This document provides information on organic disorders, specifically delirium and dementia. It defines organic disorders as disorders caused by a known pathological condition of an organic structure. Delirium is described as a state of mental confusion caused by a disturbance in brain metabolism, with rapid onset and fluctuating symptoms. Dementia is defined as the progressive deterioration of brain function occurring after maturation, characterized by deficits in memory, thinking and behavior. The document discusses the causes, signs and symptoms, diagnosis, and treatment/management of delirium and dementia.
mania is an alteration in mood that is characterized by extreme happiness, extreme irritability, hyperactivity, little or no need for sleep. the main etiological factors include biological factors, biochemical influences, physiological factors, and psycho social theories. mania is broadly classified into three categories- hypo mania, acute mania and delirious mania. there are three types of treatment for mania- pharmacological treatment, psycho-social treatment and ECT.
Organic mental disorders are disturbances that may be caused by injury or disease affecting brain tissues as well as by chemical or hormonal abnormalities.
A phobia is an excessive and irrational fear reaction. If you have a phobia, you may experience a deep sense of dread or panic when you encounter the source of your fear. The fear can be of a certain place, situation, or object. Unlike general anxiety disorders, a phobia is usually connected to something specific
mania is an alteration in mood that is characterized by extreme happiness, extreme irritability, hyperactivity, little or no need for sleep. the main etiological factors include biological factors, biochemical influences, physiological factors, and psycho social theories. mania is broadly classified into three categories- hypo mania, acute mania and delirious mania. there are three types of treatment for mania- pharmacological treatment, psycho-social treatment and ECT.
Organic mental disorders are disturbances that may be caused by injury or disease affecting brain tissues as well as by chemical or hormonal abnormalities.
A phobia is an excessive and irrational fear reaction. If you have a phobia, you may experience a deep sense of dread or panic when you encounter the source of your fear. The fear can be of a certain place, situation, or object. Unlike general anxiety disorders, a phobia is usually connected to something specific
Homoeopathy for Industrial Workers By Dr. Kabita Mishra, BHMS, MBA (Hospital)Dr. Kabita Mishra
This presentation is an attempt to spread understanding, usefulness and importance among the pool of industrial workers about homoeopathic holistic medicines. Using homoeopathic medicine, help them fit, healthy and useful for the industry, society, and family as a responsible human being.
Right Temporal Lobe Meningioma presenting as postpartum depression: A case re...Apollo Hospitals
Meningiomas are tumors which arise from arachnoid cells and can occur both in the brain and spinal cord. Meningiomas can present with psychiatric symptoms (such as depression, anxiety disorders, or personality changes) in the absence of any neurologic signs or symptoms.
LESSONS IN BEHAVIOURAL SCIENCES FOR THE STUDENT NURSE - RICHARD OPOKU ASARERichard Asare
The knowledge of behavioural sciences is instrumental in advancing nursing and midwifery practice. Nurses and midwives can benefit from thorough understanding of factors of health behaviour change. Thus behavioural sciences can provide an understanding of client behaviour; it helps to appreciate factors determining health behaviour and health service delivery, and it can offer alternative approaches to nursing and midwifery practice that may improve the effectiveness of client care.
The content of this handbook is a compilation of lecture notes. It discusses the development of psychology and sociology, human growth and development, and some theories that explain the uniqueness of the individual’s personality. It explains some of the theories of learning, memory and motivation, and further explains socialization.
More so, it will help the student nurse/midwife acquire the needed skills and attitude to relate with other members of the healthcare team as they perform their various roles. Besides, it allows the student nurse/midwife to recognize the hospital as part of the social system and helps him or her to gain knowledge in managing conflict and to identify social factors that influence health.
THERAPEUTIC COMMUNICATION FOR THE STUDENT NURSE - RICHARD OPOKU ASARERichard Asare
This handbook introduces the student nurse/midwife to the basic therapeutic techniques in the care of their clients. It is prepared in such a way to develop students’ interest in cultivating effective interviewing skills, including attentive listening, eliciting patients’ concerns, fears and feelings, establishing rapport, and to develop the skill in using open-and close-ended questions in deriving health history from their clients to be able to plan the appropriate nursing care.
One of the main ways nurses establish trust with clients is through communication. Because nurses are likely to have the most direct contact with clients, effective nurse-patient communication is critical. Nurses can utilize proven therapeutic communication techniques that promote quality care. More so, nurses provide patients with support and information while maintaining a level of professional distance and objectivity.
Although this handbook cannot automatically change practice, it is hoped that by observing and thinking about ways in which we communicate, from a cultural point of view, we can also begin to change our practice.
It is hoped that other allied health professionals would find this handbook a useful learning material.
Many people get defensive or sad when they are criticized at work. However, criticism is an evaluative or corrective exercise that can occur in any area of human endeavour. Appreciating criticism as an exercise that is meant to improve your skills and change for the better is worth learning.
This piece of presentation introduces you to the types of criticisms and how to receive and give criticism.
Most people have difficulty differentiating between seizure and convulsion. This presentation also highlights the differences between hysterical fit and grand mal seizure.
How to manage the client is briefly discussed.
The term personality is frequently used to refer to certain qualities possessed by some people which influence or impress others. This notion of personality is incomplete and superficial.
In psychology, the term Personality has a wider meaning. It refers to the sum total of a person’s psychological and physical characteristics which make him a unique person.
The term embraces the individual’s behavioural tendencies, his intellectual qualities and his emotional disposition.
Personality is the total quality of an individual behaviour as it is shown in the habits, thinking, attitudes, interests, manner of acting and personal philosophy of life.
Our will power helps us to overcome many obstacles and hindrances in our lives. It is imperative that motivation forms an aspect of our desire to achieve our ends. Understanding motivation gives us insight into our behaviours and appreciate the efforts of others.
SOCIALIZATION AND CONFLICT & CONFLICT MANAGEMENT.pdfRichard Asare
For one to be a good practitioner, the individual needs to be socialized well in his/her chosen profession/career. One needs to be imbibed in the culture and ethics of the job he/she means to profess. As humans as we are, and members of a health team, there is bound to be conflict as we work together. Understanding the basis of conflict will help the individual to resolve issues as they crop up.
Postpartum psychosis is a severe mental illness which develops acutely in the early postnatal period. It is a psychiatric emergency. Identifying women at risk allows development of care plans to allow early detection and treatment. Management requires specialist care. Health professionals must take into account the needs of the family and new baby, as well as the risks of medication whilst breast-feeding.
Postpartum psychosis is a severe mental illness which develops acutely in the early postnatal period. It is a psychiatric emergency. Identifying women at risk allows development of care plans to allow early detection and treatment. Management requires specialist care. Health professionals must take into account the needs of the family and new baby, as well as the risks of medication whilst breast-feeding.
The term personality refers to enduring qualities of an individual that are shown in his ways of behaving in a wide variety of circumstances. It is the sum total of a person’s intellectual, emotional and volitional traits; and it is revealed by his appearance, behavior, habits and relationships with other people, which differentiate him as unique individual.
Psychotherapeutic agents are a key component in the management of psychiatric disorders. Knowledge in this aspect of therapy goes a long way to help the health professional and the patient as well. However, care must be taken in administering these agents to pregnant women, and if possible stop, or consult your psychiatrist before taking these agents.
somatoform disorders are characterized by persistent requests for medical attention because of physical complaints that cannot be sufficiently explained by medical causes.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. INTRODUCTION
asareor@yahoo.com 20162
An organic disorder is a disorder caused by a
known pathological condition. In general, any
disorder that is caused by a known pathological
condition of an organic structure may be
categorized as an organic disorder, or more
specifically, as an organic mental disorder, or a
psychological disorder.An example is delirium, a
disorder that is caused by a known physical
dysfunction of the brain.
3. INTRODUCTION – Cont’d
asareor@yahoo.com 20163
An organic mental disorder is a dysfunction of the
brain that may be permanent or temporary.
Organic mental disorders may be caused by
inherited physiology, injury, or disease affecting
brain tissues, chemical or hormonal
abnormalities, exposure to toxic materials,
neurological impairment, or abnormal changes
associated with aging (Logsdon, 2011).
5. Definitions
asareor@yahoo.com 20165
It is a state of great mental confusion in which
consciousness is clouded, attention cannot be sustained
and the stream of thought and speech incoherent,
accompanied with illusions, hallucinations and delusions.
This is a state of mental confusion characterized by
relatively rapid onset of wide spread disorganization of
the higher mental processes caused by a generalised
disturbance in the brain metabolism. It may include
impaired perception, memory and thinking, and
abnormal psychomotor activity (Carson, et al., 1996).
6. Definition – cont’d
asareor@yahoo.com 20166
It is a change of consciousness that occurs over a short period
of time (Morrison-Valfre, 2005).
Delirium is an acute organic mental disorder characterized
by impairment of consciousness, disorientation and
disturbances in perception and restlessness that develop over
a short period of time.This condition is reversible.
Note: Delirium can be life threatening and should be viewed as
an emergency. It is usually caused by an infection, and so the
underlying cause needs to be treated.
7. Other terms used to describe delirium
asareor@yahoo.com 20167
Acute Organic Brain Syndrome
Acute Confusional State
Acute Brain Failure
Toxic Confusional State
Acute Organic Psychosis
Acute Brain Syndrome
8. Incidence
asareor@yahoo.com 20168
Highest among the organic mental disorders
In the general hospitals, about 10% –20% of the medical-
surgical inpatients suffer delirium.
About 30% of the elderly or the geriatric patients suffer this
condition.
It also higher in post-operative patients.
Course and Prognosis
The onset is usually abrupt.The duration of an episode is
usually brief, lasting for about a week.
9. Aetiology/Causes
asareor@yahoo.com 20169
Systemic infections, e.g., pneumonia, puerperal sepsis,
typhoid, septicaemia, peritonitis, etc.
High fever, e.g., high body temperature.
General disturbance in brain metabolism and other
intracranial infections, e.g., frontal lesions of the right
parietal lobe, neurosyphilis, meningitis, cerebral malaria,
encephalitis, etc.
Inadequate oxygenation of the brain or anoxia, e.g.,
congestive cardiac failure, pneumonia, pulmonary failure,
anaemia, etc.
Metabolic disturbance, e.g., uraemia, electrolyte
imbalance, etc.
10. Aetiology/Causes – Cont’d
asareor@yahoo.com 201610
Neurological disorders, e.g., convulsions, seizures, etc.
Head trauma, e.g., injury to the head, etc.
Excessive alcohol use and/or withdrawal symptoms,
e.g., delirium tremens (also known as abstinence delirium).
Drug intoxication and/or withdrawal symptoms,
e.g., atropine, cocaine, bromides, withdrawal from opiates
and barbiturates, etc.
Vitamin deficiency, e.g., pellagra, nicotinamide
deficiency, thiamine deficiency,Wernicke’s encephalopathy,
etc.
Metal poisons, e.g., lead, manganese, mercury, carbon
monoxide, etc.
11. Mnemonic for causes of delirium
asareor@yahoo.com 201611
A useful mnemonic for remembering possible causes of delirium is I
WATCH DEATH
I = Infection
W =Withdrawal (drug)
A =Acute metabolic
T =Traumatic injury
C = CNS lesion
D = Deficiency of vitamins
E = Endocrine
A =Acute vascular
T =Toxins (Including medications)
H = Heavy metals
12. Signs and Symptoms
asareor@yahoo.com 201612
1. Physical symptoms
Headache
Malaise
Perspiration
Oversensitivity to noise
and light
Aches and pains
Pale flush face
2. Disturbance of the sleep
cycle
Insomnia or in severe cases
total sleep loss.
Daytime drowsiness
Worsening of symptoms at
night (nightmares) which
may lead to hallucinations
upon waking up.
Restlessness
14. Signs and Symptoms – Cont’d
asareor@yahoo.com 201614
5. Psychomotor disturbance
Sluggish
Stuporose
Hyper/hypo-activity
Picking at the bed clothes
(flocculation)
6. Cognitive disturbance
Impairment of abstract
thinking and
comprehension
Disturbance in recent
memory
7. Attention impairment
• Very hard to focus and
sustain attention
15. Signs and Symptoms – Cont’d
asareor@yahoo.com 201615
8. Disturbance in perception
Illusions
Hallucinations (mostly
frightening visual images)
9. Disturbance in orientation
Disorientation in all spheres
(i.e., time/day, person/people,
and environment/place or
situation)
Patient disturbed by irrelevant
environment stimuli
10. Disturbance in thinking
Delusion
Incoherent speech
11. Impairment of consciousness
Clouding of consciousness
ranging from drowsiness to
stupor and coma
16. Diagnosis
asareor@yahoo.com 201616
History
Physical Assessment
Short period of onset
Laboratory investigations
State of sensorium, e.g., clouding of
consciousness, disorientation, memory loss, etc.
17. Treatment
asareor@yahoo.com 201617
Treat the underlying cause of infection
immediately, if known.
Administer IV fluids to correct electrolyte
imbalances.
Give oxygen for hypoxia.
Correct thiamine deficiency by giving IV 100 mg
ofVitamin B12.
Serve diazepam, lorazepam, haloperidol, or
chlorpromazine to treat psychotic symptoms.
18. Nursing Management
asareor@yahoo.com 201618
Provide Safe Environment
Restrict environmental stimuli, such as reducing sound
volumes of radio andTV.
Keep unit calm.
Keep surroundings well illuminated or bright.
There should always be the presence of a familiar face by
the patient, reassuring and supporting him or her.
Protect patient from harming self and/or others as s/he
responds to hallucinations, illusions, and delusions.
19. Nursing Management
asareor@yahoo.com 201619
Provide Safe Environment – Cont’d
Give chemical and/or mechanical restraint to deal with
agitation and aggression demonstrated by the client.
Arrange unit/room of patient in such a way to prevent
injuries.
Teach client to request assistance for activities, such as
getting out of bed, going to bathroom.
Promptly respond to client’s call for assistance.
20. Nursing Management
asareor@yahoo.com 201620
Meet the Physical Needs of the Patient
Conduct physical assessment on the patient regularly.
Provide appropriate care by using the needed nursing
measures to reduce high fever, if present.
Maintain intake and output chart.
Take care of hygiene needs, such as grooming, oral and skin
care, etc.
Monitor vital signs and document as appropriate.
Keenly observe the patient for any sign of drowsiness and
sleep, as this may be an indication that he or she is slipping
into coma.
21. Nursing Management
asareor@yahoo.com 201621
Alleviate Patient’s Fear and Anxiety
Remove any object(s) in the room that
seems to be a source of misinterpreted
perception.
Have the same nurse all the time by the
patient’s bed side, if possible.
Keep room well lighted, especially at night.
22. Nursing Management
asareor@yahoo.com 201622
Manage client’s confusion
Speak to client in a calm manner in a clear, low voice;
use simple sentence.
Allow adequate time for client to understand sentences
and respond.
Allow client to make decisions as much as s/he is able.
Provide orienting verbal cues when talking with client.
Use supportive touch, if appropriate.
23. Nursing Management
asareor@yahoo.com 201623
Facilitate Orientation
Constantly repeat and explain to the patient where s/he is,
what date, day, and time it is.
Have a calendar in the room and tell patient what day it is
always.
Have a clock in the room and inform him/her what time it
is, if s/he is not able to do so.
Always introduce self and others to the patient with their
names, if the patient misidentifies them.
When the acute stage is over, take patient out and introduce
him/her to others.
26. Definitions
asareor@yahoo.com 201626
It is a progressive deterioration of brain
functioning occurring after the completion of
brain maturation in adolescence. It is
characterized by deficits in memory, thinking and
behaviour.
This is the medical diagnostic term that describes
an organic mental disorder characterized by a
cluster of cognitive impairment that are generally
of gradual onset and irreversible.
27. Definitions – Cont’d
asareor@yahoo.com 201627
It is a diffused brain dysfunction characterized by a gradual
progressive and chronic deterioration of intellectual
functioning. Judgement, orientation, memory, affect or
emotional stability, cognition and attention are all affected
(Shives, 1994).
Dementia is a permanent loss of the function of the brain. It
has a gradual onset (i.e., week to years), has a progressive
course, with intact consciousness.The intellect, memory, and
the personality of the individual are severely affected. Mostly
it is irreversible.This condition normally affects the
elderly.
28. Other terms used to describe dementia
asareor@yahoo.com 201628
Chronic Brain Syndrome
Chronic Organic Mental Disorder
29. Classification
asareor@yahoo.com 201629
Primary dementias – are those in which the dementia
itself is the major sign of some organic brain disease not
directly related to any other organic illness, e.g.,
Alzheimer’s disease.
Secondary dementias – are caused by or related to
another disease or condition, such as HIV or a cerebral
trauma.
Note: Keep in mind that a person with dementia may also
become delirious.
30. Incidence
asareor@yahoo.com 201630
It is estimated that over 5% of people over age 65 have
severe form of dementia.
12% of the elderly suffer from mild to moderate severe.
Prognosis for this disease is poor.
Characteristics
Memory impairment.
Cognitive defects such as impaired language abilities and
decreased intellectual functioning.
Decline in social and occupational functioning.
31. Types of Dementia
asareor@yahoo.com 201631
According to DSM IV-TR, there are five types of dementia (APA,
2000).These are:
Dementia of theAlzheimer’s type.
Vascular Dementia.
Dementia due to other General Medical Condition.
Substance-Induced Persisting Dementia.
Dementia due to Multiple Aetiologies.
However, these types dementias could be grouped into two main
forms:
a) Senile dementia
b) Presenile dementia
32. Forms
asareor@yahoo.com 201632
Senile Dementia: - the age range for this condition is
usually 60 years and above. It is a progressive deterioration
marked by disturbances of memory. Mental changes may be
profound. Memory may be poor, especially for recent events.
Impaired judgement, imagination, concentration and
attention are commonly present, as well as episodic
excitement, delirium, expression, delusions and
hallucinations. Physical stamina is diminished.Tremor,
physical and mental sluggishness, and rigidity are commonly
seen when the basal ganglia are significantly affected.
Parkinsonian gait and drooling posture may be apparent.
33. Forms – Cont’d
asareor@yahoo.com 201633
In Senile Psychosis, the frontal lobe gradually shrinks
and the space previously occupied by them is filled
up with cerebrospinal fluid, scattered throughout the
brain, there is evidence of cortical damage.The
amount of cerebral atrophy varies from person to
person. In some the wearing process is more rapid
and devastating having been assisted perhaps by
overwork, worries, syphilis, alcohol and other toxic
substances.Additionally, much depends upon
hereditary factors.
34. Forms – Cont’d
asareor@yahoo.com 201634
Presenile Dementia: - the age range for this condition is
about 40–50 years. It is a steadily progressive disease with
symptoms resembling those of senile dementia. It shows
itself insidiously. Lack of concentration, irritability, delusions
of suspicion and persecution with a gradual impairment of
memory occurs. Disorientation, emotional liability and
restlessness are found. Physically, aphasia, apraxia, paralyses,
stereotyped movements may also be present.
Futher reading:
Senile delirium
Senile Paranoid and Depressive States
35. Diagnosis
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History from a reliable family member
Mental status examination
NeurologicTest
PsychometricTesting
Positron EmissionTomography (PET) scan
EEG
CT scan
Autopsy
36. Causes
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Alzheimer’s disease
Huntington’s disease
Pick’s disease
Parkinson’s disease
Creutzfeldt-Jakob disease
Dietary deficiency, e.g.,
Vitamin B deficiency, etc.
Head trauma, e.g., repeated
head injury
Sexually transmitted
infections, e.g., HIV,AIDS,
syphilis, etc.
Intracranial infections, e.g., brain
abscess, meningitis, intracranial
tumours, space occupying lesions, etc.
Alcohol and other toxic substances,
e.g., inhalants, etc
Medications, e.g., sedatives, hypnotics,
anxiolytics, etc.
Neurological disorders, e.g., seizures,
etc.
Physical illnesses, e.g., fever,
dehydration, severe anaemia, etc.
Metabolic disturbance, e.g., electrolyte
imbalance, hypoglycaemia, etc.
Respiratory failure
Degenerative process, such as aging.
37. Clinical features
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Hallucinations – may be visual or auditory.
Delusions – may be in the form that something has been stolen;
after he has forgotten the exact environment he placed an item,
blaming close attendants for stealing it.Another delusion is
jealousy, where he accuses his spouse of having an affair.
Personality changes – lack of interest in day to day activities,
easy mental fatigability, self-centered, withdrawn, decreased self-
care.
Memory impairment – recent and short term memory is
critically affected.
Cognitive impairment – disorientation, poor judgement,
difficulty in abstract thinking and/or calculation, decreased
attention span, confabulation.
38. Clinical features – Cont’d
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Affective impairment – exaggerated mood swings, labile mood,
irritability, depression.
Behavioural impairment – neurotic/psychotic behaviour, changes in
sexual drives and activities, stereotyped behaviour.
Neurological impairment – aphasia, apraxia, agnosia, seizures,
headache.
Sundowner syndrome – drowsiness, confusion, ataxia; accidental falls
may occur at night when external stimuli such as light and interpersonal
orienting cues are diminished.
Catastrophic tendency – agitation, attempt to compensate for defects
by using strategies to avoid demonstrating failures in intellectual activities,
such as changing the subject, cracking jokes or diverting the conversation.
39. Other symptoms include
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Incontinence
Swallowing problems
Difficulty performing tasks that take some thought, but that used
to come easily, such as balancing a checkbook, playing games
(such as “oware”, ludo, bridge, etc), and learning new
information or routines.
Getting lost on familiar routes.
Language problems, such as trouble finding the name of familiar
objects.
Losing interest in things he/she previously enjoyed, flat mood.
Misplacing items.
Personality changes and loss of social skills, which can lead to
inappropriate behaviors.
40. Other symptoms – Cont’d
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Change in sleep patterns, often waking up at night.
Difficulty doing basic tasks, such as preparing meals, choosing proper
clothing, or driving.
Forgetting details about current events.
Forgetting events in his/her own life history, losing awareness of who
he/she is.
Having hallucinations, arguments, striking out, and violent behavior.
Having delusions, depression, agitation.
More difficulty reading or writing.
Poor judgment and loss of ability to recognize danger.
Using the wrong word, not pronouncing words correctly, speaking in
confusing sentences.
Withdrawing from social contact.
41. Patients with severe dementia may
also exhibit the following symptoms
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Difficulty performing basic activities of daily
living, such as eating, dressing, and bathing.
Difficulty recognizing family members.
Can no longer understand language.
42. Behavioural and psychologic symptoms
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Reduced inhibition of inappropriate behaviors (e.g., patients
may undress in public places)
Misinterpretation of visual and auditory cues (e.g., they may
resist treatment, which they perceive as an assault)
Impaired short-term memory (e.g., they repeatedly ask for
things already received)
Reduced ability or inability to express needs (e.g., they
wander because they are lonely, frightened, or looking for
something or someone)
43. Nursing Management
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Provide a Safe Environment
Make sure that lights are bright enough.
Keep matches, lighters, bleach, paints, etc. out of reach of
patient.
Arrange the surroundings to minimize hazards and to prevent
falls.
Supervise patient to take medications. Do not allow him to
take medications alone.
Promptly respond to client’s call for assistance.
44. Nursing Management – Cont’d
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FacilitateAdequate Rest and Sleep
Provide calm and quiet environment for sleep.
Keep patient clean and dry.
Provide regular exercises during the day like sitting in a chair,
walking, or other activities client can manage to improve
sleep.
Monitor sleep and elimination patterns.
Discourage day time napping to help sleep at night.
45. Nursing Management – Cont’d
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Establish Good Interpersonal relationship
Give clear, simple verbal instructions.Verbal communications
should not be hurried.
Ask questions that require‘Yes’ or‘No’ answers.These are
the best for the patient.
Always introduce self and others with names.
Address patient appropriately by his name and/or title.
46. Nursing Management – Cont’d
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FacilitateAdequate Hygiene Needs
Compliment and/or praise the patient when he looks good.
Encourage and help in cleaning teeth and bathing.
Attend to his grooming needs.
Check finger and toe nails regularly; cut them if they are
overgrown.
Remove the lock, if patient have problems with the lock on the
bathroom door.
Remind the patient to attend to nature’s call at regular intervals,
just leave the toilet door open, and leave a light at night to find the
way.
Assist patient with other activities of daily living.
47. Nursing Management – Cont’d
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MaintainAdequate Food and Fluid Intake
Serve well balanced diet with plenty of fibre, such as
vegetables, whole wheat, fruits, to prevent constipation.
Allow plenty of time for meals.
Inform patient which meal it is, and what is there to eat.
Do not serve food too hot or too cold.
If patient is on fluids, maintain adequate fluid balance chart.
Provide prompt assistance to eat and drink adequate amounts
of foods and drink.
48. Nursing Management – Cont’d
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Facilitate the Development of Socially Acceptable Behaviour
Decrease socially inappropriate behaviour by reinforcing
socially acceptable skills.
Avoid overcorrection.
Repeat necessary information.
Focus on the positive behaviours of the patient, rather than
dwelling on the mistakes and/or failures.
Give appropriate reward for positive behaviours shown by
patient.
Ignore unacceptable behaviour.
49. Nursing Management – Cont’d
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Facilitate Orientation
Orient patient to reality in order to decrease confusion.
Orient patient to time, place, and person, especially when
approaching.
Provide clock with large faces to aid in orientation to time.
Use calendar with large writings and a separate page for each
day.
Provide newspapers, magazines, and journals to stimulate
interest in current affairs.
50. Nursing Management – Cont’d
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Increase interest in surroundings
Allow patient to chat and play with old friends, to relive the
past.
Make sure that each day has activities of interest, if possible,
for the demented patient.
Go for a walk together, listening to music, watching an
entertainment program onTV, and/or talk about the
activities of the day.
51. Nursing Management – Cont’d
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Involve Family and the Community in theTreatment and
Rehabilitation Programs
Instruct patient to always carry an identity card with him, in
case he is lost and could not find his way back after roaming
about.
Offer emotional support to the patient and family.
Educate family on the disease process and how to deal with
the patient.
Refer family to agencies and support groups for people living
with dementia for legal and financial advice, and support,
where necessary.
52. Nursing Management – Cont’d
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Administer Prescribed Medications
Serve medications according to time and dosage to deal with
hallucinations and inappropriate outburst of the patient.
Antipsychotics, e.g., Olanzapine
Vitamins supplements
Zolpidem, for insomnia.
Antidepressants, for depression.
Tacrine, for memory deficits.
Enkephalins, to slow the disease process.
53. Other treatment approaches
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Avoiding antacids,
Avoiding the use of aluminum cooking utensils, and
Avoid aluminum-containing deodorants
NB:These help to decrease aluminum intake.
54. Differentiating Delirium from Dementia
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CHARACTERISTICS DELIRIUM DEMENTIA
Onset Acute/Abrupt/Rapid Insidious/Slow
Course Fluctuates Slow decline
Reversibility Reversible Irreversible
Attention Impaired Intact early; often impaired late
Memory Impaired (registration, recent, and
remote)
Impaired (recent and remote)
Consciousness Impaired, can fluctuate rapidly Normal until later stages
Sleep-wake cycle Disrupted Usually normal
55. Differentiating Delirium from Dementia
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CHARACTERISTICS DELIRIUM DEMENTIA
Duration Hours to weeks Months to years
Alertness Impaired Normal
Orientation Impaired Intact early; impaired late
Behaviour Agitated, withdrawn or depressed: or
combination
Intact early
Speech Incoherent, rapid/slowed Coherent; word-finding
problems
Thoughts/Thinking Disorganized, delusions Impoverished
Perceptions Hallucinations/illusions Usually intact early
Aetiology Usually immediate cause identified or
known
Usually no immediate cause