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Under supervision:
Dr/Soheir Gooda.
By/Rasha Mohamed El Saied Abd El Ghany.
Out lines:
Introduction.
Definition of organic brain syndrome.
Acute organic brain disorder (delirium).
Definition of delirium.
Symptoms of delirium.
Types of delirium.
Causes of delirium.
Risk factors of delirium.
Common nursing diagnosis of delirium.
Chronic brain disorder (dementia)
Definition of dementia.
Symptoms of dementia.
Types of dementia.
Progressive dementias.
Risk factors of dementia.
Common nursing diagnosis of dementia.
Dementia VS delirium.
References.
Introduction
What is Organic Mental Disorder?
-When we speak about mental illness, most of us
assume that biological, genetic, or environmental
factors can affect the functioning of the brain and
cause different types of mental illnesses.
-However, some physical diseases or medical
conditions like brain injury, neurological
impairment, surgery, extreme physical or mental
trauma can also affect the functioning of the
brain.
-Organic mental disorder or organic brain
syndrome is not a disease; rather, it is a term
used to refer to any of the conditions caused due
to the gradual decrease in the functioning of the
brain.
-The brain cells could be damaged due to a physical
injury or due to psycho-social factors like severe
deprivation, physical or mental abuse, and severe
psychological trauma.
-A person affected with this condition may be able to
think, remember, comprehend and learn, but the
person's judgment may be so poor that continual
supervision is required.
Pain drugs.
Sleep medications.
Medications for mood disorders, such as
anxiety and depression.
Allergy medications (antihistamines).
Parkinson's disease drugs.
Drugs for treating spasms or
convulsions.
Asthma medications.
Risk Factors Of Delirium
Any condition that results in a hospital stay,
especially in intensive care or after surgery,
increases the risk of delirium, as does being a
resident in a nursing home.
Examples of other conditions that
increase the risk of delirium include:
Brain disorders such as dementia, stroke or
Parkinson's disease.
Older age.
Previous delirium episodes.
Visual or hearing impairment.
Having multiple medical problems.
Common nursing diagnosis
Risk for torturing themselves, others and the
environment related to the response in mind
delusions and hallucinations.
Ineffective individual coping related to the
inability to express in a constructive way.
Change the thought process related to the inability
to trust people.
Risk for Imbalanced Nutrition : Less Than Body
Requirements related to intake is less, the status
emotional increased.
Impaired Verbal Communication related to
communication pattern that is not logical or
incoherent and side effects of drugs, the
pressure to talk and hyperactivity.
Lack of social interaction (social isolation)
are related to inadequate support systems.
Lack of self-care related to a decreased
willingness.
(1) Risk for injury related to hallucination and
illusion as evidenced by removing IV tubes and
falls.
The Goal: The client will remain safe and free
from injury.
Intervention
1.Provide one to one observation.
2. Decrease stimulus in the environment (low
light, low noise).
3- Keep any dangerous equipment a way
from the client.
4. Bed side rails may be used to prevent
falling.
5. Bed should be away from windows and
doors.
6. Reassure the client that the environment is
safe or provide safety measures as simple
room, simple furniture.
7. Restraint if it's necessary.
(2) Sensory/ Perceptual Alteration
related to neurological dysfunction as evidenced by
illusion and hallucination.
The Goal: The client will demonstrate accurate
perception of environment.
Intervention:
1.Introduce self and call client by name at the
beginning of each contact.
2.Maintain face to face contact to give positive
interaction.
3. Use short, simple phrases.
4.Briefly explain every thing you are going to do
before doing it.
5.Keep room well lighted and provide clocks
and calendars to orient pt to time.
6.When hallucination is present, clarify reality
(EX: "I know you are frightened, but I don't se
spider on you sheets).
7. When illusion is present, clarify reality
(EX: This is intravenous tubing not a snakesee
You seem frightened, I will stay with you).
Dementia
Dementia isn't a specific disease.
Instead, Dementia describes a group of
symptoms affecting memory, thinking and social
abilities severely enough to interfere with daily
functioning.
So memory loss alone doesn't mean you have
dementia.
Alzheimer's disease is the most common cause of a
progressive dementia in older adults, but there are a
number of causes of dementia.
Depression.
Although not yet well-understood, late-life
depression might indicate the development
of dementia.
Diabetes.
If you have diabetes, you might have an
increased risk of dementia, especially if it's
poorly controlled.
Smoking.
Smoking might increase your risk of
developing dementia and blood vessel
(vascular) diseases.
Sleep Apnea.
People who snore and have episodes
where they frequently stop breathing
while asleep may have reversible memory
loss.
Common Nursing Diagnosis
Impaired memory.
Altered thought process.
Impaired verbal communication.
Functional urinary incontinence.
Impaired environmental interpretation.
Ineffective coping.
1- Impaired Memory
Related to Pathologic changes in the brain as
evidenced by Inability to recall factual
information or events.
The Goal: Use long-term memory effectively as
long as it remains intact.
Intervention
1-Provide opportunities for recall of past events.
This can be done on a one-to-one basis or in a
small group.
2-Encourage the client to use written cues such as
a calendar, lists, or a notebook.
3-Keep environmental changes to a necessary
minimum.
Attention.
The ability to stay focused or maintain attention
is significantly impaired with delirium.
A person in the early stages of dementia
remains generally alert.
Fluctuation.
The appearance of delirium symptoms
can fluctuate significantly and frequently
throughout the day.
While people with dementia have
better and worse times of day, their
memory and thinking skills stay at a
fairly constant level during the course of
a day.
Delirium vs. Dementia
Delirium Dementia
Acute Gradual
Reversible Irreversible
Consciousness: fluctuating Consciousness: rarely alters
Decreased awareness of self Decreased awareness of self
Perceptions: Hallucinations not
Perceptions: illusions, common
hallucinations common
Speech: repetitive difficulty
Speech: slow, incoherent finding words
Disorientation: time, others Disorientation: time, person,
Cognitive dysfunction place
Illness, med. toxicity: often Memory impairment
Diurnal disruptions Illness, med. toxicity: rarely
Diurnal disruptions
Outcome: excellent if corrected
early Outcome: poor
References:
http://www.nytimes.com/health/guides/disease/or
ganic-brain-syndrome/overview.html
http://www.healthline.com/health/organic-brain-
syndrome
http://www.nmihi.com/d/dementia.htm
https://medlineplus.gov/ency/article/001401.htm
http://www.medicinenet.com/dementia_pictures_s
lideshow/article.htm