1. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company

2. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company 4 Stages of Alzheimer’s Disease  STAGE 1 - Mild Alzheimer’s Disease  Recent memory losses, may try to cover this up with confabulation  Personality and social behavior patterns remain  Depression  Some aphasia  Difficulty learning new things

3. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company 4 Stages of Alzheimer’s Disease  STAGE 2 - Moderate Alzheimer’s  Deterioration more evident  Moods labile  May have inability to remember address or date  Hygiene may begin to deteriorate  Driving hazardous  Patient may wander  Aphasia, Agnosia, Apraxia, Anomia, Amnesia worsen

4. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company 4 Stages of Alzheimer’s Disease  STAGE 3 - Moderate to Severe  Unable to recognize familiar people or even spouse: severe agnosia  Needs directions for simplest task, e.g. getting dressed: advanced apraxia  May become incontinent  Person may become agitated, frightened, paranoid, violent; screaming  Wandering at night - gets lost  May need professional care provision

5. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company 4 Stages of Alzheimer’s Disease  STAGE 4 - Late stage (Severe)  Agraphia - inability to read or write  Hyperorality - Need to taste everything  Hypermetamorphosis - Need to touch everything  Loses ability to talk and walk.  Choking may become frequent  Eventual stupor and coma  Death

6. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company DEFINITIONS  DELIRIUM - Disturbance in consciousness and cognition: sudden, reversible, secondary to some other medical condition  DEMENTIA – memory impairments without loss of consciousness  Primary = NOT reversible  Secondary = Due to another medical illness

7. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company DELIRIUM  VERY COMMON  Occurs in 11%- 42% of medical pts  May be up to 60% in elder medical pts  Change in consciousness  Disturbance of cognition  No destruction of brain cells  ACUTE - DEVELOPS OVER SHORT PERIOD OF TIME (hours to days)

8. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company Always secondary to underlying medical condition or toxic agent!!  Metabolic disorder - e.g. hypoglycemia  Endocrine disorder - e.g. hyperthyroidism  Drugs toxicity or W/D - Digitalis, lithium, ETOH  Neurological - head trauma  Infection – septicemia from urinary tract infection  Dehydration Resolves when primary condition treated and reversed. DELIRIUM

9. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company ASSESSMENT -- Delirium  Cardinal Features (Wei, et. al.)  Acute onset / fluctuating course  Inattention  Disorganized thinking  Disturbance of consciousness  Significant fluctuations in level of consciousness  Confusion and disorientation

10. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company ASSESSMENT -- Delirium  Perceptual disturbances:  Hallucinations  Illusions  Moods may fluctuate widely—labile moods  Emotionally, patient may be very fearful and anxious

11. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company 11 DEPRESSION  Incidence of depression in the elderly is high  For general population “estimated” at 1 – 2 %  For elderly, estimates range from 3.5 – 40%; usually about 15 – 20%  suicide rate is highest among those over 65  Retirement may contribute to development of depression for some  Likely ¾ of elder suicides are depression related  Most could have been helped with treatment

12. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company 12 DEPRESSION  Society’s current very negative attitude towards aging and the aged creates many obstacles to overcome  elderly internalize societal attitudes = self hatred because of their age  Some assume depression is to be expected and is “normal” for someone elderly. IT IS NOT.

13. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company 13 DEPRESSION  Prolonged and excessive feeling of sadness or grief usually associated with a loss  May be result of anger turned inward  Feelings of hopelessness and helplessness  Negative view of self and / or life in general  May be secondary to medical illness  May be diagnosed as dementia  May remain undiagnosed altogether

14. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company 14 Affect  “Gray colored glasses”  Poor posture  Tearfulness/No tears  Gloominess  Despondency  Apathy  Anhedonia

15. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company 15 Feelings  Anxiety  Sense of worthlessness / Low self- esteem  Hopelessness / Helplessness  Guilt  Anger/irritability

16. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company 16 Thought Processes PPoor judgment DDifficulty making decisions MMemory and concentration are poor CConfusion SSuicidal or homicidal thoughts MMust always be assessed AAsk direct questions

17. 17 Physical Behavior  Psychomotor retardation or agitation  Anergia  VEGETATIVE SIGNS OF DEPRESSION:  change in eating  sleeping  libido / sex  elimination  Poor personal hygiene (seen in severe depression — not reliable gauge of severity )

18. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company 18 Masked Depression  Manifestation influenced by  age  culture  gender

19. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company 19 Types of Dysfunction (nursing diagnoses) /Planning – examples of desired outcomes  Risk for self directed violence  OutCome: Client will state reasons for living by ______.  Self Esteem, Chronic Low / Situational  O.C: Client will name 3 + attributes about self by ______.  Powerlessness  O.C: Client will demonstrate one new coping skill by _____.  Impaired social interaction  O.C: Client will initiate attendance at one or two group activities per week by ______.

20. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company NURSING INTERVENTIONS  Assess suicide risk - greatest when pt. is coming out of depression  Ensure physical health - Record sleep, elimination, health-promoting nutrition  Encourage physical activity  Monitor medication side effects  Encourage expressions of feelings  Therapeutic Communication  Group activities / Socialization

21. F. A. Davis’s Fundamentals of Nursing, Second Edition Copyright © 2011. F.A. Davis Company 21 Evaluation  Is client free from self harm and free of harmful intent?  Is client’s mood becoming more optimistic?  Has client been taught and demonstrated new, positive coping skills?  Is client more willing to engage in social interaction? To initiate it?  Has client developed a recovery plan?