Part 2 Delirium • Delirium Nursing Care • Anticholinergics • Dementia • Pseudodementia • Stages of Dementia

What are neurocognitive disorders?

Disorders caused by changes in the brain that impair orientation, memory, intellect, judgment, and affect.

What are the two major neurocognitive disorders discussed in this lecture?

Delirium and dementia.

What is delirium?

An acute disturbance in cerebral metabolism that causes sudden changes in cognition, behavior, and awareness.

Why is delirium considered a medical emergency?

It can lead to death or permanent cognitive decline if untreated.

How does delirium typically begin?

Suddenly over hours to days.

What conditions commonly trigger delirium?

Infection, surgery, myocardial infarction, head trauma, medication intoxication, chronic hypoxia, and renal failure.

How does cognition change during delirium?

It fluctuates throughout the day with occasional periods of clarity.

What types of disorientation occur in delirium?

Time, place, and person.

How are thought processes affected in delirium?

They become disorganized with impaired judgment and poor decision-making.

What perceptual disturbances occur in delirium?

Hallucinations and misinterpretation of stimuli.

How does mood often appear in delirium?

Labile and rapidly changing.

What behaviors may occur in delirium?

Wandering, assaultive behavior, disinhibition, low energy, or poor engagement.

Which cognitive processes are affected by delirium?

Consciousness, attention, cognition, perception, and motor ability.

What is the overall goal of delirium treatment?

Return the patient to their previous cognitive and functional baseline.

What is the highest nursing priority when caring for a patient with delirium?

Maintaining physiological needs and patient safety.

What physiological needs may require nursing intervention during delirium?

Nutrition, hydration, medications, one-to-one observation, urinary catheterization when necessary.

When should restraints be used for delirium?

Only as an absolute last resort.

How can nurses compensate for cognitive deficits in delirium?

Frequent reorientation and reinforcing reality.

How should instructions be given to a patient experiencing delirium?

Clear, simple, and brief.

How should the environment be managed during the day for delirium?

Lighted room with minimal clutter.

How should the environment be managed at night?

Dark room whenever possible, with warm yellow light only if needed for safety.

Why should excessive nighttime lighting be avoided?

It may worsen delirium even though it reduces fall risk.

Why should teaching be repeated frequently during delirium?

Retention is impaired.

What underlying causes should always be evaluated in delirium?

Sepsis, bowel or bladder problems, and recent head injury.

What does palliative treatment mean in delirium?

Symptom management rather than cure.

Why are physical restraints avoided in delirium?

They increase the risk of injury and impaired circulation.

Why are chemical restraints avoided in delirium?

They may worsen or prolong delirium and increase respiratory depression.

Why are older adults especially sensitive to anticholinergic medications?

They metabolize medications more slowly, have fewer acetylcholine receptors, and produce less acetylcholine.

What neurotransmitter decreases with aging, increasing anticholinergic sensitivity?

Acetylcholine.

Which medications commonly have significant anticholinergic effects?

Tricyclic antidepressants, diphenhydramine, and antimuscarinic medications.

What is dementia?

A chronic, progressive loss of cognitive function that significantly interferes with daily functioning.

Is dementia considered a normal part of aging?

No.

What percentage of dementia cases are Alzheimer's disease?

Approximately 70%.

What causes dementia?

Neurostructural and neurochemical brain changes caused by trauma, infection, cerebrovascular disease, substance use, or genetics.

What is pseudodementia?

Reversible cognitive impairment caused by depression.

How is pseudodementia treated?

By treating the underlying depression.

Why is pseudodementia important to recognize?

It can improve when depression is treated.

How does dementia typically develop?

Gradually over time.

Does dementia cause sudden changes in consciousness?

No.

What cognitive abilities decline in dementia?

Memory, judgment, abstract thinking, and personality.

What is the overall nursing goal for dementia?

Help the patient function at the highest level possible using remaining abilities.

What occurs during Stage I (mild) dementia?

Repeats words, forgets names, gets lost, loses items, early ADL problems, subtle personality changes, decreased interest.

How long does Stage I usually last?

Approximately 2–4 years.

What occurs during Stage II (moderate) dementia?

Obvious memory loss, confusion about recent events, decreased ADLs, anxiety, depression, behavioral problems, close supervision needed.

How long does Stage II usually last?

Approximately 2–10 years.

What occurs during Stage III (severe) dementia?

Poor memory, little recognition of familiar people or self, minimal speech, total dependence for ADLs, decreased mobility.

How long does Stage III usually last?

Approximately 1–3 years.

What is the nursing priority for patients with dementia?

Maintaining the highest possible level of functioning.

What should nursing care focus on rather than tasks?

The person.

What should be adjusted during dementia care?

Communication strategies, responses to behaviors, and the patient's environment.

Who should receive education about dementia?

Both the patient and family.