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Med surg 2 (Endocrine, Gastro, Neuro and musculoskeletal)

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Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)

Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)

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Altered Mental Status- Delirium and Dementia

Definition/Etiology:

Altered mental status is a change in mental function. It stems from certain illnesses, disorders and injuries affecting your brain. The change is often temporary, but can quickly become life-threatening.

Delirium
- Acute brain dysfunction starts suddenly (over a period of one to two days) and symptoms often also vary a lot over
  the day.
- Cause
  - Drug toxicity/ETOH withdrawal
  - Infection (UTI, Sepsis)
  - Electrolyte Imbalance (NA+)
  - Liver Failure
  - Recent CVA
Dementia
- Deterioration symptoms of a large group of illnesses that cause a progressive decline in functioning.
- Cause
  - Age – chronic vascular changes
  - Brain Tumors
  - Alzheimer’s

Pathophysiology:

Pathophysiology is dependent on etiology.
Cognitive Decline
Deterioration
- Emotional control
- Social behavior
- Memory
- Orientation
- Judgment

Noticing: Assessment & Recognizing Cues:

Delirium
- Fluctuating LOC
- Vital signs altered
- Attention difficulty
- Slurred speech
- Agitated
- Hallucinations
Dementia
- Normal LOC
- Vital signs stable
- Remembering difficulty
- Forget words
- Apathetic
Shared Cues
- Disorganized sleep

Interpreting: Analyzing & Planning:

Diagnostics are much more helpful in Delirium r/t finding underlying cause
Labs
- Urine drug screen
- Blood Alcohol level
- Cultures – Infection
- CMP – Electrolytes
- Ammonia Level – Liver
Diagnostics
- Imaging
  - For underlying causes
  - Example MRI
    - Stroke = Delirium
    - Chronic vascular changes = Dementia

Responding: Patient Interventions & Taking Action:

Common interventions
- Pain/Agitation
- Support Sleep Cycle
  - Cluster activities, alarms/noise, keep voice down at night
- Support Safety
- Avoid Restraints
- Glasses/Hearing aids
Delirium
- Notify Pharmacy – med review
- Confusion Assessment Method (CAM)-ICU
  - tool is validated for the identification of delirium in the ICU among older patients
Decrease Agitation
- Antipsychotics (Hadol)
  - Used less but still tested
  - Control dopamine receptors
- ETOH = Benzodiazepines okay
- Overdose = Antidotes
Dementia
- Slow Progression with Medications
  - Cholinesterase inhibitors (Aricept)
    - Supports neuron communicating
  - N-methyl-D-aspartate blockers (Namenda)
    - regulates glutamate (learning and memory)

Reflecting: Evaluating Patient Outcomes:

Delirium
- Patient is oriented to person, time, and place
- Patient does not demonstrate signs or symptoms of anxiety, fear, and confusion
- Patient responds to simple, concrete questions
Dementia
- Patient’s safety was considered
- Encouraging mobility = better function outcomes
- Feel safe and unthreatened

Linchpins (Key Points):

Notice – Onset
- Onset fast or slow will point to either delirium or dementia
Interpret Labs & Imaging
- Labs – Delirium based
- Imaging – helps with underlying cause
Respond
- Etiology
  - Delirium -treat underlying cause
  - Dementia – slow down progression
Reflect
- Patient Stable & Safe

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Transcript

References

AACN, & Hartjes, T. (2023). AACN Core Curriculum for Progressive and
Critical Care Nursing (8th ed.). Elsevier Health Sciences (US).
Dennison, R. D., & Farrell, K. (2015]). Pass PCCN!. Elsevier Health Sciences
(US).
Kupchik, N. (2017). Ace The Pccn®!: You can do it!: Practice question review
book. Nicole Kupchik Consulting, Inc.
Stone, L. M. (2018). Certification and Core Review for High Acuity, Progressive,
and Critical Care Nursing (7th ed.). Elsevier Health Sciences (US).
Trivium Test Prep. (2019). Pccn review book 2019-2020: Pccn Study Guide
and Practice Test Questionsfor the Progressive Care Certified Nurse Exam.

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Med surg 2 (Endocrine, Gastro, Neuro and musculoskeletal)

Concepts Covered:

Study Plan Lessons

03.05 Endocrine Practice Questions for CCRN Review

Diabetes Mellitus for Progressive Care Certified Nurse (PCCN)

Factors That Can Put a Pregnancy at Risk Nursing Mnemonic (RIBCAGE)

Glucose Tolerance Test (GTT) Lab Values

Health & Stress

Hypertension (Uncontrolled) and Hypertensive Crisis for Progressive Care Certified Nurse (PCCN)

Hypoglycemia for Progressive Care Certified Nurse (PCCN)

Metabolic & Endocrine Module Intro

Metabolic & Endocrine Terminology

Metabolic/Endocrine Course Introduction

Mnemonic for Organ Systems (MR DICE RUNS)

Nursing Care and Pathophysiology for Menopause

Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)

Nursing Care Plan (NCP) for Hyperthyroidism

Nursing Care Plan (NCP) for Osteoporosis

Nutritional Requirements

Pharmacology Terminology

Pituitary Adenoma

Potassium-K (Hyperkalemia, Hypokalemia)

Urinalysis (UA)

Anti-Infective – Carbapenems

Anti-Infective – Macrolides

Anti-Infective – Sulfonamides

Bariatric Surgeries

Cirrhosis for Certified Emergency Nursing (CEN)

Colorectal Cancer (colon rectal cancer)

Constipation and Encopresis (Incontinence)

Cystic Fibrosis (CF)

Digestion & Absorption

Digestive Terminology

Discomforts of Pregnancy

Endoscopy & EGD

Erythroblastosis Fetalis

Famotidine (Pepcid) Nursing Considerations

Gastrointestinal (GI) Bleed Concept Map

Gastrointestinal (GI) Course Introduction

Gastrointestinal Trauma for Certified Emergency Nursing (CEN)

Hemorrhagic Fevers for Certified Emergency Nursing (CEN)

Hyperbilirubinemia (Jaundice)

Imperforate Anus

Intussusception

Iron (Fe) Lab Values

Liver Function Tests

Lower Gastrointestinal (GI) Module Intro

Nursing Care Plan (NCP) for Abdominal Pain

Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)

Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)

Nursing Care Plan (NCP) for Anemia

Nursing Care Plan (NCP) for Anxiety

Nursing Care Plan (NCP) for Appendicitis

Nursing Care Plan (NCP) for Bowel Obstruction

Nursing Care Plan (NCP) for Cholecystitis

Nursing Care Plan (NCP) for Colorectal Cancer (Colon Cancer)

Nursing Care Plan (NCP) for Constipation / Encopresis

Nursing Care Plan (NCP) for Cystic Fibrosis

Nursing Care Plan (NCP) for Dehydration & Fever

Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis

Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed

Nursing Care Plan (NCP) for Hyperemesis Gravidarum

Nursing Care Plan (NCP) for Imperforate Anus

Nursing Care Plan (NCP) for Inflammatory Bowel Disease (Ulcerative Colitis / Crohn’s Disease)

Nursing Care Plan (NCP) for Intussusception

Nursing Care Plan (NCP) for Nutrition Imbalance

Nursing Care Plan (NCP) for Ovarian Cancer

Nursing Care Plan (NCP) for Pancreatitis

Nursing Care Plan (NCP) for Peptic Ulcer Disease (PUD)

Nursing Care Plan (NCP) for Sepsis

Nursing Care Plan (NCP) for Stomach Cancer (Gastric Cancer)

Nursing Care Plan (NCP) for Urinary Tract Infection (UTI)

Nursing Care Plan for Hiatal Hernia

Nursing Care Plan for Liver Cancer

Nursing Care Plan for Scleroderma

Nursing Case Study for Colon Cancer

Nutrition (Diet) in Disease

Pediatric Gastrointestinal Dysfunction – Diarrhea

Pharmacology Terminology

Physiological Changes

Thromboembolic Disease- Deep Vein Thrombosis (DVT) for Certified Emergency Nursing (CEN)

Total Bilirubin (T. Billi) Lab Values

Umbilical Hernia

Upper Gastrointestinal (GI) Module Intro

Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder)

Nursing Care Plan (NCP) for Hashimoto’s Thyroiditis

Nursing Care Plan (NCP) for Hyperparathyroidism

Nutrition Assessments

Alcohol Withdrawal (Addiction)

Altered Mental Status Nursing Mnemonic (AEIOU TIPS)

Ammonia (NH3) Lab Values

Autonomic Nervous System (ANS)

Bowel Perforation for Certified Emergency Nursing (CEN)

Calcium and Magnesium Imbalance for Certified Emergency Nursing (CEN)

Chemotherapy Patients

Complications of Immobility

Day in the Life of a Med-surg Nurse

Dementia Nursing Mnemonic (DEMENTIA)

Head to Toe Nursing Assessment (Physical Exam)

Meds for Alzheimers

Nuclear Medicine

Nursing Care and Pathophysiology for Hypothyroidism

Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)

Nursing Care Plan (NCP) for Anaphylaxis

Nursing Care Plan (NCP) for Aspiration

Nursing Care Plan (NCP) for Celiac Disease

Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder)

Nursing Care Plan (NCP) for Encephalopathy

Nursing Care Plan (NCP) for Endocarditis

Nursing Care Plan (NCP) for Hashimoto’s Thyroiditis

Nursing Care Plan (NCP) for Hyperparathyroidism

Nursing Care Plan (NCP) for Hypoparathyroidism

Nursing Care Plan (NCP) for Hypothyroidism

Nursing Care Plan (NCP) for Hypovolemic Shock

Nursing Care Plan (NCP) for Omphalocele

Nursing Care Plan (NCP) for Reye’s Syndrome

Nursing Care Plan (NCP) for Somatic Symptom Disorder (SSD)

Nursing Care Plan (NCP) for Vomiting / Diarrhea

Nursing Care Plan (NCP) for West Nile Virus

Nursing Care Plan for Distributive Shock

Nutrition Assessments

Pituitary Gland

Stomach Cancer (Gastric Cancer)

Advanced Cardiovascular Life Support (ACLS)

Anti-Infective – Antifungals

07.01 CVA (Cerebrovascular Accident/Stroke) for CCRN Review

07.10 Neurologic Review questions for CCRN Review

Acute Confusion

Altered Mental Status Nursing Mnemonic (AEIOU TIPS)

Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)

Assessment of Guillain-Barre Syndrome Nursing Mnemonic (GBS=PAID)

Blood Brain Barrier (BBB)

Cerebral Metabolism

Cerebral Palsy (CP)

Cerebral Perfusion Pressure Case Study (60 min)

Electroencephalography (EEG)

Encephalopathies

Encephalopathy Case Study (45 min)

Head and Spinal Cord Trauma for Certified Emergency Nursing (CEN)

Increased Intracranial Pressure

Impulse Transmission

Increased Intracranial Pressure (ICP) for Certified Emergency Nursing (CEN)

Intracranial Hemorrhage

Intracranial Pressure ICP

Levels of Consciousness (LOC)

Mannitol (Osmitrol) Nursing Considerations

Membrane Potentials

Meningitis Assessment Findings Nursing Mnemonic (FAN LIPS)

Meningitis for Certified Emergency Nursing (CEN)

Nerve Transmission

Nervous System Anatomy

Neuro A&P Module Intro

Neuro Assessment

Neuro Assessment Module Intro

Neuro Course Introduction

Neuro Disorders Module Intro

Neuro Terminology

Neuro Trauma Module Intro

Neurogenic Shock for Certified Emergency Nursing (CEN)

Neurological Disorders (Multiple Sclerosis, Myasthenia Gravis, Guillain-Barré Syndrome) for Certified Emergency Nursing (CEN)

Neurological Fractures

Nursing Care Plan (NCP) for Brain Tumors

Nursing Care Plan (NCP) for Encephalopathy

Nursing Care Plan (NCP) for Meningitis

Nursing Care Plan (NCP) for Migraines

Nursing Care Plan (NCP) for Multiple Sclerosis (MS)

Nursing Care Plan (NCP) for Seizures

Nursing Care Plan (NCP) for Spinal Cord Injury

Nursing Care Plan (NCP) for Stroke (CVA)

Nursing Case Study for Head Injury

Parasympatholytics (Anticholinergics) Nursing Considerations

Parasympathomimetics (Cholinergics) Nursing Considerations

Seizure Causes (Epilepsy, Generalized)

Seizure Disorder for Progressive Care Certified Nurse (PCCN)

Seizure Disorders for Certified Emergency Nursing (CEN)

Seizure Management in the ER

Seizures Case Study (45 min)

Spina Bifida – Neural Tube Defect (NTD)

Spinal Cord Injury

Spinal Cord Injury Case Study (60 min)

Stroke (CVA) Management in the ER

Stroke Assessment (CVA)

Stroke Case Study (45 min)

Stroke Concept Map

Stroke for Certified Emergency Nursing (CEN)

Stroke for Progressive Care Certified Nurse (PCCN)

Stroke Nursing Care (CVA)

Casting & Splinting

Complications of Immobility

Head to Toe Nursing Assessment (Physical Exam)

Health & Stress

Intro to Health Assessment

Introduction to Health Assessment

Marfan Syndrome

Musculoskeletal Assessment

Musculoskeletal Course Introduction

Musculoskeletal Module Intro

Musculoskeletal Terminology

Nursing Care Plan (NCP) for Abdominal Pain

Nursing Care Plan (NCP) for Activity Intolerance

Nursing Care Plan (NCP) for Cerebral Palsy (CP)

Nursing Care Plan (NCP) for Clubfoot

Nursing Care Plan (NCP) for Lyme Disease

Nursing Care Plan (NCP) for Marfan Syndrome

Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida

Nursing Care Plan (NCP) for Osteoporosis

Nursing Care Plan (NCP) for Scoliosis

Nursing Care Plan (NCP) for Spinal Cord Injury

Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)

Nursing Care Plan for Fibromyalgia

Nursing Care Plan for Scleroderma

Nutrition Assessments

Physiological Changes

Positioning (Pressure Injury Prevention and Tourniquet Safety) for Certified Perioperative Nurse (CNOR)

Report For Transferring To a Higher Level of Care

The SOCK Method – O