delirium AND
because delirium is a _____ condition, we must first do what to rule out assumed permanent decline?
reversable, rule out the underlying cause first.
a patient has come into the ED claiming they just started seeing spiders crawling all over their body and their breath reeks of liquor. The EMT says they were pulled from walking down the middle of the road saying they cant don't know how they got there.
what is this patient most likely dealing with and what would we do for them?
delirium
Identify the underlying cause, stay with the client, maintain a low level of stimuli , maybe a low dose antipsychotic like haloperidol or even a benzo for a day or two to treat withdrawal
secondary NCD disorders
TBI -accident
vascular disease - stroke
Parkinson's - 75% develop NCD
substance/medication- drugs
HIV infection - fungal infections
Prion like mad cow
other medical conditions
THESE ALL HAVE MODIFIABLE RISK FACTORS THE NURSE CAN TEACH ABOUT!
acute reversable causes must be ______ before a NCD can be diagnosed
ruled out
when the client fills memory gaps like stating they had lunch with someone who dies years ago. they did in fact have someone come over but they did not have lunch and it was not said person. what is this called in Alzheimer's
confabulation
this is NOT a normal part of aging and worsening symptoms need further evaluation. this condition ____be reversed.
dementia , can not
Olive started out he morning in good spirits but now she is agitated and its only noon, her daughter is unsure as to what has triggered her agitation. later on around 1500 her daughter can not seem to calm her agitation and Olive is unbothered that she keeps coming out of the rest room with out her cloths on talking about how her pastor paid her a visit earlier this week when in reality It was her daughter.
DELIRIUM, NCD, OR PSEUDODEMENTIA ?what clues?
NCD
agitation as the day progressed, unbothered about being unclothed, confabulation
I 75 yr old male presents to the nurse confused and unable to complete a sentence. upon looking in the clients medical history you notice that the client has a HX of HTN, high cholesterol, syncope, diabetes mellites, and had a stoke 3 years ago. what do you think it is and what is the priority test we should preform to rule it out.
delirium
glucose test to rule our acute BS problems.
check pulse ox and apply O2 if too low
what is the difference between mild NCD and Major NCD?
what impairments will you see in both mild and Major?
mild>no interference with independence, can work, shop, cook, slightly forgetful, and early intervention can begin.
major>this is when dementia will show up, significant cognitive decline, independence will be affected, might not be able to drive or work, this is the progressive decline.
both>cant think abstractly. " like don't cry over spilled milk", judgement ( wouldn't want them babysitting), impulse control, personality changes, movement, speach
the client with Alzheimer's decreased as the day goes down. what is this called ?
sundowners
and the client generally seems unconcerned and concentration is impaired
a woman complains of not being able to remember where she has set her car keys down, where she parks her car when going to church, and has several late notice bills sitting on the counter top. the nurse asks when she started to notice these symptoms. IT takes the client a moment to answer but she puts her hand to her forehead and says "I don't know!" 3 times. " It is hard for me to remember anything after my husband passed 3 weeks ago." what kind of neurocognitive disorder is this client dealing with and what are the clues that helped you decide that?
pseudodementia
symptoms follow an event, rapid onset, most likely depression due to the loss of a loved one. saying I don't know repeatedly
before labeling new confusion or dementia the nurse must also get information from _________ so help establish a base line for the client
secondary source ( collateral information)
family or others who are familiar with the client
What are things that can happen on a nursing shift that would cause a patient to develop delirium?
ICU stays, restraints, medications, uncontrolled pain, UTI, Infection, Hypoxia
impaired judgment and impulse control are safety hazards for a client with NCD....what should we do for these patients
lock up meds, chemicals, firearms, and car keys, and disable or supervise the stove before client goes home.
what are the 5 stages of Alzheimer
1. no apparent symptoms
2. subtle memory loss
3.confabulation
4. sundowners
5. imminent death
most common mental illness in elderly, we use antidepressants and anxiolytics as treatment. can you name some medications we would use and the major concern we would have?
pseudodementia
depression> SSRI (sertraline, paroxetine),TRICYCLICS(nortriptyline)
USE WITH CAUTION IN ELDERLY, HYPONATREMIA AND SERITONIN SYNDROME
anxiety> BENZODIAZEPINE (lorazepam: acute) NONBENZO( buspirone: chronic)
USE BENZOS WITH CAUTION, MAY CAUSE DEPENDENCE AND/OR OVER SEDATION.
why would a neurocognitive assessment need to be preformed
because focal changes suggest stroke or head trauma as the cognitive change
what is the difference in illusions and hallucinations
illusions is a misinterpretation of what is actually there
hallucinations are seeing things that are actually not there
Alzheimer's disease involves ______ and _____. this is the _____ _______ NCD and is ____ a normal part of the aging process.
amyloid plaque and tau tangles
most common
NOT
at 1700 an 84 yr old client paces the hallway, tugs at the exit door, and says she MUST get home to feed the children. what should the nurse do?
turn on the lights, walk with her, offer warm drink and a familiar photo instead of correcting her
what are diagnostic labs we would expect to see ordered when dealing with a potential neurocognitive disorder.
RPR and HIV
LFT THYROID GLUCOSE ELECTROLYTE B12 DRUG AND ACLCOHOL SCREENING CT PET MRI
what are primary NCD
Alzheimer's
frontotemporal neurocognitive disorder
Lewy body dementia
Huntington's disease
a nurse checks on her patient at the start of her shift at 0700 and the patient is calm, lethargic, and has a sad expression on her face, at 1100 the patient is trying to untangle her self from the "snakes" around her head and is franticly waving her arms....at 1430 the nurse observes the client laughing at the TV but the TV is off, at 1900, before the nurse leaves, the nurse charts "pt. resting, A&OX4, but is complaining of fealing restless even though she has "done nothin all day", having a hard time focusing and maintaining attention when giving education on ways to help her feel relaxed"
what is her nursing diagnosis?
delirium
what are some increased risks to getting alzheimers
TBI, Downs syndrome, older age
a confused patient is found in the stair well trying to fine their room by a nurse, what is this called
elopement....when patient leaves care without staff awareness