, constipation through tests like bloodwork and imaging, and to treat the underlying cause. Non-pharmacological interventions like reassurance and redirection are preferred, with medication being a last resort option. It is important to involve nursing, occupational therapy, and other experienced colleagues for
Depression is common, affecting 10% of people at some point in their lives. Risk factors include being female, past depression, chronic illness, and other mental health problems. Symptoms include persistent sadness, loss of interest, changes in appetite or sleep, feeling worthless, and suicidal thoughts. Severity is determined by number of symptoms, from mild (4 symptoms) to severe (7 or more). Diagnosis involves questionnaires like the PHQ-9 or HAD scale. Treatment includes antidepressants like SSRIs or SNRIs and talking therapies such as CBT. Referrals are made for counseling or more specialized therapies.
Emergency Department and Outpatient Senior Healthcare Consultant Coursenomadicnurse
The one day course provided by Piedmont Hospital of ED and outpatient nursing staff on Geriatric Patient care issues. Funded by the HRSA Comprehensive Geriatric Education Grant.
- A neonate presenting as unwell requires prompt assessment and consideration of serious illnesses like sepsis, congenital heart disease, and metabolic disturbances.
- A structured evaluation of vital signs, history, and physical exam can help identify concerning symptoms suggesting an underlying illness and guide appropriate management and investigations.
- Initial management should include empiric antibiotics, fluid resuscitation if needed, and treatment targeted to the suspected condition while consulting pediatric specialists. Ongoing monitoring is needed until the neonate's condition is stabilized.
This document discusses pediatric palliative care, including:
- Defining pediatric palliative care as relieving suffering and improving quality of life for children with life-threatening conditions and their families.
- Common pediatric conditions that require palliative care like cancer, heart disease, prematurity, and neurological disorders.
- Key aspects of care include managing pain, other symptoms, psychological distress, and end-of-life care while communicating effectively with children and families.
- The importance of an interdisciplinary approach to provide holistic care from diagnosis through the end of life.
The document discusses acute mental status changes that can occur in intensive care unit patients. It describes conditions like delirium, decreased levels of consciousness, and their causes. Delirium is the most common disorder and results from factors like infection, medications, electrolyte imbalances, and pre-existing dementia. The document recommends screening patients for delirium regularly using tools like the Confusion Assessment Method, and treating underlying causes and symptoms with antipsychotics like haloperidol. Delirium is associated with increased mortality, length of stay, and long-term cognitive impairment.
The patient is a 63-year-old male with a history of alcohol abuse presenting with symptoms of acute alcohol withdrawal including tremors, anxiety, tachycardia and hypokalemia. Initial treatment involves monitoring, managing withdrawal symptoms, addressing nutritional deficits and providing counseling and referrals to support ongoing sobriety and prevent relapse.
Diarrhea is accompanied by abdominal pain (colic) which lessens as the stool gets passed.
Source: https://www.rchomeopathy.com.au/homeopathic-treatment-for-diarrhea-2/
Senior Healthcare Consultant (Geriatric) class at Piedmont Hospitalsnomadicnurse
The first of a 2-day class on Geriatric issues for nursing staff at all 4 Piedmont hospitals funded by a HRSA Comprehensive Geriatric Education Grant 2009-2012.
This document discusses hypochondriasis (excessive worry about having a serious illness despite medical evaluation finding no evidence of physical disease), including its diagnostic criteria, associations, and differential diagnoses. It also provides guidance on evaluating and managing patients with hypochondriasis, including the use of cognitive behavioral therapy and antidepressants.
Ch15 eec3Diabetic Emergencies and Altered Mental Statusparamedicbob
This document provides information on diabetic emergencies, altered mental status, seizures, strokes, dizziness, and syncope. It discusses signs and symptoms, patient assessment, and emergency care steps. Key points include administering oral glucose for hypoglycemic patients who can swallow, positioning seizure patients on their side and protecting airway after, and using the Cincinnati Prehospital Stroke Scale to assess for facial droop, arm drift, and slurred speech to identify potential stroke patients.
The document discusses the physiology of diabetes, including the roles of the pancreas, glucagon, and insulin in regulating blood sugar levels. It describes the two main types of diabetes: type 1 caused by an autoimmune destruction of insulin-producing cells, and type 2 which usually develops in adulthood. Uncontrolled diabetes can lead to damage of blood vessels, retina, kidneys, and nerves as well as death or coma if left unregulated. Proper management requires careful diet, exercise, insulin injections, blood sugar testing, and regular medical care.
This document provides information on alcohol, its effects on the body, alcohol dependence and withdrawal, and treatment approaches. It discusses how alcohol acts in the brain to produce both pleasurable and reinforcing effects. It outlines recommended daily and weekly drinking limits, signs and symptoms of alcohol intoxication at different blood alcohol levels. It also summarizes common presentations to the emergency department related to alcohol, approaches to assessing and managing alcohol withdrawal, risks of Wernicke's encephalopathy from thiamine deficiency, and options for ongoing treatment and support.
This case study documents an interprofessional assessment of a 74-year-old male patient admitted to the hospital with pneumonia, sepsis, and confusion. A team of healthcare students gathered information on the patient's medical history of diabetes, Parkinson's disease, and prior varicose vein surgeries. The team evaluated the patient's mental status, examined him, developed a treatment plan, and considered discharge needs involving his family and community supports. The experience highlighted the importance of interprofessional collaboration to provide comprehensive patient-centered care, but also the challenges of assessing a real patient with limited clinical experience and access to full medical records.
The document discusses bipolar disorder in children and adolescents. It notes that the presentation of bipolar disorder can be different in children compared to adults, with symptoms often overlapping with other disorders like ADHD. Children may experience more mixed states and rapid cycling between moods. Treatment involves mood stabilizers and atypical antipsychotics, though their use requires monitoring side effects. The prognosis is often one of recovery from initial episodes but high rates of relapse.
This document provides information on irritable bowel syndrome (IBS), including its definition, epidemiology, etiology, clinical features, diagnosis, investigations, treatment, and prognosis. IBS is a functional bowel disorder characterized by abdominal pain or discomfort and altered bowel movements in the absence of structural abnormalities. It has a prevalence of 1-20% worldwide and is more common in women. The cause is uncertain but may involve GI motor abnormalities, visceral hypersensitivity, brain-gut axis dysregulation, and abnormal psychology. Diagnosis is based on symptoms and ruling out other diseases. Treatment involves diet modification, pharmacotherapy including antispasmodics, antidepressants, and probiotics, as well as psychological therapies like CBT.
The document provides information about Parkinson's disease including:
- Symptoms can include motor symptoms like tremors as well as non-motor symptoms affecting mood, behavior, and cognition.
- Diagnosis is based on medical history and exam, and dopamine levels are reduced in the brain.
- Treatment options include medications to manage symptoms, deep brain stimulation surgery, and therapies like physical, speech, and exercise.
- Risk factors include age and possible environmental toxins, though the exact causes are still being researched. Progression varies between individuals.
This document provides information on hospice eligibility and recertification. It discusses identifying eligible patients early and understanding local coverage determinations (LCDs). Prognostic accuracy is based on a physician's clinical judgment that individuals with the same disease generally die within 6 months. The document then reviews eligibility from different perspectives and myths. It outlines the criteria patients must meet for Medicare payment, including meeting LCD criteria or demonstrating clinical decline. General guidelines are provided for documenting decline across clinical status, symptoms, signs, labs, nutrition, function, and comorbidities. Disease-specific criteria are then reviewed for conditions like cancer, pulmonary disease, heart disease, renal disease, liver disease, and neurological disorders.
Pediatrics History Taking and Physical Examination.pptxAJAY MANDAL
This document outlines the components and steps for taking a pediatric history and conducting a physical examination for newborns, infants, children, and adolescents. It discusses obtaining a thorough history, including chief complaint, history of present illness, review of systems, past medical history, family history, and social history. The document also provides guidance on performing a complete physical exam for newborns, assessing vital signs, appearance, and examining each body system.
Ns Palliative & Supportive Care criteriaJane Webley
The document outlines criteria for registration in the North Shore Palliative and Supportive Care Program in 2011. [1] It lists clinical indicators of advanced disease for various conditions like cancer, organ failure, frailty, and neurological diseases. [2] It also notes factors like performance status, prognosis within 6-12 months, choice for comfort care only, and special needs as criteria. [3] The Palliative Performance Scale is described as a measure of patient performance status and level of self-care from 100% normal to 10% totally bedbound and minimal intake.
Key points of obstetrics and gynaecological historyNaila Memon
This document contains a template for taking a thorough medical history. It includes sections for collecting the patient's biodata, chief complaints, history of present illness, obstetric history, gynecologic history, past medical history, family history, medications, allergies, social history, and systems review. The template provides guidance on the key information to collect under each section to fully understand the patient's history and current medical concerns.
Similar to Day 2 senior healthcare consultant conference (20)
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
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NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
Are you looking for a long-lasting solution to your missing tooth?
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low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
LOW BIRTH WEIGHT. PRETERM BABIES OR SMALL FOR DATES BABIES
Day 2 senior healthcare consultant conference
1. Dee Tucker RN, MS, GCNS-BC Nursing Service An Overall Assessment Tool of Older Adults SPICES
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4. SPICES Interventions Assessment S leep Disorders P roblems with Eating/Feeding, P ain I ncontinence C ognition E vidence of Falls, Mobility problems S kin Breakdown
5. SPICES Interventions Assessment S leep Disorders Restless or wake-sleep cycle disturbance Sleep protocol Evaluate for cause & treat (pain, delirium, etc)
6. SPICES Interventions Assessment P roblems with Eating/ Feeding, P ain % food eaten for each meal last 24hr PO fluid intake amount UOP Wt if daily LBM If less than 50% If less than 1.5 to 2 Liters; or NPO, or clear liquid diet for 24 hrs or more If less than 30 ml/hr If gain 1-2 Kg in 24 hrs If no BM in 3 days
7. SPICES Interventions Assessment I ncontinence Any episode Foley catheter Begin Toileting schedule Evaluate for UTI DC’ing when C ognition Any change in LOC, attentiveness, memory, Evaluate for cause (pain, delirium, etc
8. SPICES Interventions Assessment E vidence of Falls, Mobility problems Orthostatic BP & pulse Function & mobility as observed in last 24 hrs Falls- circumstances If greater than 20 point drop in systolic If below baseline, or declining If occur S kin Breakdown Any change With risk or actual impairment
Normal aging brings about inevitable and irreversible changes. These normal aging changes are partially responsible for the increased risk of developing health-related problems within the elderly population. Prevalent problems experienced by older adults include: Normal aging brings about inevitable and irreversible changes. These normal aging changes are partially responsible for the increased risk of developing health-related problems within the elderly population. Prevalent problems experienced by older adults include:
Using consistent review of high risk areas decreases likelihood of missing things
Need to know baseline prior to illness
Nl aging: Older adults usually have more difficult time falling asleep, have impaired sleep maintenance because of arousals, and more difficulty in returning to sleep once they are awakened during night There is a decrease in stage 3 or 4 “deep sleep” and increase in stage 1 or “light sleep” Older adults are more likely to awaken because of environmental factors such as noise or physiological factors such as pain or nocturia Sleep: what is their baseline sleep apnea- do they snore; , restless leg syndrome, depression, delirium Do they use sleep aid at home?? Has it been ordered sleep protocol
Nl aging changes: Early satiation, when miss a meal- don’t play catch up Oral health / care Loss of taste buds, sense smell, thirst sensors Affected by chronic issues as pain, PD, COPD, depression as well as medications and constipation With increased frailty and deconditioning, loss of function follows a predictable pattern, with the ability to feed oneself the last activity of daily living (ADL) to be lost Hospital acquired malnutrition: patient may be kept on downgraded diet when the original problem has resolved. If less than 50% need further intervention/nutrition consult Keeping accurate track of I/Os extremely important as older adults at increased risk for dehydration If intake < 1500 ccs need to intervene
New onset incontinence= infection Foley cath only reason for having: Foley Catheters are indicated for: ____Urinary Tract Obstruction ____Gross Hematuria with clots ____Neurogenic bladder with retention ____Urologic surgery or studies ____Sacral decubiti Stage 3-4 ____Hospice, Comfort or Palliative Care Remove ASAP- risk for CAUTI increases 5% each day with dramatic rise at 4 days Cognition: affected by lack of sleep, pain, medications, anxiety Screen as snapshot and to identify if need further evaluation Cannot screen for dementia or depression if delirium present; if have undertx or untx depression can not clearly eval for dementia
Ortho can be early indicator of higher fall risk, dehydration Often overstate their abilities; if can do task but takes long time or barely able – very close to losing ability Verify with family or facilities Intervention- for pt or work with family- consult rehab Pressure ulcers are associated with complications including cellulitis, osteomyelitis, sepsis, increased length of stay, financial and emotional costs Easier to prevent than heal; “Never event” for CMS
Nurses rely on signs and symptoms from patients to direct their care. Older adults respond differently to illness, treatments and interventions due to : changes in organ systems Progressive loss of reserve Interaction of multiple conditions with the acute illness
Treatment and interventions will be more accurate Earlier intervention prevents progression to more serious situation Prevent common complications and issues for older patients We will look at changes is S&S with older adults in general and then specifically with cardiac and infections you are most likely to see in the hospital.
Must compare to normal prior to the illness Differentiate between normal aging and illness in signs and symptoms Set of symptoms see in older adults that should raise red flags
Older adults have the most variability than any other age group. Perception of older adult may not reflect true abilities situation; verify with family, caregivers, facility staff, etc Frail older adults are most likely to have atypical presentation of illness- their reserves are stressed to the max- Add to this normal aging-
Symptoms reported become less specific- that is what the older adults is experiencing- usually due to aging changes indifferent organ systems. Discomfort may become a generalized area rather than a limited spot which more clearly defines which organs are involved The different components to respond are muted or dampened with injury or illness thus symptoms reported and signs we look for will be less Ex: immune system, T cells The sensors and alarms systems in body take longer to marshal a response thus pt will have been ill longer before it is recognized- allows greater load of bacteria or virus, or illness process will be further along This leads us to how do problems present -
Cognition: less sharp in processing, impaired thinking, all the way to “confusion” Mobility: older adults presenting with New onset falls, weakness impairing daily activities needs to be evaluated for an underlying problem- not just checked for apparent physical injury Decreased appetite, lethargy, self care can be present with any number of medically treatable conditions Let’s look at infections and cardiac issues you will come in contact with in hospital.
These issues can be community acquired and result in hospitalization or be acquired during a hospital stay. Looking at the symptoms the patient may be reporting, then the signs you would assess for, and then any labs you might anticipate abnormals in with a younger pt
Not all older pt have abd discomfort- they may attribute to bowl issues Decline in sense of smell- they might not have noted this at home Pt may not have reported because they assume incontinence is just part of getting older Thinking- here need baseline and comparison by someone other than pt Temp of 100 can be fever if base temp 97 Blood WBC can be nl – by time see left shift in differential have serious infection; may have dehydration in lab due to decrease intake with incontinence and kidney unable to conserve water (aging); Less T cells to respond and less aggressive and slower to present- temp remains lower thus does not provide help in killing off bacteria/virus as temp at 101 does
Not all older pt have abd discomfort- they may attribute to bowl issues Decline in sense of smell- they might not have noted this at home Pt may not have reported because they assume incontinence is just part of getting older Thinking- here need baseline and comparison by someone other than pt Temp of 100 can be fever if base temp 97 Blood WBC can be nl – by time see left shift in differential have serious infection; may have dehydration in lab due to decrease intake with incontinence and kidney unable to conserve water (aging); Less T cells to respond and less aggressive and slower to present- temp remains lower thus does not provide help in killing off bacteria/virus as temp at 101 does
Dehydration makes lungs dry- thus no mucus moving- no cough; May not report this is their nl lifestyle does not have any exertion Nl resp rate 14-16 Falls- no clear explanation but depleted reserves Need baseline and a someone to compare- not sure if due to decreased O2 or stressed reserves chest Xray may not be definitive until hydrated
Dehydration makes lungs dry- thus no mucus moving- no cough; May not report this is their nl lifestyle does not have any exertion Nl resp rate 14-16 Falls- no clear explanation but depleted reserves Need baseline and a someone to compare- not sure if due to decreased O2 or stressed reserves chest Xray may not be definitive until hydrated
Depending on site: May have peripheral neuropathy, some states pain reception declines as age comes from immune systems response with WBC and increased blood flow to area- all decline with aging Lab: same as with other infections
These are fairly common cardiovascular issues older adults can present with or acquire while hospitalized. We can cause heart failure with too rapid infusion of IV fluids Stress of hospitalization Being too immobile can result in DVT which can lead to PE
Lifestyle may include little exertion so would not c/o this May already sleep on elevated pillows or recliner for other reasons Rales may be masked by co-existing lung disease Rales can be caused by reclining posture- basilar rales is a sign of ventricular failure Need baseline and someone to compare Not too different but sloe to show elevations
Pain often isolated to throat, or shoulder or abdomen, or “silent MI” Dyspnea is most common symptom; need baseline, someone to compare; confusion with decreased O2 to brain Slow to elevate; may not elevate high enough to confirm in some malnourished patients
50% of pts with proximal DVT will have asymptomatic PE presentation RARELY hempoptysis Leg edema, discomfort, erythema, warmth Positive D dimer also found in recent surgery, malignancy, trauma, active CV disease ABG can be normal or reveal resp alkalosis due to hyperventilation You can see how the symptoms are vague, overlapping, - not clear cut but are not normal signs for older patients. Try this quick case with an older patient
Progressive issues with strength, mobility over short period of time: had falls Some baseline
The report you receive does not have any major definitive problems. Let’s look at the symptoms, signs and lab
Symptoms indicate a major change that has not improved Temp and resp that could be important – need to know baseline if possible; but know that 20 is higher than expected; temp could indicate a fever From what we have looked at today; could this be heart failure, MI, UTI? Or a combination of these and others such as depression.
Recognize the significance of atypical symptoms / presentations and pursue possible causes- may be more than one medical issue involved By recognizing that older adults can have atypical presentations, Nurses can ensure quality care and positive outcomes.
Older patients are at high risk for complication of delirium which can require increased nsg time and staff as well as increased LOS, NH placement, morbidity, mortality, fall risk, infection, aspiration, malnutrition- dehydration Delirium is a frequent complication of illness and hospitalization for older adults- up to 80 %, and up to 89% of pts with delirium. But it’s effects can be largely or completely reversed when cause is identified and treated Nurses are the primary professionals to detect delirium in patients and prevent these complications. We are going to look at specifics of delirium, how to assess and prevent this and appropriate interventions when it occurs.
Delirium is a disorder of multiple factors 1. normal aging, there is less physiological reserve with the brain being more susceptible; the balance is more fragile 2. changes in environment- such as hospitalization, ICU stay -74% of all cases occur in critical care areas), terms such as ICU psychosis imply an expected outcome; or move to NH 3. Leading cause of delirium is Adverse drug reactions- always think drugs 4. Malnutrition ( can have on admission or may cause during stay), anything that alters cerebral blood flow ( CVA, head injury, blood loss); decreased O to brain ( shock, heart Failure, anemia); fluid, lyte imbalance- dehydration, hypo or hyper natremia); vit deficiency, infections, metabolic disorders( DM, hypercalcemia, liver failure); Withdrawal- alcohol, narcotics, barbiturates, SSRIs Under treated pain 5. Surgery-up to 60% of older surgical pts have delirium with hip fx,vascualr surgery and elective joints have highest incidence, use of versed increases risk ( hyperactive most commonly seen) as does epidural anesthesia and longer duration of anesthesia Can begin with transient restlessness in the immediate post op period- leads us to assessment for delirium but there are 3 types of delirium presentation
agitated, aggressive, hallucinations, constant motion, non-purposeful-repetitive movements, verbally and physically aggressive, hallucinations Clouded inattention- requires strong stimulation to arouse; withdrawn, apathy, inattention; Often unrecognized- poorer overall prognosis- most common in older adults fluctuates unpredictably Behaviors you see demonstrated vary somewhat depending on type of delirium; Generally see trying to escape the environment, removing medical equipment, maybe combative, non purposeful repetitive movements, moaning- calling out, resistive to care Delirium develops over hours- days Lasts days to months First symptom is often anxiety ATTENTION night staff- 1-3 days prior to full blown delirium see change in sleep-wake cycle or disturbed sleep, restless, anxious, irritable, loss of mental clarity or some disorientation, change in ability to shift or change focus
Watch labs, record I&O and food intake; encourage 1500 ml as minimum; check orthostatic BP OOB, eat in chair, ambulate 3x/day; obtain PT referral as needed Clocks, calendars, white boards; Therapeutic Rec for engagement orient and engage Begin sleep protocol ( warm drink, back rub, oral care and warm washcloth- turn on music, turn down lights, consolidate staff trips, decrease noise in hallway Glasses, hearing aids- working battery, wears glasses, telephone aids from hospital operator Assessment requires a way that different nurses can compare their findings as well as comparing a patient’s behaviors over time.
Prior to illness- caregiver, facility staff, family, friends Baseline Memory- short term, and processing , completing tasks Alertness is basic arousal, attentiveness = thoughtful engagement with environment; select what want out of environment, sustain focus to process information- without this have safety risk Function- independent, or requires assistance Mobility Now need to compare to current status-
Is this their baseline mental status or has pt had any fluctuations in mental status in past 24 hrs as evidenced by fluctuation on sedation scale, GCS, or previous delirium assessment
First establish that pt can follow a simple “yes” “no” – such as nod head, squeeze hand- if can do this then conclude there is the basic ability to understand directions Did the patient have difficulty focusing attention, for example, being easily distractible or having difficulty keeping track of what was being said? 2.Letters: Say to patient “ I am going to read you a series of 10 letters. Whenever you hear the letter A, indicate by squeezing my hand” Then read letters in normal tone Score this a incorrect if they squeeze on any letter other than A, or do not squeeze when you say A OR can use pictures- most commonly used in ICUs or CCUs . Show 5 pictures 3 sec each. Then tell them going to show them more pictures and to squeeze or indicate when they see a picture from the first set
First establish that pt can follow a simple “yes” “no” – such as nod head, squeeze hand- if can do this then conclude there is the basic ability to understand directions Did the patient have difficulty focusing attention, for example, being easily distractible or having difficulty keeping track of what was being said? 2.Letters: Say to patient “ I am going to read you a series of 10 letters. Whenever you hear the letter A, indicate by squeezing my hand” Then read letters in normal tone Score this a incorrect if they squeeze on any letter other than A, or do not squeeze when you say A OR can use pictures- most commonly used in ICUs or CCUs . Show 5 pictures 3 sec each. Then tell them going to show them more pictures and to squeeze or indicate when they see a picture from the first set
If pt is not positive on BOTH 1 and 2 then stop. Was the patient’s thinking disorganized or incoherent, such as rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject? Use these questions Command Say to pt “Hold up this many fingers ( hold up 2 fingers in front of pt. “Now do same thing with the other hand ( not repeating the number of fingers) This helps affirm that pt did not randomly guess correctly the 4 questions
Score 1&2 and either 3 or 4 = for delirium. Alert ( normal) Vigilant ( hyperalert) Stupor (difficult to arouse) Coma (unarousable)
Look at handout / worksheet in folder- looks very busy because have put all the info on one page. Do not be overwhelmed- just 4 questions CAM was designed to be scored based on observations made during brief but formal cognitive testing. There is a false positive rate of 10%. The tool identifies the presence or absence of delirium but does not assess the severity of the condition Now that you have a tool, How frequently do you assess for delirium?
On admission to get current status Daily so can compare if changes When see potential subtle changes in behavior to determine what your actions need to be In order for this info to be useful, it must be documented for other staff to com pare to.
To compare need to record baseline prior to illness, the score from the CAM and specific behaviors noted
Collaborate with MDs re: possible untreated infection( often UTI or resp), lab work,; MDs and pharmacists for a med review and evaluate for interactions ( lasix, lanoxin, theophyllin)
Family Have them bring familiar items ( pictures, play favorite music; determine if they are a source of support-ask them to stay; educate family delirium is a temporary condition that will improve with tx It is reasonable and appropriate to ask family to help- similar to a parent staying with a frightened hospitalized child !
Remove unnecessary equipment Avoid physical and chemical restraints; foley catheters and IV are one point restraints Only 4 reasons for foley cath: oveflow with obstruction, fl balance is critical, short term for stage 3 or 4 ulcer, severely impaired or terminally ill 80% hosp acquired UTI from foley and 40% of ALL UTI due to foleys Staff continuity- approach in calm manner and voice; use simple terms, avoid sudden movements Calm approach / reassure
Proactively address- nutrition, hydration, skin breakdown, blood clots ( immobility), mobility and deconditioning / loss of function, use sensory aids,
Baseline- essential On adm and daily: miss the hypoactive ones- we have hours to days to pick up on it building Prevention easier than treating It is obvious when you look the type and length of contact we have with our patients that nurses were found to be superior when compared to physicians in detecting delirium. You are the best group positioned to prevent the medical complications for the pts and therefore the increased stress on nsg staff.
Under diagnosed because symptoms may be confused with the effects of illness or medications. These could be our frequent fliers who complain of multiple physical ailments. Depression can amplify these. Depression is NOT a normal part of aging.
Explaining depression to someone who has not experienced it is hard. For those of you who experience severe PMS…..imagine feeling like that ALL THE TIME.
Usually a decrease in appetite/ daytime sleepiness and fatigue, insomnia, awakenings./memory loss, difficulty concentrating, abnormal thoughts, excessive guilt, thoughts of death and suicide. Different people can present with different symptoms. Some are overtly sad. Others…just angry. OR Apathy...they just don’t care anymore.
Overlapping symptoms: Fatigue, psychomotor slowing, loss of appetite, sleep disturbances, etc. Often in clinical setting physician doesn’t have time to address anything except physical complaints. Because of the Stigma associated with mental illness many patients will deny feelings of depression.
Women higher prevalence, but white males over the age of 80 have higher rates of suicide. It may not be that women are MORE depressed. It may be the way they show it. Men are less likely to present with overt sadness or crying the way women do. Men more likely to present with anger, irritability, emotional withdrawl or substance abuse. I don’t think older men are any less depressed it is just the way they show it.
I am a firm believer that what it boils down to is a chemical imbalance of the neurotransmitters that control mood. serotonin, dopamine and norepinephrine. And there are many things that can throw these out of whack. You’ve heard people say “get over it. It’s all in your head” Well…….yeah. And you can’t just ‘Get over it’. Alcohol and drug abuse used to be considered only a symptom of underlying depression. New studies have shown that it can actually be a cause. Think about it…you’ve all seen the commercials…’here’s you brain on drugs’? What initially may produce euphoria, with continued use could alter brain chemistry causing depression.. The synapses get fried. Alcohol by definition is a depressant. So the depressed person who turns to alcohol to improve their mood is not doing themselves any favors. Heredity plays less of a role in late life onset of depression. Usually, familial depression presents earlier in life and is more chronic in nature. Medications: Illnesses:
This makes sense. These diseases are associated with vascular ischemia. For instance, diabetics have chronic circulation issues resulting in kidney failure, blindness, amputations. It stands to reason that the cerebrovascular system is affected as well. Limiting the blood supply can cause neurobiological changes in the neurotransmitters responsible for mood.
SSRI’s generally the first line of treatment. SNRI – Cymbalta has been associated with fatal liver disease in patients with pre-existing liver disease. DNRI – Wellbutrin less likely to be associated with wt. gain. May be effective for patients who are lethargic. Remeron – is sedating and can cause increased appetite and wt.gain in a high percentage of patients. Tricyclics – Anticholinergic effects such as dry mouth, constipation, urinary retention, tachycardia, confusion, delirium and hallucinations. Elderly particularly susceptible. Can also cause orthostatic hypotension. MAO’s – Way too many interactions.
This is the tool we use at Piedmont. Remember this is just a screening tool. It does not diagnose. How you approach a patient with this is important. Don’t just barge into the room and say “please fill this out”. These are personal questions. Get to know your patient first. Develop a relationship. A truly depressed person may not be inclined to tell the truth. If they know you care they may be more straightforward. Ask permission to discuss the tool and then explain why it is important to be honest. Ask them to complete the first 5 questions. If they score more that one on these, ask them to answer all the questions.
Primarily talk about malnutrition- where intake is less than your needs
We are going to focus on hospitalized older adults: Actually med surg pts nutritional status actually tends to worsen during a hospitalization Just how important is nutrition during a hospital stay?
LOS increases by 90% Hospital charges can be as much as 75% higher As it weaken the respiratory muscles – leads to respiratory infections Protein calorie malnutrition, type most often in these pts, results in skeletal muscle wasting- then decreased strength and falls
Immune system is affected Also puts at higher risk for emboli If protein drops enough leads to edema in tissue or ascites, diarrhea Affects CO, hr , and BP- all should be monitored closely medications that bind to protein will then have higher levels – thus standard dose can actually be at toxic levels : think dilantin, coumadin
You have more specifics on these in your handout so I am going to focus on the physiological factors particularly as they would affect a hospital patient
Chronic issues such as cardiac and COPD increase the calorie requirements due to increased muscles required for basic function Medications- alter taste, absorption, appetite Last 3 items refer to normal aging changes that affect food intake Decreased lean muscle ( skeletal) and increased percent of fat When have protein calorie malnutrition- breakdown skeletal muscle then loss of strength which causes decraesed physical activity- vicious cycl Others are early satiety ( feel full with less eaten) ,overgrowth of bacteria in bowel prevents absorption of nutrients Disease/ symptoms that affect nutrition: N/V/D, anxiety, pain, fatigue, depression, SOB, neuro conditions affect chewing-swallowing Surgery- injury-burns all increase nutritional needs significantly Then add in NOSOCOMIAL causes: hospital acquired being in hospital – meals held due to tests and not replaced; long periods of NPO due to concurrent tests scheduled; diets not advanced; intake not observed; Data shows Older adults don’t “play catchup” when they miss intake and have wt loss Mismanagement/inattention: MD writes order- dietitian dev plan- nurse records intake Who’s job is it to evaluate nutritional interventions for effectiveness; take a “wait and see” attitude for improvement- this gets our older pts in trouble
Need to know baseline so can evaluate where and what are needs, issues- goes toward the discharge plan
Need accurate info for med calculations and determine nutritional needs Measure do not use pt/family reports
Use calorie cts for accurate estimate of calorie and nutrient intake However- if less than 50% eaten off tray- this is a red flag- intervene; NPO for more than a few hours should also raise your concern
Can also indicate self neglect, cognitive impairment Fluid intake is related to food intake: if not eating enough then almost sure they are not drinking adequately
Why is this more a problem with older pts? Mortality of up to 50% if not treated Risks: Nl aging shift in body composition- have a decrease in total fluid thus less to lose before get in trouble plus kidneys become less able to concentrate urine Meds- diuretics Illnesses v/d Chronic issues- incontinence- they will restrict intake to decrease this!!!!!!!!! Being in hospital- functional problem of getting to fluids , selection
Makes early dx difficult symptoms vague, deceptive, absent
Look for tongue and mucus membrane dryness as well as longitudinal furrows, speech difficluties, CONFUSION or may be a decline in sharpness
Particularly if they are symptomatic;c /o dizziness with rising very telling
3 types of dehydration- one easiest to recognize with labs- hypertonic ( water deficit) Na > 150, serum osmolality >300 Water and electrolyte deficiency= isotonic Hypotonic- loss of lytes greater than loss of waqter
Symptomatic interventions- after if has occurred Easier to address hydration ad nutrition than it is to correct malnutrition and dehydration: proactive is best
Food intake less than 50% at a meal – don’t wait, intervene; liberalize diet- better to eat something than little or nothing; nutrient dense foods NPO for multiple concurrent tests- rearrange to space them so pt can get food and fluids ; if npo for extended time be sure they have IV hydration Encourage fluid intake of 1500 ml- don’t wait until IV is out- may actually get it out sooner this way; unless medically contraindicated- chf, renal Involve pt- explain nl aging diminishes thirst “alert” and they need to consciously drink when not thirsty- studies show older pts will try when informed Company during meals- we all eat more when we have this; meals are a social event for most people; family , friends, bring favorite foods as allowed
If feeding a patient- when have memory issues- may try mime actions sit across as though at dinner table
Silent aspiration Look for repeated swallows to move food, thick or congested voice or coughing while eating Do not provide nutritional supplements WITH meals- use between as with med passes; these are rich and may result in diarrhea so introduce slowly: start with ¼ to ½ can a day for several days then if no change in bowel habits increase to a full can and continue like this
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Home with no aftercare needs identified Home Health Care; Transportation needs; Financial assistance;Assisted Care/ Personal Care Homes;Nursing Homes ( 2 levels SNF/Subacute or Custodial);LTAC;Rehab facilities Hospice Care ( home or facility); Homeless Shelters; Psych Tx ( Inpatient /OP)
Pt returned home with daughter with HH. She was to have Emergency Response System/ Lifeline and HH with increased days for Housekeeper assistance when she returned to her home in Maryland.
Pt was drawing prison uniform with Prison ID #. Upon investigation, he had spent past 20 yrs. In Ga State prison System. With Atlanta Police assistance, his family was located in Ala. And he was placed in a Personal Care Home in Ala.
When I talk about incontinence, I’m speaking of those individuals that have a significant problem and it has a major affect on their everyday life. For instance, my mother unconsciously crosses her legs when she sneezes so she doesn’t leak. Even though she meets Webster’s definition for incontinence, she has found a way to manage her sphincter weakness and therefore it is not bothersome to her… she does NOT meet the clinical definition of incontinence.
Cerebral Cortex – social continence Pontine Micturition Center – automatic coordinated voiding Micturition reflex – threshold Spinal Cord Pathways – communication pathways (sympathetic, parasympathetic, pudenal) Bladder – smooth muscle contracts, norm: low pressure storage with ability to stretch Urethral Sphincter – norm: remain closed during bladder filling & to relax prior to and during voiding “ Head to Tail” assessment
Males have 3 advantages over females in remaining continent. These things give greater urethral resistance and are less likely to allow urine to involuntarily pass from the bladder Length of urethra is greater in males Prostate gland in a man gives additional compression at the proximal urethra 2 curves of the urethra in a male So, incontinence is widely seen in females but males do have their own set of problems, usually involving the prostate.
Prostatectomy: the sphincter is located just below the prostate. At risk of damaging the sphincter or the nerves that innervate the sphincter muscle. Pelvic Floor Relaxation Prostatectomy Sphincter Denervation ( SCI, Myelomeningocele ) Talk about the use of Urinary catheters later.
urine loss due to inappropriate bladder contractions Characterized by frequency and/or urgency Men with enlarged prostates have urinary frequency issues. Need to be worked up by a urologist to determine the true etiology.
CORRECT THE CAUSE! Stress – Meds: Sympathomimetic drugs increase the muscle tone in the proximal urethra (Sudafed, Ornade, Dexatrim without Caffeine) OAB - Anticholinergic Meds: raise the sensory threshold and reduce bladder irritability. But, can cause urinary retention
Pt with dementia. The brain is not interpreting the signals from the bladder. Lack of orientation or unfamiliar surroundings… Where’s the bathroom? Physically unable to get out of bed or the chair to get to the bathroom… Orthopaedic surgery patients.
D: Happens w/ new surroundings, narcotic use given for pain I: Irritants – Caffeine, nicotine, Nutrasweet, alcohol A: Estrogen deficiency can reduce urethral resistance as much as 33%... PINK and PLUMP P: Sedatives, narcotics, muscle relaxants, some anti-hypertensives, anitdiarrheals, antipsychotics, antidepressants, diuretics P: severe depression can reduce a person’s motivation to stay dry… DULOXETINE (not FDA approved) E: Polyuria with Diabetes R: Our ortho patients can’t get to the BR S: #1! When stool stays in the colon, it takes up space and can shift or irritate the urinary structures enough to create incontinence.
Having a urinary catheter means the door is always open for infection Use of silver catheters (antimicrobial) D/C them ASAP Every time the closed system is opened (draining the BSB, flushing the catheter, taking a culture) microorganisms are introduced to the urinary tract Rather do in & out cath, b/c the doorway to the bladder stays closed