REASONS FOR SUDDEN DEMENTIA – DELIRIUM AND DEMENTIA Part III

As stated in Part I of this series on Sudden Dementia, the key here is to have the diagnosis, of delirium. Once the patient has the diagnosis, the nursing home is mandated by Medicare to investigate all of the previously mentioned  probable causes. The nurse or nursing assistant may be very concerned, and listen to the story of how rapid this change came over this patient, but there will be little follow though with this information. Only physicians, and nurse practitioners are able to write a diagnosis,and the delirium diagnosis is what drives the investigation.

As well as the previously mentioned possible causes in part I and part II, there will be attention given to the circulatory system, the respiratory system and metabolism. Circulatory – did the patient possibly have a stroke, are they in congestive heart failure, have they had a heart attack, or are they possibly suffering from severe anemia?  Respiratory – does the patient have asthma, emphysema, or is in respiratory failure? Lack of oxygen to the brain caused by a circulatory or respiratory condition can cause confusion.

Does the patient have a metabolic problem – diabetes, or thyroid disease? Anyone familiar with and experiencing these disease processes knows how they can impact so many other areas of the patient’s health. Ruling out these very significant  disease states is extremely important.

The center for Medicare Services has created this special focus for delirium showing how seriously this condition is viewed. When a patient in a nursing home, covered by Medicare, the patient’s power of attorney for healthcare is able to ask to see the patient’s diagnosis. Reviewing the diagnoses and making sure that someone who doesn’t know the patient’s history has called this sudden confusion, Alzheimer’s disease, is very important. Once the patient has the diagnosis of Alzheimer’s , the healthcare community finds no need to look any further.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing 

REASONS FOR SUDDEN DEMENTIA – DELIRIUM AND DEMENTIA – Part I

The increase number of people experiencing sudden dementia has caused delirium to be a focus of Medicare. As with everything else the way to capture attention is to create a monetary connection. In this case, Medicare reimbursement for sudden dementia is tied to identifying the cause of the patient’s delirium. The list of possible reasons, is to be a guide for consideration for every patient on Medicare with sudden dementia or delirium. Or any person admitted to a nursing facility who has sudden dementia as a diagnosis.

The basic physical changes that can cause a person to become delirious:

CHANGES IN VITAL SIGNS – COMPARED TO BASELINE (baseline, you always want to compare with what is usual)

  •  elevated temperature – 2.4 degrees higher than baseline
  • pulse rate less than 60 or higher than 100 beats per minute
  • breathing slower than 16 breaths a minute or higher than 25
  • a significant drop in blood pressure compared to baseline
  • a significant increase in blood pressure compared to baseline

ABNORMAL LABORATORY VALUES

  • electrolytes
  • kidney function
  • liver function
  • blood sugar
  • thyroid function
  • arterial blood gases (this is blood tested from an artery instead of a vein to check the ph of the blood as well as to see how well the lungs are moving oxygen into the blood and removing carbon dioxide out of the blood)

PAIN

  • how often is the pain, how intense, how long does it last, what is the quality of the pain?
  • how is the pain affecting the patient’s ability to function?

A complete pain assessment must be conducted at this time.

SIGNS OF INFECTION

  • fever
  • cloudy or foul smelling urine
  • congested lungs or cough
  • shortness of breath – or painful breathing
  • diarrhea
  • abdominal pain
  • wound draining pus
  • any redness around an incision or wound

Some of these symptoms may be present but if there isn’t a good reason for something such as a slow pulse –  that is related to a medication the patient is on, then this symptom must be considered as a cause for the sudden dementia, and investigated further.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

 

WHEN DEMENTIA AND CONFUSION AREN’T PERMANENT – SUDDEN DELIRIUM

I receive emails from families who can’t understand what has happened to Mom, Dad, Uncle Charlie and so on. You see this person was just fine a couple of weeks age, driving, shopping, living alone, balancing their check book, and now the doctor says Mom has Alzheimer’s disease and needs to live in a nursing home. What usually happened is that Mom had an infection, an accident, change in medication or surgery and this put Mom into a state of delirium

Synonyms for delirium are; irrational, raving, deranged, and yes even demented. Once the stress is over, the elder returns to their previous state of cognition. But what if Mom is in the hospital when she becomes delirious? The hospital personnel don’t know Mom and  don’t recognize her delirium. Mom will be labelled a confused, demented elder and medicated to keep her under control and “safe.” This will only lead to increased confusion making Mom appear even more confused.

The presence of delirium can indicate that the elder’s brain has a decrease in capacity and may indicate an increased risk of developing dementia. The healthcare community sees delirium frequently with the elderly and infrequently with the young. The same person can have had no history of delirium, even though they have experienced several hospitalizations, yet when they are old, they become confused and disoriented every time they are admitted.

Whenever there is a sudden change in an elder’s ability to think, focus, reason, and remember, look back to whatever stress could have caused the change. The longer the person suffers from delirium, the more chance it will not be resolved.

Remember Alzheimer’s Disease is slow, delirium is fast and doesn’t have to be permanent.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing