University:
American Career College
Course:
NURS112 | Fundamentals of Nursing
Academic year:

2021
Views:

51

Pages:

1
Author:

Accinkiquicpqw

System Disorder ACTIVE LEARNING TEMPLATE: Delirium DISORDER/DISEASE PROCESS __________________________________________________________ REVIEW MODULE CHAPTER ___________ Alterations in Health (Diagnosis) state of confusion that develop over days to hours Pathophysiology Related to Client Problem Health Promotion and Disease Prevention brain gets less oxygen and has problems using it. Multiple neurotransmitter abnormalities may be involved Know who is at high risk dementia, stroke, cns infection, PD. ASSESSMENT SAFETY CONSIDERATIONS Risk Factors Expected Findings Age 65+, male gender, dementia, depression, hx of delirium, dehydration, malnutrition, drugs, hospital stay, hx of falls, immobility, sepsis, fever, terminal illness, sensory depr., sensory overload, surgery. Laboratory Tests range from hypoactivity, and lethargy to hyperactivity, agitation, and hallucinations. Diagnostic Procedures CBC, serum electrolytes, BUN, creatinine lvls, ECG, urinalysis, liver and thyroid func tests, and O2 sat., CSF, CT, MRI CAM PATIENT-CENTERED CARE Complications Nursing Care Medications prevention, early recognition, and treatment. Precedex sedation Therapeutic Procedures Communicate in a calm tone Speak in possitively worded phrases Reinforce orientation to time, place and person Establish eye contact Break instructions and activities into shorter time frames Limit number of choices when dressing or eating Approach slowly from the front Encourage family visitors Fall risk Safety Sleep deprivation Malnutrition Dehydration Agression towards staff Low dose antipsychotics Short acting benzos Client Education Educate about the clients illness, methods of care, and adaptation of the home environment Ensure a safe environment in the home Interprofessional Care To prevent delirium, interprofessional teams including physicians, nurses and possibly other healthcare professional are to use multiple nondrug approaches throughout at-risk older adult hospital stay. Dementia Permanent neuronal damage