Eating Disorders, Somatic Symptom Illness, Cognitive Disorders PDF

EATING DISORDERS Mr. Leo Vincent O. Lumalang→ Psychiatric Nursing OVERVIEW DEVELOPMENTAL FACTORS MIDDLES AGES → starvation in female saints for purity 2 ESSENTIAL TASKS OF ADOLESCENCE [Erik erikson] ○ Thin – more ideal...

EATING DISORDERS Mr. Leo Vincent O. Lumalang→ Psychiatric Nursing OVERVIEW DEVELOPMENTAL FACTORS MIDDLES AGES → starvation in female saints for purity 2 ESSENTIAL TASKS OF ADOLESCENCE [Erik erikson] ○ Thin – more ideal 1. Struggle to develop autonomy LATE 1800s IN ENGLAND & FRANCE – self-starvation to 2. Establish a unique identity avoid obesity Identify potential risk factors 1960s – Anorexia nervosa established as mental disorder ○ FAMILY: Overprotective or ENMESHMENT (lack of clear 1979 – BULIMIA NERVOSA was first described. role boundaries), lack of or no familial support ○ PERSONAL: body dissatisfaction, body image EMANCIPATION – severe weight loss; sign of anorexia nervosa disturbance, influence of mass media FAMILY FACTORS STATISTICS Family problems or discords (disordered eating becomes a Overlapping among eating disorders distraction from emotions) 30 - 35% of normal-weight people with bulimia have a hx of Childhood adversity anorexia nervosa and low body weight ADVERSITY – physical neglect, sexual abuse or parental 50% of anorexia nervosa have bulimic behavior maltreatment that includes little care, affection, and empathy 90% of cases of anorexia nervosa and bulimia occurs in as well as excessive parental control, unfriendliness or females overprotectiveness. PREVALENCE: estimated to be 1-3% of the general SOCIOCULTURAL FACTORS population in the US; 70% of the general population is simply preoccupied with weight and body image. Influence of mass media The culture which considers being overweight as a sign of ANOREXIA NERVOSA BULIMIA NERVOSA laziness, lack of control, or indifference Equates pursuit of the perfect body with beauty, desirability, Earlier age of onset Later age of onset success, and willpower Below-normal body weight Near-normal body weight Pressure from others (e.g. coaches, parents, peers) Fails to recognize the Usually are ashamed or Bullying and peer harassment eating behavior as a embarrassed by the ANOREXIA NERVOSA problem eating behavior Mirror – fixated on how PURGING & USING OF ANOREXIA NERVOSA → life-threatening eating disorder they look like LAXATIVE – characterized by the client’s restriction of nutritional intake compensatory behavior necessary to maintain minimally normal body weight, intense Toilet – where they vomit fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and ANOREXIA NERVOSA steadfast inability or refusal to acknowledge the seriousness An – lack of of the problem or even that one exists. Orexis – appetite Body weight less than minimum expected weight, considering Nervosa – nervous origin their age, height, and overall physical health. 2 SUBGROUPS BULIMIA NERVOSA Bulimia – “ox” hunger RESTRICTING SUBTYPE → lose weight primarily through dieting, fasting, or excessive exercising. Nervosa – nervous origin BINGE EATING and PURGING SUBTYPE → engage ETIOLOGY regularly in binge eating followed by purging BIOLOGIC FACTORS BINGE EATING → consuming a large amount of food (far greater MAIN CAUSE: idiopathic than most people at one time) in a discrete period of usually 2 hours or less Genetics – tends to run in the family PURGING → involves compensatory behaviors designed to Dysfunction of the HYPOTHALAMUS – disrupts hunger and eliminate food by means of self-induced vomiting or misuse of satiety (satisfaction of appetite) laxatives, enemas, and diuretics ○ Deficits in LATERAL HYPOTHALAMUS > decreased eating and decreased responses to sensory stimuli CHARACTERISTICS: important in eating [no appetite] May not binge but still engage in purging behavior after ○ Disruption of the VENTROMEDIAL HYPOTHALAMUS > ingesting small amounts of food leads to excessive eating, weight gain, decreased Totally absorbed (focused) on weight loss and thinness. responsiveness to satiety effects of glucose (seen in No appetite loss; still experience hunger but bulimia) [decrease in satiety or fullness] suppressed/ignores it and signs of physical weakness and Neurochemical changes fatigue will occur. ○ NEUROEPINEPHRINE LEVELS Believes that if they eat anything, they will not be able to Increase in response to eating to metabolize & use stop and they will become fat. nutrients Pre-occupied with food-related activities such as grocery Does NOT rise during starvation due to low nutrients shopping, collecting recipes or cookbooks, counting available to metabolize calories, creating fat-free meals and cooking family Low levels are seen in episodes of restricted meals food intake → because the body has nothing Engaged in unusual or ritualistic food behaviors such as to metabolize refusing to eat around others, cutting food into minute Also related to decrease in HR and BP (due to low pieces, or not allowing the food they eat to touch their epinephrine levels in anorexic patients) lips → increases sense of control Excessive exercise is common; several hours per day BSN 3A - Marjorie D. Solayao PHYSICAL PROBLEMS OF ANOREXIA NERVOSA PROGNOSIS Amenorrhea 30% becomes well Constipation 30% partially improves Overly sensitive to cold – lack of fats 30% chronically ill Lanugo hair on body – bc of nutrient depletion 10% die of anorexia-related causes Hair loss TREATMENT & PROGNOSIS Dry skin – dehydration Dental caries Very difficult to treat – resistant, appears uninterested, and Pedal edema – bc they do not consume protein necessary for denies their problems oncotic pressure resulting in pedal edema GOALS OF MEDICAL MANAGEMENT: Bradycardia ○ Weight restoration Enlarged parotid glands and hypothermia ○ Nutritional rehabilitation Electrolyte imbalance (less than body requirements) ○ Rehydration ○ Hypokalemia ○ Correction of electrolyte imbalacnces MEDICAL MANAGEMENT: BULIMIA NERVOSA ○ Nutritionally balanced meals and snacks gradually An eating disorder characterized by recurrent episode of increasing in caloric intake appropriate to age, size Often precipitated by strong emotions and followed by guilt, and activity remorse, shame, or self-contempt ○ TPN, tube feedings, hyperalimmination fro serverly Weight is usually in normal range; although some may be malnourished clients. overweight or underweight ○ Supervised bathroom privileges to prevent purging – 1 Recurrent vomiting causes tooth decay; dentists often first to to 2 hours after eating identify clients with bulimia. ○ Weigh gain & adequate food intake – criteria to determine effectiveness of treatment RELATED DISORDERS PHARMACOLOGIC: BINGE EATING DISORDER ○ AMITRIPTYLINE (Elavil) and CYPROHEPTADINE ○ Recurrent episodes of binge eating; nor regular use of (Periactin) – an antihistamine in high doses, can inappropriate compensatory mechanism (e.g. purging, promote weight gain excessive exercise, overuse of laxative) ○ OLANZAPINE (Zyprexa) – antipsychotic effect (on ○ Usually affects people over age 35 y/o; men more than bizarre body image distortions) and associated weight women; characterized by overweight or obese gain NIGHT EATING SYNDROME ○ FLUOXETINE (Prozac) – prevent relapse; use cautiously. Side effect: weight loss. ○ Characterized by morning anorexia, evening hyperphagia (consuming 50% of daily calories after the PSYCHOTHERAPY: last evening meal), and night time awakenings (atleast ○ Beneficial for families of clients younger than 18 y/o once a night) to consume snacks ○ Individual therapy – cognitive-behavioral therapy ○ Associated with life stress, low self-esteem, anxiety, ○ Family therapy – most effective depression, and adverse reactions to weight loss BULIMIA NERVOSA ○ Obese PICA ONSET: 18-19 y/o ○ Eating disorder in children late adolescence or early adulthood ○ Persistent ingestion of nonfood substances CHARACTERISTICS: RUMINATION Binge eating happens during or after dieting ○ Repeated, regurgitation of food that is then rechewed, reswallowed, or spit out In between binging and purging, are restrictive eating ○ Both to parent-child conflict or family dysfunction Restrictive eating prepared them for next episodes of binging, and purging and the cycle continues ONSET & CLINICAL COURSE Aware that eating behaviors are pathologic and goes great lengths to hide it from others ANOREXIA NERVOSA Bizarre food habits (e.g. stashing food in cars, desks, secret storage, driving by at least 6 fast food restaurants and ONSET: between 14 to 18 y/o ordering food within 1-2 hours) EARLY STAGE Condition may exist for years before being detected by Denial of negative body image or anxiety regarding family and friends appearance Have near-normal weight reduces the concern about Pleased with ability to control weight; openly expresses this severe malnutrition – a factor in anorexia nervosa. Unable to identify or to explain their emotions about life events such as school or relationships with family or friends PROGNOSIS A profound sense of emptiness is common 30% continued to engage in recurrent binge eating and LATE STAGE purging behaviors 38-47% fully recover (although ⅓ of them may relapse) Depression and labile mood become apparent Have poorer outcomes if with personality disorder Sieting and compulsive behaviors increase comorbidities Social isolation happens Death rate for bulimia: estimated 3% or less Believes that peers are jealous of their weight loss TREATMENT Family and health care professionsals are trying to make them “fat and ugly” COGNITIVE BEHAVIORAL THERAPY (CBT) – most effective treatment BSN 3A - Marjorie D. Solayao  PHARMACOLOGIC: HEMATOLOGIC Pancytopenia (leukopenia, anemai, ○ Fluoxetine (Prozax) – the one recognized by FDA thrombocytopenia) ○ OTHER ANTI-DEPRESSANTS: Hypercholesterolemia Desipramine (Norpramin) Hypercarotenemia imipramine (Tofranil) Amitriptyline (Elavil) NEUROPSYCHIATRIC Abnormal taste sensation Nortriptyline (Pamelor) Apathetic depression Phenelzine (Nardil) Mild organic mental symptoms ASSESSMENT Sleep disturbances ANOREXIA NERVOSA BULIMIA NERVOSA COMPLICATIONS RELATED TO PURGING (VOMITING/LAXATIVES) Perfectionist with Pleasing others and above-average intelligence avoiding conflict METABOLIC Electrolyte imbalances Achievement-oriented History of impulsive (hypokalemia, hypochloremic Dependable behavipors alkalosis, hypomagnesemia, Eager to please (substance abuse, elevated BUN) Seeking approval shoplifting DENTAL Erosion of dental enamel GENERAL APPEARANCE (perimyolysis) or front teeth Slow, lethargic, fatigued Generally close to GI Inflammation and enlargement of Emaciated expected body salivary glands and pancreas → Apprehensive to talk because weight for age and increased amylase they do not want to size Esophageal & gastric erosion or acknowledge any problems Open and willing to rupture Limited eye contact talk Dysfunctional bowel Layered clothing NEUROPSYCHIATRIC Seizures, mild neuropathies MOOD AND AFFECT Fatigue, weakness Owns a sense of control over Actions lead to actions anxiety, depression, NURSING DIAGNOSIS Seems sad, anxious, worried feeling out of control Imbalanced nutrition: Seldom smile, laugh, or enjoy Initially pleasant and any attempt to humor cheerful as though Somber and serious nothing is wrong EXPECTED OUTCOMES Mood change Establish adequate nutritional patterns Eliminate use of compensatory behaviors such as excessive COMPLICATIONS RELATED TO WEIGHT LOSS exercise and use of laxatives and diuretics Demonstrate coping mechanism not related to food MUSCULOSKELETAL Loss of muscle mass, fat Verbalize feelings of guilt, anger, anxiety or an excessive Osteoporosis, pathologic fracture need for control Verbalize acceptance of body image with stable body METABOLIC Hypothyroidism (includes lack of weight (5-10% of normal body weight with no medical enegry, weakness, intolerance to complications from starvation or purging) cold) Hypoglycemia NURSING INTERVENTIONS Decreased insulin sensitivity ESTABLISH NUTRITIONAL EATING PATTERNS ○ Sit with the client during meals and snacks CARDIAC Bradycardia, hypotension ○ Offer liquid protein supplement if unable to complete Loss of cardiac muscle meal Cardiac arrhythmia (PAC, PVC, ○ Adhere to treatment program guidelines regarding V-tach) restrictions Sudden death ○ Observe after meals adn snacks for 1 to 2 hours ○ Weight daily in uniform clothing – during waking hours GI Delayed gastric emmptying ○ Be alert to attempts to hide or discard food or inflate Bloating, Constipation weight Abdominal pain, gas, and diarrhea ○ COLLABORATIVE: diet of 1,200 to 1,500 calories/day, with gradual increases based on height, activity levels, REPRODUCTIVE Amenorrhea and growth needs, divided into 3 meals and 3 snacks. Hormonal imbalance (low LH, FSH) HELP IDENTIFY EMOTIONS AND NON-FOOD-RELATED COPING STRATEGIES DERMATOLOGIC ○ Ask to identify feelings Dry, cracking skin due to DHN ○ Self-monitoring using a journal Lanugo (fine baby hair) ○ Relaxation techniques Edema ○ Distraction Acrocyanosis (blue hands, and feet) ○ Assist to change stereotypical beliefs BSN 3A - Marjorie D. Solayao  HELP DEAL WITH BODY IMAGE ISSUES ○ Recognize benefits of a more near-normal weight ○ Assist to view self in ways not related to body image ○ Identify personal strengths, interests, talents PROVIDE HEALTH TEACHINGS FOR: ○ CLIENT Basic nutritional needs Harmful effects of restrictive eating, dieting and purging Realistic goals for eating Acceptance of health body image ○ FAMILY AND FRIENDS Provide emotional support Express concern about client’s health Avoid talking only about weight, food intake, calories Become informed of eating disorders Do not force client to eat; seek professional PREVENT EATING DISORDERS ○ Get rid of the notion that a particular diet, weight, or body size will automatically lead to happiness and fulfillment. ○ Learn everything you can about anorexia nervosa, bulimia nervosa, binge eating disorder, and other types of eating disorders ○ Make the choice to challenge the false idea that thinness and weight loss are great and that body fat and weight gain are horrible or indicate laziness, worthlessness, or immorality. ○ Avoid categorizing foods as “good/safe” versus “bad/dangerous.” Remember that we all need to eat a balanced variety of foods. Finally... Stop judging yourself and others based on body weight or shape. Turn off the voices in your head that tell you that a person’s body weight is an indicator of their character, personality, or value as a person. BSN 3A - Marjorie D. Solayao SOMATIC SYMPTOM ILLNESS Mr. Leo Vincent O. Lumalang→ Psychiatric Nursing OVERVIEW ONSET AND CLINICAL COURSE EARLY 1800s → various social and psychological factors OCCURRENCE: Chronic or recurrent, may even last for that influence illness decades Psychosomatic... Desperate to obtain relief from symptoms; may tend to go ○ PSYCHE – mind from one physician or clinic to another ○ SOMA – body Can develop PESSIMISM to medical establishments with the Effects of stress (emotional) to the body (physical) belief that their condition could be diagnosed if providers HYSTERIA [Greek “wandering uterus”] → multiple physical were more competent complaints with no organic basis; complaints are usually May seek medical attention first, but when all possibilities described dramatically. are exhausted, will seek psychological or mental health ○ originated in Egypt and is about 4,000 years old diagnosis. ○ MIDDLE AGES → hysteria was associated with RELATED DISORDERS witchcraft, demons, and sorcerer Somatic symptom illnesses need to be distinguished from ○ usually women, were considered evil or possessed by other body-related disorders. evil spirits. MALINGERING PAUL BRIQUET & JEAN MARGIC CHARCOT – identified ○ intentional production of false or grossly exaggerated hysteria as a disorder of the nervous system physical or psychological symptoms SIGMUND FREUD – observed that people with hysteria ○ motivated by external factors (e.g., avoiding work, improved with hypnosis and experienced relief from their evading criminal prosecution, obtaining financial physical symptoms when they recalled memories and compensation, or obtaining prescription drugs) expressed emotions. ○ have no real physical symptoms or grossly exaggerate SOMATIZATION → people can convert unexpressed relatively minor symptoms emotions into physical symptoms ○ can stop the physical symptoms as soon as they have SOMATIZATION gained what they wanted transference of mental experiences and states into bodily FABRICATED AND INDUCED ILLNESS symptoms ○ FACTITIOUS DISORDERS SOMATIC SYMPTOM ILLNESSES → characterized as the intentionally produces symptoms for some purpose presence of physical symptoms that suggest a medical or gain ( usually attention); may even inflict injury condition without a demonstrable organic basis to account on themselves to receive attention fully for them common term for factitious disorder imposed on self is Munchausen syndrome 3 CENTRAL FEATURES OF SOMATIC SYMPTOM ILLNESS ○ MUNCHAUSEN SYNDROME BY PROXY 1. Physical complaints suggest major medical illness but have no factitious disorder imposed on others demonstrable organic basis. Although uncommon, usually occur in people who 2. Psychological factors and conflicts seem important in are in or are familiar with medical professions, such initiating, exacerbating, and maintaining the symptoms. as nurses, physicians, medical technicians, or 3. Symptoms or magnified health concerns are not under the hospital volunteers client’s conscious control. are arrested and prosecuted in the legal system for injuring or inflicting injury to clients and children REMEMBER: Client really experience the symptoms they ETIOLOGY describe and cannot voluntarily control them. PSYCHOSOCIAL THEORIES SOMATIC SYMPTOM DISORDERS INTERNALIZATION – somatic symptom illnesses keep stress, SOMATIC SYMPTOM DISORDER anxiety, or frustration inside rather than expressing them ○ characterized by one or more physical symptoms that outwardly have no organic basis ; causes significant distress and Instead of emotional expression, these internalized anxiety feelings nad stress show through physical symptoms CONVERSION DISORDER These are unconscious defense mechanisms ○ Also called conversion reaction The more they become stressed or placed in situations ○ Involves unexplained, usually sudden deficits in sensory of conflict, the physical symptoms worsen. or motor function (e.g., blindness, paralysis) ; usually PRIMARY GAINS VS. SECONDARY GAINS significant functional impairment PRIMARY GAIN – direct internal benefits that being ○ suggest a neurologic disorder but are associated with sick provides (e.g. relief of anxiety, conflict, distress) psychological factors. SECONDARY GAIN → external or personal benefits ○ LA BELLE INDIFFÉRENCE – an attitude of lack of received from others because one is sick (e.g., concern or distress, about the functional loss. attention from family members and comfort measures, PAIN DISORDER such as being brought tea, receiving a back rub) ○ primary physical symptom of pain; UNRELIEVED by Boys in the United States are taught to be STOIC and to analgesics and greatly affected by psychological “take it like a man,” causing them to offer fewer physical factors in terms of onset, severity, exacerbation, and complaints as adults. maintenance. WOMEN: HYPOCHONDRIASIS (Illness Anxiety Disorder) seek medical treatment more often than men; more ○ Preoccupation with the fear that one has a serious socially acceptable for them to do so. disease (DISEASE CONVICTION) or will get a serious more often receive treatment for psychiatric disorders disease (DISEASE PHOBIA). with strong somatic components such as depression. ○ Clients with this disorder misinterpret bodily sensations CHILDHOOD SEXUAL ABUSE: related to somatization, or functions happens more frequently to girls. BSN 3A - Marjorie D. Solayao  BIOLOGICAL THEORIES 14. Feeling tired or having low energy 15. Trouble sleeping Different reactions to stimuli HISTORY CULTURAL CONSIDERATIONS Type and frequency of somatic symptoms and their meaning Extensive, detailed account of physical problems, diagnostic may vary across cultures tests, multiple consults to healthcare providers Reports physical crises SYNDROME CULTURE CHARACTERISTICS La belle indifference (conversion disorder) Dhat India Hypochondriacal concern GENERAL APPEARANCE about semen loss Discomfort, physical distress (pain disorder) Exaggerated reporting but lacks specific information Koro Southeast Asia Belief that penis is shrinking Labile; mood shifts from depressed and sad to bright and and will disappear into excited abdomen, resulting in death THOUGHT PROCESSES Falling-out Southern Sudden collapse; person Would talk more about the physical symptoms rather than episodes United States, cannot see or move of emotional causes Caribbean Fear of serious illness (hypochondriasis) islands ROLES AND RELATIONSHIP Hwa-byung Korea Suppressed anger causes Likely unemployed due to excessive absenteeism or inability insomnia, fatigue, panic, to perform work indigestion, and generalized Socialization takes place within members of the healthcare aches and pains community Reports lack of family support and understanding Sangue Portuguese Pain, numbness, tremors, Home life is often chaotic and unpredictable dormido Cape Verde paralysis, seizures, blindness, NURSING DIAGNOSIS (sleeping Islands heart attack, miscarriage blood) Ineffective coping Ineffective denial Shenjing China Physical and mental fatigue, Impaired social interaction shuairuo dizziness, headache, pain, Anxiety sleep disturbance, memory Disturbed sleeping pattern loss, gastrointestinal problems, Fatigue sexual dysfunction Pain (Acute/Chronic) TREATMENT EXPECTED OUTCOMES FOCUS: Managing symptoms and improving quality of life Identify the relationship between stress and physical symptoms. empathetic and sensitive to the client’s physical complaints; trusting relationship to ensure clients stay with and receive Verbally express emotional feelings. care from one provider instead of “doctor shopping.” Follow an established daily routine. pain management – visual imaging and relaxation Demonstrate alternative ways to deal with stress, anxiety, physical therapy – maintain and build muscle tone to help and other feelings. improve functional abilities. Demonstrate healthier behaviors regarding rest, activity, Cognitive behavioral group therapy and nutritional intake. PHARMACOLOGIC: NURSING INTERVENTIONS ○ Depression – SSRI antidepressants [Fluoxetine HEALTH TEACHINGS (Prozac), Paroxetine (Paxil), Sertraline (Zoloft)] ○ Establish daily routine ○ NSAIDS for pain management; avoid narcotic ○ Promote adequate nutrition and sleep analgesics, high risk for dependence or abuse EXPRESSION OF EMOTIONAL FEELINGS ASSESSMENT ○ Recognize relationship between stress/coping and For the past 4 weeks, each of the following symptoms is rated as: physical symptoms Not bothered at all = 0 ○ Keep a journal Bothered a little = 1 ○ Limit time spent on physical complaints Bothered a lot = 2 ○ Limit primary and secondary gains by giving 1. Stomach pain restrictions 2. Back pain COPING STRATEGIES 3. Pain in arms, legs, and joints ○ EMOTION-FOCUSED coping strategy 4. Menstrual cramps or other problems with periods (females Relaxation techniques, deep breathing, guided only) imagery, distraction (e.g. music) 5. Headaches ○ PROBLEM-FOCUSED coping strategy 6. Chest pain Identifying stressful situations, 7. Dizziness problem-solving strategies, 8. Fainting spells role-playing social situations and 9. Feeling your heart race or pound interactions 10. Shortness of breath 11. Pain or problems during sexual intercourse 12. Constipation, loose stools, or diarrhea 13. Nausea, gas, or indigestion BSN 3A - Marjorie D. Solayao COGNITIVE DISORDERS Mr. Leo Vincent O. Lumalang→ Psychiatric Nursing OVERVIEW injury; and exposure to gasoline, paint solvents, insecticides, and related substances COGNITION – brain’s ability to process, retain, and use information. INFECTION SYSTEMIC: Sepsis, urinary tract infection, Cognitive abilities include reasoning, judgment, perception, pneumonia attention, comprehension, and memory. CEREBRAL: Meningitis, encephalitis, HIV, Essential in making decisions, solving problems, interpreting syphilis the environment, and learning new information. INDICATIONS DELIRIUM DEMENTIA DRUG INTOXICATION: Anticholinergics, lithium, RELATED alcohol, sedatives, and hypnotics ONSET Rapid Gradual and insidious WITHDRAWAL: Alcohol, sedatives, and hypnotics DURATION Brief (hours to Progressive deterioration Reactions to anesthesia, prescription days) medication, or illicit (street) drugs LOC Impaired, Not affected TREATMENT & PROGNOSIS fluctuates PRIMARY TREATMENT: identify and treat causal or contributing medical conditions MEMORY Short-term Short- and then HALOPERIDOL (HALDOL) – antipsychotic medications memory long-term memory ○ Avoid sedatives, benzodiazepines – worsens delirium impaired impaired, eventually Nutritional Management destroyed Physical restraints when agitated SPEECH May be slurred, Normal in early stage, DEMENTIA rambling, progressive aphasia in pressured, later stage involves multiple cognitive deficits, initially, memory irrelevant impairment, and later, the following cognitive disturbances may be seen: THOUGHT Temporarily Impaired thinking, ○ APHASIA → deterioration of language function PROCESSES disorganized eventual loss of thinking ○ APRAXIA → impaired motor functions abilites ○ AGNOSIA → inability to recognize names of objects ○ Disturbance in EXECUTIVE FUNCTIONING → inability PERCEPTION Visual or tactile Often absent, but can to think abstractly hallucinations, have paranoia, CHARACTERISTICS delusions hallucinations, illusions MEMORY IMPAIRMENT – early sign of dementia ; recent memory first then to remote memory in later stages MOOD Anxious, fearful Depressed and anxious ECHOLALIA – echoing what is heard if hallucinating, in early stage, labile weeping, mood, restless pacing, PALILALIA – repeating words or sound over and over irritable angry outbursts in later without an external stimuli stages Underestimate the risks associated with activities or overestimate their ability to function in certain situations DELIRIUM COPING STRATEGIES Syndrome that involves a disturbance of consciousness accompanied by a change in cognition EMOTION-FOCUSED PROBLEM-FOCUSED Develops over a short period, sometimes a matter of hours, COPING STRATEGY COPING STRATEGY and fluctuates, or changes, throughout the course of the day Difficulty paying attention, easily distracted and disoriented, FOCUS: help clients relax and FOCUS: help resolve or and have sensory disturbances (illusions, misinterpretations, reduce feelings of stress change a client’s behavior or or hallucinations) Relaxation techniques situation or manage life Disturbances in the sleep–wake cycle, changes in deep breathing stressors psychomotor activity, and emotional problems guided imagery Identifying stressful distractions (E.g., music) situations RISK FACTORS Problem-solving Increased severity of physical illness strategies Older age Role-playing social Baseline cognitive impairment (e.g., dementia) interactions IN CHILDREN: Febrile illnesses or medications such as anticholinergics ONSET & CLINICAL COURSE ETIOLOGY Progressive in the absence of an underlying, treatable cause PHYSIOLOGIC Hypoxemia; electrolyte disturbances; renal or MILD: Forgetfulness – hallmark of beginning, mild dementia OR hepatic failure; hypoglycemia or Physiological ; may remain in the community METABOLIC hyperglycemia; dehydration; sleep MODERATE: Confusion is apparent, along with progressive deprivation; thyroid or glucocorticoid memory loss ; may remain in the community but with or metabolic disturbances; thiamine or vitamin adequate caregiver support deficiency (B12, C, Niacin, Protein); SEVERE: Personality and emotional changes occur ; require cardiovascular shock; brain tumor; head assistance with ADLs ; may be confined in nursing facilities BSN 3A - Marjorie D. Solayao  ETIOLOGY ○ NMDA RECEPTOR ANTAGONIST – slows the progression of Alzheimer's in moderate or severe ALZHEIMER’S DISEASE stages ○ progressive brain disorder that has a gradual onset Memantine (Zimers) but causes an increasing decline in functioning (loss of speech, loss of motor function, and profound ASSESSMENT personality and behavioral changes) ○ evidenced by atrophy of cerebral neurons, senile Mini-Mental State Examination (MMSE) plaque deposits, and enlargement of the third and fourth ventricles of the brain. MINI MENTAL STATE EXAM SCORING CHART ○ CAUSES: SCORE LEVEL OF DEMENTIA atrophy of cerebral neurons 23-30 Normal senile plaque deposits enlargement of the third and fourth ventricles of 19-23 Borderline the brain