Nursing care of patient with Dementia

8/7/2019 Nursing care of patient with Dementia

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NURSING CARE

OFPATIENT

WITHDEMENTIA

PRESENTED BY:

H. RUFUS RAJ,

LECTURER, ACON


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DEFINITION

Deprived of mind"

A progressive organic mental disorder

characterized by personality changes, confusion,disorientation, and deterioration of intellect

associated with impaired memory and judgment

Dementia is a syndrome characterized bydysfunction or loss of memory, orientation,

attention, language, judgment, and reasoning


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INCIDENCE

Most often in older adults

Increases with aging

60% to 80% of the patients with dementiahaving the diagnosis of Alzheimers disease

60,000 new cases are diagnosed in Canada

each year


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ETIOLOGY

NEURO DEGENERATIVE

DISORDERSAlzhiemers diseaseFrontal lobe dementiaDown syndromeParkinsons diseaseHuntingtons disease

VASCULAR DISEASESqCardiac diseaseqSubarachnoid hemorrhageqSubdural hematoma

SYSTEMIC DISEASESoEncephalopatyo

Wilsons diseaseoHepatic encephalopathy

TRAUMAHead injury

METABOLIC ORTOXIC DISEASEvAlcoholismvThiamine deficiencyvHyperthyroidismvHypothyroidismvHyperglycemiavHypercalcemia

IMMUNOLOGICDISEASES

Multiple sclerosisChronic fatigue

syndromeInfectionsMeningitisEncephalitisNeurosyphilis

TUMORSvBrain tumorsvMetstatic tumors

VENTRICULARDISORDERS

Hydrocepalus

SEIZURE DISORDERS

DRUGSDiureticsDigoxinAnticolinergicsOpoidsHypnoticsAntiypertensives


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CLASSIFICATION

Slowly progressive dementia

Begins gradually and worsens progressivelyover several years

Caused by neurodegenerative disease, that is,by conditions affecting only or primarily theneurons of the brain and causing gradual but

irreversible loss of function of these cells.

Eg. Alzheimer's disease, Vascular dementia


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Rapidly progressive dementia

Possible causes include

Brain infection (viral encephalitis, subacutesclerosing panencephalitis,

Tumors : lymphoma or glioma

Drug toxicity (e.g. anticonvulsant drugs)Metabolic causes: liver failure or kidney failure

Brain injury: chronic subdural hematoma.


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Pathophysiology

Vascular dementia or multiinfarct dementia

Ischemic, ischemic hypoxic & hemorrhagic lesions

Narrowing & blocking of arteries that supply the brain

Decreased blood supply to the brain


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CLINICAL MANIFESTATIONS

EARLY (mild)

ForgetfulnessSort term memoryimpairmentLoss of initiative &interestDecreased judgementGeographic

disorientation

MIDDLE (moderate)Impaired ability torecognise family

membersAgitation

Lss of remote memoryConfusionInsomniaDelusions

HallucinationsApraxia

Behavioural problems

LATE (severe)Little memoryCannot understandwordsDifficulty ineating/swallowingRepitious wordsImmobilityIncontinence

Unable to perform selfcare activities


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DIAGNOSTIC EVALUATION

ASSESSMENT

MINI MENTAL STATUS EXAMINATION

Orientation to timeRegistration

Naming

Reading

IMAGING STUDIES


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MANAGEMENT

PREVENTIVE MEASURES

Treatment of risk factors

Hypertension Diabetes

Smoking

Orthostatic hypertension

Cardiac dysrythmias


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NURSINGCARE

OF

PATIENTWITHDELIRIUM


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DEFINITION

Delirium is the state of temporary but acutemental confusion , is a common, life threatening& possibly preventable syndrome in older adults

Delirium is a common and severeneuropsychiatric syndrome with core features ofacute onset and fluctuating course, attentional

deficits and generalized severe disorganizationof behavior


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CORE FEATURESDisturbance of consciousness (that is, reduced

clarity of awareness of the environment, withreduced ability to focus, sustain, or shiftattention)

Change in cognition (e.g., problem-solvingimpairment or memory impairment) or aperceptual disturbance

Onset of hours to days, and tendency tofluctuate.


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INCIDENCE

Hospital setting: 15% to 53%(postoperatively)

Intensive care setting: 70% to 87%

The highest prevalence of delirium isgenerally seen in critically ill patients in theintensive care unit or ICU ( ICU Psychosis)


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FACTORS PRECIPITATING

Demograpic

characteristics:65 years or olderMale gender

Cognitive status:Dementia

Cognitive impairmentH/O deliriumDepression

Environmental:ICU admissionUse of physical

restraintsPain (untreated)Emotional stressProlonged sleepdeprivation

Functional status:

Functional dependenceImmobilityHistory of falls

Sensory:Sensory deprivation

Sensory overload

Decreased oral intake:DehydrationMalnutrition

Drugs:Sedative hypnoticsOpioidsAnticholinergic drugsAlcohol or drugwithdrawl

Coexisting medicalconditions:

Severe acute illnessChronic renal or hepaticdiseaseH/O stroke

Neurologic diseaseInfection/sepsisFracture/TraumaTerminal illnessHIV infection

Surgery:Orthopedic surgeryCardiac surgeryNon cardiac surgery


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PATHOPYSIOLOGY

Precipitating factors (cholinergic deficiency,excess release of dopamine, and both, incereasedor decreased serotonergic activity

Delirium persists for months and that it mayeven be associated with permanent decrementsin cognitive function


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CLINICAL MANIFESTATIONS

Inability to concentrate

Irritability

InsomniaLoss of appetite

Restlessness

Confusion

Agitation

Misperception


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DRUG THERAPY

Low dose anti-psychotics

Haloperidol,

Side effects- hypotension, extrapyramidal sideeffects, tardive dyskinesia, athetosis, muscle tonechanges

RisperidoneOlanzapine

Quetiapine

Short acting benzodiazepines: lorazepam


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COLLABRATIVE & NURSINGMANAGEMENT

The role of nurse includes prevention,early recognition, & treatment

Recognizing patients who are at risk

Neurological disorders (Stroke ,dementia, CNS infection, Parkinsons

disease), sensory impairment &

advanced age.

Untreated pain

Eliminating the risk factors


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Reorientation or behavioral interventions

Reorientating to time , place, & procedures

Scheduling the activities of patients

Enhancing communication

Use of restraints should be avoidedRecreation therapy

(Relaxation techniques, music therapy,

massage)Interdisciplinary approach

Polypharmacy, pain, nutritional status

Prevention of com lications of immobilit

S O S G AG OS S


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LIST OF NURSING DIAGNOSES1. Disturbed thought process related to effects of

Dementia as evidenced by loss of memory &other cognitive deficits

2. Deficit in self-care (bathing, dressing, toileting)related to memory deficit and neuromuscularimpairment as evidenced by inability toindependently and appropriately bath, dress ortoilet.

3. Risk for injury related to impaired judgment,possible gait instability, muscle weakness &sensory/perceptual alterations .

4. Wandering related to disease process as


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Than

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Nursing care of patient with Dementia

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