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106 Cards in this Set
- Front
- Back
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Depression
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*common in older adults
*lower mood tone, difficulty thinking, somatic changes precipitated by guilt and/or feelings of loss |
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Depression increases...
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with medical illness
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Different types of depression
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minor, major, adjustment disorder, bipolar, SAD, dysthymia
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What are characteristics of depression?
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depressed mood, loss of interest and pleasure, decrease in energy, change in sleep pattern, anxiety, loss of or excessive appetite, crying, agitation, loss of libido
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What is the most common emotional disorder in older adults
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depression
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Some suicide risk factors
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depression, family history, lack of support systems
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What are some consequences of depression?
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amplification of pain, delayed recovery, worsening of medical symptoms, risk of physical illness, alcoholism, cognitive impairment, increased utilization of healthcare resources, malnutrition, increased rates of suicide
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Who has the highest rates of completed suicide
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white men
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People with these illnesses commonly commit suicide
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cancer, stroke, quadripilegics, chronic illness, Diabetes
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What does a Geriatric Depression Score over 5 suggest?
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Depression and follow up
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What are some assessment instruments for depression?
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geriatric depression scale, hamilton rating, Zungself rating, Cornell scale
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What are some illness associated with depression in elders?
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hypothyroidism, CHF, GI malignancy, DJD, CVA, alzheimers, Parkinsons, anemia, vitamin deficiencies, systemic malignancies
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What are some interventions for depression
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safety, monitor nutrition, elimination, sleep and comfort, focus on enhancing physical function, activity, and social support, and pleasant events
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Is depression natural in old age?
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depression
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What is SIG E CAPS for depression?
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sleep patterns, interests/ loss of pleasure, guilt, energy, concentration, appetite changes, psychomotor changes, suicide
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Delirium
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acute confusion with rapid onset (hours to days) that is REVERSIBLE
*disturbance in teh ability to concentrate, maintain attention, language distrubance (slurred, rambling), perceptual disturbances often with paranoia that worsens at night, often prodromal phase with anxiety, restless, insomnia and disturbing dreams |
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What can happen in delirium?
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full recovery or progression to stupor and death
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What does delirium put you at risk for?
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longer hospital stays, falls, more institutions, more nursing and home care
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What do the agitated behaviors of delirium usually lead to
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physical and chemical restraints
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Some risk factors for delirium
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advanced age >80, dementia, severe illness, comordity, alcohol, depression, sensory impaired, dehydration, infection, polypharmacy (over 4 meds), previous episode
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what are common causes of delirium in older hospitalized patients?
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medication, pain, dehydration, infection, electrolyte and metabolic disturbance
PIE MD |
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What are variables which predispose to delirium
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vision impaired, severe illness, preexisting cognitive impairment, dehydration, present on admission, use of physical restraints, bladder cath, more than 3 meds added, iatrogenic effect
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What are 3 subtypes of delirium
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hyperactive, hypoactive, mixed
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Hyperactive delirium
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increased psychomotor activity, such as rapid speech irritability and restlessness: easily recognized and treatment is sought
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Hypoactive delirium
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present with slurred slow speech, lethargy, decreased alertness, apathy, behavior is not disruptive so its often missed
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Mixed delirium
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behavior shifts between hyper and hypo: during hyper phase people may think the behavior has improved
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Assessing delirium
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history and physical, (did they use alternative therapies), mini cog, digit span (20 backwards), days/months backward, WORLD backward, test of attention, current meds, lab chemistries, O2 sat, thyroid function, cultures, drug levels, UA, EKG, CXR, B12, folate level
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Delirium Prevention
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immunization, community support, early diagnosis and treatment, careful use of meds, pain control, identify risk factors
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Managing delirium
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prompt treatment, discontinue meds, nutrition and hydration, supportive environment, consolidate nighttime care, noise reduction, communication, cognitive enhancement
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What is better choice for delirium in older adult: Haldol or Ativan
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ativan, because haldol can cause extrapyramidal symptoms
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Some meds for delirium
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haldol, ativan, risperdol, zyprexa, geodone IM, benzodiazepines, lorazepam
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What are main dementias?
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alzheimers, vascular dementia, dementia with Lew bodies
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What may help dementias?
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cholinesterase inhibitors and N-ethyl d-aspartate antagonists
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Who has more dementia: male or female
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female
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20-30% of those with dementia have..
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vascular or combination of alzheimers with vascular dementia
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Causes of vascular dementia
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HTN, stroke, etc
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What is diagnosis of dementia
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decline in 2 or more areas of cognitive functioning: memory and one of others (aphasia, apraxia, agnosia)
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Aphasia
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difficulty speaking
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Apraxia
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difficulty with movement
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Agnosia
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inability to know specific objects
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Dementia usually beings after
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age 60
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Dementia is...
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progressive and irreversible
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60-70% of dementia have...
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alzheimers
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What occurs in dementia?
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brain cells are destroyed, which affects memory, thinking and behavior which then interferes with work, hobbies, and social life
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What is the 6th leading cause of death
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dementia
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10% of people over 65 have?
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dementia
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50% of people over 90 have
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dementia
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What occurs with the brain in dementia
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accumulation of proteins in the brain, causing neurofibrillary tangles
*cortex shrivels up *hippocampus shrinks *ventricles grow |
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What occurs in dementia when the cortex shrivels
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damages areas for thinking, planning and remembering
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What occurs in dementia when then hippocampus shrinks?
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it is the area for new memories, so you cannot form new memories
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What are risk factors for dementia?
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advanced age/family, mild cognitive impairment, genetics, family history, female, environment, head injury, low education, lower occupational status, alcohol abuse, lack of mental stimulation
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What are risks for vascular dementia?
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stroke, hypertension, high LDL, hyperlipidemia, older age, male, smoking
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What is one of the earliest symptoms of AD?
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impairment of smell function
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What may a person with A.D. be unable to smell?
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leather, clove, menthol, strawberry, pineapple, soap, smoke, lemon, lilac, natural gas (egg odor added)
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What is genotyping for dementia
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APOE gene, has 3 alleles APOE 2, 3, & 4
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Definition of dementia
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clinical syndrome of cognitive deficits that invovles both memory and a disturbance in at least one other area of cognition that is commonly associated with changes in function and behavior
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most common forms of dementia
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alzheimers and vascular
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Agitation in dementia
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excessive verbal or motor activitiy
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Motor agitation in dementia
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irritable, restless, resisting assitance even when needed, pacing, hyperactivity, wandering, assaultiveness, threatening gestures, spitting, and physical destructiveness
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Verbal agitation in dementia
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verbal abuse, beligerance, screaming, swearing, expressions of anger
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What is cognition affected in dementia
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orientation x 3, memory (register, retain or recall info), attention and concentration, thinking, language (receive and express message), praxis function (direct and coordinate movement)
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What is some behavior in dementia?
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disruptions, agitation, aggression, anxiety, disinhibitions, delusion, hallucination, insomnia, decreased energy, weight loss/gain, mood changes, feeling helpless, decreased initiation, lack motivation
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Goals for dementia patients
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delay progression, delay functional decline, promote quality of life, control symptoms, promote dignity
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What should you do for nursing strategies in dementia?
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rule out everything else
physical exam, medication review, labs (to check for reversible conditions like thyroid, b 12, cbc, syphilis, hiv), treate underlying pathology, monitor effectiveness of meds, assure adequate rest, nutrition, fluid, elimination, pain control, and comfort |
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What is treatment for dementia?
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treat cognitive symptoms, treat behavioral disturbances, and educational interventions
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How do you treat dementia cognitive symptoms
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acetylcholinesterase inhibitors, NMDA receptor antagonist, stroke prevention
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how do you treat dementia behavioral disturbances?
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antipsychotices, benzodiazepines, selected TCAs
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Some meds for dementia
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Ach-1 inhibitors: aricept exelon, gonex, reminyl (mild to moderate): slow cogitive decline and may slowly improve symptoms and may delay onset new symptoms
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S/E of Ach-1 inhibitors
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GI, diarrhea most common
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When is namenda used?
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moderate to severe dementia; can be add on to initial start
*blocks glutamate, which is the main excitatory NT in areas of memory and cognition |
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What is a goal in behavior of dementia
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reduce overstimulation, know that basic human needs may trigger behavior disturbance
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delirium is often caused by?
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underlying condition such as UTI, med toxicity
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What may antipsychotic meds do?
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reduce agitation
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What may antidepressants do?
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help symptoms of depression
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What is lewis body dementia?
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prominent psych symptoms, cognitive deterioration and parkinsonian features, distinct psychotic behavior, such as visual hallucinations
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Some goals in dementia
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avoid use of restraints, treat comorbidities, provide symptom management
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Nonpharm interventions dementia
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activity therapy, bright light and white noise, psychosocial program, environmental designs for safety, massage, prosthesis for sensory impaired, simulated presence therapy, structured daily activity, activities that promote fatigue at bedtime, bedtime routines, strategies to promote positive behaviors, use personal history as able, maintain routine alternate rest with activities, slow down, speak clearly, eye contact, cue person to do as much for self as possible, modify environment, monitor for symptoms of personal distress
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What are some ways to promote positive behaviors in dementia?
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identify environmental triggers, medical conditions, caregiver conflict, limit stimuli, respect space, distract, redirect
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Strategies for safe and therapeutic environment
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avoid overstimulation or understimulation, name tags, wander gaurd, medic alert bracelet, eliminate environment hazards, provide snesory cues to promote cognition, safety
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Strategies to promote quality end of life care
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advance directive, promote communication early in disease
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is confusion a normal part of aging?
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no
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How can you ensure adequate comfort in dementia
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food, eliminatio, etc.
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What should you realize as a nurse in different behaviors
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every behavior has a reason, needs not met
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Which is reversible: delirium or dementia
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delirium
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What is cause of delirium
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physical
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cause of dementia
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unknown
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increases risk dementia
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family history, increased age, CV disease
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Treatment for delirium
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immediate care to fix the physical cause
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What is most important in wandering
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prevention
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Some good things to do for wandering?
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wristbands, prevention
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How to assess delirium in older adults with dementia
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risk factors, baseline, assess every shift, perception, elimination
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Prevent delirium in dementia patients
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treat/prevent infections, pain control, sensory aids, therapeutic environment, education of family, nutrition, decrease risk factors, prevent dehydration
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When is delirium fatalistic?
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if physical cause is unfixed
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Some common behaviors in dementia
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aggression, questioning, throwing things, sleep disturbance, agitation, paranoia, forgetting to eat/bathe, sundown syndrome
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What is sundown
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acting differently at night
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What is very important with mental disturbances
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DISTRACTION
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what is a way to assess nutrition in dementia
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Edinburgs
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Some things to assess in eating?
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sloppy, able to chew, bring cup to mouth, need help or eat alone, sit up, open packages, need supervision, check amount of food able to eat, if they have remnants after, if tired after, hydration
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Do feeding tubes help in dementia near end of life?
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there is no evidence that feeding tubes help!
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What can you do to check for aspiration?
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cookie swallow test
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Lewis body dementia
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in cortex, plaque/tangles in hippocampus, like Parkinsons
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Important in lewis body dementia
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safety, physical therapy and occupational therapy
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Interventions for difficulty eating in dementia
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decrease distractions, show how to physically eat, involve family, familiar foods or comfort foods, out of bed to eat, weight, eating is social, but must be supervised
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Alzheimers behaviors
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irritable, depression, decrease movement, reorientation necessary, use scrapbook or crossword puzzles to help
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Cause and behavior is different between
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alzheimers and lewis body dementia
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What are some activities for alzheimers patients?
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go to the zoo, make a collage, music specific to their age, help with meal prep, folding washclothes, old movies
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