The PMHNP is asked to prepare a presentation for non-nursing health care workers in a local long-term care facility on the various causes of cognitive impairment in the elderly

 

The PMHNP is asked to prepare a presentation for non-nursing health care workers in a local long-term care facility on the various causes of cognitive impairment in the elderly

Answer:

A sleepy, confused, or forgetful older patient who is a new resident at a long-term care facility is seen by the PMHNP each morning. After careful assessment of her presentation, the PMHNP asks  her what she ate for breakfast that morning and where she lives. The PMHNP provides support to the resident and collaborates with the team members to determine if this patient’s symptoms are due to dementia, delirium, depression, or any other causes of cognitive impairment in the elderly. After ruling out other possible causes of symptoms and confirming that these symptoms are reasonable to assume are part of her dementia syndrome; the resident needs an adjustment in medication to treat delirium.

Delirium is a sudden and unpredictable change in mental function that can occur due to a wide variety of medical problems. Here, we will present a case study of Mr. Jones, a 78-year-old patient with Alzheimer’s disease who has developed delirium due to urinary tract infection. Our case study will review various aspects of the patient’s medical history, physical exam findings, diagnostic tests, and diagnosis along with causes in order to present to you several important cognitive impairments that should be identified in your patients and reported promptly to their primary care physician.

Delirium is a condition characterized by changes in mental status and can be caused by various factors in the elderly population. These factors include physiological, psychological, and social alterations within the older adult. When used as part of a case presentation, patients with delirium display at least one of three symptoms:Inappropriate Bladder Elimination; Anosmia; Confusion

The spectrum of cognitive impairment and dementia in the elderly is wide and ranges from normal age-related decline to severe confusion. The most common cause of severe decline is a treatable condition called delirium. The NANDA (North American Nursing Diagnosis Association) lists this condition as “cognitive confusion associated with an underlying medical condition”.

Delirium is a state of temporary confusion in an older person that may occur fast and get worse quickly. It is a common cause of falls and injuries in the elderly, especially those that live alone or those that live in long-term care settings. There are many risk factors for delirium which include urinary tract infection, brain tumors, dehydration, heart disease, and recent hospitalization.

The features listed below are closely correlated with delirium:

Some of the signs and symptoms of delirium include restlessness, confusion, altered level of consciousness, disorientation as to time and place, hallucinations, bizarre behaviors, and sleep disturbances. Therefore, some of the most common features of delirium are changes in mental status or orientation. The disorder usually begins suddenly and its origin may be sudden or gradual.

It is important to know the usual behavior of your patient and to pay attention for changes. A person with a baseline of confusion with longstanding dementia will still be confused in the hospital setting, but will likely remain the same. Someone who has no history of confusion, suddenly refuses to eat, is inappropriately dressed for the weather and time of day, may have a medical problem that needs to be addressed.

Question:

The PMHNP is asked to prepare a presentation for non-nursing health care workers in a local long-term care facility on the various causes of cognitive impairment in the elderly. A case presentation approach is used to reinforce principles of identifying delirium, which needs to be reported to the patient’s attending provider right away. The case should emphasize which of the following features as being closely correlated with delirium?

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