DELIRIUM DEMENTIA

BEHAVIOR: BEHAVIOR:
 have difficulty paying attention  impaired memory (prominent early sign)
 easily distracted and disoriented
 have illusions, misinterpretations and hallucinations  recent memory is impaired
 common in acutely ill old clients
 may exhibit aphasia, agnosia & disturbance in executive functioning
RISK FACTORS:
 increased severity of physical illness, older age, baseline cognitive impairment
 language function deteriorates
ETIOLOGY:
 results from an identifiable physiologic, metabolic, or cerebral disturbance/disease  loses ability to perform self care activities
 drug intoxication
 withdrawal
(box 21.1 page 466) STAGES:
1. Mild- forgetfulness; hallmark of beginning of mild dementia (exceeds usual forgetfulness
SIGNS & SYMPTOMS: common in aging people)
 difficulty w/ attention 2. Moderate- confusion & progressive memory loss; cannot perform complex task but still oriented
 easily distractible to time & place
 disoriented 3. Severe- personality and emotional changes occur; may be delusional, wanders at night; forget
 have sensory disturbances such as illusions, misinterpretations & hallucinations names of immediate family; usually is brought to a nsg care facility
 can have sleep-wake cycle disturbances
 change in psychomotor activity ETIOLOGY:
 may experience anxiety, fear, irritability, euphoria, or apathy  APOE gene = AD

PSYCHOPHARMACOLOGY:  HIV
 Haloperidol @ 0.5-1mg ( HALDOL)
- decreases agitation  Creutzfeldt-Jakob Disease
 sedatives and benzodiazepines are avoided except in DELIRIUM INDUCED by ALCOHOL WITHDRWAL
SIGNS & SYMPTOMS:
PSYCHOTHERAPY:  loss of memory
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ASSESSMENT:  deterioration of language function

1. HISTORY
• prescribed medications  loss of ability to think abstractly
• alcohol
• illicit drugs PSYCHOPHARMACOLOGY:
• OTC meds  Tacrine(Cognex)

2. GEN. APPEARANCE & MOTOR BEHAVIOUR

 Donopezil (Aricept)
• restless
• hyperactive, frequently picking at bed clothes
 Galantamine(Reminyl)
• less coherent
• may call out or scream at night
• others have slowed motor behavior, sluggish, lethargic w/ little movement
PSYCHOTHERAPY:

ASSESSMENT:
1. mental status examination
2. HISTORY- interview w/ family, friends & caregivers
3. MOOD & AFFECT 3. GEN. APPEARANCE & MOTOR BEHAVIOUR
• have rapid and unpredictable mood shifts • conversation becomes repetitive
• anxiety, fear, irritability, anger, euphoria & apathy • speech may become slurred then total loss of language function
 • gait disturbance
4. THOUGHT PROCESS & CONTENT • uninhibited behavior
• disorganized & makes no sense • neglecting personal hygiene
• thoughts are fragmented • profanity that was never done before

5. SENSORIUM & INTELLECTUAL PROCESS 4. MOOD & AFFECT

• initial sign is altered level of consciousness • experiences anxiety & fear
• oriented to person but not to time & place • labile & shifts over time rapidly & drastically
• cannot focus and sustain attention
• impaired recent and immediate memory
• may display anger & hostility
6. JUDGEMENT & INSIGHT • displays catastrophic reaction like verbal aggression/ physical, wandering at night,
• Judgment is impaired agitation
• Cannot perceive potentially harmful situations • lethargic, look apathetic
• loss emotional affect seem dazed & listless
7. ROLES & RELATIONSHIP
•Unlikely to fulfill roles 5. THOUGHT PROCESS & CONTENT
• delusion of persecution are common
8. SELF CONCEPT • may accuse others of stealing objects he or she has lost or he/she is being cheated or
•frightened threatened pursued

NURSING OUTCOMES: 6. SENSORIUM & INTELLECTUAL PROCESS

•client will be free of injury
•client will demonstrate increased orientation and reality contact
•client will maintain balance of activity and rest
•client will maintain adequate nutrition and fluid balance
•client will return to his/her optimal level of functioning
NURSING INTERVENTION
• may make up answers to fill memory gap(CONFABULATION)
• Agnosia (another hallmark of dementia)
• lose visual spatial relations(loses ability to write/draw simple objects)
• disoriented to time in mild; time & place in
• moderate; to self in severe
• hallucinations are most common

• Promote Client’s safety 7. JUDGEMENT & INSIGHT

• Managing client’s confusion • Judgment is impaired
• Controlling environment to reduce sensory overload • Cannot perceive potentially harmful situations
• Promoting sleep and proper nutrition.
8. ROLES & RELATIONSHIP
•Unlikely to fulfill roles
•children experiences role reversal and partners feel they have lost the previous relationship

9. SELF CONCEPT
•may be angry or frustrated
•Loses awareness of self then slowly fail to recognize their own reflections.

NURSING OUTCOMES:
• the client will be free of injury
• the client will maintain an adequate balance of activity and rest, nutrition, hydration, &
elimination.
• the client will function as independently as possible given his or her limitations
• the client will feel respected and supported
• the client will remain involved in his or her surroundings
• the client will interact with others in the environment

NURSING INTERVENTION:
• Promoting client’s safety and protecting from injury
• promoting adequate sleep, proper nutrition, hygiene, & activity
• structuring environment and routine
• providing emotional support
• promoting interaction & involvement