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jtruett
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Conditions that cause major decline in cognitive functioning
- Dementia
- Metabolic disorders
- Stress
- Alcohol Abuse
- Medication Effects
- Vision/Hearing Impairments
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Conditions associated with confusion
- Vascular insufficiency
- Trauma
- Tumors
- CNS infections
- Hypotension
- Systemic disorders
- Pulmonary/Cardiovascular disease
- Metabolic disorders
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Benign senescent forgetfulness or age related memory impairment
- Age related mental impairment
- Modest decline in short term memory
- Slight, gradual decline in cognitive skills
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Mental changes not caused by normal aging
- Confusion
- Disorientation
- Inappropriate behavior
- Depression
- Inability to follow directions
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Conditions associated with Confusion
- Electrolyte Imbalance
- Anemia
- Altered renal function
- Drug Toxicity
- Endocrine disorders
- Nutritional deficiencies
- Stress
- Pain
- Anesthesia
- Altered body temp
- Dehydration
- Anxiety
- Depression/Grief
- Fatigue
- Sensory deprivation/overload
- New environment
- Toxic substance
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How to assess cognitive changes in the elderly
- Mental status questionnaire (MSQ)
- Observe and ask question them and significant others about events before admission
- Assess factors (medication effects, new environment, disease processes
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Acute confused state that can occur suddenly or over a long period
If left untreated can lead to coma or death
Delirium
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A result of an underlying biologic cause or psychological stressor
Delirium
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Appearance or increase of symptoms of confusion or agitation in late afternoon or early evening hours and continues into the night
Nocturnal Delirium (Sundown Syndrome)
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What steps would be taken to assess cognitive changes in the elderly
- Older adult with significant changes in mental function should be given an mental status exam
- A detailed and accurate medical history and physical should be performed (allow enough time to respond, compensate for sensory limits)
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Difficulty remembering, learning, following directions, and communicating needs
Confusion
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Can significantly influence a patient's dignity, independence, personality and support system
confusion
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May complicate diagnosis and treatment of a patient's illness
confusion
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A slow, insidious onset that affects memory, intellectual functioning, and the ability to problem solve.
A permanent condition
Characterized by several cognitive deficits
Dementia
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This is primarily seen in Alzheimer's disease
Can occur with brain tumors or serious medical/surgical disorders
Dementia
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Psychosocial Approaches
- Validation Therapy
- Remotivation Therapy
- Reality Orientation
- Reminiscence
- Resocialization Therapy
- Pharmacotherapy
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This intervention primary goal is to produce a feeling of well being in the confused and disoriented elderly
Psychosocial
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Therapy that tries to decrease stress and promote self esteem and communication
Uses group support
Activities include: singing favorite songs, reminiscing, sharing memories, and family photos
Validation
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Therapy that stimulates senses and provides new motivation through facts rather than feelings
Includes things such as: pics, plants, animals, sounds.
Art or Music
Remotivation
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This therapy uses time, place, and person
Done on a consistent basis (consistent interaction with staff and family, meals served at same time every day)
Encourages use of clocks, media, newspapers, calendars, TV)
Reality
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This therapy reexamines the past life experiences to promote socialization, and mental stimulation
reminiscence
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This therapy encourages socializing within a group
Group projects, group games
Serving each other refreshments
Resocialization
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This therapy uses major tranquilizers, minor tranquilizers and antidepressants
Pharmacotherapy
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Name major tranquilizers
What they do
- chlorpromazine (thorazine)
- haloperidol (Haldol)
- Manages anxiety, agitation, hostility, paranoia
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Uses of minor tranquilizers
Manage symptoms of anxiety and agitation
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ymbaltName the Antidepressants
And their uses
Citalopram (Celexa), duloxetine (Cymbalta)
- Used if depression coexists with dementia
- Improve appetite and sleep, increase energy level, enhance socialization
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Most common form of dementia (70%)
4th leading cause of death in elderly
Alzheimers
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This disease results from a loss of neurons in the frontal and temporal lobes
Cannot process and integrate new information or retrieve memory
Alzheimers
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Late Stages of Alzheimers
- Severe memory impairment
- Impaired mobility
- Speech deteriorates
- Bedridden
- Weight Loss
- Difficulty Swallowing
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How can the nurse give family support for those with Alzheimers
- By integrating the family in the care plan
- Encourage them to use adult day care or respite care if elderly live at home.
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Early Stage of Alzheimer
- Mild short-term memory problems
- Difficulty learning new things
- Mild depression
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Middle stage Alzheimer
- Increased short and long term memory loss
- Suspicion
- Agitation
- Hallucinations
- ADLs affected
- Wanders
- Incontinent
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Nursing interventions of Alzheimer depends on
The stage of the illness
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Treatment for Alzheimer's is primarily
Symptomatic
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These medications work by increasing acetylcholine in the cerebral cortex
Cholinesterase Inhibitor drugs
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Name the Cholinesterase Inhibitor drugs
- Donepezil (Aricept)
- Galantamine (Reminyl)
- Rivastigmine (Execlon)
- Tacrine (Cognex)
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Name some other drugs that are useful in Alzheimer's
- Indomethacin (Indocin)
- Estrogen
- Vit E
- Folic Acid
- Cholesterol lowering drugs (possibly)
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Behaviors associated with cognitive disorders
- Agitation/hostility/paranoia
- Wandering
- Eating problems
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Signs of agitation/hostility/paranoia
- Irritability usually follows
- Sudden explosive outbursts
- Loud talking or pacing
- Self protective response to confusion, fear, sensory loss
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Interventions for Agitation
- Engage in conversation
- Maintain safe distance but keep eye contact
- Move patients or visitors out of immediate area
- Behavior modification
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This behavior usually affects those with Alzheimer's that were very active before the onset
May be a need to combat boredom
Wandering
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Nursing interventions for Wandering
- Ensure safe environment
- Inform others
- ID bracelet for patient
- Check on patient frequently
- Observe behavior that triggers wandering
- Divert patient attention
- Regular activity program
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Common feeding challenges for Alzheimer patients
- Lack of appetite
- Refusal to open mouth'
- Holding food in mouth
- Refusal to swallow
- Choking
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If patient lives at home, name some ways to keep them safe
- Alarms on outside doors
- ID sewn in clothes
- Alarms to know if leaves bedroom at night
- No driving
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Ways to decrease nocturnal confusion
- night lights
- call bell within reach
- reduce stimulation in environment
- move patient closer to nurse station
Do not use restraints unless it is last resort
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