Health Optimization: Getronics Nursing Care - Essay Example

? Health Optimization - Getronics Nursing Care Dementia is an irreversible of cognitive impairment and short-term memory loss associated to a brain disease (Saxon et al, 2010). On the other hand, delirium is a recent confusion and cognitive impairment related to another illness besides brain illnesses (Gagliardi, 2008). Despite the fact that dementia and delirium are very different, there is an overlap of some symptoms since both conditions refer to a mental confusion. For instance, both conditions involve dysfunction of the cognitive part of the person. Moreover, “confusion, disorganized thinking, memory loss, spatio-temporal disorientation, reduced attention span, flat affect and motor skills loss characterize both conditions” (Page et al, 2011). Sullivan (2008) further points out that the patients suffering from dementia and delirium tend to have issues and behavioral problems of the same type including purposeless activity, sleep disorders, inappropriate conduct or aggressiveness. In both cases, the patient is most likely to be disoriented, have hallucination and delusions. Virani et al (2010) adds that patients suffering from dementia are at a high risk of getting into the condition of delirium. However, the overlap does not account for all the symptoms associated with each condition. Each condition has a set of unique symptoms that are entirely different from the other. According to Thomas et al (2008), “delirium is characterized by acute consciousness disturbances and global changes in cognition”. Moreover the patient can be extremely hyperactive if agitated or extremely hyper alert. On the other hand, Eliopoulos (2010) points out that a delirium patient can be hypoactive if the patient is confused, lethargic or even when sedated. Dementia on the other hand has many characteristics. According to Ouldred et al (2008), “dementia is characterized by slower move into deficits in cognition that include memory impairment and at least one of the disturbances of cognition such as aspraxia, asphasia, and a disturbed or agnostic executive functioning”. The impairment cause must be significant in occupational or social functioning and represent a great decline from a previous level of functioning. Course of illness According to Miller (2009), delirium is transitory. Its onset is quick and its treatment will remit symptoms. A sudden drop to baseline causes delirium. Dementia on the other hand is characterized by a slow progress and a long-term gradual decline from the baseline. Furthermore, it is chronic, progressive and irreversible. Etiology When comparing both delirium and dementia etiologically, a big difference comes out. Metabolic imbalance, substance abuse, failure of the liver, congestive heart failure or its infection all cause delirium. On the other hand, dementia is mainly caused by degeneration of the nervous system including neurodegenerative diseases and Alzheimer (Waszynski et al, 2008). Treatment According to Saxon et al (2010), the delirium symptoms can be prevented or reversed to prevent further medical or cognitive impairment. Some of the management of delirium, which are non-pharmacological, include steps such as provision of optimized, quite environments, in contrast, the dementia symptoms cannot be remitted but can be managed. Assessment The elderly patients like Mr. Webb are mostly at a higher risk of cognitive disorders. These cognitive disorders can be chronic such as dementia or acute such as delirium. For effective treatment, the first step is clarifying the diagnosis and assessment at onset. However, as Thomas et al (2008) explains, this can be challenging to the elderly patients like Mr. Webb. They often have accompanied medical co-morbidities that can result to affective and cognitive changes (Gagliardi, 2008). 1. Approach the patient (Mr. Webb) As explained by Gagliardi (2008), I will try to reduce the number of people in the room. As well, as encourage him to rest either on the bed or on the chair. I will initiate a conversation where I will quietly talk or listen to him for a while. At this stage, something like a cup of tea is very important. The conversation is meant to increase trust and raise friendship. I will avoid touching him and not even attempt any physical examination until I am sure I have gained Mr. Webb’s trust. Moreover, I will also turn off all the bright lights around to allow him have a good moment of expressing himself without fear of being observed. The room will need also to be quite from all kind of noise as well as allow a family member, who he is more comfortable with, to be with him while we talk. This will make him relax and feel safe. 2. Examination After establishing some form of friendship, I will then start my examination of Mr. Webb. He may at this point respond to stimulus like the phone (Page et al, 2011). I will keenly observe his speech content, his behavior and appearance in general. All this will be directed towards examining his mental state. To be specific, I will test for attention, orientation and cognitive functions. Next, I will perform physical examinations. At this point, I will look for evidence such as the dysfunction of the nervous system, dehydration, and tachycardia. Moreover, I will try to discover signs of illnesses, neurological focal abnormalities, head trauma, meningitis and intracranial pressure increase as pointed out by Sullivan (2008). Similarly, as suggested by Virani et al (2010), I will carry an examination on the lint picking, multifocal twitching, asterixis and shivering which are some of the common characteristics of delirium. Moreover, I will test his eye movements and fields by observing him as he looks around. I may try blood test after being sure that my patient is comfortable with the whole procedure. Before I start evaluating Mr. Webb, I will assess his cognitive status and find out his baseline functional ability on the activities of daily living. These activities include, getting out of bed, taking a shower, eating, dressing, using of the toilet, just to mention a few. Furthermore, I will examine Mr. Webb’s daily living instrumental activities such as his ability to manage his finances, do housework, go shopping and use the telephone among others. As a nurse, I will apply the Confusion Assessment Method to detect the possibility of Mr. Webb suffering from delirium. This is a screening tool of four questions on an inpatient service (Eliopoulos, 2010). 1 I will first look for Consciousness disturbance. This is related to the precision of responsiveness to the surroundings with the capability of maintaining focus or alteration to concentration. 2 The next feature I will also look for is the cognition change. To find this characteristic in Mr. Webb, I will examine whether Mr. Webb is confused, has memory failure, language and perceptual disorder. 3 I will also ask Mrs. Webb, the wife, in my assessment procedures, the behavior patterns of the disturbance. I would seek to know whether the disturbances developed over a short period of time that is in hours or days and whether it tended to fluctuate during the course of the day. 4 I will also look at the evidence from the physical examination, history and laboratory findings. If the evidence showed that the condition is related to the general condition or the medications, I will conclude that it is delirium. As I will be assessing Mr. Webb for the possibilities of suffering from delirium, I will also examine him for the possibility of suffering from dementia. This is because, a progressive cognitive impairment is always thought to be a normal occurrence among the aged and therefore very few cases are reported either by the patients themselves or by their family members (Miller et al, 2009). To achieve this, I will make use of Mr. Webb’s medical records to ascertain whether he suffers from dementia. If I notice any symptoms of cognitive impairments as outlined by Waszynski (2008), which are slow understanding, low memory on instructions, missed appointments, poor grooming and hygiene, I will be in a position to conclude that Mr. Webb is suffering from dementia. After suspecting cognitive impairment on Mr. Webb, I will undertake screening using Folstein Mini-Mental State Examination or the Memory Impairment Screen. To be precise, I will employ Saxon et al (2010) assessment as follows; I will ask Mrs. Webb the onset of the condition, if she responds that it was between hours to days, I would conclude it is delirium. However, if the onset ranged from months to years, I will conclude it is dementia. I will also assess Mr. Webb’s mood. If it fluctuates, there is possibility of both dementia and delirium. Next, I will examine the course, if it is acute and respond well to treatment, I will conclude it is delirium, however, if it is chronic and further deteriorates with time; I will conclude it is dementia. My next assessment will be on self-awareness of Mr. Webb, if he is aware of cognitive changes or there are fluctuations, then Mr. Webb is suffering from delirium, however, if he is hiding or he is unaware of the cognitive deficits, then he is suffering from dementia. Moreover, I will assess his daily living activities. If Mr. Webb can perform them well or with little impairment, then he is suffering from delirium. However, if his impairment on the functioning of the activities of daily living progress as the disease progresses, then he is suffering from dementia. Similarly, I will assess his daily living instrumental activities. If they are intact or slightly impaired, I will conclude Mr. Webb is suffering from delirium. However, if the activities were intact early in life, but get impaired as the disease progress, then I will conclude he is suffering from dementia. Planning and delivering person –centred quality care Person centred quality care recognizes that individuals have exclusive characteristics, morals and history thus each person should have equal right to reverence, stateliness and full participation in the environment (Gagliardi, 2008). When planning for Mr. Webb’s person centred care, I will reflect the following as suggested by Page et al (2011): 1) Ensure that I understand and put into practice the person centred care philosophy 2) I understand connections that improve personhood and demonstrate it through courteous relationships. 3) I focus on supporting, retaining and reinstating autonomy of Mr. Webb 4) I make sure Mr. Webb has access to quality care without any form of discrimination. 5) Ensure curative intervention, mood, and behaviour change regulation are implemented proactively. 6) Encourage Mr. Webb to make perfect decision through supporting his preferences, values and interests. In delivering the care, I will encourage Mr. Webb to participate actively. I will also get to know his tastes and will ensure I understand what the following means to him I. Individual hygiene such as toileting, oral hygiene, bathing, regular foot care and dressing II. Enjoyment of meals III. Meaningful activities such as physical activities, leisure, opportunities to contribute to other people’s lives and home, mental exercises IV. Satisfying social activities like visiting and chatting with friends. V. Relationships and interactions Discharge As pointed out by Page (2011), when preparing to discharge Mr. Webb and his wife, like with all the elderly patients, my discharge plan will be done in conjunction with all the involved disciplines in caring of Mr. Webb. These include those at the hospital, from the community and the family, which includes his wife Mrs. Webb. I will also make practical arrangements before the discharge. These arrangements include dressing, washing and medication among others. I will also ensure the following: I. Communicate with all the involved parties in the patient care II. I will assess Mr. Webb’s functional and cognitive status before discharging him. I will apply the standardized tools such as the Barthel index and AMT III. I will also ensure that I promptly complete the discharge summaries. References Saxon, S. V., Etten, M. J., & Perkins, E. A. (2010). Physical change & aging: A guide for the helping professions. New York, NY: Springer Pub. Co. Page, V., & Ely, E. W. (2011). Delirium in critical care. New York, NY: Cambridge University Press. Virani, T., & Registered Nurses' Association of Ontario. (2010). Caregiving strategies for older adults with delirium, dementia and depression. Toronto, TR: Registered Nurses Association of Ontario. Thomas, C., Hestermann, U., Walther, S., Pfueller, U., Hack, M., Oster, P., Mundt, C., Weisbrod, M. (January 01, 2008). Prolonged Activation EEG Differentiates Dementia with and without Delirium in Frail Elderly Patients. Journal of Neurology, Neurosurgery, and Psychiatry, 79, 2, 119-25. Eliopoulos, C. (2010). Gerontological nursing. Philadelphia, Phil: Wolters Kluwer Health/Lippincott Williams & Wilkins. Miller, B. L., & Boeve, B. F. (2009). The behavioral neurology of dementia. Cambridge, UK: Cambridge University Press. Gagliardi, J. P. (January 01, 2008). Differentiating among Depression, Delirium, and Dementia in Elderly Patients. The Virtual Mentor: Vm, 10, 6, 383-8. Ouldred, E., & Bryant, C. (January 01, 2008). Dementia care. Part 1: guidance and the assessment process. British Journal of Nursing (mark Allen Publishing), 17, 3, 14-27. Waszynski, C. M., & Petrovic, K. (January 01, 2008). Nurses' Evaluation of the Confusion Assessment Method: A Pilot Study - Better identify delirium (and differentiate it from dementia) in hospitalized patients with this easy-to-use method, which takes less than 1 minute to complete. Journal of Gerontological Nursing, 34, 4, 49. Sullivan, M. (July 01, 2008). Exams Differentiate Delirium From Dementia. Clinical Psychiatry News, 36, 7, 31-31. Read More