delirium and dementia

risk factors for delirium

• Infection 

• Fluid/electrolyte imbalance 

• Hepatic or renal failure 

• Head trauma 

• Post-anesthesia 

• Seizure 

• Hypoxia 

• Medication-induced 

• Substance intoxication or withdrawal 

risk factors for dementia

• Non modifiable: age, female, ApoE e4 Gene, prior head injury, family history, ethnicity 

• Modifiable: stroke, hypertension, hyperlipidemia, diabetes, social isolation, mental & physical inactivity, smoking 

delirium symptoms

• Altered level of consciousness 

• Dec. Awarenesss of the environment 

• Attention problems (change in attention) 

• Recent memory impairment 

• Disorientation to time and place 

• Language disturbance 

• Perceptual disturbances (illusions, hallucinations) 

• Change in condition 

• Abrupt onset 

• Fluctuating course 

dementia symptoms

• Issues with long-term memory 

• Slow progression from months to years  

• Apathy and withdrawal 

• Inability to complete ADLs 

• Psychiatric symptoms associated with dementia: mood changes, sleep disturbances, apathy, paranoia, aggression, social withdrawal, disinhibition, hypersexuality 

common causes of delirium

• Infection 

• Fluid/electrolyte imbalance 

• Hepatic or renal failure 

• Head trauma 

• Post-anesthesia 

• Seizure 

• Hypoxia 

• Medication-induced (ie sedative/hypnotic, anticholinergic, antihistamine) 

• Substance intoxication or withdrawal 

delirium workup

• Subjective 

• HPI 

• Medication reconciliation 

• Collateral contacts 

• Objective 

• VS 

• Labs (CBC, UDC, UA, urine/blood C&S, LP, HIV, RPR) 

• Imaging (chest x-ray, head CT, MRI) 

• Physical assessment 

• MSE 

dementia workup

Assessment: 

• Interview the pt 

• Interview the caregiver 

• Functional status (ADLs & IADLs) 

Objective: 

• Blood tests: CBC w/ diff, CMP (electrolyte levels, liver, & kidney function), vitamin B12, TSH (thyroid function), ESR, CRP, lipid panel-cholesterol, HIV, lyme 

• Urine C&S 

• EEG 

• Imaging studies: brain imaging such as a CT or MRI scan 

• Neuropsychological exam (MMSE/MoCA/Mini-Cog) 

Nursing care for patients with altered mental status 

Effective communication 

• Maintaining eye contact 

• One-on-one interaction 

• Use of simple, clear language and short sentences 

• Patience 

• No arguing or question of hallucinations/delusions 

Establish a routine 

• Create a daily schedule 

• Utilize visual and verbal reminders 

• Staff consistency 

• Routine assessment of basic needs (food, water, pain, toileting) 

Cognitive interventions 

• Reorientation: frequently cuing the patient about their surroundings, the current time, and place 

• Cognitive stimulation: engage in activities that promote cognitive function 

Environmental modifications 

• Adjust lighting and noise levels to reduce confusion and anxiety 

• Use familiar items surrounding the patient to trigger positive mems and bring comfort 

• Daily natural lighting to regulate the circadian rhythm 

• Physical activity: encourage consistent physical activity & group activities to foster social connections 

Safety considerations for patients with dementia 

• Falls 

• Elopement/wandering 

• Malnutrition 

• Swallowing difficulty 

• Medication management 

• Financial abuse 

• Physical abuse 

• Neglect 

• Electrical/gas safety