Delirium & Dementia

Learning Objectives

  • Differentiate between delirium and dementia and give an example of a condition that causes each.

  • List five etiologic factors linked to Alzheimer disease (AD).

  • Discuss the pathophysiologic changes associated with AD.

  • Name the first symptom of AD.

  • Identify two methods for diagnosing AD.

  • Explain the mechanism of drug therapy in AD.

  • Describe nursing management for clients with AD.

  • Name three characteristics of schizophrenia.

  • Describe two psychobiologic explanations for schizophrenia.

  • Differentiate between positive and negative symptoms of schizophrenia and give two examples of each.

  • Discuss the medical management of most people with schizophrenia.

  • Name three examples of antipsychotic drugs and their mechanisms of action.

  • Explain the term extrapyramidal symptoms (EPSs) and list four examples.

  • Describe a technique to prevent nonadherence to drug therapy in clients with schizophrenia.

  • Describe the nursing management of clients with schizophrenia.

Delirium and Dementia

Delirium

  • Definition: A sudden transient state of confusion.

  • Causes:

    • Fever

    • Head trauma

    • Infection

    • Drug intoxication

  • Symptoms:

    • Difficulty processing information

    • Disorientation

    • Impaired judgment

    • Poor intellectual capacity

    • Suspiciousness

    • Frightened demeanor

    • Inappropriate behavior

  • Treatment: Address the underlying medical condition.

Dementia

  • Definition: A gradual decline in memory and thinking abilities, often irreversible.

  • Common Causes:

    • Stroke

    • Parkinson's Disease

    • Abnormal gene mutations

  • Characteristics:

    • More commonly affects older adults.

    • Affects daily life due to cognitive decline.

Alzheimer Disease (AD)

Pathophysiology and Etiology

  • Forms of Alzheimer's:

    • Early onset (before 60 years)

    • Late onset (after 60 years, more common)

  • Five Etiologic Factors:

    • Environmental and lifestyle factors

    • Family history with first-degree relative having AD

    • Inherited genetic abnormalities

  • Pathologic Changes in the Brain:

    • Decreased cortex size

    • Deficient acetylcholine levels

    • Presence of neuritic plaques

    • Neurofibrillary tangles

Assessment Findings

  • Signs and Symptoms:

    • Seven distinct stages as per the Global Deterioration Scale

    • Classic first symptom: Memory loss

    • Insidious onset affecting abilities for long-term memory, judgment, and problem-solving

    • Behavioral disturbances and personality changes

    • Advanced stages show deterioration in memory, cognition, awareness, self-care, wandering, and violent behavior

    • Other symptoms may include aphasia, alexia, agraphia, acalculia, agnosia, ataxia, tremors, and apraxia

Diagnostic Findings

  • Methods of Diagnosis:

    • Electroencephalography (EEG)

    • CT Scan

    • PET Scan

    • MRI

    • Emerging use of biomarkers

Medical Management

  • Treatment Approach:

    • No known cure; supportive treatment is the focus

    • Drug therapy: Folic acid supplements, antidepressants, tranquilizers

  • Nursing Management:

    • Encourage client’s independence for as long as feasible

    • Transition to Extended Care Facility (ECF) if appropriate

    • Assess client safety regularly and monitor caregiver burden

Schizophrenia

Definition and Characteristics

  • Definition: A thought disorder characterized by a significant deterioration in mental functioning, disturbances in sensory perception, and affective changes.

  • Pathophysiology and Etiology:

    • Considered a lifelong condition, typically appearing in young adulthood

    • Classified as a psychobiologic disease with a genetic component and some prenatal viral infections

  • Three Characteristics of Schizophrenia:

    • Positive symptoms: e.g., delusions, hallucinations, disorganized speech

    • Negative symptoms: e.g., impoverished speech, difficulties in establishing relationships and emotional expression

Assessment Findings

  • Positive Symptoms:

    • Delusions

    • Hallucinations

    • Fluent yet disorganized speech

  • Negative Symptoms:

    • Impoverished speech

    • Lack of motivation for work/school

    • Poor hygiene and appearance

Diagnostic Findings

  • Diagnosis Methods:

    • Symptom evaluation and ruling out other potential causes

    • Imaging studies including CT, PET, MRI, and brain mapping

Medical Management

  • Therapies Used:

    • Psychotherapy

    • Avoid institutionalization unless there is potential danger to self/others

    • Community mental health services

    • Drug Therapy: includes antipsychotic medications, atypical antipsychotics, and possibly anticholinergic medications alongside anticonvulsants

  • Effects of Noncompliance:

    • For non-hospitalized clients, depot injections may be necessary

    • Risk for extrapyramidal symptoms (EPSs)

Nursing Management

  • Focuses on ensuring continuity of care and medication adherence.

Living with Alzheimer's

  • Video resource: "Living with Alzheimer's - the White Family"

Living with Schizophrenia

  • Video resource: "Living with Schizophrenia"

Case Study on Alzheimer

Patient Background

  • Patient: Frank Brown, a 72-year-old retired accountant with a history of musical talent who shows symptoms of early Alzheimer’s disease.

  • Symptoms: Increasing difficulty with memory and cognitive abilities, leading to retirement from organist positions.

Nurse's Response Questions

  1. On medication: How to address Mrs. Brown's question regarding rivastigmine's effects.

  2. Comparison on medications: Explain to Mr. Brown the reason for different medication prescriptions compared to his friend.

  3. Teaching Plan: Summarize essential points to include in patient education about rivastigmine for the Brown family.