Acute confusional state is common and occurs among 15 – 60% of long term care residents and is often undiagnosed and untreated. The alert nurse can identify the symptoms of acute confusion, evaluate precipitants and causes and take steps to recommend evaluation and treatment and prevent complications. When the nurse identifies an infection or a medication change that may have triggered the confusion. The nurse has a pivotal role to play in early case finding, collaboration with provider, evaluation and treatment.
Evaluating and Managing Acute Confusion in Long Term Care Changes in consciousness and behavior such as confusion are serious, frequent, and can have immediate and long term consequences for 15% to 60% of elderly long
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The copyright Mini Mental State is an 11 item tool that measures orientation, attention, calculation, recall, and language. Scores indicate functioning, 24-30 intact cognition, 18-23 mild impairment; 0-17 severe impairment (Folstein, Folstein, McHugh, 1975). The Confusion Assessment Method has 4 features (onset, inattention, disorganized thinking, and altered level of consciousness) and assists the nurse to document the confusion (3). TheNeelon and Campagne Confusion Scale (NEECHAM) is a nursing tool that measures cognitive processing, behavior, physiological and includes the Nursing assessment (3). It measures the risk, presence, and severity of confusion. In this case study, both the infection (e.g., URI, UTI) and the discontinued psychiatric medications could have precipitated the acute confusional state. Detecting such changes promptly is essential because it allows the cause (e.g., infection) to be identified and treated and often allows the mental status changes to be …show more content…
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Dizziness is a common part of the aging process that can result from various factors including dehydration, malnutrition, peripheral and central disorders such as labyrinthitis; cardiovascular issues such as hypotension or the effects of certain medications (Fernández, Breinbauer & Delano, 2015). The nurse could speak with Mrs Jones to ascertain the type of dizziness that she experiences by identifying when the dizziness occurs and how often it occurs. If the dizziness is a result of dehydration or malnutrition, the nurse could recommend increasing fluid intake and refer Mrs Jones to a dietician to increase nutrient intake or if the dizziness is caused by any type of hypotension or inner ear problems, the nurse could refer Mrs Jones to her Doctor for treatment or provide strategies to reduce her symptoms (Bunn & Hooper, 2015; Fernández, Breinbauer & Delano, 2015; Gupta & Lipsitz,
Long-term care (LTC) covers a wide range of clinical and social services for those who need assistance due to functional limitations. These limitations usually result from complications associated with age related chronic conditions, from disabilities related to birth defects, brain damage, or mental retardation in children; or from major illnesses or injuries suffered by adults (Shi L. & Singh D.A., 2011). LTC encompasses a variety of services including traditional clinical services, social services and housing. Unlike acute care, long-term care is much more complicated and has objectives that are much harder to measure. Acute care mainly focuses on returning patients to their previous functional level and is primarily provided by specialty providers. However, LTC mainly focuses on preventing the physical and mental deterioration of an individual and promoting social adjustments to suit the different stages of decline. In addition the providers of LTC are more diverse than those in acute care and is offered in both formal and informal settings, which include: hospitals, physicians, home care, adult day care, nursing home care, assisted living and even informal caregivers such as friends and family members. Long-term care services have been dominated by community based services, which include informal care (86%, about 10 to 11 million) and formal institutional care delivered in nursing facilities (14%, 1.6 million) (McCall, 2001). Of more than the 10 million Americans estimated to require LTC services, 58% are elderly and 42% are under the age of 65 (Shi L. & Singh D.A., 2011). The users of LTC are either frail elderly or disabled and because of the specific care needs of this population, the care varies based on an indiv...
In the play Doubt, by John Patrick Shanly, Sister Aloysius is treating Father Flynn unfairly. Sister Aloysius is the principal of St. Nichols School, who is suspicious and always doubt everyone, especially Father Flynn. She thinks that Father Flynn is guilty, but has no proof. Sister Aloysius doesn’t like Father Flynn in the school and his ideas. She treats him unfairly. Sister Aloysius treats Father Flynn unfairly when she still accuses Father Flynn of giving the altar wine to Donald Muller after Father Flynn tells her the truth. She treats him unfairly by forcing him to request the transfer without proving if Father Flynn is guilty or not and also makes him resign by lying about his past.
The nurse needs to describe what focused health assessments they think would best suit the patient. The nurse needs to work out a way in which we can help decrease Alice’s heart rate and blood pressure. To do this the nurse would perform a neurological assessment and a head to toe assessment. These two assessments will give the nurse more information about Alice’s nervous system, if she is in any pain and what further assessments and treatment need to be completed. A neurological assessment is a technique of gaining specific data in relation to the role of a patient’s nervous system (Ruben Restrepo).
The framework of this model is utilized throughout hospital settings to form a basis for all nursing decisions in respect to nursing diagnosis, care plans, discharge planning, and quality assurance (Reynolds & Cormack, 1991). This conceptual model focuses on the effects of internal and external environments that contribute to someone’s behavior. Pain (being the internal force) in patients with altered mental status usually manifests externally in non-verbal cues. Nursing as the external force can use tools that focus on the non-verbal cues given by the patients to accurately assess the pain and properly treat it.
Did you know tobacco and alcohol use cause over 475,000 deaths in the U.S. annually? To assist young people in avoiding these harmful behaviors, the D.A.R.E. program enhances the knowledge and awareness of the hazards regarding dangerous substances throughout a ten week program. The acronym D.A.R.E. stands for drugs, abuse, resistance, and education. D.A.R.E. ensures the safety of adolescents in various situations and instills beneficial strategies, techniques, and tips to aid young people in making responsible decisions.
In “The Fish” by Elizabeth Bishop, the narrator attempts to understand the relationship between humans and nature and finds herself concluding that they are intertwined due to humans’ underlying need to take away from nature, whether through the act of poetic imagination or through the exploitation and contamination of nature. Bishop’s view of nature changes from one where it is an unknown, mysterious, and fearful presence that is antagonistic, to one that characterizes nature as being resilient when faced against harm and often victimized by people. Mary Oliver’s poem also titled “The Fish” offers a response to Bishop’s idea that people are harming nature, by providing another reason as to why people are harming nature, which is due to how people are unable to view nature as something that exists and goes beyond the purpose of serving human needs and offers a different interpretation of the relationship between man and nature. Oliver believes that nature serves as subsidence for humans, both physically and spiritually. Unlike Bishop who finds peace through understanding her role in nature’s plight and acceptance at the merging between the natural and human worlds, Oliver finds that through the literal act of consuming nature can she obtain a form of empowerment that allows her to become one with nature.
Thirty minutes before evening shift change and you receive the call. A new admission is in route to your facility. The patient is reported to be of high acuity, requires intravenous antibiotics, and has a diagnosis of chronic pain. In some health care settings this would be considered a typical new patient admission. However, for rural long-term care facilities there is potential for considerable complications. In a setting where registered nurses are only required to be in the facility eight hours within a twenty-four hour time frame, significant complications can arise during admissions that require certain specialty care specific to the RN. Ineffective discharge planning between any health care settings can be detrimental to patient care.
The start if college is like the end of one’s childhood. Yet I had no intension of letting that go when I woke up yesterday at 7:00 am. Still, like high school, my mom dropped me off and picked me up; copping almost the exact same routine from the four years I spent in high school. Just as I thought this ought to be the easiest way of transportation, my mom proved me wrong once we reached the University of Washington’s parking lot.
Uncertainty, according to the theory put into place by Merle Mishel, is the inablility to determine the meaning of illness-related events because of a lack of sufficient cues that allow patients to assign value to objects or events and accurately predict outcomes (Elphee, 2008). This author believes it is important for nurses to completely understand the patient as a whole and what they are experiencing when faced with a new and frightening diagnosis. It is necessary to supply patients with sufficient information regarding their diagnosis, if they desire. This author believes the Theory of Uncertainty may help the nurse understand more fully what challenges and uncertainty the patient is presented with when undergoing a new diagnosis. Mishel’s Uncertainty of Illness Theory is a middle-range theory indicating the theory is not overly broad or narrow (Black, 2014).
Jane had not slept for 72 hours and had poor diet and was observed not to be drinking fluids. Jane has a diagnosis of Bipolar
Moore, R. D., Bone, L. R., Geller, G., Mamon, J. A., Stokes, E. J., & Levine, D. M. (1989). Prevalence, detection, and treatment of alcoholism in hospitalized patients. JAMA: the journal of the American Medical Association, 261(3), 403-407.
Introduction This assignment critically discusses dementia, a widespread disability among older adults today. It provides an introduction to dementia and analyses its prevalence in society. The various forms of dementia are elaborated with descriptions of dysfunctions and symptoms. Nursing Assessment and Interventions are provided in the further sections which discuss actions nurses should take while evaluating patients and treating them.
As our aging population increases, so will the number of people who develop dementia. This condition is distressing for everyone involved, including the patient, family, and caregiver. As research continues, there is hope for a better quality of life for those affected. It is important to increase awareness, encourage prevention, and to be aware of the early signs and symptoms. Each case of dementia presents itself differently, so it is important to know there are different types of dementia along with slightly different signs and symptoms. The sooner dementia can be recognized and intervened, the greater the outcome for the patient.