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.  Reply (http Jamie Mears  (https: / Feb 7, 2019 Instructor Response Dr. Alteza, As I have mentioned most of my experience has been in long-term care with geriatrics. I see many cases of irreversible dementia such as Alzheimer's but I have also seen many patients with dementia that are reversible. In practice, I have seen dementia being reversible in patients whose dementia was caused by drug or alcohol abuse, poor nutrition, vitamin imbalances, and depression. One of my most interesting patients in a long term care facility was a patient who had been diagnosed with Alzheimer's, an irreversible form of dementia. The patient was brought to our facility with very poor nutrition and depression r/t progression of Alzheimer's. Upon admission, the medical director completed the standard order lab values, the Alzheimer's staging tool, a Mini- mental exam and left the patient on the medications prescribed by their primary care provider. I had brought to his attention many fluid and electrolyte imbalances but it was thought to be because the patient's nutrition was so poor. After being at our facility for a couple months, the resident starting showing many signs of cognitive improvement. I completed a Mini-mental exam at the 90 day period and there was only mild impairment. I called the doctor and he started removing several of the antipsychotics the patient was receiving. This resident was released home 4 months later. I stress to my students today that it is very important to evaluate dementia symptoms comprehensively. It is imperative for the patients not to miss a potentially treatable condition, however it is relatively common, especially in the geriatric population. Thank you, Jamie Mears, BSN, RN  Reply (http Philip Elackatt  (https: / Feb 7, 2019 Hi Dr. Alteza, You mentioned reversible causes of dementia- after research on this topic, it turns out there are several indications were dementia may be reversed. Some examples of this includes thyroid disorders, vitamin deficiencies, depression, medication induced impairments, systemic inflammatory disorders, hydrocephalus, cns infections, and intracranial masses (Ladika & Gurevitz, 2011). This is one reason I feel it is so important to do a proper and thorough history and physical. Many times the definitive diagnosis of a disease is like solving a crime. The primary investigator needs to take the time to interview the patient or close family member to gain better understanding of the symptoms and any potential causes. Unfortunately, the medical community varies from what is taught in the textbooks; often times patients are rushed by the provider with very little time given for a proper H&P. Reference Ladika, D. J., & Gurevitz, S. L. (2011). Identifying the most common causes of reversible dementias: A review. JAAPA: Journal of the American Academy of Physician Assistants, 24(3), 28-57.  Reply (http Philip Elackatt  (https: / Feb 7, 2019 Ladika, D. J., & Gurevitz, S. L. (2011). Identifying the most common causes of reversible dementias: A review. JAAPA: Journal of the American Academy of Physician Assistants, 24(3), 28-57.  Reply SHOW MORE 1 1 (http Byron Bunal  (https: / Feb 9, 2019 Dr. Alteza, Dementia is a loss of mental functions that includes thinking, memory and reasoning. Dementia is irreversible when the main cause is by a degenerative disease (Alzheimer’s disease) or trauma. It is a late-life disease more common on elderly patients. Dementia can also be caused by a reversible condition. Treating the primary etiology can reverse this type of dementia. Some causes can be: (a) Central Nervous system infection, (b) Normal pressure hydrocephalus, (c) Central nervous system tumors and space occupying lesions, (d) Nutritional causes- Vitamin B12 and Iron deficiency, and depression. A proper assessment and examination need to be done in order to identify if the type of dementia can be reversed or not (Chari, Ali, & Gupta, 2015). Reference Chari, D., Ali, R., & Gupta, R. (2015). Reversible dementia in elderly: Really uncommon? Journal of Geriatric Mental Health, 2(1), 30-37. Retrieved from:  Reply (http Natalie Friess  (https: / Feb 9, 2019 Dr. Alteza, Yes, there are several instances in which dementia is reversible. One such instance is when dementia occurs as a side effect to a medication. This happened to my grandmother a few years ago. My grandmother is going to be 89 this summer and she is as sharp as a tack. A few years ago, my grandmother called my aunt, who is a LPN and works on an Alzheimer's dementia unit, and completely out of character and with a flat affect told my aunt she was going to, "go upstairs and drown herself in the bathtub". We were all shocked!! It was very sudden. We quickly called an ambulance and took her for care. It turned out, my grandmother was taking Metoclopramide, and one of the rare side effects that can happen in the elderly is toxicity, which exhibits as confusion (or dementia) with suicidal ideation. Once my grandmother was properly treated she was back to herself, and we were all relieved! She did spend some awful days on a geriatric psych unit until we figured out what was going on, though. Natalie  Reply (http Stacy Muc  (https: / Feb 10, 2019