O. Mine-Boss. State University of New York College at Cortland. 2019.
The clinical presentation is typical of the syndrome of dementia buy generic wellbutrin on-line mood disorder vs bipolar disorder, and the course is extremely rapid cheap generic wellbutrin canada definition von depression, with progressive deterioration and death within 1 year after onset 300 mg wellbutrin with amex anxiety or panic attacks. This type of dementia is related to the persisting effects of substances such as alcohol, inhalants, sedatives, hypnotics, anxiolyt- ics, other medications, and environmental toxins. The term “persisting” is used to indicate that the dementia persists long after the effects of substance intoxication or substance withdrawal have subsided. Symptomatology (Subjective and Objective Data) The following symptoms have been identiﬁed with the syndrome of dementia: 1. Memory impairment (impaired ability to learn new informa- tion or to recall previously learned information). Impaired ability to perform motor activities despite intact motor abilities (apraxia). Amnestic Disorders Deﬁned Amnestic disorders are characterized by an inability to learn new information (short-term memory deﬁcit) despite normal at- tention and an inability to recall previously learned information (long-term memory deﬁcit). Transient amnestic syndromes can also occur from epi- leptic seizures, electroconvulsive therapy, severe migraine, and drug overdose. This type of amnestic disorder is related to the persisting effects of substances such as alcohol, sedatives, hypnotics, anxiolyt- ics, other medications, and environmental toxins. The term “persisting” is used to indicate that the symptoms persist long after the effects of substance intoxication or substance withdrawal have subsided. Symptomatology (Subjective and Objective Data) The following symptoms have been identiﬁed with amnestic disorder: 1. There is an inability to recall events from the recent past and events from the remote past. Common Nursing Diagnoses and Interventions for Delirium, Dementia, and Amnestic Disorders (Interventions are applicable to various health-care settings, such as inpatient and partial hospitalization, community outpatient clinic, home health, and private practice. Assess client’s level of disorientation and confusion to deter- mine speciﬁc requirements for safety. Knowledge of client’s level of functioning is necessary to formulate appropriate plan of care. Place furniture in room in an arrangement that best accommodates client’s disabilities. Observe client behaviors frequently; assign staff on one- to-one basis if condition warrants; accompany and assist client when ambulating; use wheelchair for transporting long distances. Remove potentially harmful articles from client’s room: cigarettes, matches, lighters, sharp objects. Institute seizure precautions as described in procedure manual of individual institution. If client is prone to wander, provide an area within which wandering can be carried out safely. Disori- entation may endanger client safety if he or she unknowingly wanders away from safe environment. Use tranquilizing medications and soft restraints, as pre- scribed by physician, for client’s protection during periods of excessive hyperactivity. Teach prospective caregivers methods that have been successful in preventing client injury. These caregivers will be responsible for client’s safety after discharge from the hospital. Client is able to accomplish daily activities within the envi- ronment without experiencing injury. Prospective caregivers are able to verbalize means of provid- ing safe environment for client. Assess client’s level of anxiety and behaviors that indicate the anxiety is increasing. Recognizing these behaviors, nurse may be able to intervene before violence occurs. Maintain low level of stimuli in client’s environment (low lighting, few people, simple decor, low noise level). In a disoriented, confused state, client may use these objects to harm self or others. Have sufﬁcient staff available to execute a physical confronta- tion, if necessary. Assistance may be required from others to provide for physical safety of client or primary nurse or both. Correcting misinterpretations of reality enhances client’s feelings of self-worth and personal dignity. Use tranquilizing medications and soft restraints, as pre- scribed by physician, for protection of client and others during periods of elevated anxiety. Use restraints judiciously, because agitation sometimes increases; however, they may be required to ensure client safety. Sit with client and provide one-to-one observation if assessed to be actively suicidal. Client safety is a nursing priority, and one-to-one observation may be necessary to prevent a suicidal attempt. Teach prospective caregivers to recognize client behaviors that indicate anxiety is increasing and ways to intervene before violence occurs. Prospective caregivers are able to verbalize behaviors that indicate an increasing anxiety level and ways they may assist client to manage the anxiety before violence occurs. W ith assistance from caregivers, client is able to control impulse to perform acts of violence against self or others. Possible Etiologies (“related to”) [Alteration in structure/function of brain tissue, secondary to the following conditions: Advanced age Vascular disease Hypertension Cerebral hypoxia Long-term abuse of mood- or behavior-altering substances Exposure to environmental toxins Various other physical disorders that predispose to cerebral abnormalities (see Predisposing Factors)] Deﬁning Characteristics (“evidenced by”) Altered interpretation Altered personality Altered response to stimuli Clinical evidence of organic impairment Impaired long-term memory Impaired short-term memory Impaired socialization Longstanding cognitive impairment No change in level of consciousness Progressive cognitive impairment Delirium, Dementia, and Amnestic Disorders ● 63 Goals/Objectives Short-term Goal Client will accept explanations of inaccurate interpretations within the environment. Long-term Goal With assistance from caregiver, client will be able to interrupt non–reality-based thinking. Use oth- er items, such as a clock, a calendar, and daily schedules, to assist in maintaining reality orientation. Maintaining reality orientation enhances client’s sense of self-worth and personal dignity. Teach prospective caregivers how to orient client to time, person, place, and circumstances, as required. These care- givers will be responsible for client safety after discharge from the hospital. Give positive feedback when thinking and behavior are appro- priate, or when client verbalizes that certain ideas expressed are not based in reality. Positive feedback increases self-esteem and enhances desire to repeat appropriate behaviors. Use simple explanations and face-to-face interaction when communicating with client. Speaking slowly and in a face-to-face position is most effective when communicating with an elderly indi- vidual experiencing a hearing loss. Shouting causes distortion of high-pitched sounds and in some instances creates a feeling of discomfort for client. Express reasonable doubt if client relays suspicious beliefs in response to delusional thinking.
There is much research linking these social factors to health inequalities with research consistently showing that psychological distress order 300 mg wellbutrin with mastercard anxiety loss of appetite, coronary heart disease and most cancers are more prevalent among lower class individuals who have more chronic stress in their lives (e discount wellbutrin 300mg on line anxiety united. However wellbutrin 300 mg with amex depression quotes, untangling this relationship is diﬃcult as although chronic stressors such as poverty may cause heart disease they are also linked to a range of other factors such as nutrition, hygiene, smoking, social support which are also linked to health status. Furthermore, whereas lower socioeconomic position is linked to chronic stressors such as poverty, higher socio-economic position is linked higher perceived stress (Heslop et al. As a result of these methodological problems many researchers have focused on speciﬁc areas of chronic stress including job stress and relationship stress. Job stress Occupational stress has been studied primarily as a means to minimize work related illness but also as it provides a forum to clarify the relationship between stress and illness. Early work on occupational stress highlighted the importance of a range of job related factors including work overload, poor work relationships, poor control over work and role ambiguity. According to the model, there are two aspects of job strain: job demands, which reﬂect conditions that eﬀect performance, and job autonomy, which reﬂects the control over the speed or the nature of decisions made within the job. Karasek’s job demand and control model suggests that high job demands and low job autonomy (control) predicts coronary heart disease. Karasek and co-workers have since developed the job demand control hypothesis to include social support. Within this context, social support is deﬁned as either emotional support, involving trust between colleagues and social cohesion, or instrumental social support involving the provision of extra resources and assistance. It is argued that high social support mediates and moderates the eﬀects of low control and high job demand. Karasek and Theorell (1990) report a study in which subjects were divided into low social support and high social support groups, and their decisional control and the demands of their job were measured. A series of studies have tested and applied Karasek’s model of job strain and associations have been reported between job strain and risk factors for heart disease and heart disease itself (Pickering et al. A total of 812 employees from a metal factory in Finland that manufactures paper machines, tractors, ﬁrearms along with other equipment completed a baseline assessment in 1973 including measures of their behavioural and biological risks and their work stress. Cardiovascular mortality was then recorded between 1973 and 2001 using the national mortality register. The results showed that 73 people had died from cardiovascular disease since the study onset who were more likely to be older, male, have low worker status, to smoke, have a sedentary lifestyle, high blood pressure, high cholesterol and higher body mass index. Further, when age and sex were controlled for death was predicted by high job strain and low job control. Relationship stress There is much evidence indicating an association between relationship status, psycho- logical distress and health status. For example, separated and divorced people have the highest rates of both acute and chronic medical problems even when many demo- graphic factor are controlled for (Verbrugge 1979). In addition, these people also have higher rates of mortality from infectious diseases such as pneumonia (Lynch 1977). They are also over represented in both inpatient and outpatient psychiatric populations (Crago 1972; Bachrach 1975). However, it is not just the presence or absence or a relationship that is important. These links between relationship status and quality have been understood using a range of literatures including attachment theory, life events theory and self-identity theory. In one study they assessed the associations between marital status and marital quality and markers of immune function. Their results showed that poor marital quality was associated with both depression and a poorer immune response. In addition, they reported that women who had been recently separated showed poorer immune response than matched married women and that time since separation and attachment to the ex- husband predicted variability in this response (Kiecolt-Glaser et al. In another study they explored the relationship between measures of stress hormones during the ﬁrst year of marriage and marital status and satisfaction ten years later. The results showed that those who were divorced at follow-up had shown higher levels of stress hormones during conﬂict, throughout the day and during the night than those who were still married. Further, those who marriages were troubled at follow-up also showed higher levels of stress hormones at baseline than those whose marriages were untroubled. This suggests that stress responses during the ﬁrst year of marriage are predictive of marital dissatisfaction and divorce ten years later (Kiecolt-Glaser et al. However, many people also experience chronic stress caused by factors such as poverty, unemployment or work load. Much research has focused on two aspects of chronic stress, namely job stress and relationship stress. This research indicates an association between chronic stress and illness, with a role for changes in immune function. In part this can be explained by factors such as stress reactivity and stress recovery which have been described above. However, research also highlights a role for other moderating variables which will now be considered. The relationship between stress and illness is not straightforward, and there is much evidence to suggest that several factors may moderate the stress–illness link. These factors are as follows: s Exercise: this can cause a decrease in stress (see Chapter 7). Coping with stress, social support, personality and control will now be examined in greater detail (see Figure 11. How individuals cope with illness was described in Chapter 3 with a focus on coping with a diagnosis, crisis theory and cognitive adaptation theory. This chapter will describe how coping relates to stress and the stress illness link. Coping has been deﬁned by Lazarus and colleagues as the process of managing stressors that have been appraised as taxing or exceeding a person’s resources and as the ‘eﬀorts to manage. In the context of stress, coping therefore reﬂects the ways in which individuals interact with stressors in an attempt to return to some sort of normal functioning. Or it might involve changing the way a person thinks about the problem or learning to tolerate and accept it. For example, coping with relationship conﬂict could involve leaving the relationship or developing strategies to make the relationship better. In contrast it could involve lowering one’s expectations of what a relationship should be like. Lazarus and Folkman (1984) emphasized the dynamic nature of coping which involves appraisal and reappraisal, evaluation and re-evaluation. Likewise, coping is also seen as a similar interaction between the person and the stressor. Further, in the same way that Lazarus and colleagues described responses to stress as involving primary appraisal of the external stressor and secondary appraisal of the person’s internal resources coping is seen to involve regulation of the external stressor and regulation of the internal emotional response. To reduce stressful environmental conditions and maximize the chance of recovery; 2. Styles, processes and strategies When discussing coping, some research focuses on ‘styles’, some on ‘processes’ and some on ‘strategies’.