Week 5: Delirium or Dementia

This is a graded discussion: 25 points possible due Feb 10 Week 5: Delirium or Dementia 67 73 You and your students have been assigned to the rehabilitation center in Seneca and you have assigned Mr. Gibson to your student, June. This is your opportunity to help your student with a complex topic related to the 3 Ps. Based on the potential for either delirium or dementia in Mr. Gibson, devise and share a table that illustrates the difference between delirium and dementia. Then describe (1) why Mr. Gibson might be vulnerable to both delirium or dementia and (2) what assessments or factors you would use to determine which condition is occurring. Hint: develop your table first in MS Word and then copy it into the discussion. This will be easier than trying to construct a table in the textbox. Search entries or author Unread   Subscribed  Reply Kelly Allgier  (https: / Feb 3, 2019 Dr. Alteza and Class, Please see the attached document for this week's discussion as my table would not copy and paste correctly from Word into this discussion board. Thank you, Kelly NR526 week 5 (  Reply (http Kelly Allgier  (https: / Feb 3, 2019 Dr. Alteza, My apologies, Please disregard the previous attachment as the spacing was not correct. This attachment is correct. Thank you for your understanding! Kelly  Reply (http Kelly Allgier  (https: / Feb 3, 2019 NR526 week 5 (  table to compare the two types of confusion in the elderly made the differences quite clear. Delirium is a serious, short-term disruption of consciousness brought on by an acute illness, sepsis, dehydration, alcohol or drug withdrawal, or trauma (Brooke, 2018). Delirium is generally reversible if the cause is determined and treated quickly. Dementia occurs gradually and is typically caused by damage to brain cells in the cerebral cortex, which is responsible for memory, language, perception and consciousness (D, 2019). If the damage to these brain cells is not permanent, the resulting dementia can be reversed, or slowed, with appropriate treatment (D, 2019). Examples of reversible causes of dementia include alcoholism induced thiamine deficiency, vitamin B-12 deficiency/pernicious anemia, subdural hematoma, hypothyroidism or hyperthyroidism, brain tumors, and toxic reactions to drugs or other chemicals (D, 2019). By correcting these underlying conditions, dementia can be significantly reduced or reversed. Kelly References Brooke, J. (2018). Differentiation of delirium, dementia, and delirium superimposed on dementia in the older person. British Journal of Nursing, 27, 363-367. doi:10.12968/bjon.2018.27.7.363 D. (2019). Causes of dementia. Retrieved from  Reply (http Janet Belford-Burleigh  (https: / Feb 5, 2019 Dr. Alteza, It's difficult to add much to what Kelly already posted, since she 'hit it out of the park' with her post (excellent job, Kelly!), but I'll try. According to Chari, Ali, and Gupta (2015), about 70% of dementia cases consist of Alzheimer's-related or vascular-related dementia, with approximately 18% of cases under the age of 65 possibly reversible, while only 5% of cases over the age of 65 are. Chari et al. (2015) go on to explain that labelling some dementias as reversible is misleading, as it often is confused with delirium, and nothing is reversible until the underlying cause is identified and treatment begun. Underlying causes for treatable or reversible dementia are infections in the central nervous system such as meningitis, neurosyphilis, tuberculosis, encephalitis, hydrocephalus, brain tumors, Wernicke-Korsakoff Syndrome, iron-deficiency anemia, medications such as benzodiazepines, hyperthyroidism, hypothyroidism, and depression (Chari et al., 2015). Testing for someone presenting with dementia must be thorough to rule out any potentially reversible causes (Chari et al., 2015). Reference Chari, D., Ali, R., Gupta, R. (2015). Reversible dementia in elderly: really uncommon? Journal of Geriatric Mental Health, 2(1), 30-37. doi: 10.4103/.161378  Reply (http Gisela Tong  (https: / Feb 6, 2019 Hi Dr. Alteza and class, When dementia is caused by degenerative and damages to brain cells, such as Alzheimer’s disease; there is no cure and treatment is usually supportive. However, when dementia is due to nutritional disorders (i.e., folate or vitamin B12 deficiency), sleep deprivation, depression, or side effects from drugs (i.e., antihypertensive, sedatives, and narcotics), it is reversible with treatment of the underlying cause (Tweed, 2018). For example, dementia caused by vitamin B12 deficiency. Vitamin B12 is required for one’s body to produce red blood cells (RBCs), DNA, and contribute to cognitive function (Marcel, 2017). It is mostly found in meat, fish, eggs, milk products, but not in plants (Marcel, 2017). Vitamin B12 binds to the protein in foods, is released by hydrochloric acid and gastric protease in the stomach (Marcel, 2017). Deficiency in vitamin B12 prevents folic acid metabolism (necessary in RBCs formation) causing pernicious anemia, cognitive impairment, and neurodegenerative disease (Marcel, 2017). Signs and symptoms include fatigue, weakness, confusion, poor memory, depression, dementia, numbness and tingling in hands and feet (Marcel, 2017). Risk factors include the elderly, people who follow pure vegetarian diet or suffer from malnutrition, people with celiac or Crohn’s disease, and those with gastric bypass surgery (Marcel, 2017). Assessment includes patient’s complete medical, surgical, dietary, and medication histories; labs (CBC, vitamin B12 level); alcohol consumption; and mental status (Marcel, 2017). Treatment is by giving vitamin B12 injection or high doses of oral vitamin B12 (Marcel, 2017). Our patient, Mr. Gibson, has many risk factors that contribute to him having dementia although he may seem to be getting better. One thing concerns me is it seems he is also experiencing depression that may slow down his recovery because this can conceal his other symptoms. Any thoughts? Gisela Thank you. References Marcel, C. B. (2017). Vitamin B12 Deficiency. CINAHL Nursing Guide. Retrieved from Tweed, V. (2018). 10 Reversible Causes of DEMENTIA. Better Nutrition, 80(3), 50–54. Retrieved from  Reply (http Katherina Martin  (https: / Feb 6, 2019 Hello Dr. Alteza, Dementia and delirium are two interesting topic as both state can be interchanged and may overlap. Both diseases may show the same symptoms of impaired memory that can be manifested by confusion or disorientation. However, as nurses, it is part of our responsibility to distinguish the difference between dementia and delirium. It is important that nurses are able to assess the patient and find out the etiology as to why the patient shows a decline in cognitive functioning in order to get a proper diagnosis. The two most common dementia in elderly are Alzheimer’s dementia and vascular dementia. Study shows that most patients with dementia can be treated. Reversible dementias are conditions that may be linked with cognitive and behavioral symptoms that can be resolved once the origin of the disease is treated. The examples of reverse dementia are depression, alcohol –induced cognitive impairment, normal pressure hydrocephalus (NPH), and Vitamin B12 deficiency. The common causes of reversible dementia are: Central nervous system infection (Ex. Chronic meningitis), Vitamin B12 deficiency and NPH. Other causes include depression, sleep apnea, nutritional impairment, endocrine causes, and drugs (Chari, Ali, & Gupta, 2015). In order to accurately diagnose patients with dementia and determine the possibilities of reversible dementia, clinicians should be thorough about the patient’s history and physical assessment. Patients with dementia can maintain a good prognosis if their cognitive impairments are treated and detected early. Thank you, Katherina Martin References Chari, D., Ali, R., & Gupta, R. (2015). Reversible dementia in elderly: Really uncommon? Journal of Geriatric Mental Health, 2(1), 30-37.