HEALTH

ALTERATION

CAUSES/RISK
FACTORS

SYMPTOMS

DIAGNOSIS NURSING
ACTIONS/
TREATMENT

DEPRESSION

CAUSES:
- AGING LOSSES
- LIFE EVENTS
- NEUROENDOCRINE
CHANGES

- SLEEP
- FATIGUE
- DIMINISHED
INTEREST
- GUILT
- POOR
CONCENTRATION
- POOR APPETITE
- PSYCHOMOTOR
AGITATION OR
RETARDATION
- PSEUDODEMENTIA
- SUICIDE
(STARVATION,
MEDICATION
MISMANAGEMENT,
SELF-NEGLECT, OR
FIREARMS)
- DISORIENTATION TO
TIME AND PLACE
- IMPAIRED RECENT
MEMORY
- HALLUCINATIONS

- BECK
DEPRESSION
- GERIATRIC
DEPRESSION
SCALE
- MENTAL
STATUS EXAMS
HAVE
SCREENING FOR
DEPRESSION

ALWAYS SCREEN
FOR IT WITH ANY
NEW ONSET OF
SYMPTOMS

IDENTIFY
CHANGE IN
BEHAVIOR.
HYPOACTIVE
MOST
OVERLOOKED.

PREVENTION:
- COMPENSATE FOR
SENSORY DEFICITS
- AVOID MULTIPLE
NEW MEDS
- KEEP WELL
HYDRATED

PROLONGED
DELIRIUM CAN
LEAD TO

TREATMENT:
- ID AND TREAT
CAUSE

MOST COMMON
PSYCHOSOCIAL
IMPAIRMENT

RISK FACTORS:
- PHYSIOLOGIC
DISORDERS,
- MEDICATIONS
(ANTIHYPERTENSIVES),
- SOCIOCULTURAL
CHANGES

DELIRIUM
RAPID CHANGE IN
COGNITION
SHORT DURATION
REVERSIBLE

CAUSES:
MEDICAL CONDITIONS
SUCH AS:
- OXYGENATION
- INFECTION (UTI OR
PNEUMONIA)
- IMPACTION
SUBSTANCE ABUSE OR
WITHDRAWAL

TWO TYPES:
HYPOACTIVE
EXTREMELY PASSIVE
AN WITHDRAWN

TRAUMA, MIXED CAUSES

DEMENTIA
PERMANENT LOSS
OF MULTIPLE
MENTAL
FUNCTIONS.
IMPAIRMENT IN
ABSTRACT THINKING,
JUDGMENT, OR
PERSONALITY
CHANGE; SEVERE
ENOUGH TO
INTERFERE WITH
WORK, SOCIAL
ACTIVITIES, AND/OR
RELATIONSHIPS WITH
OTHERS

CAUSES/TYPES:
- MILD COGNITIVE
IMPAIRMENT
- ALZHEIMERS DISEASE
- VASCULAR DEMENTIA
- DIFFUSE LEWY BODY
DISEASE
- OTHERS
(FRONTO-TEMPORAL
DEMENTIA, PICKS
DISEASE, MAD COW,
PARKINSON DISEASE,
ETOH, SYPHILIS,
RADIATION, SECONDARY
TO BRAIN INFECTIONS
OR OTHER BRAIN
DESTRUCTIVE
PROCESSES)

HYPERACTIVE
PANIC; ATTEMPTS TO
CONTROL OR PLACE
IN ORDER
INTELLECTUAL:
- AMNESIA
- APHASIA
- APRAXIA
- AGNOSIA.
BEHAVIORAL:
- INAPPROPRIATE
BEHAVIOR
- WANDERING
- HOARDING
- UNDRESSING
- RESISTING CARE
- IRRITABILITY

DEMENTIA.

- SUPPORTIVE CARE
OF PATIENT AND
FAMILY

DETERMINE
PERSON HAS
DEMENTIA:
- MENTAL
STATUS EXAMS
- MEMORY
SCREENING
- SYMPTOM AND
BEHAVIOR
REVIEW

NONPHARMACOLOGIC:
- MINIMIZE
MEDICATION USE
(ESP. SLEEPING
PILLS, ANTI-ANXIETY
MEDS, OTC MEDS
FOR
COLDS/ALLERGIES)
- DIET
- PHYSICAL FITNESS
- MENTAL
EXERCISES
- STRESS
REDUCTION

DETERMINE
TYPE OF
DEMENTIA.

PHARMACOLOGIC
PREVENTION:
- BLOOD PRESSURE
MAINTENANCE
- CHOLESTEROLLOWERING STATINS
- ANTIINFLAMMATORY
PHARMACOLOGIC
TREATMENTS:
- HORMONES
- SUPPLEMENTS

(GINKGO BILOBA)
- MULTIVITAMIN
- CHOLINESTERASE
INHIBITORS
[TACRINE (COGNEX)]
- NMDA RECEPTOR
ANTAGONIST

ALZHEIMERS
DISEASE

CAUSES:
- GENETICS 20-60%
- DAMAGE FROM A TOXIC
ACCUMULATION OF
AMYLOID PLAQUES AND
THE DEVELOPMENT OF
NEUROFIBRILLARY
TANGLES.
RISK FACTORS:
- ADVANCING AGE
- GENETIC
PREDISPOSITION
- RISK FOR OTHER
CONCURRENT
DEMENTIAS
- VASCULAR DEMENTIA
RISK FOR LEADING TO
DEMENTIA

EARLY (3-5 YEARS):

- MILD AMNESIA
- GOOD FUNCTION AT
HOME
- FEW PSYCHIATRIC
SYMPTOMS
MIDDLE (3-10
YEARS):
- MANY
INTELLECTUAL
IMPAIRMENTS
- POOR FUNCTION AT
HOME
- MANY PSYCHIATRIC/
BEHAVIORAL
PROBLEMS
LATE (3-10 YEARS):
- MULTIPLE & SEVERE
INTELLECTUAL
IMPAIRMENTS
- MINIMAL FUNCTION
AT HOME

MOST
DIAGNOSIS
BASED ON
SYMPTOMS.
AUTOPSY CAN
REVEAL
AMYLOID
PLAQUES AND
NEUROFIBRILLA
RY TANGLES.

COMMUNICATION
TECHNIQUES:
- USE NONVERBAL
COMMUNICATION
- CLEAR
COMMUNICATION
- DO NOT RUSH
- KEEP ROUTINE
- ALLOW TIME TO
WAKE UP
- AVOID
CONFRONTATION
- DO NOT CONVINCE
OR FORCE
- USE SKILLS THEY
HAVE
- AVOID
AMBIGUITIES
- DECREASE
DISTRACTIONS
- KEEP COMMANDS
SIMPLE
- USE VISUAL CUES
- AVOID OPTIONS

- PROBLEMS
WALKING, TALKING,
CHEWING, AND
SWALLOWING
- LOSS OF BOWEL
AND BLADDER
FUNCTIONS

- MINIMIZE FAILURES
APPROACHES TO
DIFFICULT
BEHAVIOR:
- WATCH YOUR OWN
STRESS
- BE CALM
- REDIRECT OR
DISTRACT
- PROVIDE RIGHT
ENVIRONMENT
- SUPERVISE
ACTIVITIES
- PROVIDE
ADEQUATE SUPPORT
- PROVIDE
STRUCTURE AND
ROUTINE
- USE PLEASANT
ACTIVITIES
- KEEP THINGS
SIMPLE
- BE FLEXIBLE
- SOOTHE
- COMPENSATE FOR
COMPLEX TASKS
- PROVIDE
REASSURANCE
- MANAGE
WANDERING
- JUMPSUITS FOR
DISROBING