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DELIRIUM
- A syndrome that involves a disturbance of consciousness accompanied by a
change in cognition.
- Usually develops over a short period, sometimes a matter of hours, and fluctuates,
or changes, throughout the course of the day.
- Common in older acutely ill clients.
- Prolonged disorder can lead to dementia.
Etiology
• Results from an identifiable physiologic, metabolic ,or cerebral disturbance or
disease or from drug intoxication or withdrawal
Common causes
• Physiologic or metabolic
• Infection
• Drug related
• Hypoxemia, electrolyte imbalances, renal or hepatic failure, hyper/hypogly, B12,
vit C, niacin or CHON deficiency, brain tumor, head injury, paint solvents, insecticides
and related substances,cardiovascular shock
• Systemic: sepsis, UTI, pneumonia
• Cerebral: meningitis, encephalitis, HIV, syphilis
• Intoxication: anticholinergics,lithium, OH, sedatives and hypnotics
• Withdrawal: OH, sedatives, hypnotics
• Rxn to anes, Rx meds or illicit drugs
Hyperactive Behavior
Hypervigilance
Restlessness
Incoherent, loud, or rapid speech
Anger
Distractibility
Nightmares
Persistent abnormal thoughts(delusions)
Hypoactive Behavior
Lethargy
Speaks or moves little or slowly
Has spells of staring
Reduced alertness
Generalized loss of awareness of the environment
Pharmacologic and Non-pharmacologic Treatment
Primary tx: identify and treatany causal or contributing medical condition
DRUGS
• Sedatives: to prevent inadvertent self-injury
• Antipsychotics (Haldol): to decrease agitation
• Benzodiazepines: ONLY for delirium induced by OH withdrawal
***NOTE: Sedatives and benzodiazepines are avoided because they may worsen
delirium
Health Teachings:
• Monitor chronic health conditions carefully
• Visit physician regularly
• Tell physicians and health care providers the meds taken, inc over-the-counter
meds, dietary supplements and herbal preparations.
• Check with physician before taking any non Rx meds
• Avoid OH and recreational drugs
• Maintain a nutritious diet.
• Get adequate sleep.
• Use safety prec when working with paint solvents, insecticides and similar
products.
Nursing Interventions
• Promote client’s safety.
• Manage client’s confusion
• Control env’t toreduce sensory overload
• Promote sleep and proper nutrition.
DEMENTIA
- Marked by progressive deterioration in intellectual function, memory, and ability
to solve problems and new skills.
Common Types
• Alzheimer’s dementia
• Vascular dementia (multi-infarcts)
• HIV dse
• Head trauma
• Parkinson’s dse
• Huntington’s dse
• Pick’s dses
• Creutzfeldt-jakob dse
• General medical condition (brain tumors, subdural hematoma)
• Substance use
Alzheimer’s Dementia
• Progressive brain disorderthat has gradual onset but causes and increasing decline
in functioning: speech, loss of motor function and profound personality and behavior
changes (paranoia, delusion,hallucintation, inattention to hygiene)
• Risk of the dse increases with age, and average duration from noset of Sx to death
is 8-10years
Vascular dementia
• CT scan/ MRI result: multiple vascular lesions of the cerebral cortex and
subcortal structures resulting to decrease blood supply to the brain
HIV diseases
• These may result directly from the invasion of nervous tissue by HIV or other
AIDS-related illnesses such as toxoplasmosis and cytomegalovirus.
• Sx: from mild sensory impairment- gross memory and cognitive deficits-severe
muscledys function
Parkinson’s Disease
• Slowly progressive neurologic condition characterized by hand tremor, rigidity,
bradikinesia and postural instability.
• The dse begins late 30’s- early 40’s and may last for 10-20 years or more before
death.
• Involves facial contortions, twisting, turning and tongue mov’ts during waking
hours
Pick’s Disease
• Degenerative brain dse that particularly affects frontal and temporal lobes
resulting to Alzheimer’s dse manifestations.
• Early signs: personality changes, lossof social skills and inhibitions, emotional
blunting and language abnormalities.
Creutzfeldt-jakob Disease
• CNS disorder that typically develops in 40-60 years
Donepezil (Aricept)
c. Rovastigmine (Exelon)
d. Galantamine (Reminyl)
Nursing Considerations
- Monitor for hapatotoxic effect
- Monitor for flu-like Sx
- Monitor for nausea, vomiting, abdominal pain and loss of appetite, dizziness
andsyncope
Nursing Interventions
• Promote client’s safety andprotect from injury
• Promote adequate sleep, proper nutrition and hygiene and activity
• Structure env’t and routine
• Provideemotional support
• Promote interaction and involvement in
Delirium vs Dementia
Onset: acute impairment of orientation, memory, intellectual fxn, judgment and affect
Essential Feature: Disturbance in consciousness, fluctuating levels of consciousness and
cognitive impairment
Cause: secondary to many underlying d/o that cause temporary, diffuse disturbances of
brain fxn
Course: usually brief (hours-days) prolonged may lead to dementia
• Slow insidious dedterioration in cognitive fxning
• Progressive deterioration inmemory, orientation, calculation and judgment, Sx do
not fluctuate