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

2021
Views:

483

Pages:

1
Author:

Hallie Randolph

DISORDER/DISEASE PROCESS Alterations in Health (Diagnosis) A condition characterized by the disruption of thinking, memory, processing, and problem solving Neurocognitive Disorders - Delirium Pathophysiology Related to Client Problem Health promotion and disease prevention commonly associated with hospitalization of older adult clients Health Promotion and Disease Prevention minimize risk factors and promote early detection ASSESSMENT Risk Factors physiological changes, infections, surgery, substance abuse metabolic (renal failure, fluid and electrolyte imbalances) Cardio and respiratory diseases Laboratory Tests SAFETY CONSIDERATIONS Expected Findings hallucinations, restlessness, agitation, moaning or calling out, quiet, withdrawn, disturbed sleep habits, slowed movement, lethargy, reversal of night and day sleep cycle Diagnostic Procedures no specific lab tests to diagnose provide appropriate environment (low level of stimuli, low lighting, low noise level) remove all potentially dangerous objects from client's environment stay calm with client Meets DSM-5 criteria observe suicide precautions Confusion Assessment Method confusion is often worse at night and early morning Cognitive Testing Complications PATIENT-CENTERED CARE Nursing Care -assess client's risk of injury or falls -protect airway -mobility assistance -pain management Therapeutic Procedures -reduce environmental stimuli -address any underlying causes or triggers -adequate nutrition and hydration Medications antipsychotics antianxiety meds benzodiazepines Client Education Encourage patient to use assistive devices as needed Encourage patient to keep a calm, quit, well-lit environment Educate client on how to improve communication can occur rapidly, may last for a few hours to a few days or weeks general decline in health poor recovery Interprofessional Care possible need for institutional care eliminate precipitating factors higher risk of death