Gerontological nursing chapter 33

Gerontological nursingchapter 33

Delirium • Disruption in brain function due to medication side effects, circulatory disturbance, dehydration, low or high blood pressure, low or high thyroid activity, low or high blood glucose, surgery or stress. • Onset is rapid with a change noted within a day or days. • Short- term memory is impaired more than long-term.

Delirium • Level of consciousness may be changed, pt. may act very dull or agitated. • Behavior can be hyperactive, less active than normal or may fluctuate between the two. • Disease can be reversed and normal mental status restored if treated promptly.

Delirium • Significant perceptual changes can occur, such as visual hallucinations and illusions. • The patient may be suspicious and have personality changes. • Delirium alters level of consciousness, whereas dementia does not.

Delirium

Nurses Role • Nurse can play a significant role by detecting signs of confusion promptly. (Know your patient!) • A thorough history and assessment of mental status on initial contact can provide a good baseline status. • Any change in behavior or cognitive pattern warrants an evaluation.

Treatment • Depends on the cause, e.g. correcting dehydration, or stabilizing blood sugar. • Treating symptoms rather than the cause can result in a worsening mental status or physical condition that could be life threatening. • Older adults have multiple health conditions, it is important to remember that several coexisting factors can be responsible for delirium.

Treatment (cont’d) • The primary goals during initial acute stage is establishing stability and minimizing stimulation. • Consistency in care is important, limit the number of people caring for the patient. • Control environmental temperature, noise, and traffic flow. • Place patient in a quiet area and minimize bright lights.

Caring for a patient with Delirium • The nurse must ensure that the patient does not harm himself or herself or others. • It is important to speak to the patient and offer explanations of activities and procedures. • Families may need support and realistic explanations to alleviate anxiety. E.g. his confusion occurred because the level of glucose in his blood dropped too low, he will be better as soon as the level is brought back to normal.

Dementia • Dementia is an irreversible, progressive impairment in cognitive function affecting memory, orientation, judgment, reasoning, attention, language, and problem solving. • It is caused by damage or injury to the brain. • An estimated 4.5 million older adults suffer some form of dementia.

Alzheimer’s Disease • 4% to 5% of older adults are victims of Alzheimer’s disease. • It is the most common form of dementia. • Likelihood of developing the disease doubles every 5 years after the age of 65.

Alzheimer’s Disease • Two changes take place in the brain: • 1. Presence of neuritic plaques. • 2. Microtubules in the brain disintegrate and collapse the neuron’s transport system.

Possible Causes • Environmental factors • Genetics • Chromosomal abnormalities • Higher than normal levels of aluminum and mercury have been found in brain cells of Alzheimer’s patients.

Symptoms • Symptoms develop gradually and progress at different rates. • Early in the disease the patient may be aware of changes in intellectual ability and become depressed, anxious, or attempt to compensate by writing down information, structuring routines, and simplifying responsibilities. • It may take some time for the symptoms to be detected, even by those close to the patient.

Key Concept The greatest risk for suicide for a patient with Dementia is in the early stage of the disease when the individual is aware of the changes experienced.

Diagnosis • Obtain a thorough history from patient and family members or significant others. • Brain Scans-reveal changes in the brains structure that are consistent with the disease. • Neuropsychological testing that evaluates cognitive functioning.

Treatment • No treatment to prevent or cure Alzheimer’s disease. • Clinical trials are being conducted by the National Institutes of Health in hopes of finding a means to improve function and slow progress of the disease. • Interest in estrogen to enhance cognitive function. • Medications that stop or slow the breakdown of acetycholine such as Aricept, Exelon, and Reminyl. (Acetylcholine falls sharply in people with Alzheimer’s disease.)

Caring for person’s with dementia Ensuring patient safety: • A safe structured environment is essential. • Persons and components of the environment should be consistent. • Items to trigger memory are useful to include, such as photographs of the patient or a consistent symbol (e.g. flower or triangle) on the bedroom door or personal possessions. • Noise, activity, and lighting levels can overstimulatethe patient and further decrease function.

Caring for patient’s with dementia • Cleaning solutions, pesticides, medications should be stored in locked cabinets. • Matches and lighters should not be accessible. • Windows and doors can be protected with Plexiglas and non-removable screens to prevent falls. • Protective gates and alarms to protect the patient from wandering. • Have patient wear an ID bracelet at all times and have a recent photo available.

Sundowner Syndrome • Individuals with cognitive impairments may experience a nocturnal confusion. • Named for it’s presentation “after the sun goes down.” • Factors that increase the risk of sundowner’s: unfamiliar environment, disturbed sleep patterns, unfamiliar staff. • Nurses can prevent and manage sundowner syndrome by, using touch to provide human contact and calm the patient, keeping a nightlight on, controlling noise and traffic control, placing familiar objects in the patient’s room.

Key Concept • Other diseases can mimic Alzheimer’s disease; therefore, a comprehensive evaluation is essential to rule out other possible causes of dementia before the diagnosis of Alzheimer’s is made.

Therapy and Activity • Occupational Therapy and expressive therapy can benefit those with early dementia. • Reality orientation, daily groups, and reminding the patient who he or she is. • Stimulation through touching activities and listening to music.

Providing Physical Care • The nurse needs to get to know the patient and do a thorough assessment of the patient. • Patients may not complain or may not be able to verbalize their feelings. • Patients need close observation for s/s of pain, dehydration, or hunger. • Look for facial grimace, or repeated touching of a body part.

Alternative Therapies • Variety of alternative medical therapies are being used to treat dementia. • Nutritional supplements that are used include vitamins B6,B12, C & E, folic acid, zinc & selenium. • The herb ginkobiloba has been shown to improve circulation and mental function in several clinical trials. (Caution is needed, ginko can increase the risk of intraocular hemorrhage.)

Respecting the Individual • As patients regress, their dignity, personal worth, freedom, and individuality may be .jeopardized. • Loved ones may view the demented family member as a stranger living in the body that once housed the person they knew. • They are viewed less and less as a normal human being and may be treated in a dehumanizing manner

Respecting the individual • Special Attention must be paid to maintain and promote the following qualities: • Individuality • Independence • Freedom • Dignity • Connection

Supporting the Family • Assistance and support to the families of patients are integral parts of nursing care for patients with dementia. • The physical, emotional, and socioeconomic burden of caring for a cognitively impaired relative can be immense. • It should not be assumed that family members understand basic care techniques.

Supporting the Family • Nurse needs to review basic, specific care techniques, including lifting, bathing, and managing inappropriate behaviors. • Nurse can help prepare families for the guilt, frustration, anger, depression, and other feelings that may accompany the responsibility. • Refer families to support groups, Alzheimer’s Association.

Key Concept • It cannot be assumed that family members understand feeding, bathing, lifting, and other basic caregiving skills.

Gerontological nursing chapter 33