...Allyson Rosen Ruth O’Hara Maya Yutsis Brian Yochim Geoff Kerchner Neurocognitive Disorders • Delirium • Major and Mild Neurocognitive Disorder (NCD) Neurocognitive Disorders (NCD) • Primarily COGNITIVE disorders • Acquired and represent decline (i.e. not developmental) Neurocognitive Disorders • Primarily COGNITIVE disorders • Acquired and represent decline (i.e. not developmental) • Underlying brain pathology • For degenerative disorders monitor consensus guidelines in addition to DSM 5 Updates on Neurocognitive Disorders???? Updates on Neurocognitive Disorders???? NO We can still be Updates on Dementia Neurocognitive Disorders (NCD) vs. Dementia • Dementia typically refers to degenerative d/o in elderly Neurocognitive Disorders (NCD) vs. Dementia • Dementia typically refers to degenerative d/o in elderly • DSM expands category to d/o of younger – E.g. HIV, traumatic brain injury Major and Mild Neurocognitive Disorders (NCD) Major NCD • • • • Significant Cognitive Decline Interfere with independence Not due to delirium Not due to other mental disorder Major NCD vs. Dementia • Can be single domain – E.g. Amnestic – Exception: Major NCD due to Alzheimer’s disease. Major NCD • • • • Significant Cognitive Decline Interfere with independence Not due to delirium Not due to other mental disorder Mild NCD • • • • Moderate Cognitive Decline NOT Interfere...
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...She was unable to state the day or place. She mumbled and appeared to be preoccupied. I completed the confusion assessment method (CAM) test. She was CAM positive for delirium. She had features of acute fluctuation of mental status, inattention, and changes in baseline mental status. The inattention assessment was completed by performing the SAVEAHAART test. She was unable to squeeze my hand as requested. The lungs were clear in all fields. S1S2 were auscultated without a murmur. Negative peripheral edema/jugular venous distention was noted. We began to look for sources of infection. She was not febrile and was without complaints of pain, cough, or urinary frequency. A complete blood count, urinalysis, electrolytes, CRP, and urinalysis was ordered. These results were to be called to Dr....
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...We often hear that it’s not unusual to be confused when you’re old. It’s true that we can expect many changes as part of normal aging. But a sudden change in cognitive function or the way we think and process information is not one of them ( 2016, U.S. Department of Veterans Affairs). When the confusion comes on suddenly, or the older adult becomes difficult to arouse, this could be a condition called delirium ( 2016, U.S. Department of Veterans Affairs). Delirium is an acute disorder of attention and cognitive in the elderly mostly those age 65 years or older (2013, Dr Meng-Chuan Lai, PhD). Contributing factors that can be traced to the causes of Delirium are chronic medical illness, changes in metabolic balance, medications, infection,...
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...The older adult population differs from other age groups that we as nurses provided care for; this should not mean they are treated any different as far as the care, compassion and respect they receive. This paper will review age related challenges that the elderly progress though as they age. Next I will describe a general overview of literature and how this relates to the challenges I explained. Following this I will identity physical and emotional changes that make quality improvement a challenge and continue with barriers and solutions to quality improvement programs. Concluding this paper I will discuss what the quality of care look like for the elderly in the future. As we grow and mature the human body goes through many physical and...
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...Ethics of Chemical and Physical Restraints Ethics of Chemical and Physical Restraints A restraint is the use of some kind of equipment or drug used for the purpose of restricting a patient from free will movements. There are times when using restraints would seem like the best thing to do for a patient, but in-fact it could be quite the opposite. Agens Jr., J. (2010). The use of restraints is mostly used to deal with an agitated patient, mainly can be found in residential-care facilities. Those 65 years and older have been reported to have higher restraint use rate in residential and acute care facilities. Many have been found with at least two different types of restraints at the same time. Mott, S., Poole, J., & Kenrick, M. (2005). How often restraints are used often will depend on what kind of restraint is used and the setting that it is being used in. According to Agens Jr., J. (2010) that in the health care facility setting has reported a 7.4% to 17% restraint use ten years ago, and a decade before that it was 28%-37%. Thanks to the Department of Health and Human Services and the new rules that the CMS put into effect in 2007, restraint use is down about 5%. The use of Chemical restraints is a bit higher than physical restraints that reached upwards to 34% in the long term care facilities. However, there is some hope that this number will decrease because of the US government regulation. Chemical and physical restraint use has been known to cause many hazards...
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...reduced or lost reflexes or sensation, leading to problems with movement and safety. Some slight slowing of thought, memory, and thinking seems to be a normal part of aging. Although these changes are natural, many people have misconceptions about the type and extent of these changes. A common myth is that all elderly people become senile. Or, many people blame increased confusion on "getting old" when it may really be caused by an illness. These changes are not the same in everyone. Some people have many physical changes in their nerves and brain tissue, others have few changes. Some people will have atrophy and plaques, some will have plaques and tangles, and some will have other changes. Furthermore, these changes are not always clearly related to the effects on your ability to think. For example, plaques and tangles are associated with Alzheimer's disease, but some people with the most severe symptoms have fewer plaques and tangles than those who have mild or moderate symptoms. NERVOUS SYSTEM PROBLEMS IN THE ELDERLY Dementia and severe memory loss are NOT normal processes of aging. They can be caused by degenerative brain disorders such as Alzheimer's disease. Delirium can complicate dementia, but is often due to illnesses that are not related to the brain, which can also cause...
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...Assessment on a geriatric patient is usually different from standard medical evaluation of other patients. For the elderly patients, especially those that are really old. General assessment like the physical and history-taking might not be done at the same time because patient becomes tired easily. The elderly usually have multiple health issues which requires the use of many drugs which is also called polypharmacy. The elderly are best evaluated using a comprehensive geriatric assessment, which includes evaluation of function and quality of life usually by an interdisciplinary team. While assessing a geriatric patient, the nurse should consider that at this point in their lives a lot is going on, there is degenerative changes, multiple disorders, caregiver problems, missed or delayed diagnosis. On average, elderly patients have 6 diagnosable disorders, which their primary care giver might be unaware of A disorder in one organ system can weaken another system, exacerbating the deterioration of both and leading to disability, dependence, and, without intervention, death . The nurse should also pay particular attention to certain common geriatric symptoms (eg, delirium, dizziness, syncope, falling, mobility problems, weight or appetite loss, urinary incontinence) because they may result from disorders of multiple organ systems. Occasionally, problems of elderly patients are related to neglect or abuse by their caregiver (see Elder Abuse).The nurse also should consider the possibility...
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...Jennings, published by the Agency for Healthcare Research and Quality, discusses different nursing assessment tools and methods to improve functional ability in the elderly hospitalized client. It stated, “The hospital environment, a tertiary care setting, has traditionally focused on medically managing illness states, not on improving patient functioning.” (Kleinpell RM, Fletcher K, Jennings BM, 2008). One key assessment tool when caring for the elderly hospitalized patient would be a comprehensive geriatric assessment (CGA). When interviewing and assessing the patient, it is important to ask about family/social support (patients with dementia- it may be necessary to get information from family), psycho-social well-being, cognition (are they oriented to person, place,date/time, situation?), and sensory perception (check visual acuity, hearing, ability to smell and ability to feel...
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...medically necessary (citation). The elderly represents 14% of the United States (US) population and it is expected to increase to 23% in 2043 with the aging of the baby boomers (citation). They consume about 33% of prescribed medications in the US. It is estimated that 24-39% of the elderly take on average more than five medications on a daily basis (citation). Common medications in this population are cardiovascular, antihypertensive, antiglycemic, anticoagulant, analgesics, sedatives, and gastrointestinal preps. It is believed that medication therapy...
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...making the person addicted. Xanax goes through the body very quickly and because of this many people will begin to experience withdrawal symptoms between doses, which increases the necessity for the drug. The long-term effect, include physical health and mental health. Long-term use can also make the brain function slow. There are a number of side effects associated with addiction such as depression and flu like symptoms. Due to increasing physical mental symptoms from long-term use of Xanax, slowly withdrawing is recommended. Today many people use and abuse Xanax. Young and elderly people consume the drug. For the elderly long term use can lead to syndromes and symptoms including drowsiness, fatigue, confusion, weakness, depression, panic delirium, hallucinations, sleep walking, and insomnia. Elderly individuals who are long-term users have a higher chance of post confusion. It is recommended that the elderly should avoid the drug and not use it. For the youth the effect can come from experiments. While attending high school many experimentations are almost bound to happen. Students will experiment new and fun things just to try and achieve the best high. The danger comes into play when teens have no ideas of the consequences. The most important factor of Xanax is that if you take it everyday for a couple of months, you become physically dependent on it and if you built up a significant dependence on it and suddenly, you can go into a fatal seizure. It slows the heart rate way...
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...Assessing Mental Status Most of a mental status assessment can be done during an interview. Assess the patient’s appearance, behavior, mood, thought processes and cognitive function, coping mechanisms, and potential for self-destructive behavior. Record your findings. Most of us already do an assessment of mental status everyday, esp. in our jobs. But now we are going to take a little closer observation. Mental Status exam is a FOCUSed exam. Used for screening, assess state of consciousness (expected or unexpected) or to assess whether the patient is experience delirium versus dementia. Past Medical and Family History Any history of * Neurological disorders * Brain surgery * Psychiatric counseling * Mental retardation * Alzheimer disease * Learning disorders Personal and Social History Pertinent data should include: · Emotional status · Life goals, relationship with family members · Intellectual level · Sleeping/eating patterns, weight loss/gain · Anxiety · Use of alcohol or street drugs Age and Condition-Related Variations * Children * Areas relevant to children are speech & language, behavior, performance of self-care activities, personality and behavior patterns and learning difficulties * Older Adults * Ask about any experiences with depression, or changes in mental functions Let’s look at appearance… this can help to indicate emotional and mental status, specifically noting his/her dress and grooming. Some things...
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...of reimbursement for some components. Overall elements of comprehensive geriatric assessment includes: Physical Health-This focuses on medication use and the risk for malnutrition, falling, incontinence and immobility. The physical examination seeks to identify specific diseases or conditions for which curative, restorative, palliative or preventive treatment may be available. Special attention is directed towards visual or hearing impairment, nutritional status and conditions that may contribute to frailty and falling or difficulty in ambulation. Mental Health-Cognitive, behavioral and emotional statuses are evaluated with particular emphasis on detecting dementia, delirium and depression. Social and Economic Status-The social support network includes the availability and competence of caregivers, the elderly person’s economic resources and other sources of support such as cultural, ethnic and spiritual resources. It also includes the individual’s own assessment of the quality of...
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...Aging Population Discuss findings related to geriatric syndromes and trends evident in the aging population. According to Rodgers, Geriatric Syndromes are groups of specific signs and symptoms that occur more often in the elderly and can impact patient mortality and morbidity. Normal aging changes, multiple co-morbidities, and adverse effects of therapeutic interventions contribute to the development of Geriatric Syndromes (Rodgers, 2008, p. 323). Geriatric Syndrome includes sleep disorders, eating disorders, incontinence, confusion, falls, and skin breakdown. Mental disparities such as depression, delirium, dementia and pain are also symptom that accompanies aging (Rodgers, 2008, p. 323). Discuss cultural diversity and the impact of diversity on life transitions. The aging baby boomers generation will contain a greater racial and ethical mix than any other previous generation. This is in direct correlation with increasing immigration from primarily nonwhite countries and a lower fertility rate among Caucasians. The U.S. Census bureau predicts that nonwhite populations will account for approximately 39% of the U.S. population by 2050 (Chop, 2006). Life expectancy for nonwhite Americans is less than it is for whites. African American men and women currently live on average 6-5 years less, respectively, than their white counterparts. However, if a black person of either gender lives to age 65; his or her life expectancy is much closer to whites than it was at birth...
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...STUDY GUIDE for C475 Care of Older Adult Objective Assessment Exam questions are taken from the Learning Objectives under the 9 Competencies: #1 Competency 742.1.1: Compassionate and Respectful Care of Older Adults The graduate integrates principles of compassion and respect for patients and their families into the planning and delivery of care to a diverse population of older adults and into advocacy for vulnerable older adults. This topic addresses the following learning objectives: * Recognize the impact of attitudes, values, and expectations about aging. * Describe how the RN’s personal beliefs and values may impact the care of older adults. * Articulate the concept of individualized care as the standard of practice with older adults, considering the right care, at the right time, in the right place and by the right provider of care. * Define Baby Boomers (those born from 1946–1964) reach retirement age (as of 2011) A large group of people born between 1946 and 1964, in the time after the Second World War. * What are the five racial groups listed in your text? African American, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander/Asian, Hispanic, White * How would you perform discharge teaching to an Hispanic patient Teach the family as well because more than likely, pt is going home and family is his/her primary caregivers. * Apply effective and respectful communication strategies in the care of older adults and their...
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...Case study #1 1. The priority teaching would be to never abruptly stop taking the medication especially without consulting your physician, but try to take it in the morning so she would not have to get up a lot during the night to empty her bladder. 2. Decreased cardiac output r/t increased vasoconstriction aeb variations in blood pressure readings a. Monitor and measure blood pressure in both arms, using a manual technique for an accurate reading b. Monitor response to medication to control blood pressure. Give fluid and sodium restriction as indicated Disturbed Sleep Pattern r/t use of prescription diuretic aeb awaking various times in the middle of the night * instruct patient to take hctz in the morning to avoid waking up at night * assist the patient to identify envoiormental factors that make sleep difficult. Knowledge deficit related to lack of information about the disease process and self-care as evidence by patient lack of complaiance with medications. * Describe the nature of the disease and the purpose of the procedure and the treatment of hypertension * Explain the importance of a peaceful environment and theraupetic, and management of stressors. 3. Two non pharmacologic ways of managing hypertension include limiting your alcohol intake and the DASH diet which includes a diet that encourages you to reduce sodium intake and eat foods rich in nutrients such as potassium, calcium and magnesium. ...
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