Disorientation, Delirium, Depression, Dementia PDF

Disorientation vs. Delirium vs. Depression vs. Dementia  Quick Recap  You should be aware that disorientation, delirium, depression, and dementia are NOT a normal part of aging. These all- effect cognitive function.  Diseases that affect the brain can affect cognitive funct...

Disorientation vs. Delirium vs. Depression vs. Dementia  Quick Recap  You should be aware that disorientation, delirium, depression, and dementia are NOT a normal part of aging. These all- effect cognitive function.  Diseases that affect the brain can affect cognitive function (the term cognitive relates to brain or mind). Cognitive functioning involves the following functions of the brain:  Memory  Thinking  Reasoning  Ability to understand  Judgement  Behaviour  Loss of cognitive function affects all dimensions of a person’s life. The state of having lost some or all ability to remember, think, reason, understand, or live independently is referred to as cognitive impairment. Disorientation  Disorientation, also called confusion, refers to an impaired ability to recall people, time, or places as a result (or any combination) of physiological changes to the brain, a disease process, or substance- induced factors. In most circumstances, disorientation is a symptom of an underlying medical condition such as depression, electrolyte imbalance, or even a brain tumour.  The word disorientation is a generic descriptive term, and refers only to the client’s disturbed orientation to people, time, or places.  Disorientation can occur suddenly (such as after ingesting too much alcohol) or over a long period (such as when it is associated with a mental health disorder). Continued…  Disorientation can be reversible or not reversible, depending on its causes.  Disorientation that is permanent is caused by physical changes in the structure of the brain and is called nonreversible dementia.  Disorientation that is reversible can occur during hospitalization or in other unfamiliar surroundings or when clients are in pain, experience electrolyte imbalance, or are suffering from lack of sleep.  Itis important that people who experience sudden disorientation without a known cause be seen by a physician. For example, sudden disorientation resulting from a stroke needs to be treated medically within hours, or it could result in permanent cognitive, mental, or physical disorders or even death.  Angry, restless, depressed, or irritable Aggression Anxiety Signs & Tremors Hallucinations: false perceptions, where you sense an object, person, or event even though it is not there or didn't happen Symptoms Delusions: a fixed false belief that persists despite evidence proving it false Decline in level of consciousness (LOC or ALOC) Disorganized thinking and speech Impaired attention span Causes Common: Delirium (UTI, electrolyte imbalance, medication, sleep Low blood sugar Head trauma/injury Concussion deprivation, dehydration) and dementia Carbon monoxide Nutritional deficiencies Fever Hypothermia poisoning Low levels of Infections Brain tumor Clinical depression oxygen/hypoxia Schizophrenia Seizures Sepsis Stroke  Diagnosing Disorientation Doctors Role HCA Role The doctor will check for signs of disorientation, Observe and Document: Monitor the client's behavior, such as confusion about time, place, or people, noting any confusion, changes in routine, or unusual being awake at odd hours, or struggling to answer actions (e.g., mixing up date, place, people, situation). Document these observations accurately and promptly. simple questions. Support the Client: Provide reassurance and maintain a The doctor will ask about other possible causes of calm environment to reduce confusion or anxiety. Assist disorientation, such as recent illness, head injury, with orientation by gently reminding clients of the time, diabetes, lung issues, urinary problems, date, their location and situation. medication errors, or drug and alcohol use. Communicate with the Team: Share observations with The physical examination will include a thorough the nurse or doctor, ensuring all relevant details are conveyed, such as the timing, frequency, and triggers of evaluation of the nervous system, including the disorientation. This is done during care rounds. brain, through various brain imaging scans, as Assist with Care Needs: Help with basic needs such as well as blood and urine tests dependent on the eating, drinking, and toileting, as dehydration or signs and symptoms. infections can worsen disorientation. After the necessary tests, the doctor may be able Follow Care Plans: Adhere to care instructions provided to identify the cause of the disorientation and by the healthcare team and support the client during will determine if it is a symptom of a persistent physical exams or tests if required. Check to see if they illness such as diabetes or COPD, or that of an have been ordered a 24 hour urine collection sample or do they have routine bloodwork where they need 1:1 acute condition such as delirium. support with the phlebotomist.  Support Given to Clients with Disorientation Encouraging Supporting a Limiting Alcohol Helping Manage Discouraging Regular Sleep Balanced Diet: Consumption: Diabetes: Smoking: Patterns: Help establish a consistent Assist with meal planning Gently remind and support If the client has diabetes, Provide encouragement sleep routine by ensuring and preparation to ensure the client to avoid assist with blood sugar and resources to reduce or the environment is quiet the client eats nutritious excessive alcohol use by monitoring, ensuring they quit smoking, such as and comfortable during meals rich in vitamins and offering healthier follow their meal plan and suggesting alternatives or sleep hours and minerals. Encourage alternatives and helping medication schedule, and connecting the client with discouraging naps that hydration and monitor for them follow guidelines set report any unusual smoking cessation might disrupt nighttime any eating difficulties. by the healthcare team. symptoms related to their programs. sleep. diabetes diagnosis (hypoglycemia vs hyperglycemia). Case Study  Eileen Thomas is a 68-year-old woman who lives with her husband in her own home. She was a chronic smoker for 40 years but quit 2 years ago, when she was diagnosed with chronic obstructive pulmonary disease (COPD). Mrs. Thomas’s husband reports to their family doctor that recently she seems “confused”: She has been leaving the stove on, forgetting to turn off the tap in the kitchen sink, and so on. Mrs. Thomas’s doctor tells the family that because of her long-term smoking (and other health issues), she has hardening of the arteries (atherosclerosis), which prevents oxygen from going to her brain in the normal manner. Although she is put on medication, her family is told that her condition cannot be cured and that she has dementia. As a support worker, you are to assist Mrs. Thomas with bathing and with cooking meals, and her husband now buys the groceries for the family. You need to monitor her for unsafe behaviours and report your observations to your supervisor.  How can the HCA help with:  Ensuring Safety in Daily Activities  Assist with Personal Care  Prepare Nutritious Meals  Observe and Report  Provide Emotional Support  Support the Family Takeaway  It isn’t necessarily life-threatening. But some of the illnesses that cause disorientation can be serious, and life threatening.   Disorientation that occurs suddenly and usually without warning is called delirium. It is usually caused by a treatable physical or mental health disorder; it is often temporary and disappears once the illness has been treated. Delirium is a serious change in mental abilities. It results in confused thinking and a lack of awareness of someone's surroundings. The disorder usually comes on fast — within hours or a few days. Delirium   Delirium should always be treated as an emergency!!! It often is the first or only sign of a physical disorder in older persons and in people with dementia. If you observe any sudden occurrence of signs and symptoms of delirium, inform your supervisor at once.  The cause of the delirium needs to be determined, and the delirium needs to be treated immediately. In many cases (such as with stroke), the symptoms can become permanent or could progress and cause death. Signs & Symptoms  Delirium involves a rapid alternation between mental states. For example, someone with delirium may become drowsy, then agitated, and then drowsy again  Attention disturbance, such as an inability to maintain goal-directed, purposeful thinking or behaviour, or difficulty concentrating  Incoherent speech and inability to stop speech patterns or behaviours  *Disorientation to time or place*  Sign of illusions (illusions are misinterpretations of sensory inputs, this happen when you misinterpret something real in your environment) or hallucinations  ALOC (Altered Level of Consciousness)  Decrease in short-term memory and recall  Emotional or personality changes, such as anxiety, anger, apathy (appearance of indifference), depression, euphoria (exaggerated expression of well-being), or irritability Causes Infection in the body (such as a urinary tract infection [UTI]) Injury from a fall Extreme lack of sleep An electrolyte imbalance (from a bout of influenza, for example) Certain drugs, a combination of prescription and over-the-counter (OTC) medications, or a toxic amount of these drugs Alcohol/drug use or withdrawal Poor nutrition Risk Factors  Any condition that results in a hospital stay increases the risk of delirium. This is mostly true when someone is recovering from surgery or is put in intensive care.  Delirium is more common in older adults and in people who live in nursing homes.  Brain disorders such as dementia, stroke or Parkinson's disease  Past delirium episodes  Multiple medical problems  Delirium may last only a few hours or as long as several weeks or months. If the causes are addressed, the recovery time is often shorter.  People with other serious, long-lasting or terminal illnesses may not regain the thinking skills or function that they had before the onset of delirium. Delirium Complications in seriously ill people is more likely to lead to:  More severe decline in health  Increased support needs  Increased risk for death Diagnosing Delirium Doctors Role HCA Role The client with delirium should be seen as Observe and Report Symptoms: Monitor the client for sudden changes in mental state, such as soon as possible by a physician, who will confusion, agitation, or drowsiness most likely order blood work, brain Note specific signs like disorientation, memory loss, speech changes, hallucinations, or personality shifts imagining scans, chest X-ray, or a lumbar Pay attention to physical symptoms like fever, pain, or signs of puncture (spinal tap) to determine the infection (e.g., urinary issues) cause of the delirium. Communicate with the Healthcare Team Report any observations of delirium symptoms to the supervisor or nurse immediately, emphasizing the sudden onset or severity Share details about the client’s recent activities, medications, or changes in routine that might be contributing factors Assist with Information Gathering Provide input on the client’s behavior patterns, habits, and recent changes to help the healthcare team identify possible triggers or risk factors Documentation Support Diagnostic Procedures: Help prepare the client for tests such as blood work, imaging scans, or X-rays Assist with positioning during diagnostic procedures as directed by the healthcare team Support Given to the Client with Delirium HCA's Support for Diagnosing Delirium Observe and Report Communicate with the Assist with Information Support Diagnostic Symptoms: Healthcare Team Gathering Procedures: Monitor the client for sudden Report any observations of Provide input on the client’s Help prepare the client for tests changes in mental state, such as delirium symptoms to the behavior patterns, habits, and such as blood work, imaging confusion, agitation, or supervisor or nurse immediately, recent changes to help the scans, or X-rays drowsiness emphasizing the sudden onset or healthcare team identify possible Assist with positioning during Note specific signs like severity triggers or risk factors diagnostic procedures as directed disorientation, memory loss, Share details about the client’s Documentation by the healthcare team speech changes, hallucinations, recent activities, medications, or or personality shifts changes in routine that might be Pay attention to physical contributing factors symptoms like fever, pain, or signs of infection (e.g., urinary issues) Treatment The goal of treatment is to control or reverse the cause of the symptoms, and treatment depends on the specific condition causing delirium. Sometimes, treatment requires stopping medications (or alcohol consumption). Disorders that contributed to disorientation—for example, heart failure, decreased oxygen, or psychiatric conditions (such as depression)—will be treated. Successful early treatment for coexisting medical and psychiatric disorders often greatly improves mental functioning. Some clients may require medications to control their aggressive, agitated behaviours or behaviours that are dangerous to themselves or to others. Medications are usually given in very low doses, with adjustments made as needed. Prevention  The best way to prevent delirium is to target risk factors that might trigger an episode. Hospital settings present a special challenge. Hospital stays often involve room changes, invasive procedures, loud noises and poor lighting. Lack of natural light and lack of sleep can make confusion worse.  Support Given to Clients with Delirium Preventinal Support to Clients with Delirium Maintain a Promote Encourage Minimize Support Monitor for Provide Consistent Restful Sleep Orientation Sensory Hydration and Triggers and Emotional Environment Overload or Nutrition Changes Reassurance Deprivation Reduce room Encourage a Regularly remind Reduce loud Offer regular Observe and Stay calm and changes whenever regular sleep the client of the noises, alarms, or fluids and document any provide possible and keep routine by date, time, and unnecessary balanced meals to signs of confusion, reassurance to the client in minimizing noise, location. disruptions in the prevent restlessness, or reduce anxiety or familiar dimming lights Use clocks, environment. dehydration and changes in fear, which can surroundings. during nighttime, calendars, and Ensure proper nutritional behavior. worsen delirium. Arrange personal and avoiding clear signage to lighting to prevent deficiencies, Report concerns to Engage in soothing items or interruptions help with confusion caused which can the supervisor or activities, such as comforting objects during rest orientation. by poor visibility. contribute to healthcare team gentle within the client’s periods. delirium. promptly to conversation or Gently engage reach to create Close blinds during them in address potential listening to familiarity. the night to block conversation to triggers or calming music. artificial light and keep them underlying causes. open them during mentally active. the day to allow natural light, which helps maintain the client’s sleep- wake cycle. Case Study  Mrs. Thomas has been your client for several months now, and although she has occasionally displayed unsafe behaviours—such as leaving the stove on—her condition has remained unchanged. On a particular day recently, Mrs. Thomas was acting completely differently. When you arrived, you found that she was very drowsy; then she woke up, became very tearful and agitated, threw some dishes on the floor, and finally fell asleep on the sofa.  As her support worker, you were understandably concerned, so you immediately notified your supervisor. Your supervisor advised you to call 9-1-1 and to accompany Mrs. Thomas to the hospital. The paramedics examined Mrs. Thomas and rushed her to the hospital by ambulance. At the hospital, it was found that the cause of this sudden, erratic behaviour was viral meningitis. The doctors expected that Mrs. Thomas would recover completely to her pre-meningitis state.  How can the HCA help with the entire process, from responding to the emergency to long term support.  Recognize and Respond to the Emergency  Accompany Mrs. Thomas to the Hospital  Communicate to the Healthcare Providers  Assist During Recovery  Reinforce Safety Measures  Provide Emotional and Physical Care  Dementia (a quick review) Dementia Symptoms Risk Factors and HCA's Role Treatment and Overview Prevention Therapies Definition: Progressive, Memory lapses, confusion, Risk Factors: Age, Promote healthy living: Medical: Medications like chronic condition poor judgment, difficulty hospital stays, dementia balanced diet, safe Donepezil, Memantine; affecting memory, with tasks. history, brain disorders, exercises, social occupational therapy. thinking, reasoning, and Mood, behavior, or multiple health issues engagement. Alternative: Music, pet, daily activities. personality changes. Prevention: Healthy diet, Support mental health: aromatherapy, art, and Causes: Includes Early signs include physical activity, mental calming environments, Snoezelen therapy. Alzheimer's, vascular misplaced items, stimulation, and chronic relaxation techniques. Home Strategies: Night dementia, Lewy body, and communication struggles, disease management Report observations and routines, calendars, safety frontotemporal dementia. and social withdrawal support diagnosis. measures Key Features: Not a normal part of aging; involves cognitive decline, mood changes, and behavioral shifts Case Study  Mrs. Thomas has fully recovered and returned to her pre-meningitis state, but she is becoming increasingly forgetful. Last week, you noticed that she needed help with buttoning her clothing while she was getting dressed. Mrs. Thomas herself mentioned to you that she “forgot” to undo her pants when she had to go to the bathroom and soiled herself. On your last two visits, she did not recognize you but could read your name tag. Earlier this week, her husband told you that she did not recognize him when he was helping her undress for bedtime and started punching him, accusing him of trying to molest her. She also started to yell at her reflection in the mirror because she did not recognize herself.  Her husband took her to her doctor, and after numerous tests, the doctor told Mr. and Mrs. Thomas that her dementia was probably due to Alzheimer’s disease. The doctor said that Mrs. Thomas’s symptoms had progressed at a very rapid rate and her cognition would probably decline quickly. Mrs. Thomas’s husband was very upset about the diagnosis; the couple had made plans to drive across Canada to visit their children and their grandchildren. Mr. Thomas told you that he was very grateful for your support in his wife’s care  How can the HCA help  Daily Care Assistance  Safety Measures  Emotional Support  Cognitive Engagement  Observation and Reporting  Mr. Thomas Depression  Depression and dementia are not always connected, and having depression does not mean a person will develop dementia.  However, depression and delirium can sometimes be mistaken for dementia because they share similar symptoms.  Depression is sometimes called "pseudo- dementia" because it can mimic dementia symptoms.  Similarly, people with Alzheimer’s Disease & Related Dementia (ADRD) might appear depressed, but their symptoms are caused by their condition, not depression. ADRD = Alzheimer's Disease & Related Dementia Signs and Symptoms Lack of Loss of interest Social concern for in activities withdrawal and surroundings and hobbies isolation Trouble Impaired concentrating thinking  It may be difficult to diagnose depression in clients with ADRD because their symptoms may differ from those of people without ADRD. Symptom differences may include the following: Symptoms of depression may not last as long for people Diagnosing  with ADRD as dementia symptoms increase.  Symptoms of depression may come and go in people with ADRD. Depression  Symptoms of depression may be less severe in people with ADRD.  People with ADRD may be less likely to talk about or attempt suicide Treatment  Treatment includes a combination of:  Medication  Counselling  Encouraged socialization and activities  We’ll discuss more in detail later throughout the course. Supporting Clients with Dementia who are Depressed Encourage Plan with Purpose: Boost Energy: Validate Emotions: Provide Comfort: Connection: Suggest support groups Create a predictable Focus high-energy tasks, Acknowledge sadness, Offer favorite foods and and celebrate small routine and schedule like exercise or bathing, in express hope, and frequent reassurance that successes together. enjoyable activities during the morning. reassure them of love and they won't be abandoned. their best times. appreciation. So…what's the difference between all four? Disorientation: Delirium: Dementia: Depression: Definition: A Definition: An acute, Definition: A chronic, Definition: A mood symptom where sudden change in progressive decline in disorder individuals lose track mental abilities, cognitive abilities characterized by of time, place, or marked by confusion affecting daily persistent sadness, identity. and disorganized functioning. loss of interest, and Key Point: It’s often thinking. Key Point: It’s cognitive effects. a symptom of a Key Point: It’s a irreversible and Key Point: Treatable, larger issue (e.g., medical emergency requires long-term but symptoms can delirium, dementia, that is usually care and mimic or coexist with or medical reversible with management. dementia and conditions) and can prompt treatment. delirium. be reversible. And…how are all four connected? All four conditions can involve confusion, memory problems, behavioral changes, and mood disturbances. This overlap often leads to misdiagnoses. Disorientation can be a symptom of delirium, dementia, or depression. Delirium can occur in people with dementia when they experience acute stressors like infections or dehydration. Depression is common in early dementia and can exacerbate cognitive decline. Dementia may lead to episodes of delirium during hospital stays or illness.