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64 Cards in this Set
- Front
- Back
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Delirium
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sudden onset
hrs-days can turn into dementia or cause brain damage can be caused by polypharmacy or UTI in the elderly |
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Dementia
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Chronic and progressive
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Treatment for dementia
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primary consideration in the treatment is the etiology.
focus should be directed to identify and resolve potentially reversible processes. meds are perscribed according to symptomatology. |
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Dementia meds for cognitive impairment
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-physotigmine (antilirium)
-cyclandelate (cyclan) -tacrine (cognex) -donepezil (aricept) -rivastigmine (exelon) -galantamine (reminyl) |
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Dementia meds for agitation
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-risperidone (risperdal)
-olanzapine (zyprexa) -quetiapine (seroquel) -ziprasidone (geodon) -haloperidol (haldol) |
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invega
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not safe for use with elderly, replaces risperdal with patients that have schizophrenia
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antipsychotics, antidepressants, and antihistamines all cause anti- cholinergic side effects which include:
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blurred vision
urine retention dry mouth constipation increased confusion |
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interventions for anti-cholinergic side effects of medications
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increase fluid intake
increase activity hard candy increase fiber intake normal sleep/wake cycle |
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dementia medications for depression
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-fluoxetine (prozac)
-paroxetine (paxil) -sertraline (zoloft) -citalopram (celexa) -trazadone (desyrel) |
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dementia medications for anxiety
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-diazepam (valium)
-chlordiazepoxide (librium) -alprazolam (xanax) -lorazpam (adavan) -oxazepam (serax) |
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dementia medications for sleep
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-flurazepam (dalmane)
-temazepam (restoril) -triazolam (halcion) -zolpidem (ambien) -trazadone (desyrel) -diphenhydramine (benadryl) |
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Treatments for delirium
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-determine underlying cause
-attn to f/e status, hypoxia, anoxia, diabetes, UTI, lab values, o2 level -assign someone to stay with the patient -may or may not medicate -low dose anti-psychotics |
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nursing interventions for patients with delirium
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safe environment
assist with ADL's assess if caused by meds if so d/c meds with an order good assessment to determine cause |
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communcation with persons who are cognitively impaired
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-approach from the front,avoid any sudden movement
-get persons attention,identify yourself and address person by name -speak slowly and clearly,dont shout -monitor your tone of voice -cover one point at a time,do not rush -treat person with dignity and respect -avoid talking down to person -avoid pet names -make sure glasses and hearing aids are being worn |
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ways to help patient communicate
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-remain calm and supportive
-eye level -convey openess -show interest -observe nonverbal communication -supply correct word when a wrong one is used |
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counseling
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-supportive
-directed at orienting client -in early stages use signs and written messages -later stages use nonverbal communication: especially touch -help patient communicate |
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milieu therapy
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-provide structure,involve patient in care as long as possible,maintain safety,manage problem behaviors,provide adequate low glare lighting ,remove potential dangers,schedule mealtimes consistently,use cues such as calendars, clocks, pictures, holiday deco
-remove mirrors if pt. is frightened by them -decrease noise levels -provide space for pacing and wandering -provide boundaries e.g. stop signs -label clothing -schedule rest times -provide bedside commodes to prevent wandering at night -label doors to bathroom, bedroom, etc -diversional activities when agitated |
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self care activities
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-introduce change in routine slowly
-may need tube feedings for adequate nutrition |
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health teaching for cognitively impaired patients
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-aimed at family members (provide support)
-disease process -support services -safety (teach family about rugs, stove knobs, and door locks) -nutrition of the patient -rest (for patient and family) -taking care of one's own health and not that of the patient |
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nursing diagnosis for cognitively impaired patients
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disturbed thought process
risk for trauma impaired verbal communication self care deficit nutrition less than body req. (loss of apetite, forget to eat) |
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nursing interventions for cognitively impaired patients
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-keep a dim light in the room
-assist client with ambulation -frequently orient client to place, time and situation -is patient is prone to wandering, provide an area that is safe -provide a simple, structured environment with a routine that does not change from day to day -label clothing with patients name -give step by step instructions when needed -monitor food and fluid intake -offer finger food that the patient can take away from the table -weigh patient regularly (weekly) |
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possible outcome criteria for patients with cognitive impairment
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-patient will remain safe in the hospital or at home
-with the aid of an identification bracelet and neighborhood or hospital alert, patient will be returned within one hour of wandering -patient will communicate needs -patient will participate in self-care at optimal level -patient will be able to follow step by step instructions for dressing, bathing, and grooming -patient will maintain body weight |
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amnestic disorders
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-memory impairment disorder
-inability to learn new information -inability to recall previously learned information -usually caused by physical trauma -no impairment in thinking or judgment |
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types of amnestic disorders
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due to a general medical condition
transient or chronic |
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dissociative fugue
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-rapid spontaneous recovery
-inability to recall an extensive amount of personal information -memory loss is defining characteristic -often precipitated by traumatic event -sudden travel away from home with confusion about identity |
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types of dissociative amnesia
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local
selective general continuous systematized |
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local dissociative amnesia
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unable to recall incidents associated with traumatic event
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selective dissociative amnesia
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inability to recall certain incidents associated with trauma
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general dissociative amnesia
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cannot recall anything during one's life, including identity
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continuous dissociative amnesia
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inability to recall events from a specific time to present
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systematized dissociative amnesia
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cannot remember events that relate to a specific category or information such as one's family, or one particular person or even
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#1 coping mechanism for addiction
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denial
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common characteristics of addictive behaviors
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-low self esteem
-anxiety -obsession with object, activity, or substance -withdrawal upon cessation -loss of control -denial of the problem |
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three Cs of addiction
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1. Craving to Compulsive Spectrum
2. Continued use despite adverse consequences to health, mental state, relationships, occupation, or finances 3. loss of Control |
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Non-chemical addictions
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hoarding
shopping pathological gambling internet sexual addiction |
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hoarding
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the excessive collection and retention of things or animals until they interfere with day-to-day functions such as home, health, family, work and social life
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compulsive shopping
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pattern of chronic and repetitive purchasing that becomes difficult to stop and results in harmful consequences
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pathological gambling
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inability to stop or control the behavior, denial, severe depression, and mood swings and results in changes in the neurochemistry of the brain
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internet addiction
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provides a high, and person needs that high to feel normal
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sexual addiction
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the pursuit of persistent and excalating patterns of sexual behavior despite negative consequences to self and others
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common indications of a chemically impaired nurse
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often volunteers for extra shifts
may leave unit frequently lot of time in restroom pts c/o unrelieved pain increase in inaccurate drug counts or vial blockage |
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chemical addictions
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alcohol
nicotine caffeine cns stimulants cannabis opoid |
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physical dependence
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physical dependence is a characteristic of drug addiction that is present when withdrawal of the drug results in physiological disruptions (withdrawal)
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tolerance
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the need for increasingly larger or more frequent doses of a substance in order to obtain the same desired effects originally produced by a lower dose
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psychological dependence
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defined as an overwelming desire to repeat the use of a particular drug to produce pleasure or avoid discomfort. can be extremely powerful, producing intense cravings for a substance as well as compulsive use.
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legal intoxication
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0.08g/dL
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clinical intoxication
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100-200mg/dL
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withdrawal syymptoms of alcohol abuse
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coarse tremor of hands/tongue or eyelids
N & V malaise tachycardia sweating increase in B/P anxiety depressed mood irritability transient hallucinations headache insomnia |
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treatment for alcohol abuse
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AA
antabuse (a drug adm. to deter drinking) vivitrol |
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antabuse
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can't have alcohol for 12 hours before consumption
must wait two weeks for alcohol use after d/c can be fatal if pt. uses alcohol |
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teaching for use of antabuse
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no mouthwash or aftershave
no cough syrup no alcohol wipes,swabs cannot use during pregnancy doesnt always work |
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five warning signs of relapse
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being around other users
severe cravings stop attending meetings not expressing feelings going through a crisis |
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nicotine
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primary psychoactive substance found in tobacco products, CNS stimulant, initial hit reaches the brain in seconds
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side effects of nicotine
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tremors and convulsions (large doses)
depression resp. failure (from paralysis of resp. muscles) lung cancer lung disease heart disease facial wrinkling (systems face) reproductive effects second-hand smoke speeds up metabolism constricts vessels decrease birth weight increases wrinkles increases blood pressure |
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nicotine withdrawal symptoms
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irritability
restlessness difficulty with concentration insomnia depression increased appetite |
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caffeine
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CNS stimulant that can be found in OTC drugs and combination-perscription drugs, contained in beverages and food, pregnancy category b drug
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side effects of caffeine
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palpitaions
tachycardia HTN dysrhythmias nervousness restlessness jittery anxiety insomnia headache nausea vomiting diarrhea abd. pain increased urination diuresis |
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marijuana
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most commonly abused illicit substance. impairs short term memory and learning, the ability to focus attn, and coordination. also increases heart rate, can harm the lungs, and can cause psychosis in those at risk.
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cannabis abuse symptoms
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impaired motor coordination
euphoria anxiety sensation of slowed time impaired judgement conjunctival injection increased appetite dry mouth tachycardia impaired motor skills 8-12hrs |
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physical effects of CNS stimulant abuse
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tachy/bradycardia
pupillary dilation elevated/lowered b/p perspiration or chills nausea or vomiting weight loss psychomotor weakness muscualar weakness resp. depression chest pain confusion seizures coma |
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cns stimulants
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meth, cocoaine
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withdrawal from cns stimulants
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dysphoria
fatigue sleep disturbances increased appetite high lasts for hours stop eating dry mouth sores age faster increased metabolism malnourshed meth bug sensation |
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inhalants
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popular with yound adults
solvents produced when inhaled gases nitrates |
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inhalant intoxication
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2 or more must be present:
dizziness, nystagmus, incoordiantion, slurred speech, unsteady gait, lethargy, psychomotor retardation, stupor, coma, euphoria, generalized muscle weakness, blurred or double vision |
