NUR2459- CONCEPT GUIDE- MODULE 4-6
Module 04 – Nursing Interventions for Clients Exhibiting Cognitive Dysfunction and
Substance-Related Conditions
Describe neurocognitive disorders: difference between delirium/dementia
Delirium is a disturbance in attention and awareness and change in cognition that develops
rapidly over a short period. Differentiating delirium from dementia can be a complicated
process, but failure to recognize delirium and the cause can delay appropriate treatments
causing severe consequences. It is also the most frequent complication of hospitalization in
older adults. It is associated with increased morbidity and can have lasting long-term results,
such as permanent cognitive decline.
Delirium causes
• D-dementia
• E-Electrolyte disorders
• L- Lung, liver, heart, kidney or brain dysfunction
• I-Infection
• R-RX drugs
• I-Injury, pain or stress
• U-Unfamiliarly environment
• M-Metabolic
Examples of Causes
• Systematic infections
• Febrile illness
• Head trauma
• Seizures
• Migraine headaches
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, • Stroke
• Electrolyte imbalance
• Post-operative status
• Substance withdrawal
• Certain medications
• Substance intoxication
Symptoms
• Disorganized thinking
• Disorientation to time and place
• Impaired reasoning ability and goal-directed behavior
• Speech that is rambling, irrelevant, pressured, incoherent
• Very distractible
• Lack of focused attention (shifting and sustaining)
• Disorientation
• Impairment of recent memory
• Misperceptions of the environment
o illusions
o hallucinations
• State of awareness my range from hypervigilance to stupor
• Sleep may fluctuate between hypersomnolence and insomnia
• Psychomotor activity may fluctuate between agitated, purposeless movements to a state
resembling catatonic stupor.
• Vivid dreams and nightmares are common
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, Autonomic Symptoms
• Tachycardia
• Sweating
• Flushed face
• Dilated pupils
• Elevated blood pressure
The onset of the symptoms is usually quite abrupt, and duration is typically brief (1 week -
rarely one month)
Treatment
• The first step is to determine and correct the underlying cause (get back to base)
Pharmacological Treatment
• Antipsychotic (low dose) haloperidol (Haldol)
• Benzodiazepine-commonly used if etiology is substance withdrawal. (lorazepam
(Ativan) or diazepam (Valium)
• B1 IV for thiamine deficiency
• Supplemental oxygen
Implementation
• Prevent harm caused by confusion, aggression, or fluid and electrolyte imbalance
• Perform a comprehensive nursing assessment to aid in identifying that cause
• Assist with proper health management to eradicate the underlying cause
• Use supportive measures to relieve distress
Environmental Interventions (safety)
• Decrease stimulation
• Have family stay with the client
3|Page
Module 04 – Nursing Interventions for Clients Exhibiting Cognitive Dysfunction and
Substance-Related Conditions
Describe neurocognitive disorders: difference between delirium/dementia
Delirium is a disturbance in attention and awareness and change in cognition that develops
rapidly over a short period. Differentiating delirium from dementia can be a complicated
process, but failure to recognize delirium and the cause can delay appropriate treatments
causing severe consequences. It is also the most frequent complication of hospitalization in
older adults. It is associated with increased morbidity and can have lasting long-term results,
such as permanent cognitive decline.
Delirium causes
• D-dementia
• E-Electrolyte disorders
• L- Lung, liver, heart, kidney or brain dysfunction
• I-Infection
• R-RX drugs
• I-Injury, pain or stress
• U-Unfamiliarly environment
• M-Metabolic
Examples of Causes
• Systematic infections
• Febrile illness
• Head trauma
• Seizures
• Migraine headaches
1|Page
, • Stroke
• Electrolyte imbalance
• Post-operative status
• Substance withdrawal
• Certain medications
• Substance intoxication
Symptoms
• Disorganized thinking
• Disorientation to time and place
• Impaired reasoning ability and goal-directed behavior
• Speech that is rambling, irrelevant, pressured, incoherent
• Very distractible
• Lack of focused attention (shifting and sustaining)
• Disorientation
• Impairment of recent memory
• Misperceptions of the environment
o illusions
o hallucinations
• State of awareness my range from hypervigilance to stupor
• Sleep may fluctuate between hypersomnolence and insomnia
• Psychomotor activity may fluctuate between agitated, purposeless movements to a state
resembling catatonic stupor.
• Vivid dreams and nightmares are common
2|Page
, Autonomic Symptoms
• Tachycardia
• Sweating
• Flushed face
• Dilated pupils
• Elevated blood pressure
The onset of the symptoms is usually quite abrupt, and duration is typically brief (1 week -
rarely one month)
Treatment
• The first step is to determine and correct the underlying cause (get back to base)
Pharmacological Treatment
• Antipsychotic (low dose) haloperidol (Haldol)
• Benzodiazepine-commonly used if etiology is substance withdrawal. (lorazepam
(Ativan) or diazepam (Valium)
• B1 IV for thiamine deficiency
• Supplemental oxygen
Implementation
• Prevent harm caused by confusion, aggression, or fluid and electrolyte imbalance
• Perform a comprehensive nursing assessment to aid in identifying that cause
• Assist with proper health management to eradicate the underlying cause
• Use supportive measures to relieve distress
Environmental Interventions (safety)
• Decrease stimulation
• Have family stay with the client
3|Page
