hi class my name is Professor Paula and we're going to talk about alterations in cognition today what are learning objectives we're going to explain the path of physiology for cognition explore epidemiological and Theological risk factors describe the impact of overall health differentiate the clinical presentation of client experienced alteration and condition explore the role of the nurse when caring of clients experience alteration in condition and apply nursing process through use of the clinical judgment function while providing care to clients experiencing alterations in condition cognition is controlled by the brain and neurons which send signals throughout the body to help control movement and behaviors it also controls processes related to problem solving memory coding storage and recall and language and comprehension adequate blood flow to the brain must be established and maintained to ensure oxygen reaches all the neurons and neurotransmitters to allow for appropriate communication and function the brain is a complex organ designed to communicate by sending signal throughout the body in order to function and operate first condition we're going to talk about is dementia dementia occures when injury or physiological changes within the brain cause damage making it difficult for signals to be sent to and from the brain when the communication is disrupted changes in behaviors emotions thinking problem solving concentration and memory can occur as the disease progress the changes and decline in cognition lead to an ability to carry out activities of daily living and function both simple and complex task may be difficult for the client to perform leading to insufficient self-care and health and safety risk as client's age they are likely to experience changes in cognition but dementia should uh should never be an expected change with aging it is important to realize that many disease processes medications and even treatment can cause demential like manifest ations the cause of demential like manifestations can usually be treated and cognitive effects are reversed the factor that influence the development and progression of dementia should be identified as soon as possible so that client may be diagnosed quickly and correctly with dementia alterations related to cognition may occur due to a variety of reasons and can lead to a variety of Behavioral and uh and empowerment behaviors and empowerment clients who experience this empowerments may experience acute or chronic manifestations dementia is the result of a change in the brain that impairs cognitive processes types of dementia are vascular dementia Levi body dementia frontal temporal dementia and mixed dementia and we are going to talk about them in the next a couple slides vascular dementia and it's more most common dementia occures when there are changes to the vasculature within the brain the blood vessels within the brain are altered due to blood vessel damage causing disruption of oxygen flow the interruption of oxygen supplies supply to the brain make it difficult for the brain to communicate which causes changes in cognitive function l dementia occurs due to deposits of um protein found in the brain this deposits are called Alpha uh clean also known as Levi bodies the deposits block communication in the brain because they are not normally found within the brain these deposits can cause imper communication between neurons and lead to change in thinking communication mod movement and emotional processing frontal temporal dementia is a rare form of dementia seen in clients younger than 60 you might heard that Bruce Will is the one who has a front of temporal dementia this type of dementia affects the frontal L of the brain causing changes in behaviors and temporal Lopes of the brain causing changes with language and emotions the changes in this areas of the brain are are created by an increased number of specific protein to and TDP 43 leading to the loss of nerve cells mixed dementia occures when clients show characteristic of more than one type of dementia diagnostic um Imaging of the brain will reveal characteristic causing neuron damage associated with different forms of dementia influencing the mix of manifestation the client May display the causes of dementia may be either treatable or untreatable depending on risk factors and the time of detection and treatment Alzheimer's disease is the most common cause of dementia accounting for 60 to 80% of the population who has dementia Alzheimer disease will be discussed in a more detail later in this Le lesson vascular dementia is considered the second most common type type of dementia causes of vascular dementia are discover disorders that cause changes to the vasculature of the brain leading to decreased supply of the oxygen in the brain such as hematomas hemorrhages and cereal vascular accident also known as a CVA or Strokes risk factors associated with dementia include Advanced age unhealthy diet and lack of physical activity while age is a risk factor beyond the client's control diet and physical activity can be controlled by the client eating a balance diet can help reduce or control overall blood pressure fluctuation of the blood glucose level and the build up of cholesterol within the vessels which can help reduce changes of uh chances of changes occurring in brain inje of drugs and alcohol exposure to air pollution and lower social economic status are also risk factors that can contribute to cognitive decline a nurse should be aware of risk factors that place the client at greater risk for developing dementia such as a brain injury Alzheimer disease cardiovascular issues and neurogenerative disease like Huntington disease uh and verik Caraco syndrome comorbidities associated with dementia can defer due to the variety of potential causes of dementia comorbidities that may exist with or lead to dementia include Advanced age hypertension high cholesterol levels diabetes depression and Social Anxiety isolation disease processes such as hypertension especially with poorly control can potentially disrupt oxygen flow to the brain high cholesterol and high blood glucose level can contribute to heart disease mental health disorders such as depression and anxiety and social isolation are associated with decreased cognitive stimulation according to the World Health Organization Dem Mantia is among the top 10 causes of death disability and dependency around the world 55 million people are living with this disorder within the United States and worldwide and 10 million of new cases are being reported each year this are several reasons why there may be an increase the number of clients who have dementia to begin with clients are living longer which means increased exposure to toxins like air pollution which create changes in the brain another reason for uh for the increase in the number of clients who have dementia could be attributed simply to the growing number of Americans within the United States and the increase of clients who who are 65 and older known as the baby boomer generation a larger population means more clients who have the risk of developing dementia overall health of an individual who has dementia will vary based on the individual's previous level of functioning the manifestation of dementia progress gradually and will impact cognitive processes but do not impact level of consciousness the manifestations that can occur will impact the client's quality of life and ability to carry out activities of daily living independently in turn the impact of dementia on a client's family can be significant and widespread impacting their physical mental and financial abilities psychos social consideration should be evaluated based on the impact of on the client in client caregivers the client may experience changes in mood due to the disorder however since dementia does not impact Consciousness the client may be aware of the cognitive manifestations they are experiencing this can create feelings of frustration fear sadness and anxiety for caregivers caring for a family member who has dementia can lead to feeling of stress and emotional distress it can also create other burdens such as Financial which can create additional hardships dementia should not be considered a normal part of agent with age some disease process can impact a client's senses movement and even the ability to carry out activities of daily living examples include healing loss or visual deficit hormonal electrolyte imbalances respiratory respir alterations these changes within a client who is also experiencing dementia can lead to increased confusion and interfere with a client's ability to perform activities of daily living the Aging adult may need additional help and may not be suited suited um to stay alone this can prove difficult for the Health Care team and caregivers as they try to maintain the client's Independence while promoting their overall safety clinical presentation the first thing many clients and family members May notice with dementia is memory loss memory loss is an early manifestation of dementia but it may not be the only man manifestations client experienced manifestations that are also associated with the Dimension include changes in judgment and problem solving confusion wondering getting lost and changes in speaking and uh language starting with difficulty remembering words to being unable to express or understand thoughts and words most types of dementia are progressive diseases meaning clients will manifest symptoms infrequently and less severe at first but over time will start having more frequent and severe manifestations some clients May display mild memory loss in which they forget their where they placed an item orward as the disease Pro uh process progress clients who have dementia may forget more frequently causing them to get lost clients may also start to display changes in judgment and problem solving abilities making it difficult to carry out tasks such as playing paying the bills or handling money their speech and language may change as well and clients May begin to forget words more often even for common objects referring to them by unfamiliar names instead soon clients may also have difficulty completing normal activities of daily living in a timely manner and they can begin to lose interest or they can have issue with balance and coordination also impacting activities of daily living as the disease process worsen some clients can experience hallucinations delusions and paranoia begin wandering and act impulsively or without regard to other people's feelings this can lead to additional burden for car givers if they strive to keep the client safe but more supervision as needed Laboratory Testing and diagnostic studies are limited in the diagnosis of dementia specific lab tests such as electrolyte levels hemoglobin and hematocrite levels liver function test and certain hormone levels as well as diagnostic studies like CT scans and MRI of the brain can benefit the healthc care team by ruling out a condition causing demential like manifestations or through physical assessment and medical history can help the health care provider assess for manifestation of dementia additional neurological testing should include a mental health assessment and well as well as test to measure problem solving abilities and memory recall like um such as checking for uh immediate memory if immediate memor is in tact or not we are asking telling our patient uh five words and then asking them to repeat this words in five minutes that's how we check immediate memory the role of the nurse uh when caring for a client who has dementia should focus on safety maintaining Independence and quality of life and reducing caregiving caregivers strain a nurse will play crucial role in the assessment of uh and monitoring for cognitive decline as well as client and family teaching the nurse will work with the client the client's Health Care team and clients family caregivers to provide a safe home and Hospital environment environmental stimula can have an impact on the care of the client who has dementia depending on the severity or stage the client is experience they can become frustrated or even fearful of unfamiliar areas and should work with family caregivers to reduce anxiety and frustration but promoting a quiet environment and establishing of a regular routine with periods of activity and rest throughout the day for the client those clients um uh really like to have the same environmental like the same room they know where everything is um you need to talk to to them and really calm ensuring positive voice and make sure to use your therapeutic communication the individuals present in a client's environment can also have an impact on the client the need for interaction and socialization with family and friends does not go away because the client has dementia a nurse should consider facilitating time for the client to meet with friends and family whenever it's possible it would benefit a nurse to become familiar with the client to help identify stressors and uh usual responders as well as identify sufficient support um and resources safety considerations for the client who has dementia should be continuously assessed and the as the disease process client needs a safety concern may be change or increase safety consideration should include the physical environment and environmental stimula as well as physical and psychological changes occurring to the client such as changes in Behavior emotions or even physical Mobility as dementia progresses the environments the client is living in and interacting with daily can lead to safety concerns for the client a nurse should work with the client and family to identify safety concern within the home or and living environments these concerns um can range from Fall hazards to equipment functioning such as stoves and hot water heaters a nurse should include other members of The healthc Care team to identify environmental safety concerns for clients who have dementia and are living at home and it doesn't matter if this uh patient lives at home alone or with someone if patient doesn't have 247 uh survivance even if someone at home every evening it still can be dangerous for the patient we can educate a family uh to remove some throw rocks quarts or VES that Expose and can cause a client to trip and making sure the client has proper uh properly fitting shoes adequate lightning throughout the home and handrails maybe in bathrooms the client who has moderate or severe dementia maybe it risk for wandering or getting lost more frequently and N should discuss with family and caregivers they need to lock locking um locking doors and consider any additional locks and maybe alarm systems and if the patient wants to go outside and walk maybe someone else need to go with this patient and and walk with this patient um some environmental stimula can lead to increased confusion agitation or fear a nurse should work with the health care team and providing care um in uh alternate location such the outpatient cleaning and rehabilitation centers uh individuals factors that can influence client care well treating clients who have dementia include the client's personality level of functional ability uh and communication and nurse will collaborate with the client client family and caregivers to learn about the client's personality how they respond to stress any personal changes and um nurse should spend some time with the patient to learn a little bit about the patient um uh client and caregiver uh education related to diena should focus on maintaining quality of life the nurse should provide client education focusing on treatment options a manifestation uh of the uh manifestation of the um complications and planning for the future a nurse should focus on providing teaching on necessary topics using clear concise information to the client in the family um there is not a specific diet that can eat uh in the treatment of dementia instead poor diet can be influenced by dementia and the client who has dementia is at risk for nutritional deficit fluid and electrolyte imbalance pharmacological factors that a nurse should be aware of and manage when caring for client with dementia vary they are medication that exist to slow the progression of dementia caused by Alzheimer disease but will not cure or re reverse manifestation of the illness a Nur should be aware of risk factors that increase the risk of dementia such as brain injury Alzheimer's cardiovascular uh issues and neurogenerative disease such as hun Huntington um a nurse geing for a client should work with family and Care Gears of the clients to determine if the client has displayed any manifestations at home and for how long physical assessments of the client should be evaluated frequently to determine the severity of dementia physical assessments includes the evaluation of physical wellness through assessment of Vital Signs weight Mobility changes to skin hair and nails and overall grooming habits when dementia is first suspected a full Tut to assessment should be be conducted to establish a baseline for the client as dementia progress progresses changes can occur within the body because of the disease process as well as changes to the self- care due to dementia most clients may start exhibiting mild symptom of dementia first for example where they put their keys or forgetting the name of uh and uh item um but over time clients will start having more frequent and severe manifestations my professor in college were saying if you forgot where you put your keys it's not dementia yet but if you forgot what there are for you have a dementia um severe manifestations of Dimension can be change in judgment difficulty concentrating mood changes difficulty solving problems delusions paranoia difficulty in uh communication clients who have dementia may not be safe to live at home by themselves and the nurse or physical therapist social worker case manager they need to evaluate uh patient uh client home as well and N caring for a client who has suspected dementia will need to analyze available client data in conjunction with assessment finding and collaborate with the interprofessional team for more data if needed this includes reviewing medication to Aid with differentiation diagnosis and medical and social history to determine progression of manifestation of course Labs review to check electrolytes um hemoglobin the most important priorities when caring for a client who has dementia are safety and maintain current level of cognitive function interventions for slowing the progression of dementia are keeping the client safe should incorporate n pharmacological methods and pharmacological therapies non-pharmacological methods should focus on maintaining a calm and positive environment when communicating with the client and family providing clear and simple information to the client and the family is beneficial the interprofessional team should also consider not pharmacological interventions that help Ure nutrition sleep and blad and bowel function needs um are being met these can include providing food the client enjoy enjoys eating promoting periods of activity throughout the day coupled with the periods of rest monitoring bladder and bowel habits and maintaining personal hygiene practices as well as not allowing the clients to rest so much that their day night schedule changes the most common intervention for clients who have dementia caused by Alzheimer's disease is usually prescribing medications that are designed to stop the progression by slowing down changes and damage occurring in the brain maintaining memory and thinking abilities or working to manage behavioral changes other types of dementias may require different medications to help with treatment clients who have vascular dementia may require medications that prevent additional damage from occuring such as antihypertensive statins for cholesterol uh and antihyperglycemic for diabetic uh control clients who experience demena due to body disease will likely experience changes in movement hallucinations or sleep disturbances a nurse May administer at typical antipsychotic medications to help reduce those manifestations there are no medication that currently exist to help cure clients who suffer from frontal temporal Dementia or even slow the progression of it frequent evaluation of effectiveness of the interventions used in the treatment of dementia is expected of the nurse and interprofessional team next disease we're going to talk today is Alzheimer disease Alzheimer's disease occures when there is a build up of certain proteins within the brain over time the build up of protein proteins cause damage to brain neurons within the brain begin to die which makes it difficult for the brain to communicate and control function properly and those affected areas within the brain start to shrink the loss of function within parts of the brain leads to a loss of function elsewhere within the body beta ameloid plugs or neurofibrillary Tangles are two classic f findings in clients who have Alzheimer's disease and they are attributed to the development of the manifestation of dementia It is believed that beta ameloid peptides are present in the brain years before the start of manifestation during metabolism components of these proteins break off and gather in the brain causing a neurotoxic buildup uh neuro fibrillary Tangles form from the pro to changes that occur over time in the body due to inflammation lipid build up and aging are believ to create a change in the structure of proteins causing the formation of neurofibrillary Tangles factors that contribute to Alzheimer's disease may be present within the brain years before but it's really can have really slow manifestation when damage to brain starts to become visible in it initially appears in the hypoc compus and and aninal cortex which are vital to the formation of memories the ethology of Alzheimer's disease is not clear researchers have determined that changes in the brain occur when Alzheimer's disease progresses and this information has allowed Healthcare provid to use technology to monitor for these changes however what causes uh these changes is not exactly known Alzheimer's disease can be inherited as well as there have been some specific causes linked to the development of disease such as trcm 21 cerebrovascular diseases and certain modifiable and nonmodifiable risk factors Advanced age is still considered an important risk factor for late unset sporadic Alzheimer's disease despite identifying additional risk factors related to genetics it is not modifiable risk factor for clients which reinforces the need for early detection in intervention lifestyle factors are considered modifiable risk factors for client most research has indicated that good cardiovascular health can promote better brain health through healthy food vessels and adequate oxygenation to the brain clients should strive to incorporate physical activity in their life as well as focus on eating a balanced diet to help reduce obesity hypertension diabetes and kidney disease smoking should be avoided as well as high stress situations which can further contribute to poor heart uh Health educational status is also considered a risk factor that influences the development of Alzheimer's disease research suggests that individuals with more with more year of formal education are at lower risk for development Alzheimer disease that those will lower levels of formal education while the direct link is unclear more education can attribute to more cognitive Reserve higher so socioeconomic status and more cognitive stimulation comorbidity is associated with um an increased risk of developing Alzheimer disease include heart disease stroke hypertension diabetes and obesity these comorbidities can be linked to higher rates of lipid and plug formation in the body increased level of inflammation and blood vessel damage um Alzheimer can have a late or early onset late onset sporadic Alzheimer disease is the seventh most common cause of death among clients older than 65 of age in the United States according to the National Institute of Aging most clients with late onet Alzheimer's disease are female possibly due to their longer life expectancy early on said familial Alzheimer's disease is considered rare occurring and only 10 10% of um the population between the ages of 30 and 60 old and individuals who have um triem 21 also called Down syndrome will likely develop Alzheimer's disease likely due to an extra chromosome that emanates harmful Amal loids which lead to increase plug build up in the brain impact on overall health first of all uh psychosocial consideration related to Alzheimer's disease should be valuing based on the impact of the client and client's caregivers um behavioral manifestations May occure with a client who has Alzheimer's disease due to changes in the brain and thereby ineffective communication from neurons behaviors such as restlessness agitation aggression anxiety and depression can occur due to neurotransmitter imbalances other behavioral changes the client can exhibit include social isolation or withdrawal and poor judgment and impulsive control Alzheimer's traumatic relocation syndrome can be responsible for Behavioral manifestations seen in clients after transitioning to a different living location the key to reducing these feelings in the client and worsening a therapeutic environment environment maybe to notify clients and their families of the expected care transition that can Ure Alzheimer's disease for example uh your um your family loved one me member you you love this family member but you know this family member probably needs to move to the facility you cannot provide care for this family member and that can cause some uh traumatic relocation syndrome it means all the symptoms will worsen caregiver strain and stress should be considered whenever working with a client who has Alzheimer disease caregivers of clients who have Alzheimer disease experience more financial emotional and physical stress than caregivers of clients who do not have a cognitive empowerment um patient most clients who have Alzheimer disease are over the age 65 years old these can impact the client's overall health and response to alzheimer's treatments because of Aging challenges sensory deficit adverse effects of medications for other disease processes Mobility challenges and financial implications may be present and conflicting issues for the Aging adult clients of course the common uh most common manifestation associated with Alzheimer disease is dementia however dementia is not the only manifestation of Alzheimer disease Alzheimer disease can have um different stages mild moderate and severe mild Alzheimer's disease begins with the mild cognitive impairment clients will have difficulty outside of minor forgetfulness create memory loss leading to interference with normal activities or daily living getting lost repeating information and questions um as observed moderate Alzheimer disease is characterized by worsening memory loss and confusion and the addition of changes to language affecting communication clients will also start to exhibit manifestation related to impaired sensory processing judgment and reasoning these impairments can affect the client's ability to recognize familiar objects or people learn new things or handle multi-step directions such as getting dressed brushing their teeth and hair it will also affect how they cope with new situations and can create stress and undesirable behaviors because of the changes in sensory processing uh processing the client may start to have hallucinations delusions or parano sun Downing may occur during this this stage as well due to increased memory and sensory impairment severe Alzheimer disease is the final stage of the disease process and leads to complete impairment of communication and process memory and physical functioning as the client progresses toward end of life their body will begin to shut down as their brain cannot communicate because of these changes with the brain the nures will see manifestations of the clients such as weight loss in ability to speak or communicate and unable to walk seat or move if Alzheimer's disease is suspected we definitely do all the blood work and if we see high cholesterol or we do assessment if a patient has blood um blood high blood pressure we're trying to treat that but we also uh do additional neurological testing such as minum mental state examination or Montreal cognitive assessment should be completed and the ameloid beta protein protein persecutor test is also used to help diagnose early unset Alzheimer disease a further Diagnostic Imaging of the brain through CT MRI or pet or pet scan the minim mental state examination in monreal cognitive assessment are two types of cognitive test that help the interprofessional team evaluate the client memory and recall abilities problem solving skill attention language and communication skill as well as other components role of the nurse environmental factors that can impact care of the client who has Alzheimer disease depend on the severity or stage of the disease the environment can influence how client who have Alzheimer disease in dpid situation it is vital for nurse uh nurses role to assess and recognize Alzheimer's disease manifestations to help determine the appropriate interventions and environmental declin will benefit from as prescribed with dementia increased environmental stimula can lead to higher levels of confusion and agitation environmental stimulus should be limited when possible and nurse should educate the client and family about ways to reduce stimul stimuli such as reducing excessive noise providing a pleasant environment with reduced safety hazards and establishing a regular routine safety consideration for the client who has Alzheimer's disease should be continuously assessed we are talking about false safety um patient has memory loss patient can wandering patient can be lost if the patient still lives uh independently that patient may may have some um uh cause some fire uh safety is always a priority with patient with Alzheimer disease individual factors can influence the care the client who has Alzheimer needs as well as respond to clients who have Alzheimer disease will respond differently to stimuli and stress based on their personality and level of cognitive function client and caregiver education related to Alzheimer disease should focus on maintaining quality of life Independence and of course safety as discussed with um dementia education should not be provided to the client alone family or caregivers should be included simple and basic language should be used when educating the client and family to avoid confusion there is not a specific specific diet can Aid in the treatment of a Alzheimer disease um the concern for Alzheimer disease patient is the risk of malnutrition and fluid and electrolyte imbalance a nurses Ro role in pharmacological management of Alzheimer disease should include administration of prescribed medications and knowledge of why they were prescribed how they work to help the client adverse effects and complications to monitor for quick quickly we will go over how we're applying the nursing process of course we are recognizing C we're doing assessment we are doing full assessment we asking how uh when uh first symptoms just started um we asking for some uh risk assessment of course uh non-modifiable like age and gender and some modifiable risk risks um if we are talking about high high blood pressure or maybe uh underlying uh diseases um and then with definitely uh doing assessment of family and caregivers because whatever they are telling us it is really important because they are with this clent 24/7 and after we analyzing the cues with our priorities always safety all our interventions we're playing on life quality but safety is always our priority um what actions we are taking uh we always trying to maintain calm and positive uh familiar environment for patients with Alzheimer we are keeping routine with this with this patient we're not giving them so many choices a level of care and transition based on on client needs if the patient was in um assisted living and uh now patient needs to maybe move to um nursing home home then you need to prepare family and patient because it can cause um uh worse reaction for the patient make sure you're using therapeutic communication and we maintain basic physiological needs sleep nutrition bowel and bladder function and we evaluate our patient constantly because um patient condition can change unfort it's never getting better but we do not know how fast Pat patient will get worse that's why we are assessing this patient and maybe we need to adjust something in our plan of action and next condition we're going to talk about is delirium delirium often leads to a change in a client's perception of reality in contrast to dementia delirium is marked by a state of confusion that develops over some hours to days causing changes in a client's abilities language memory and behaviors the changes that can occur while vared will be different from how the client normally acts and responds because of the vast causes and various manifestations from client to client it's important to have an established Baseline assessment for every client to quickly assess for changes in perception and on set of um manifestation of delirium the pathophysiology of delirium may be traced back to a lack of oxygen to the brain there can be different causes of lack of oxygen some causes may be true lack of oxygen bound to the hemoglobin for transport due to low blood pH like in the case of fluid or electrolite imbalances causing metabolic acidosis other causes of delirium can be inter interference as the oxygen tries to access the brain or while the brain tries to metabolize the oxygen this can happen with certain medications that may be prescribed for pain and surgery or can occur when there is an overuse of specific medications a recreational drug or alcohol or when the is trauma to the brain cause of delirium can range from Environmental to physiological and they may include traumatic brain injuries drugs and alcohol use or withdrawal fluid and electrolyte Ells over use of medication or adverse effects of medication such as sedative or opioids um during uh hospitalization infection sleep deprivation surgery and medication related to surgery and serious illness um we already talking about um uh talk about age uh Advanced disease um risk factors associated with delirium include like Advanced age in disease process and uh activate that can lead to lack of oxygen to the brain or alter Transportation processing of oxygenation by brains such as dehydration or recreational drug use um any disease like you're going to see a lot of uh older patient who are coming especially females who are coming to the hospital confused and family member always said oh my gosh I came to my mom and I just talked to her yesterday but she seems more confused this morning she did not recognize me and they're bringing her to uh to the hospital and uh with checking this patient for UTI and for like 90% that UTI is pos positive that's like infection can cause some delirium and confusion electrolyte imbalance or dehydration uh older adults or any who are not taking enough fluids or uh spend more time uh outside or um just forgetting to drink uh can can have delirium some medication and recreational drugs trucks such as alcohol patients with alcohol withdrawer coming to the hospital with um delirium delirium patient can come with underlying process and it it cause delirium but sometimes patient can be in the hospital for a couple days or especially in ICU and it's caused delirium because patients in ICU have a really depriva depriva sleep pattern uh patient have been checked every one to two hours P patients is waking up when patient just just fall asleep or sometimes we're giving some sedated medication maybe patient was intubated for a couple days and these medications can have those effect too 15 to 50% of hospitalized clients can have can experience delirium um and uh ICU is a number one unit when patient can can have delirium especially of the because of the sleep deprivation delirium is a acute condition that is reversible if identified and dealed with uh quickly uh the interprofessional team should um consider a priority to identify and treat the underlying cause because severe damage can can occure what what we need to uh remember that delirium is always happened fast uh if the if family member uh is bringing patient to the hospital and telling you oh oh my mom is confused and how long it like maybe for last three four months she's this is not delirium okay we're probably going to talk about dementia but if the family members saying mom I talked to my mom yesterday and she was perfectly fine and today she is forgetting some words and uh more confused that's maybe delirium and we need to find what happened with this mom maybe she has UTI maybe she has pneumonia maybe she she has some other condition but needs to be treated first to actually help patient with delirium um psychosocial consor may arise and help identify the onset of delirium if treated quickly and effectively the client will likely recover in hours to weeks or months during the time of delirium the client May exhibit mood changes hallucinations or delusions but these changes should go away when the delirium is treated there can all also be changed in the level of Consciousness for client and they may not be able to remember what uh they said or how they acted when they have uh recovered considera of Aging clients should focus on quick and through assessment to determine if the client is experiencing delirium a different type of Med medical emergency or potentially a different type of cognitive alterations such as dementia okay uh let's go over clinical um presentations again uh changes is cognition that occur suddenly over hours to days and again they are similar to dementia but dementia occurs over months to years um changes level of conscious perception orientation thinking and speech emotional response memory sleep patterns presence of hallucinations and delusions um we we don't have like specific um assessments we are assessing our patient just if we'll see the patient has delirium we need to find underlying code and try to uh treat it of course we can do some assessments to um try to determine if the patient has delirium and severity of it like some examples of this assessment scales is like confusion assessment method or infusion assessment meod of intensive care delirium rating scale lbs um when we are doing some test diagnosed Tex and Laps is again it's no definite test for delirium um the goal of Laboratory Testing and diagnostic status for the client experienced delirium should be to evaluate and help treat the underlying cause of delirium the role of a nurse when caring for a client who has Del ium should focus on safety training the underlying cause and reducing environmental stimula that can exacerbate manifestations and place the client and the greater risk for injury again safety considerations for the P client Who Um can be impulsive who can wander who can have be anxious it is um priority it needs to be continuously says um delirium can have variety of underlying causes and of course when patient are coming we cannot uh try to distinguish them right away for this patient we need to know some risk factors and what can cause this maybe for example besides symptoms of delirium patient patient has symptoms of infections we were talking about it and you're talking about elderly uh females maybe you check uh taking urine for sample you can actually smell um and you can think that patient has UTI maybe beside that patient has some symptoms of stroke and you can think that patient maybe have stroke also you need to evaluate patient um nutrition risk factors what if the patient came malnourished maybe patient lost weight maybe patient came dehydrated what can call also can cause delirium maybe patient needs to be rehydrated uh all also nurse supposed to go over all the medications and check uh which medication can cause delirium and we will go over nursing process really quickly because we will already talk about it we start always start with assessment we are uh assessing our patient we're doing a head to to assessment of course we're doing M mental uh neuron and mental assessment um we identifying any risk factors uh checking LS and um trying to analyze this cues and maybe find some what can be underlying condition for this patient and if we act if we actually find out what is our underlying condition what is the problem that we are start planning our interventions okay and what is our interventions actions to control Del usually occur in the clinical settings and again our Intervention number one is patient safety uh inter interation number two we need to uh decrease uh environmental stimuli it means no bright light no uh loud noises we probably this patient probably going to have a siter and it's going to be dark room and we will close the door that patient can can sleep um and we are going to try to uh treat under uh underly uh underlying causes and uh usually if we will if we find out the proper underlying cause and we're treating it uh that patient is getting better within days weeks sometimes month this lecture is over if you have any questions please email me anpa mcc.edu