Delirium, Dementias, and Related Disorders

Delirium, Dementias, and Related Disorders

Key Concepts
* Cognition
o System of interrelated abilities, such as perception, reasoning, judgment, intuition and memory
o Allows one to be aware of oneself
* Memory
o Facet of cognition, retaining and recalling past experiences
* Delirium
o Acute cognitive impairment caused by medical condition
* Dementia
o Chronic, cognitive impairment
o Differentiated by cause, not symptoms

Delirium Clinical Course
* Disturbance in consciousness and a change in cognition
* Develops over a short period of time
* Usually reversible if underlying cause identified
* Serious, should be treated as an emergency

Delirium Diagnostic Criteria
* Impairment in consciousness - key diagnostic criteria
* Children - can be related to medications or fever
* Elderly - most common in this group, often mistaken as dementia

Delirium Epidemiology & Risk Factors
* Prevalence rates from 10-30% of patients
* In nursing homes, prevalence reaching 60% of those older than the age of 75 years
* Occurs in 30% of hospitalized cancer patients
* 30-40% of those hospitalized with AIDS
* Higher for women than men
* Common in elderly, post-surgical patients

Delirium Etiology
Variety of brain alterations
o Imbalance of neurotransmitter
o Raised plasma cortisol level
o Involvement of white matter
Types

* Due to General Medical Condition
* Substance-Induced
* Substance-Intoxication
* Substance-Withdrawal
* Multiple Etiologies

Medications
Physiological
* Fluid/kidney
o Dehydration, Hypocalcemia, Hypokalemia, Abnormal sodium, Low serum albumin, Elevated BUN, Elevated creatinine, Azotemia, Proteinuria, CRD
* Cardiac/Respiratory
o Hypotension, CVD, CHF, AA, Elevated PT, Low hematocrit, Respiratory insufficiency, Noncardiac thoracic surgery
LABS

* BUN
* Creatinine Clearance
* Serum Albumin
* Hyponatremia
* Hypocalcemia
* Hypokalemia
* Elevated PT

Physiological
* Metabolism/Temperature
* Age, gender

PhysiologicalInfection and Trauma
o Symptomatic infection
o Urinary tract infection
o Respiratory infection
o Elevated WBC
o Emergency Admission
o Fracture
o Falls
o Orthopedic surgery
o Combination illnesses
Physiological
* More than 4 medications
* Drugs with anticholinergic or CNS effects
* Hypoxia/Ischemia
Interdisciplinary Treatment & Priorities
Nursing Management Biologic Domain Assessment
Nursing Management Pharmacologic Assessment
Delirium: Biologic Domain Nursing Diagnosis
Delirium Biologic Nursing Interventions
Delirium Psychological Domain Assessment
Delirium: Psychologic Domain Nursing Diagnosis
Delirium Psychological Nursing Interventions
Delirium Social Domain Assessment
Delirium: Social Domain Nursing Diagnosis
Delirium Social Nursing Interventions
Evaluation Delirium Dementia
Dementia Alzheimer’s Type
Personality changes
Language difficulties
Dementia/Alzheimers Progression
Diagnosis of AD
Epidemiology
Risk Factors
Etiology
Interdisciplinary Treatment
Priority Care Issues
Family Response to AD
Nursing Management Biologic Domain Assessment
Dementia: Biologic Domain Nursing Diagnosis
Dementia Biologic Nursing Interventions
Pharmacologic Interventions
Dementia Psychological Domain Assessment
Dementia: Psychological Domain Nursing Diagnosis
Dementia Psychological Nursing Interventions
Dementia Psychological Nursing Interventions
Dementia Psychological Nursing Interventions
Dementia Social Domain Assessment & Nursing Diagnosis
Dementia Social Nursing Interventions
Family Interventions
Other Dementias
Amnestic Disorder

Delirium, Dementias, and Related Disorders.ppt