Delirium, Dementia, and Alzheimer's Overview, Risk Factors and Interventions for Eating Disorders, Dissociative Disorders and Substance Abuse Overview Exam

Delirium

Rapid onset over a short period of time; can be hyperactive with agitation and restlessness, hypoactive with apathy and quietness, or mixed with a combination of both. Causes include hospitalization, malnutrition, depression, electrolyte imbalance, or substance abuse. Reversible if diagnosis and treatment of underlying cause are prompt.

Dementia

A condition characterized by cognitive decline, requiring nursing interventions such as protecting the client from injury, assigning them close to the nurse's station, using memory aids, maintaining a consistent routine, and reinforcing orientation to time, place, and person.

Apraxia

Impaired Movement.

Aphasia

Impaired speech.

Confabulation

Behavioral reaction to memory loss in which the individual fills in memory gaps with fictitious statements.

Enabling

Pattern of either consciously or unconsciously helping someone else's maladaptive behavior to continue.

Alzheimer's

A type of dementia that may require nursing actions for caregiver fatigue, such as listening to caregivers and providing information on local support groups and respite care alternatives.

risk factors of substance abuse disorder

Family history, genetics, chronic stress, socioeconomic factors.

Heroin Use Symptoms

Drowsiness, slurred speech, memory lapses, respiratory depression.

Naloxone Purpose

Prevents relapse; blocks opioid effects.

Methadone Purpose

Prevents abstinence syndrome; aids long-term maintenance.

Anorexia Nervosa Interventions

Structured meals, small frequent servings, diet high in fiber.

Weight Gain Goal

Minimum 50% of meals consumed; 2 pounds weekly.

Physical Findings of Anorexia

Low BP, 85% less than normal weight, lanugo.

Bulimia Communication

Encourage feelings; provide positive feedback; neutral approach.

Bulimia Lab Values

Electrolyte imbalance, metabolic acidosis, abnormal blood glucose.

Purging Behavior Signs

Physical signs indicating compensatory behaviors after eating.

Eating Disorder Comorbidities

Includes depression, personality disorders, substance abuse.

Chronic Stress

Long-term stress impacting mental and physical health.

Lowered Self-Esteem

Negative self-image contributing to addictive behaviors.

Trauma Impact

Past trauma increasing risk for addiction disorders.

Combat Experience

Military background influencing susceptibility to substance abuse.

Lowered Pain Tolerance

Reduced ability to cope with physical discomfort.

Dysrhythmias

Irregular heartbeats associated with anorexia complications.

Acidosis

Excess acid in body fluids, common in bulimia.

Electrolyte Imbalance

Disruption in body's mineral balance, often in eating disorders.

Multi-Vitamin Administration

Supplementing nutrients for clients with anorexia.

Acrocyanosis

Bluish discoloration of extremities, often seen in anorexia.

Dissociative Amnesia

Inability to remember important personal information, typically of a traumatic or stressful nature.

Dissociative Fugue

Subtype of dissociative amnesia where the person suddenly and unexpectedly travels away from home or work and is unable to recall all or part of their identity or past.

Malingered Fugue

A form of dissociation that is intentional, often used to avoid legal, financial, or personal consequences.

Disulfiram (Antabuse)

Used as aversion therapy to prevent alcohol use.

Disulfiram Mechanism

When alcohol is consumed while taking disulfiram, it causes acetaldehyde syndrome, which can be life-threatening.

Acetaldehyde Syndrome Effects

Nausea, vomiting, weakness, sweating, palpitations, hypotension, severe: respiratory depression, seizures, cardiovascular collapse, death.

Nursing Actions for Acetaldehyde Syndrome

Monitor liver function tests for hepatotoxicity; do not give until at least 12 hours after last drink.

Client Education for Acetaldehyde Syndrome

Avoid all alcohol-containing products (cough syrup, aftershave, hand sanitizer, etc.); effects last 2 weeks after stopping the medication; wear a medical alert bracelet; participate in self-help programs.

Acamprosate

Purpose: reduces unpleasant withdrawal effects like dysphoria, anxiety, restlessness; route: oral, 3 times a day; side effects: diarrhea (maintain hydration); contraindication: avoid in clients with kidney impairment.

Propranolol & Atenolol (Beta Blockers)

Purpose: decrease craving; lower BP and HR; nursing action: monitor HR before giving; hold if <50 bpm.

Withdrawal from Alcohol Onset & Duration

Begins within 4 to 12 hours after last drink; can continue 5 to 7 days.

Common Signs/Symptoms of Alcohol Withdrawal

Nausea/vomiting, tremors ('the shakes'), restlessness, insomnia, diaphoresis, increased BP, HR, RR, Temp, seizures (1-2 days after cessation), hallucinations and illusions, tonic-clonic seizures may occur without other symptoms.

Withdrawal Delirium (Delirium Tremens)

Onset: 2-3 days after stopping alcohol; considered a medical emergency; S/S: severe disorientation, psychotic effects (hallucinations), severe hypertension, cardiac dysrhythmias, can progress to death.

Nursing Interventions During Withdrawal

Primary focus: safety; seizure precautions; maintain safe environment (prevent falls); 1:1 supervision as needed; use restraints only as a last resort; reorient to time/place/person; maintain hydration and nutrition; low-stimulation environment; administer prescribed withdrawal medications; monitor for covert substance use; provide emotional support; educate about codependency, abstinence, and medication safety; begin motivational interviewing and emergency planning; encourage self-help group attendance.

Purpose of Naloxone (Narcan)

Used to reverse opioid overdose; rapidly displaces opioids from receptors; can precipitate acute withdrawal in dependent individuals; administered IV, IM, SQ, or intranasal; short half-life, may require repeat doses.

Purpose of Methadone

Oral opioid agonist that replaces the opioid the client is dependent on; prevents abstinence syndrome; used for withdrawal and long-term maintenance; legally prescribed and dispensed through approved programs only; transfers dependence from illegal opioids to methadone, which can then be gradually tapered under medical supervision.

Delirium

Rapid onset over a short period of time; hyperactive with agitation and restlessness; hypoactive with apathy and quietness; mixed, having a combination of hyper and hypo manifestations; unclassified for those whose manifestations do not classify into other categories; causes: hospitalization, malnutrition, depression, electrolyte imbalance or substance abuse; reversible if diagnosis and treatment of underlying cause are prompt.

Dementia Nursing Interventions/Plan of Care

Protect the client from injury; assign close to nurse's station; memory aids; consistent routine; reinforce orientation to time, place, and person.

Apraxia

Impaired Movement

Aphasia

Impaired speech

Confabulation

Behavioral reaction to memory loss in which the individual fills in memory gaps with fictitious statements.

Enabling

Pattern of either consciously or unconsciously helping someone else's maladaptive behavior to continue.

Nursing actions for caregiver fatigue

Listening to caregivers, providing information on local support groups and respite care alternatives.

Risk Factors for Addictive Disorders

Family History, Genetics, Chronic Stress, Socioeconomic Factors, Abuse, Trauma, Combat Experience, Lowered Self-Esteem, Lowered Tolerance of Pain and Frustration.

Heroin Use: physical complications related to use

Drowsiness, slurred speech, inattention, memory lapses, pupil constriction, impaired motor coordination, respiratory depression, unconsciousness, death.

Purpose of naloxone

Used to prevent relapse after opioid detoxification; if used concurrently with opioid, the pleasurable effects are blocked.

Purpose of methadone

Prevents abstinence syndrome, long term maintenance and withdrawal.

Nursing interventions for weight gain in Anorexia Nervosa

Consider the clients preferences, structured inflexible at the start of therapy only permitting food during scheduled times, provide small frequent meals, provide liquid substitutes as prescribed, provide a diet high in fiber, provide low sodium, administer multi-vitamin, contract.

Expected weight gain goals for Anorexia Nervosa

Consumes a minimum of 50% of three meals a day, gains at least two pounds in 7 days of admission, eats three meals a day in the dining room.

Expected physical findings of anorexia

Low bp with possible orthostatic hypotension, 85% less than normal body weight, fine downy hair (lanugo), yellowed skin, pale and cool extremities, dysrhythmias, heart failure, peripheral edema, acrocyanosis, acidosis, alkalosis, dehydration, electrolyte imbalance, muscle weakness, decreased energy, loss of bone density, constipation, abdominal pain.

Bulimia Therapeutic communication

Encourage clients to verbalize their feelings, and give positive feedback for doing so. Use a neutral matter of fact approach and point out the behavior to the client that is unacceptable.

Lab values in Bulimia

Electrolyte Imbalance, Metabolic Acidosis, Decrease of blood bicarbonate, increased blood bicarbonate, abnormal blood glucose, elevated bun, increased liver enzymes, elevated cholesterol.

Physical signs of purging behavior

Teeth erosion, Calluses on hands

Eating Disorder Comorbidities

Depression, personality disorders, substance abuse disorders, and anxiety.