review

Neurocognitive Disorders

• Dementia vs. Delirium

  • Dementia:

    • Slow and progressive cognitive decline.

    • Symptoms: Forgetfulness, disorientation.

    • Irreversible condition.

  • Delirium:

    • Sudden onset, usually occurring over a short period.

    • Symptoms: Confusion, restlessness, agitation.

    • Example: Sundowning - confusion and agitation occurs at night.

• Nursing Care for Delirium/Dementia:

  • Assess family situation and needs for respite care.

  • Offer limited choices to patients to reduce decision fatigue.

  • Maintain a consistent routine and caregiver where possible.

  • Use seat alarms as a safety measure.

  • Engage in reminiscence therapy: help patients review memories.

  • Confabulation: Patients may create false memories to fill gaps in memory.

Sleep and Rituals

• Sleep Rituals:

  • Designate the bedroom only for sleep.

  • Avoid TV and other distractions before bed.

  • Helpful in establishing routines, particularly for children.

Eating Disorders

• Anorexia Nervosa:

  • Symptoms include severe starvation, low body weight, amenorrhea, and elevated suicide risk.

  • Nursing considerations include monitoring cardiac concerns and discouraging excessive exercise.

• Bulimia Nervosa:

  • Characterized by bingeing and purging behaviors, often maintains normal weight.

  • Monitor for hypokalemia and educate on its signs and symptoms.

  • Suicide precautions should be taken for both disorders.

Abuse and Assessment

• Indicators of Abuse:

  • Look for unexplained bruises or injuries during physical assessments.

  • Be aware of denial as a defense mechanism in victims.

  • Nurses are mandated reporters; any suspicion of abuse must be reported.

• Support for Victims:

  • Provide immediate help and discuss shelter or safety services.

  • Understand that perpetrators often have low self-esteem and may be close family members.

Grief

• Types of Grief:

  • Anticipatory Grief: Preparedness for impending loss.

  • Complicated Grief: Issues arise that hinder the grieving process.

  • Disenfranchised Grief: Grief not socially acknowledged (e.g., loss of a pet).

  • Common feelings include guilt associated with loss.

• Hospice vs. Palliative Care:

  • Hospice care is for terminal patients (must be within 6 months of life), focuses on comfort.

  • Palliative care focuses broadly on comfort without strict time constraints.

Crisis and Safety

• Address anxiety by avoiding stimulants like coffee.

  • Maintain safety and be aware that crises can lead to psychotic episodes.

• Types of Crisis:

  • Maturational Crisis: Expected life changes (birth, marriage).

  • Situational Crisis: Unexpected events (job loss, relocation).

  • Adventitious Crisis: Natural disasters or unforeseen emergencies.

Communication in Nursing Care

• When addressing violence, stay calm and assertive.

  • Set clear limits on behavior, maintain a safe distance (arm's length).

  • Use a calm tone, listen actively, and clarify feelings.

Complementary Therapies

• Reiki vs. Acupuncture:

  • Reiki: Energy flows from the practitioner to the patient.

  • Acupuncture: Opens channels in the body to restore energy flow.

Family Therapy

• Encourage productive communication among family members during therapy.

  • Avoid blaming language to reduce conflict and facilitate understanding.

Psychoeducation

• Different from psychotherapy, focuses on educating patients about their conditions and coping strategies.