Ch 13 Delirium and Dementia

Definition: Delirium is defined as a short-term confusional state characterized by a sudden onset. It is typically reversible in nature.
Consciousness and Awareness: The condition is primarily characterized by disturbances in consciousness that significantly impair an individual's awareness of their environment.
Attention and Focus: Individuals suffering from delirium may experience extreme difficulty in focusing or paying attention, which makes them easily distracted by external stimuli.
Cognitive Impairments:
- Memory: Impaired recent memory is a common clinical feature.
- Orientation: Patients often exhibit disorientation.
- Language: Language problems are frequently observed during the delirious state.

Etiology (Causes):
- Certain underlying medical conditions.
- Substance intoxication.
- Substance withdrawal.
- Exposure to poisons.
Nursing Interventions: Clinical focus is directed toward managing several key areas:
- Impaired cognition.
- Sleep disturbances.
- High potential for injury to the patient or others.

Cognitive Decline: This disorder involves a modest decline in cognitive function.
Independence: Unlike major neurocognitive disorders, individuals with Mild NCD function well enough to continue living independently.
Associated Symptoms: Patients may exhibit several psychological and physiological symptoms, including:
- Apathy.
- Sleep disturbances.
- Hallucinations.
- Anxiety.
Nursing Focus: Interventions are primarily centered on developing and supporting strategies to cope with impaired memory.

Nature of the Condition: Major Neurocognitive Disorder is chronic and irreversible, which distinguishes it from the short-term and reversible nature of delirium.
Core Impairments: It is characterized by memory impairment and various other cognitive deficits, including:
- Impaired intellectual function.
- Reduced problem-solving ability.
- Impaired judgment.
- Deficits in memory and orientation.
- Exhibition of inappropriate behavior.
Classification: Dementia is not classified as a specific disease itself but rather as a clinical syndrome—a collection of symptoms that can occur with many different types of diseases.
Impact on Daily Life: The syndrome leads to a significant impairment in the performance of activities of daily living (ADLs).

Primary Types of Dementia:
- Alzheimer’s Disease: A leading cause of dementia.
- Vascular Dementia: Results specifically from damage to brain cells caused by an inadequate blood supply to the brain.
- Pick Disease.
- Huntington Disease.
- Creutzfeldt-Jakob Disease.
Other Associated Conditions: Dementia symptoms may also be associated with:
- Normal pressure hydrocephalus.
- Subdural hematoma.
- Brain tumors.
- Neurosyphilis.
- Acquired immunodeficiency syndrome (AIDS).

Brain Changes: Characteristic pathological changes in the brain of a person with Alzheimer's include:
- Deposits of the protein amyloid.
- Neurofibrillary tangles specifically associated with altered tau protein.
- A significant deficiency of the neurotransmitter acetylcholine.
Differential Diagnosis Note: Inadequate blood supply is a hallmark of vascular dementia, rather than the primary characteristic of Alzheimer's disease pathology.

Differentiating Delirium vs. Dementia:
- The physician must determine when the confusion first started (onset).
- Assessment data must clarify whether the confusion has been constant (progressive) or intermittent.
Data Collection and Observation:
- Observe behavior closely.
- Collect specific data regarding orientation, memory, and sleep habits.
- Obtain information from the family if the patient is unable to provide a history.
Medical History and Pharmacology:
- List all acute or chronic illnesses.
- Document all current medications, including home remedies and over-the-counter (OTC) drugs.

Primary Medications: The following drugs are commonly used to treat symptoms of Neurocognitive Disorders:
- Aricept
- Exelon
- Razadyne
- Namenda
Adjunct Therapies: Antidepressants and antipsychotics may also be prescribed depending on the patient's specific behavioral and psychological symptoms.

Prioritized Interventions:
- Addressing impaired activities of daily living (ADLs).
- Ensuring adequate nutrition.
- Managing sleep disturbances.
- Preventing potential for injury.
- Managing behavioral disturbances.
- Addressing the inability to communicate effectively.
Guidelines for Patient Interaction:
- Nurses must recognize that patients usually forget things relatively quickly.
- Nurses must accept that patients are usually unable to learn new things.
- Agitation is often a communication tool; it may indicate pain, hunger, stress, fear, or a specific need for toileting.
Creative Care and Approaches:
- Nurses should use the concepts of memory loss and the inability to learn new things to be creative in care plans.
- Cognitive Developmental Approach (CDA): A structured approach used in the management and care of patients with cognitive decline.

Question 1: What is the name of the syndrome that is chronic, generally considered irreversible, and characterized by memory impairment accompanied by many other cognitive deficits leading to impaired activities of daily living?
- Answer: C. Dementia.
Question 2: Characteristic changes in the brain of a person with Alzheimer’s dementia (AD) include all of the following EXCEPT:
- Options: A. Deposits of the protein amyloid; B. Neurofibrillary tangles associated with altered tau protein; C. A deficiency of acetylcholine; D. Inadequate blood supply to brain.
- Correct Answer: D. Inadequate blood supply to brain (this is characteristic of Vascular Dementia).