cognative_disorders_33_22_34_35

cognative_disorders_33_22_34_35 - Psychiatric Nursing...

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Unformatted text preview: Psychiatric Nursing N­127A Cognitive Disorders / chapter 33 The Homeless Client / chapter 22 The Pediatric Client / chapter 34 The Older Adult / chapter 35 What are Cognitive Disorders? What are Cognitive Disorders? • Deficit in cognitive function due to: – – – Medical condition (such as?) Medications Substance abuse Symptom = Memory deficit / Cognition deficit – how are they different? Incidents and Significance of Incidents and Significance of Cognitive Disorders • What percentage over the age of 60 have dementia? 2%­5% • What percentage over 85 have dementia? 15%­40% • Of those in Hospital over 65, 30%­40% experience delirium • All ages may experience delirium following surgery Symptoms Associated with Various Symptoms Associated with Various Cognitive Disorders With Dementia or Delirium may also experience • Frustration • Anxious • Frightened • Delusions / paranoia • Aggressive and disruptive behaviors Delirium vs. Dementia Delirium vs. Dementia Delirium Dementia Acute Rapid onset Hallucinations LOC fluctuates Prognosis = good Chronic Slower onset No hallucinations LOC not affected Prognosis = poor Delirium Delirium Risk factors? • Medications / Surgery / Infection/ electrolyte imbalances / drugs or drug withdrawal Symptoms? • Hallucinations / memory loss / disoriented X3 / often sympathetic nervous system response Prognosis? • Good when underlying cause is resolved (typically acute phase = 3­5 days) Nursing Diagnoses for Nursing Diagnoses for Delirium • Acute confusion related to known or unknown etiology • Self care deficit related to cognitive impairment • Risk for injury related to confusion and cognitive impairments • Deficit knowledge of family related to client diagnosis, prognosis and progression Delirium Nursing Interventions Delirium Nursing Interventions • Lessen environmental stimuli / adequate light • One on One for safety (avoid restraints) • Bring familiar object from home / provide activities Delirium Nursing Interventions Delirium Nursing Interventions • Orient client / acknowledge fears behind hallucinations – provide calendars, clocks • Provide for physical needs hygiene / hydration etc.. • Assure family that delirium is temporary Dementia Dementia Risk factors? • Age / family history / head trauma / high B/P Symptoms? • Impaired memory / aphasia / apraxia / agnosia / impaired social function / poor impulse control Dementia Dementia Prognosis? • Poor, onset can be delayed with medication (cholinesterase inhibitors = Tacrine, Aricept) Types of Dementia Types of Dementia Alzheimer's disease = most common/ mood swings / etiology unknown / appears to have genetic factor Vascular dementia = 2nd most common / multiple infarcts (mini strokes) Lewy body disease = visual hallucinations /adverse effects with antipsychotic meds Types of Dementia Types of Dementia Parkinson’s disease = neurological disorder / 30% have concurrent cognitive difficulties Huntington’s disease = genetic = 50% chance / onset in 40’s HIV dementia = up to 75% of those with AIDS / long progression Pick’s disease = onset 40­60 years / poor impulse control Dementia Treatment Dementia Treatment • Early diagnosis important / medications can slow onset / family needs time to adjust • Assess Mental status / perceptual problems / orientation / memory / – R/O underlying illness (depression, renal failure, brain tumor etc..) Dementia Treatment Dementia Treatment • Recognize caregiverrole strain / provide for respite care / education / support groups • Ask family for historical data Nursing Diagnosis for Nursing Diagnosis for Dementia • Chronic confusion related cerebral degeneration • Self care deficit related to cognitive and motor impairments Nursing Diagnosis for Nursing Diagnosis for Dementia • Risk for injury related to cognitive and psychomotor impairments • Interrupted family processes related to degenerative cerebral changes in a family member Dementia Nursing Interventions Dementia Nursing Interventions • Assure good nutrition and bowel function – Monitor intake and output • Decrease environmental stimuli • Make suggestions / prompts, rather than choices Dementia Nursing Interventions Dementia Nursing Interventions • Provide orientation queues = clocks, calendars • Redirect when agitated / ask to look at picture in purse, talk about family Homeless Clients Homeless Clients Chapter 22 • • • Demographics Homelessness and Mental Illness Critical Issues Affecting the Homeless and Mentally ill Current Trends in Homeless Current Trends in Homeless Populations • • • • • • 41% = White 40% African­American 11% Hispanic 8% Native American 75% = male 11% = families with children (fastest growing) – 84% = single mothers • 23% under 18 – Many have developmental delays / depression and anxiety Current Trends in Homeless Populations Current Trends in Homeless Populations 25% mentally ill (often schizophrenia) 50% substance abuse Deinstitutionalization of the mentally ill began in 1963 = community mental health programs • System broke down in 80’s / many became homeless / • Shortage of affordable housing / funding, perpetrates the problem • • • Factors that Contribute to the Homeless Factors that Contribute to the Homeless and Mentally Ill • Lack of prevention = community health systems do not treat homelessness well / lack of funding • Functional abilities and deficits = lack of situational support, unable to deal with crisis of homelessness Factors that Contribute to the Homeless Factors that Contribute to the Homeless and Mentally Ill • Poverty / Inadequate housing = gap growing between rich and poor • Substance abuse = self medicate / leads to other health problems Barriers that Prevent Care for the Barriers that Prevent Care for the Homeless Mentally Ill Lack of insurance Admissions criteria may require an address Lack of transportation for follow­up care Loss of ID Lack of knowledge of services Fear of leaving possession when attending clinic appointment • Fear of caregivers treatment • • • • • • Health Care Concerns of Homeless Health Care Concerns of Homeless Mentally Ill People • Problems related to Substance abuse /exposure / high population density / poor ventilation / Victims of crimes & Trauma / Dependent position of extremities ? • TB / HIV / lice / Frostbite / Heatstroke / Seizures / Peripheral Vascular Disease / lacerations, open wounds, infections Nursing Diagnoses Nursing Diagnoses Social isolation related to homelessness Ineffective coping related to family disruption Powerlessness related to lack fo person control over environment • Chronic low self esteem related to onset of psychotic illness • • • The Pediatric Client The Pediatric Client Chapter 34 Mental health and Psychiatric disorders in the Children and Adolescences • Child Development • Factors Contributing to Mental Illness • General Interventions • Common Disorders • Mental Retardation Theories of Child Development Theories of Child Development Psychoanalytical perspective • Freud = childhood experience effects the unconscious mind – shapes behavior • Erikson = childhood stages accomplishment grows developmentally Theories of Child Development Theories of Child Development Piaget’s cognitive­development theory = how “thinking” develops from simple to complex Contemporary approaches to child development = varied / learn from environment / Vygotsky = learn social roles from adults Temperament Theory = temperament can be genetic or environmental / adapt accordingly Effects of Childhood Mental Illness Effects of Childhood Mental Illness • May be mentally ill as adult – Childhood depression = dysthymia in adulthood – 50% of conduct disorder =antisocial adults • Shame / guilt / lower self esteem • Anger / dissociative disorders / PTSD – Often resistive to therapy Factors that Contribute to Factors that Contribute to Psychiatric disorders • Family history of psychiatric disorders / addictive disorders • Psychosocial influences / – Erikson’s stages of development / family support – Generational boundaries / gender boundaries Factors that Contribute to Factors that Contribute to Psychiatric disorders • Stressors / small stress good – Poverty / domestic violence / divorce – Response = regression / acting out • Abuse and/or neglect – World is unsafe – Develop mistrust / poor bonding General Interventions Available for General Interventions Available for Children and Adolescence Primary prevention • Head start / preschool – early training social skills Secondary prevention • Therapy = cognitive / behavioral / play / family / group / Milieu • Special education = provide structure • Pharmacologic therapy should be used in combination with therapy Common Childhood Disorders and Common Childhood Disorders and Pervasive Developmental Disorders • Attention deficit hyperactivity disorder • Conduct disorder = may lead to antisocial personality • Autistic disorder • Asperger’s disorder • Oppositional defiant disorder / Tx = Behavioral modification • Tourette’s syndrome Common Childhood Disorders and Common Childhood Disorders and Pervasive Developmental Disorders • Adjustment disorder = stress from change • Anxiety disorders / OCD – Phobias – Social phobia – Generalized anxiety disorder – Separation anxiety disorder – Post traumatic stress disorder • Mood disorders / depression; dysthymia – bipolar disorder Mental Retardation Criteria Mental Retardation Criteria • • • • • • • IQ of 70 or below = 2%­3% of population Deficit in adaptive functioning Onset prior to 18 Mild = IQ 55­70 Moderate = IQ 40­54 Severe = IQ 25­39 Profound = IQ 0­25 The Older Adult and Mental Health The Older Adult and Mental Health Chapter 35 • • • • • • Demographics of Aging Sociocultural issues The Older Adult with a Psychiatric Disorder Communicating Effectively with Older Adults Care of the Older Adult Promoting Mental Health and Wellness Different Categories of Older Adults Different Categories of Older Adults Based on Age • • • • • • • Young­old = 65­74 Middle­old = 75­84 Old­old = 85­94 Elite old = 94+ 12.3% of population Population growing / increase 100% by 2030 95% live in the community Socio­Culture Issues That Influence Socio­Culture Issues That Influence Mental Health • 80% of those over 65 have a chronic condition • Increasing in cultural diversity • Maturational crisis = retirement / relocation / bereavement – Men have more difficulty with loss than women Different Communication Different Communication Approaches with Older Adults • • • Active listening / communicating Eye contact Use respectful terms – Start formal (Mr. / Mrs.) • Lower pitch sounds / voice heard better – Less background noises • Use open ended question / allow for response Society Attitudes Towards Older Society Attitudes Towards Older Adults Ageism / Myths / Prejudices • List some: • Depression • Sleep • Dementia Often health care professionals focus on physical disabilities and ignore psych problems – 25% have treatable mental disorders Common Geropsychiatiric Common Geropsychiatiric Diagnoses and Related Interventions • Depression: – Increased risk due to losses – Treatment can help: Medication / therapy – Older adults = highest rate of suicide – Can be assumed to be dementia / normal response to aging Common Geropsychiatiric Common Geropsychiatiric Diagnoses and Related Interventions • Sleep disorder: – Advanced age need less sleep / sleep cycles disrupted = risk for injury • Substance abuse: alcohol with medications – Can be assumed to be dementia / risk for injury How to Promote Mental Health and How to Promote Mental Health and Positive Adaptation to Aging • Encourage good nutrition – Decreased calories / increase complex carbs – Frequent small meals • Encourage physical activity – Walking / hiking 30 minutes / 3 X week • Encourage interaction with peers and family – Support system / activities ...
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