Week 9 - Neurocognitive Disorders (Delirium, Dementia)

What is Delirium?

A disturbance in attention that develops over a short period of time, with an additional disturbance in cognition

What is Dementia?

A slow, gradual cognitive decline

What are the types of delirium?

• Hyperactive

• Hypoactive

• Mixed

What is the onset & nature of delirium?

It is usually considered a SUDDEN, RAPID ONSET.

Caused by medical issue or substance, can be reversible with treatment.

What are some symptoms of delirium?

• Confused thinking, memory loss

• Fluctuating alertness

• Slurred speech

• hallucinations

• Fearful or anxious behavior

What are some symptoms of dementia?

• Memory loss (short-term first)

• Thoughts start clear

• Mood/affect changes

• Delusions misidentification

• Consciousness stays normal

INSIDIOUS ONSET

SLOW, PROGRESSIVE DEVELOPMENT

What is alcohol dementia?

“Wet Brain”

• Not reversible

• Caused by long-term alcohol abuse

• Leads to permanent brain damage

What is Wernicke Encephalopathy & Korsakoff Psychosis?

Related to alcohol use, very similar to alcohol dementia but can be cured if caught early.

NEED to treat Vitamin B1 deficiency and malnutrition

What could be some causes of delirium?

• Intoxication or Withdrawal

• Drugs

• Stress, Sleep Deprivation

• Emotional Disturbances

What are some things can increase the risk factor of delirium?

• Dehydration

• Electrolyte imbalances

• Infections

• Hepatic encephalopathy

• Metabolic disorders

• Brain tumors

• Vitamin B12 Deficiency

What is alzheimer’s?

The most common form of dementia, has presence of amyloid plaques

What is vascular disease dementia?

The brain doesn’t get enough blood, causing damage over time

Brain doesn’t get enough blood due to strokes, or high BP

What type of care would you provide neurocognitive disabilities clients?

Give them equitable & sensitive care

• Knowledge

• Compassion

• Empathy

• Comfort

• Self-awareness

• Adapt care to client’s needs

What are some personal care you would provide to demented patients?

• Make sure clothes are easy to put on and take off

• Monitor food and fluid intake

  • Finger foods

  • Weigh weekly

• Support independence with ADLs as long as possible

• Encourage use of hearing aids

What is Psychosis?

A loss of contact with reality, where someone may see, hear, or believe things that aren’t real

What can cause psychosis?

• Schizophrenia

• Bipolar disorder

• Severe depression

• Sleep deprivation

• Hyperglycemia

• Hyperthyroidism

What is Schizophrenia?

A chronic mental health disorder that can affect people’s thoughts, feelings, and behaviors. They usually can lose touch with reality (which is called psychosis)

What are the types of psychosis you can have?

• Auditory (hearing)

• Vision (seeing)

• Touch (feeling)

What do you need to be diagnosed with schizophrenia according to DSM-5?

To be diagnosed, you must need 1 of the following for at least 1 month

• Delusions

• Hallucinations

• Disorganized speech

then 2 other symptoms

• Flat affect (no emotion on face)

• Avolition (lack of motivation)

What are some risk factors & causes of schizophrenia?

• Can have genetic impact

• Neurodevelopment

• Hypoxia during birth

• Infections that affect the brain early in life

• Too much cortisol

• Cannabis use (in adolescence)

What are some positive symptoms of schizophrenia?

• Hallucinations

• Delusions

• Disorganized speech

Things that are added to normal behavior!

What are some negative symptoms?

• Alogia (limited speech)

• Anergia (no energy or motivation)

• Anhedonia (no pleasure from things you used to enjoy)

things taken away from normal functioning!

What are some cognitive symptoms?

• Poor concentration

• Slow thinking

• Memory problems

thinking issues

What are the nurses role relating to schizophrenia care?

• Build trust

  • Create a safe, therapeutic relationship

• Ensure safety

• Detect psychosis early

• Assess thoroughly

  • Do a full mental status exam

• Stabilize the client

• Support recovery

What are some treatments & therapies you can use for schizophrenia?

• Recovery-oriented approach

  • Focus on helping the person live a meaningful life, not just reducing symptoms

• Antipsychotics

• Cognitive behavioral therapy

• Family support & education

What is Agranulocytosis?

A life threatening condition where the body has very few white blood cells, WBC NEEDS TO BE MONITORED REGUARLY.

THIS HAPPENS USUALLY WITH CLOZAPINE (MEDICATION)

What is Neuroleptic Malignant Syndrome?

A rare, but life threatning reaction to antipsychotic medications.

• Fever

• Diaphoresis

• Muscle rigidity

• Encephalopathy

• Vital sign instability

What are the 4 types of Extrapyramidal symptoms?

• Acute dystonia

  • Sudden, painful muscle spasms or contractions

• Akathisia

  • Restlessness, constant need to move

• Psudoparkinsonism

  • Slowed movement

  • Muscle rigidity

• Tardive Dyskinesia (TD)

  • Involuntary, repetitive facial body movements

What is Extrapyramidal symptoms?

These are movement related side effects caused by antipsychotic medications