Understanding Osteoarthritis (OA)

Delirium

• Delirium manifests as a state of confusion evolving over a short time frame, from hours to days.
• A key indicator of delirium is a reduced capacity to focus, sustain, and shift attention.
• Manifestations of delirium include impaired memory, disorientation, language difficulties, visuospatial challenges, perceptual disturbances, altered activity levels (hypo- or hyperactivity), emotional fluctuations (fear, depression, euphoria, perplexity), and sleep disruption.
• Delirium typically develops over 2-3 days and its effects may last between 1-7 days.
• Delirium is differentiated from dementia by its sudden onset of cognitive impairment, disorientation, and a clouded sensorium.

Delirium Precipitating Factors

• Advanced age (65+) and male gender are demographic risk factors for delirium.
• Cognitive and sensory impairments, reduced oral intake, drug effects, underlying medical conditions, and surgery can all contribute to the onset of delirium.
• Environmental factors like ICU stays, physical restraints, untreated pain, emotional distress, and sleep deprivation can precipitate delirium.
• Functional limitations, dependence in daily activities, immobility, and a history of falls are also linked to increased delirium risk.

Delirium Mnemonic for Causes

• D stands for dementia and dehydration.
• E represents electrolyte imbalances and emotional stress.
• L denotes lung, liver, heart, kidney, and brain issues.
• I indicates infection and ICU admission.
• R signifies Rx Drugs.
• I signifies injury and immobility.
• U is for untreated pain and unfamiliar environment.
• M is for metabolic disorders.

Delirium: Clinical Manifestations

• Delirium can present diversely, ranging from hypoactive (lethargy) to hyperactive (agitation, hallucinations).

Delirium: Diagnostic Studies

• Diagnosing delirium is challenging particularly in critically ill patients who may struggle to communicate effectively.
• Assessments include a detailed medical and psychological history, physical examination, with careful attention to current medications, the Confusion Assessment Method (CAM), and relevant laboratory tests.

Nursing & Interprofessional Management: Delirium

• Nurses are central to the care of patients experiencing delirium.
• Prevention involves identifying patients at high risk and early recognition focuses on addressing precipitating factors.
• Treatment is directed towards the underlying cause of delirium, while nursing care prioritizes patient safety, family involvement, familiar surroundings, consistent staffing, and minimized environmental stimuli.
• An interprofessional approach addresses polypharmacy, pain management, nutritional support, elimination issues, medication management, immobility, skin integrity, and exercise.
• Nurses play a crucial role in supporting family members and caregivers.
• Patient education resources are available at www.ICUdelirium.org.

Dementia

• Dementia involves a decline in cognitive abilities from a prior baseline, affecting one or more cognitive domains.
• Affected cognitive domains include complex attention, executive function, language skills, learning and memory, perceptual-motor abilities, and social cognition.
• The onset of dementia varies depending on the underlying cause, ranging from gradual progression in neurodegenerative conditions to abrupt onset in vascular dementia.
• Symptom patterns can help differentiate between different underlying causes, with acute changes occurring over days to weeks, subacute changes over weeks to months, and infectious or metabolic causes being considered.

Dementia: Diagnostic Studies

• Gathering a thorough history that includes information on judgment problems, diminished interest in hobbies, repetitive questioning, difficulties learning new tasks, forgetfulness regarding dates, financial management challenges, and consistent memory problems is vital.
• A detailed medication history is also important.
• Physical and neurologic assessments incorporate a mental status examination or cognitive screening to rule out other conditions.
• The AAN recommends conducting electrolyte panels, liver function tests, vitamin B12 level, CBC, and thyroid function tests.
• Additional specialized tests may include RBC folate for suspected alcoholism and ionized calcium for suspected multiple myeloma.
• Neuroimaging techniques like CT or MRI of the head may be utilized

Nursing & Interprofessional Management: Alzheimer's Disease

• Preventive strategies include managing risk factors such as hypertension, diabetes, smoking, hypercholesterolemia, and dysrhythmias.

Alzheimer’s Disease (AD)

• Alzheimer's Disease is a progressive, neurodegenerative brain disease that is ultimately fatal.
• Generally, death occurs 4-8 years following diagnosis.
• Currently, there is no way to prevent or cure AD, but disease progression can be slowed.
• Variations in health status, lifestyle, and socioeconomic factors influence AD risk.
• There is a genetic component to AD risk.

Clinical Manifestations of Alzheimer's Disease

• AD progresses through stages: mild, moderate, and severe, transitioning from mild to severe at a variable rate over 3 to 20 years.
• Pathological changes may occur as early as 15 years before the clinical appearance of the disease.
• As AD advances, personal hygiene and concentration/attention decline.
• Behavioral symptoms such as unpredictable actions, agitation, aggression, delusions, and hallucinations may manifest.
• Late-stage impairments include dysphasia, apraxia, visual agnosia, dysgraphia, long-term memory loss, and failure to recognize family and friends.
• Further progression leads to the inability to communicate, perform ADLs, and wandering.
• Patients in late stages become unresponsive, incontinent and require total care.

Alzheimer's Disease: Early Warning Signs

• Key early warning signs of AD include memory loss affecting job skills, challenges in performing familiar tasks, language difficulties, disorientation to time and place, impaired judgment, problems with abstract thinking, misplacing objects, mood/behavior/personality changes, and reduced initiative.

Alzheimer's Disease: Diagnostic Studies

• Diagnosing AD is by exclusion; there isn’t a definitive diagnostic test.
• Exclusion involves ruling out all other potential causes of cognitive impairment.
• Comprehensive patient evaluation, including laboratory tests and ECG, are integral to the diagnostic process.
• Brain imaging can help detect early disease-related changes and monitor treatment response.
• A definitive diagnosis usually requires a brain tissue examination at autopsy.
• Neuropsychological testing is used. Common tests include the Mini-Cog, clock drawing test, Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA).
• The MMSE assesses orientation, recall, attention, calculation, language manipulation, and constructional praxis.
• The MoCA assesses memory, language, attention, visuospatial skills, and executive functions.

Alzheimer's Disease: Interprofessional Care

• There is currently no cure or treatment available to halt the deterioration of brain cells in AD.
• Medications do not cure or reverse the progression of the disease.
• Interprofessional care includes prescriptions for depression, sleep disturbances, and behavioral problems that are severe or dangerous. These come with the risk of death and cognitive decline.

Nursing Assessment: Alzheimer's Disease

• Subjective data includes gathering important health information, past health history, and medication details.
• Functional health patterns assessed encompass health perception/management, nutritional-metabolic status, elimination, activity-exercise patterns, sleep-rest habits, and cognitive-perceptual abilities.
• Objective data includes general observations, such as disheveled appearance or agitation, neurologic status characterized as mild, moderate, or severe, and any diagnostic findings.
• Nursing Diagnosis & Planning addresses confusion, risk for injury, and altered perception.
• Overall patient goals focus on maintaining functional ability, ensuring a safe living environment, minimizing risk of injuries, fulfilling personal care needs, and upholding dignity.
• Nursing Implementation: Health promotion involves strategies for maintaining brain health and modifying dementia risk factors.
• Acute care prioritizes reducing manifestations, preventing harm, and supporting both the patient and their caregiver.
• Hospitalization of AD patients for other health issues can exacerbate dementia symptoms and lead to delirium.
• Consistent nursing staff assignments, frequent reorientation, and safety surveillance are vital to minimize anxiety.
• Memory aids can be beneficial in the early stages for ambulatory care patients.
• Adult day care offers caregivers respite in a secure setting while providing stimulation for the AD patient.
• Long-term placement becomes necessary as the severity of problems and care needs increase, potentially exceeding caregiver resources.
• Specialized dementia units are designed to provide a secure environment where patients can walk freely without being able to wander unsupervised.
• In late-stage ambulatory care, patients experience severe impairment of basic functions, requiring total care.
• Specific problems related to all disease phases include behavioral issues, safety concerns, pain management, eating and swallowing difficulties, oral care, infection prevention, skin care, elimination problems, and the need for caregiver support.
• Nursing Management: Behavioral Problems are addressed through distraction, redirection, and reassurance.
• Threatening patients with restraints is not recommended. A calming environment, positive interactions, and exhausting all other options should be employed before considering drug interventions.
• Nursing Management: Consideration of sundowning, a condition where patients experience increased confusion and agitation during the late afternoon or evening is important. This may stem from circadian rhythm disruption or other factors like pain, hunger, unfamiliar environments, medication effects, reduced lighting, and fragmented sleep.
• Encourage calm, quiet environments with ample daylight, limit naps, reduce caffeine intake, and consider medication adjustments to minimize sundowning.
• Alzheimer's Disease: Safety – Key risks involve injury from falls, ingestion of dangerous materials, wandering, self-inflicted injury, burns, and inability to respond to crises.
• Quickly recognizing and treating patient pain is vital.
• Moderate to severe stages of Alzheimer's often lead to undernutrition, necessitating focused attention on eating and swallowing difficulties, infection prevention, skin care, and managing elimination problems.

Arthritis Types

• Osteoarthritis, rheumatoid arthritis, Systemic Lupus Erythematosus (SLE), and fibromyalgia represent distinct forms of arthritis.

Osteoarthritis Treatment

• Treatment is centered around alleviating pain and enhancing joint function.

Rheumatoid Arthritis Diagnosis

• Rheumatoid arthritis diagnosis relies on specific diagnostic criteria to distinguish it from other arthritis variations.

Systemic Lupus Erythematosus (SLE) Symptoms

• SLE exhibits a variety of symptoms affecting numerous organ systems.

Fibromyalgia Management

• Fibromyalgia management incorporates a multidisciplinary approach to reduce widespread pain and associated symptoms.

Comparative Analysis of Arthritis Types

• Each type of arthritis is characterized by unique features, diagnostic methodologies, and treatment approaches.