Chapter 13: Delirium and Dementia

what is the primary difference between delirium and dementia

• Delirium is typically reversible, dementia is usually irreversible

• Agitation is constant with delirium but intermittent with dementia

• The onset of delirium is gradual; the onset of dementia is rapid

• Delirium usually lasts only few minutes; dementia lasts weeks to months.

Answer explanation

The primary difference between delirium and dementia is that delirium is typically reversible while dementia is usually irreversible. Agitation is not constant with delirium, and delirious people may be hyperactive, hypoactive, or alternate between the two. With dementia, agitation is constant with a gradual slow progression to combativeness, delusions, hallucinations, and wandering in later stages. Delirium develops over a short period of time while dementia has an insidious onset with gradual steady progression in cognitive and behavioral symptoms. Delirium can last for quite a while and depends upon managing the symptoms and treating or removing the cause while maintaining safety and comfort to reduce anxiety. Dementia is not reversible and is defined as a progressive and significant cognitive decline from a previous level of performance.

-speech may be slurred

- disjointed with aimless repetition

- individual may misinterpreted what happening in environment and may develop delusional thinking and experience hallucinations

- sleep-wake disturbances

- common delusion is that someone is trying to steal from them.

- ex: they may think that the banging of a door is a gunshot

A delirious patient repeatedly cries out for her daughter in the middle of the night. What is the best intervention?

• Check to see whether she has an order for a sedative

• Call the daughter and ask her to come see the patient

• Calmly tell her where she is and that her daughter is not there

• Tell her she needs to be quiet because she is disturbing other patients

Answer explanation

The best intervention is to be honest and tell the patient where she is and that her daughter is not there. Frequent orientation to the surroundings and the situation is important for patients with delirium. Sedatives and antipsychotic drugs should be used with great caution with older adult patients because they can increase the risk of death. Calling her daughter in the middle of the night and asking her to come to see her mother, and scolding the patient and telling her to be quiet because she is disturbing other patients, are not reasonable or appropriate interventions.

A patient with AD wanders away from the table during meals, leaving most of food untreated. What should you do?

• Consult with the dietitian about providing finger foods

• Restrain the patient in his seat during meal

• Tell him he must sit down and finish his meal

• Ask another patient to try to keep him at the table

Answer explanation

When a patient with Alzheimer disease (AD) wanders way from the table during meals, the nurse should consult a dietitian to see if finger foods can be provided for the patient. Avoid physical restraints, which can cause anxiety and agitation in confused patients and often can result in patient injuries. Arguing and ordering the patient to sit down and finish his meal does not convey respect and dignity and is not an appropriate action. Asking another patient for help can put the other patient at risk for injury.

When addressing a person who has dementia, which message is most appropriate

• "You need to be dressed for church in 30 minutes"

• " Put your arm in the sleeve of your shirt"

• " Put your shirt on"

• "What would you like to wear today"

Answer explanation

When addressing a patient with dementia, it is best to be direct and keep instructions simple. Telling the patient he needs to be dressed in 30 minutes to go to church is too detailed, and telling him to “put his shirt” on needs to be more direct. Also, asking him what he wants to wear can be too confusing and cause anxiety.

A new nurse on the special care unit for patient with AD repeatedly asks patients what time it is and if they know where they are. What information should you share with her?

• If a patient cannot answer the question correctly; wait 5 minutes and ask again

• Consistently tell patients the time ,date, and place to keep them oriented

• Frequent attempts at orientation tend to agitate patient with AD

• Ask the patient to repeat the date, time, and place after you say them

Answer explanation

Tell the new nurse that frequent attempts at orientation can agitate patients with Alzheimer disease (AD). It is best to try to weave orienting phrases into the conversation. Waiting 5 minutes to ask the patient the same question can also cause anxiety. Consistently telling or asking the patient to repeat the date, time, and place after you say them can also cause anxiety.

If you applied the principles of the CDA to the care of a patient with dementia you would:

• Consistently use the same interventions for all patients with dementia

• Have patients confront irrational fears so they can be overcome

• Insist that the patient behaves as a mature adult at all times

• Adapt expectations and interventions to the patient's abilities

Answer explanation

The cognitive developmental approach (CDA) is based upon adapting expectations and interventions to the patient’s abilities and not consistently using the same interventions for all patients. It does not include having the patient confront irrational fears, but has the nurse recognize irrational fears so that alternative ways to give personal care can be arranged. Also, insisting that the patient behave as a mature adult at all times is scolding and disrespectful of the patient and can cause anxiety.

Which type of dementia is most common?

• Alzheimer Disease

• Acetylcholine

• Dementia

• Delirious

Answer explanation

Alzheimer disease is the most common type of dementia.

Most drugs used to treated AD work by increasing the amount of which neurotransmitters in the brain

• Alzheimer Disease

• Acetylcholine

• Dementia

• Delirious

Answer explanation

Acetylcholine is the major neurotransmitter in the brain. Most Alzheimer disease (AD) drugs act to increase the amount of this neurotransmitter in the brain.

When a patient and her family are informed that the patient probably has early AD, the patient says, "Don't they have drugs to cure this disease"? To explain drug therapy for AD the health care provider should include which statements?

SATA

• Drugs are curative only if started early in course of the disease

• Drugs currently used for treatment of AD have no side or adverse effects

• There are no drugs for moderate dementia

• Benefits gained from taking AD drugs vary greatly among individuals

• A combination of drugs usually arrest the progression of AD

Answer explanation

Drug therapy for Alzheimer disease (AD) is not used for moderate dementia, and the benefits gained vary among individuals. A combination of drugs usually arrests the progression of the disease. None of the drugs are curative of the disease and all of the drugs have significant side effects that some patients are not able to tolerate.

Your home health patient has become confused over the past week. He is taking all of the drugs listed subsequently. Which of these can cause confusion?

SATA

• Digoxin for heart failure

• NSAID for arthritis

• First generation H2 receptor blocker for peptic ulcer disease

• Anticholinergics for season allergies

• Antacid for heartburn

Answer explanation

Drugs that can cause confusion include digoxin for heart failure, first-generation H2 receptor blockers for peptic ulcer disease, anticholinergics for seasonal allergies, and nonsteroidal anti- inflammatory drugs for arthritis. Antacids for heartburn do not have any properties that can cause confusion in patients.