More Related Content
What's hot
What's hot (20)
Similar to V. Wright Adult i dementia delirium 14 with narative
Similar to V. Wright Adult i dementia delirium 14 with narative (20)
Recently uploaded
Recently uploaded (20)
V. Wright Adult i dementia delirium 14 with narative
- 1. BROAD CONCEPT COGNITIVE IMPAIRMENT DISORDERS: DELIRIUM AND DEMENTIA
- 2. PATHO/DELIRIUM • Cognitive Impairment • If treat early enough is reversible • Characterized by clouding of the consciousness, inability to focus & maintain attention, & altered perception
- 3. DELIRUM • Occurs in 10-40% of hospitalized clients, 30-40% of hospitalized client with AIDS, & up to 60% of nursing home residents who are 75 years old & older. • 80% of hospitalized clients near death will develop delirium. • Occurs suddenly.
- 4. SYSTEM SPECIFIC ASSESSMENT • CNS(central nervous system) affected by many conditions e.g. anemia, ischemia, hypoglycemia, lack of Vitamin B, endocrine disorders, toxicity from alcohol or drugs, trauma, infections, etc. • Physical restraints may contribute
- 5. SYSTEM SPECIFIC ASSESSMENT • Behavior: poor impulse control, may be withdrawn or agitated • Speech: dull or rapid & pressured • Picking at clothing and/or the air • Bizarre behavior at night/Sundowner’s
- 7. SYSTEM SPECIFIC ASSESSMENT • • • • Affect: Range from apathy to irritability Labile emotions Laughing or sad
- 8. SYSTEM SPECIFIC ASSESSMENT • Cognition: disorganized thinking (rambling speech) & ↓ ability to maintain & shift attention • Visual hallucinations /altered perception are common • Thinking, memory, attention and perception are disturbed
- 9. SYSTEM SPECIFIC ASSESSMENT • Interpersonal Relationships: Families are anxious & frightened • Physical: Sleep disturbance and tremors. • Safety: Keep the client safe!
- 10. INTERVENTIONS • Eliminate cause of delirium • Monitor LOC continually • Reorient with each interaction – introduce self and call client by their name • Use short, simple, concrete phrases • Keep the room well lit • Provide clocks and calendars • Have client use assistive devices (hearing aids/glasses • Clarify reality while justifying emotions/feelings
- 11. EVALUATE PHARMOCOLGY PHARMOCOLG • Depends on cause of delirium – Treat underlying cause first • Haloperidol (Haldol) 1-2mg IV over 1-3 min may control symptoms. May be given with lorazepam (Ativan) IM
- 12. EVALUATE PHARMACOLOGY • If EPS develops, give diphenhydramine (Benadryl) 25-50mg
- 13. DEMENTIA • Alzheimer disease (AD) is behind 60-70% of late-onset dementias. Affects 4.8 million Americans • $200 billion in U.S. spent yearly • Affect 50% of persons over age 85 • Women more than men • 15-20% are inherited • Course is 5-10 years
- 14. CULTURE • Cultural Influences: • In U.S ↑ risk for AD in Latin Americans & African Americans • Japanese, Italians, & those from Hong Kong have a greater risk in Europe & Asia • ↑ lower educational and socioeconomic levels • ↑clients with previous head injuries • ↑ clients with relatives that have AD
- 15. ETIOLOGIES • Video: www.nia.nih.gov/alzheimers/ADvideo • Genetics – cause is unknown, focusing on beta-amyloid protein that accumulates into plaques • Early onset (30 to 60 y/o) is rare (5%) and is related directly to the Alzheimer’s gene
- 16. ETIOLOGIES • 1-Neurofibrillary tangles (twisted fibrils inside the neuron that disrupt cellular processes and eventually kill the cell) • 2-Plaques (it is the quantity of plaques in relation to the person’s age that is significant) (a) widened sulci and narrowed gyri
- 19. AD • AD affects: – Communication, metabolism, and repair process of neurons in the brain • Which causes: – Memory failure – Personality changes – Difficulty carrying out ADLs • There is a progressive decline
- 20. AD • • • • • 4 stages Mild – lasts 2-4 years Moderate – longest stage, day care may be necessary Moderate to Severe AD – lasts 1-2 years, 24/7 care needed Late/End stage
- 21. Stage 1 (Mild AD) • Mild – lasts 2-4 years: • characterized by – Short-term memory loss – Uses memory aids such as lists and routine – Aware of the problem – Depression is common – NOT diagnosable at this stage
- 22. Stage 2 (Moderate AD) • Stage 2 Moderate AD is characterized by: – Progressive memory loss – Withdrawn from social activities – Decline in instrumental ADLs (money management, cooking, driving) – DENIAL – fears “losing” his/her mind – Depression – Confabulation – Symptoms worsen with physical/emotional stress
- 23. Stage 3 (Moderate/Severe AD) • Stage 3 Moderate to Severe AD is characterized by: – ADL losses: willingness to bathe, grooming, choosing clothing, toileting, communication, reading/writing – Loss of reasoning ability – Depression resolves as they become unaware of loss – Difficulty communicating – Usually institutionalized or need care 24/7
- 24. Stage 4 (Late / End stage) • Stage 4, late / end stage AD is characterized by: – Family recognition/self recognition disappears – Non-ambulatory – Forgets how to eat, swallow, chew, wt loss – Incontinent – 24/7 care required – Return to infantile reflexes and ultimately Death • Death usually secondary to infection or choking
- 25. 7 WARNING SIGNS of AD • Asking the same questions over & over • Repeating the same story, word for word, again & again • Forgetting how to cook, or how to make repairs, or how to play cards – activities that were previously done with ease • Losing one’s ability to pay bills or balance one’s checkbook
- 26. 7 WARNING SIGNS of AD • Getting lost in familiar surroundings • Neglect to bathe, or wearing the same clothes over & over while insisting they are clean & are wearing dirty clothes • Relying on someone else close to them to make decisions or answer questions that they used to handle
- 27. OTHER DISORDERS • • • • • • • Pseudodementias - mimic dementia Causes: Drug toxicity Infections Metabolic disorders Nutritional deficiencies Depression- most common cause
- 28. EVALUATE PHARMOCOLOGY • DONAZEPIL (Aricept) 5mg P.O. daily @ bedtime. After 4-6 weeks↑ to 10mg • Classification: cholinesterase inhibitor • Action: improves cholinergic function by inhibiting acetylcholinesterase • Improves cognitive function • *Missed doses should be skipped and regular schedule returned to the following day.
- 29. EVALUATE PHARMACOLOGY • Rivastigmine (Exelon) 1.5 mg. twice a day with food, may ↑ by 1.5 mg. twice a day every 2 weeks if tolerated. Target dose 3 – 6 mg. twice a day. Max. dose 12 mg twice a day • Classification: Cholinesterase Inhibitor • Action: Treats mild to moderate AD
- 30. EVALUATE PHARMACOLOGY • Galntamine (Reminyl) 4 mg. twice a day for at least 4 weeks, if tolerated may ↑ by 4 mg. twice a day every 4 weeks. Target dose 12 mg twice a day. • Classification: Cholinesterase inhibitor • Action: treat mild to moderate dementia
- 31. EVALUATE PHARMACOLOGY SE: HA, diarrhea, nausea, sweating, bradycardia, & insomnia NSG: Taking after breakfast may lessen side effects, teach how family how to monitor pulse *Do not cure – only slows down the disease
- 32. EVALUATE PHARMACOLOGY • memantine HCL (NAMENDA) • Used in moderate to severe Alzheimer’s or with an acetylcholinesterase – less GI disturbance • Side effects: dizziness, HA, confusion and constipation
- 33. MULTIDISCIPLINARY INTERVENTIONS • • • • • • Speech therapy Physical therapy Occupational therapy Social workers Pastoral counselors New hope is gene therapy – new nerve growth
- 34. ALTERNATIVE THERAPIES • Antioxidants – found in green tea, grape seed extract, deepest color fruits & veggies • Omega-3 Fish Oil – found in salmon, mackerel, sardines • Phosphatidyl Serine – keeps nerve cells flexible • Melatonin – for sleep • Estrogen – may be preventative in women (not useful in existing dementia)
- 35. ALTERNATIVE THERAPIES • Dehydroepiandrosterone (DHEA) – regulates mood • S_adenosylmethionine (SAMe) – improves cell membrane flexibility, caution in people with cardiac history • Lecithin – found in soybeans & eggs • Ginkgo Biloba –increase risk for bleeding
- 36. ALTERNATIVE THERAPIES • Music – What type of music would be appropriate? • Touch – How should a client with dementia touched? What approach should the nurse take? • Animal-Assisted – Assess for fears first, if possible
- 37. SYSTEM SPECIFIC ASSESSMENT • Behavior: Wandering, unable to do complex tasks, frightened by their confusion, attempt to cover up symptoms, need assistance dressing • ↑ appetite & food intake – no ↑ in weight • Repetitive behaviors – lip smacking, pacing • Sundown Syndrome – disoriented at days’ end. Orientated in day.
- 39. SYSTEM SPECIFIC ASSESSMENT • Affect: • Mild stage: anxiety & depression occur • Moderate stage: ↑ lability of emotions (rage, irritability) • Severe stage: person becomes unresponsive to environment
- 40. SYSTEM SPECIFIC ASSESSMENT • Cognition: ↓ in concentration, ↑ distractibility, absent-mindedness, unable to make judgments • Language skills begin to deteriorate • Difficulty word-finding • In mod AD – memory loss (recent & remote) • Confabulation: filling in gaps with imaginary information
- 41. SYSTEM SPECIFIC ASSESSMENT - COGNITION • Misidentification syndrome – familiar people are unfamiliar • Aphasia – unable to understand language • Agraphia – unable to read or write • Agnosia – unable to recognize familiar people or situations • Alexia – unable to tell what to do with a frying pan, toothbrush, telephone
- 42. SYSTEM SPECIFIC ASSESSMENT • Perception: visual hallucinations most common – What would our intervention be?
- 43. HIGHER NEEDS • Can you think of some problems with clients & AD as they try to fulfill their higher needs? Which ones would be affected? – What would some interventions be to help address these higher needs?
- 44. NURSING CARE • Safety is first priority for delirium & dementia – What are some interventions we can do address the safety issues for clients with delirium and dementia? • Find local resources such as _________
- 45. NURSING CARE • What are some interventions that you can think of for someone suffering from AD? • How would you assist families?
- 46. Diagnostic Tools • • • • • No definitive test PET MRI SCT and PET MSE