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Delirium and DementiasPsychiatric Nursing: Contemporary Practice

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When determining the cause of delirium, what are some nursing interventions that should be done?
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Use of all suspected medications should be stopped and vital signs should be monitored every 2 hours at a minimum. Observe for changes in vital signs, behavior and mental status.
How can changes in elimination cause delirium?
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Constipation or diarrhea can disrupt fluid balance.
Sleep disturbances are a symptom of delirium. What should a nurse focus on in order to help?
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Restore a normal sleep cycle (extremely important) to prevent sleep deprivation and continuation/exacerbation of confusion.
Why should OTC medication use be evaluated in a patient with delirium?
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OTC medications, especially cold preparations taken in sufficient quantities, can cause delirium/confusion especially in older patients.
What are the primary interventions in the biologic domain for a patient with delirium?
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Providing a safe and therapeutic environment, maintaining F&E balance, providing adequate nutrition and prevention of decubitus ulcers and aspiration.
How can a patient with delirium be protected while in their hospital room?
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Use low beds, guardrails, and careful supervision, implement falls and delirium management precautions.
What medications are typically use to treat patients with delirium?
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Risperidone, and if the delirium is r/t alcohol withdrawal benzodiazepines.
What is the dosing rule r/t medications given to patients to treat delirium?
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Dosages are usually kept very low, especially with elderly patients and ideally it should be administered orally.
What are the drawbacks to using benzodiazepines to treat delirium?
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They can further impair cognition or cause a paradoxical agitation
What should be reported to the physician after administering medications to a patient experiencing delirium?
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Any changes or worsening of mental staus after administration of the medication.
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When using antipsychotic medications to treat delirium, what adverse event should the nurse be vigilant for?
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Neuroleptic malignant syndrome (high fever, lead-pipe rigidity, changes in mental status and ANS changes).
To ensure proper metabolism and elimination of medications used to treat delirium, what should be maintained?
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Nutrition and hydration
What are common causes of delirium?
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Drug-drug interactions, OTC sleeping, cold or allergy medications
Rapid onset of global cognitive impairment that affects multiple aspects of intellectual functioning is the hallmark symptoms of __________.
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Delirium
What parts of memory are most likely to be impaired with delirium?
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Immediate and recent memory
What cognitive processes are most likely to be affected during delirium (3)?
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Calculations, orientation (especially to time) and recall. Naming and registration are typically intact.
_________ delirium involves behaviors most commonly recognized as delirium?psychomotor hyperactivity, excitability, and a tendency towards hallucinations.
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Hyperkinetic delirium
_________ delirium is marked by lethargy, sleepiness and apathy, decreased psychomotor activity. With this presentation, it is easy to miss delirium.
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Hypokinetic delirium
__________ delirium involves behavior that fluctuates between lethargy, sleepiness and apathy and hyperactivity, hallucinations and excitability.
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Mixed variant delirium
How can a staff member help a person experiencing delirium to help reduce anxiety and fear?
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Engage in frequent interaction, encourage the patient to express their fears and discomforts, ensure adequate lighting, easy-to read calendars/clocks, reasonable noise level are in place and provide frequent verbal orientation. If possible, include familiar personal possessions in their room.
What is the priority diagnosis for a patient with delirium?
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Risk for injury
  
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