unit 14 - cognition and maladaptive behavior

define delerium

acutely disturbed state of mind - restless, illusion, incoherence

sudden onset, can be caused by sleep deprivation and UTI and withdrawal, and infection

reversible because it is caused by something

alzheimers vs dementia

dementia: cognitive function decline, damage to brain cells, memory loss, not sudden onset

alzheimers: most common form of dementia

non pharmacological therapy for dementia

• pet therapy

• distractions minimized

• picture on outside of door

• adequate lighting

• undisturbed sleep at night

• objects kept in same place

• establish routine

• same caregivers

• toilet frequently

• 1 task at a time

• ID on at all times

pharm therapy for alzheimers

cholinesterase inhibitors delay destruction of acetylcholine, reducing symptoms and slowing cognitive decline

drugs do not reverse alzheimers

antidepressants like zoloft are used for the depression aspect

managing memory for cognitively impaired

use communication board

validation therapy

encourage independant ADLs

adaptive devices

toilet Q 2 hr

limit choices and ask simple questions

use gestures and pictures when speaking

validate feelings

use clear and short sentences

risk factors for addiction

trauma

cognitive impairment

concept of addiction

compulsive and maladaptive dependance on a substance (alcohol, coke, opiates, tobacco) or a behavior (gambling, internet, porn)

dependance typically produces adverse psychologic, physical, economic, social, or legal ramifications

s/s of opioid overdose

low bp, low HR, low RR, pinpoint pupils, drowsy, dysrhythmias

s/s of opioid withdrawal

anxiety, n/v, high HR, HTN, high RR, enlarged pupils, rhinorrhea, muscle spasm/pain, hyperreflexia, gooseflesh

interventions for opioid OD

monitor vitals and ECG, risk for resp arrest, narcan

alcohol withdrawal concept

can be life-threatening

watch blood glucose for hypoglycemia

anxiety begins 6-9 hrs after last drink

DTs usually begin 48-72 hrs after last drink

early s/s of alcohol withdrawal

mental status changes

tremors

diaphoresis

tachycardia

HTN

DTs (delirium tremens) of alcohol withdrawal (within 48-72 hrs after last drink)

hallucinations

tremors

agitation

restlessness

sensitivity to light and sound

sleeplessness

interventions for DTs of alcohol withdrawal

• safety is priority: low stimuli, quiet environment, put close to nurse station

• sedatives like lorazepam or librium given q 4-6 hrs

• to prevent wernickes encephalopathy, thiamine and B complex are given (banana bag)

disulfiram/antabuse

treats alcoholism. makes them very sick if they ingest alcohol - toxic reaction that causes intense n/v, HA, sweating

common side effects disulfiram

drowsiness, headache, metallic aftertaste

disulfiram NTK

must be taken consistently to maintain aversion to alcohol

instruct pt: avoid alcohol-based skin products, read all labels of liquid meds, dont breathe paint fumes, stains, or stripping compounds

s/s amphetamine abuse

jitters, anxiety, dilated pupils, tachycardia, heart beating out of chest feeling, HTN, tachydysrhythmias

priority nursing intervention for amphetamine abuse

monitor VS and heart monitor

s/s amphetamine withdrawal

depression, fatigue, anxiety, irritability, paranoia, intense drug cravings, poor concentration