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Chapter 34
Conditions Affecting Mood and
Cognition
General Observations in Assessment of
Mental Health
• Grooming and dress
• Posture
• Movement
• Facial expressions
• Level of consciousness
• General conversation
Cognitive Testing
• Orientation
• Memory and retention
• Three-stage command
• Judgment
• Calculation
Physical Examination for Mental Status
• Review of medications
• Laboratory tests
– Complete blood count
– Serum electrolytes
– Serologic test for syphilis
– Blood urea nitrogen
Physical Examination for Mental Status
(cont.)
– Blood glucose
– Bilirubin
– Blood vitamin level
– Sedimentation rate
– Urinalysis
Principles Guiding Care of Health
Problems
• Strengthen the individual’s capacity to manage the
condition.
• Eliminate or minimize the limitations imposed by the
condition.
• Act for or do for the individual only when absolutely
necessary.
Challenges to the Elderly Affecting Mental
Health
• Illness
• Death
• Retirement
• Increased vulnerability
• Social isolation
• Sensory deficits
• Greater awareness of own mortality
• Increased risk of institutionalization; dependency
Symptoms of Delirium
• Disturbed intellectual function
• Disorientation of time and place but usually not of
identity
• Altered attention span
• Worsened memory
• Labile mood
• Meaningless chatter
• Poor judgment
• Altered level of consciousness
Interventions to Control Delirium
• Maintain stability.
• Minimize stimulation.
• Provide consistent care.
• Control environmental factors.
• Avoid bright lights but provide ample lighting.
• Ensure that the patient does not harm anyone.
Characteristics of Alzheimer’s Disease
• The excessive presence of neuritic plaques, which
contains deposits of beta-amyloid protein
• Neurofibrillary tangles in the cortex
– Tau is changed and begins to pair with other threads
of tau that become tangled.
– This causes the microtubules to disintegrate and
collapse the neuron’s transport system.
Possible Causes of Alzheimer’s Disease
• Environmental factors play a role.
• Genetic factors do increase the risk for Alzheimer’s
disease.
– Chromosomal abnormalities have been identified.
• Role of free radicals is being questioned.
Other Pathologies That May Cause
Dementia
• Vascular dementia
• Frontotemporal dementia
• Lewy body dementia
• Creutzfeldt-Jakob disease
• Wernicke’s encephalopathy and Parkinson’s disease
• AIDS
• Trauma and toxins
Diagnosing Alzheimer’s Disease
• History of symptoms from the patient and family
members or significant others
• Brain scans that can reveal changes in the brain’s
structure
• Neuropsychological testing that evaluates cognitive
functioning
• Laboratory tests and neurological examinations
Nursing Measures for Treating
Alzheimer’s Disease
• Keep the persons and components of the environment
consistent.
• Use items to trigger memory.
• Control noise, activity, and lighting levels.
• Pay attention to safety measures.
• Use recommended therapies and activities to stimulate
patient.
Nursing Measures for Treating
Alzheimer’s Disease (cont.)
• Take care of the physical needs of the patient.
• Explore the use of alternative medical therapies.
• Pay attention to the psychological needs of the patient.
Qualities to Promote in Alzheimer’s
Patients
• Individuality
• Independence
• Freedom
• Dignity
• Connection
Drugs That Can Cause Depression
• Antihypertensives and cardiac drugs
• Hormones
• Central nervous system depressants
• Others: cimetidine, L-dopa, ranitidine, asparaginase,
tamoxifen
Symptoms of Depression
• Insomnia
• Fatigue
• Anorexia
• Weight loss
• Constipation
• Decreased interest in sex
Goals in Caring for Depressed Patients
• Help patient develop positive self-concept.
• Encourage expression of feelings.
• Don’t use statements that deny the feelings.
• Ensure that physical needs are met.
• Offer hope.
Signs of Suicidal Tendencies in the Elderly
• Medication misuse
• Self-starvation
• Engaging in activities that threaten a medical problem
• Walking through a dangerous area
• Driving while intoxicated
• Subjecting oneself to other risks
Anxiety Reactions in the Elderly
• Somatic complaints
• Rigidity in thinking and behavior
• Insomnia
• Fatigue
• Hostility
• Restlessness
Anxiety Reactions in the Elderly (cont.)
• Chain smoking
• Pacing
• Fantasizing
• Confusion
• Increased dependency
Interventions to Treat Anxiety
• Allow adequate time for activities.
• Prepare the individual for all anticipated activities.
• Provide thorough, honest, and basic explanations.
• Control patient interactions.
• Adhere to routines.
• Keep and use familiar objects.
• Prevent overstimulation of the senses.
Criteria for Diagnosing Alcoholism
• Drinks a fifth of whiskey a day or its equivalent in wine or
beer.
• Has alcoholic blackouts.
• Experiences withdrawal syndrome, hallucinations,
convulsions, gross tremors, DTs.
• Continues drinking despite medical advise or problems.
Causes of Paranoid States in Older
Persons
• Sensory losses
• Illness, disability, living alone, and a limited budget
• Ageism within society
• Being victims of crime and unscrupulous practices
Nursing Considerations
• Monitoring medications
• Promoting a positive self-concept
• Managing behavioral problems
Factors to Observe and Document
Regarding Behavioral Problems
• Time of onset
• Where it occurred
• Environmental conditions
• Persons present
• Activities that preceded
Factors to Observe and Document
Regarding Behavioral Problems (cont.)
• Pattern of behavior
• Signs and symptoms present
• Outcome
• Measures that helped or worsened behavior
Source
• Eliopoulos, C. (2005). Gerontological Nursing, (6th
ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN
0-7817-4428-8).