Delirium And Dementia

Front 1

The 5 Ds of confusion

Back 1

Delirium, dementia, damage, depression, deprivation

Front 2

S/S of Delirium

Back 2

sudden onset lasting 1wk - 1mo
“disorganized thinking”
Decreased attention span
Lowered/fluctuating LOC Disturbances in the sleep/wake cycle, Disorientation x 1,2 and/or 3
Speech-rambling, irrelevant, pressured, and incoherent
Emotional instability

Front 3

Delirium could be caused by:

Back 3

General Medical condition
Substance induced
Substance intoxication
Substance withdrawal
Multiple etiologies

Front 4

Examples of types of General medical delirium

Back 4

Systemic infections, metabolic disorders, F/E imbalance, hepatic, renal, thiamine deficiency, post-op, trauma to the head

Front 5

Examples of medications causing substance induced delirium

Back 5

Anesthetics, analgesics, antiasthmatic, anticonvulsants, cardiovascular, antimicrobials, GI, H2 receptors, psychotropic drugs with ant cholinergic side effects

Front 6

Primary dementia

Back 6

Dementia itself is the major sign of some organic brain disease not directly related to any other organic illness (e.g., Alzheimer’s disease)

Front 7

Secondary dementia

Back 7

Caused by or related to another disease or condition

Front 8

These diseases could potentially cause secondary dementia

Back 8

HIV disease
Acetylcholine alterations
CVA
Plaques and tangles
Accumulation of aluminum in body
Alterations in the immune system
Head trauma

Front 9

S/S of Dementia

Back 9

Loss of memory
Deterioration of language function (aphasia)
Loss of ability to think abstractly
(executive functioning)
Agnosia (inability to recognize name of objects)

Front 10

Stage 1 Dementia

Back 10

No apparent Sx

Front 11

Stage 2 Dementia

Back 11

Forgetfullness

Front 12

Stage 3 Dementia

Back 12

Early confusion – (may get lost, depression/suicide watch)

Front 13

Stage 4 Dementia

Back 13

Late confusion – forget b-days/important things, confabulation (recognizing somethings wrong, so they lie and add details because they cant remember)

Front 14

Stage 5 Dementia

Back 14

Early Dementia - Loss of ADLs

Front 15

Stage 6 Dementia

Back 15

Middle Dementia - incontinence

Front 16

Stage 7 Dementia

Back 16

Late dementia- aphasic, bedfast, cant eat/drink. Lost control of speaking

Front 17

T or F: Dementia usually progresses more rapidly when diagnosed in a younger person

Back 17

T

Front 18

When assessing the geriatric client, first make sure whether or not _____ and _____ are intact

Back 18

vision
hearing

Front 19

T or F: Decreased tactile sensation is not a normal part of aging.

Back 19

F, it is normal

Front 20

2 important aspects of assessment process when determining dementia

Back 20

1. S/S of damage to the central nervous system
(mental status exam, reflexes)
2. Evidence of other diseases/organ changes

Front 21

Important to distinguish between possible signs of dementia and ________

Back 21

Depression

Front 22

Most common cause of Dementia

Back 22

Alzheimer's disease

Front 23

Describe vascular dementia

Back 23

arteries feeding the brain become narrowed or blocked

Front 24

Describe Lewy body dementia

Back 24

Abnormal clumps of protein

Front 25

These substances can cause neurological damage

Back 25

Lead, mercury, aluminum, manganese, organic phosphates, insecticides

Front 26

Depression Sx that tell us it's not dementia

Back 26

Rapid progression
“forgetfulness”- “I don’t know”
Oriented to time and place
Little effort is put forth in tasks
Better as day progresses
Communicates severe distress
Diminished appetite
Attention and concentration: Intact

Front 27

Characteristics of general medical induced amnesia

Back 27

Evidence form H/P, lab findings
Transient (no more than 1 month) or Chronic (present for more than 1 month)
Associated with: head trauma, CV disease, anoxia, herpes encephalitis, IDDM (poorly controlled)
Transient causes: arrhythmias, migraine, thyroid disorders, epilepsy

Front 28

Assessments/Diagnostics for ALL cognitive disorders

Back 28

H/P
Lab findings-look for hepatic (aft, alt), renal(bun, Na), endocrine(thyroid), nutritional(albumin), toxic substances
EEG
CT scan
PET SCAN
MRI

Front 29

Diagnoses for Cognitive disorders

Back 29

Risk for trauma---no physical injury
Risk for suicide--no self harm
Risk for other--directed violence--no harm to others
Disturbed thought process--maintained reality to the best of his/her capabilities
Low self esteem--positive aspects or self and life
Self-care deficit—fulfill ADL’s with assistance

Front 30

Common medications for dementia

Back 30

Aricept (donepezil)
Cognex (tacrine)
Namenda (memantine)
Zyprexa (olanzapine)

Front 31

Black box warning!

Back 31

Risperdal - high risk of MI, CVA, death in ELDERLY

Front 32

This class of drugs is contraindicated in elderly

Back 32

Barbituates

Front 33

Behavioral signs of elder abuse

Back 33

Caregiver insistence on being present during appointment
Answers for client
Expresses indifference or anger
No visits during hospital stay
Client hesitant to be open, fearful, no eye contact, ashamed, “baby-talk”
Signs over power of attorney unwillingly

Front 34

Risk factors for suicide in older population

Back 34

Males, white, divorced or widowed, lives alone, isolated, moved recently, unemployed, retired, poor health, depressed, family history, wish to end “hopelessness”, previous attempt