长照体系内谵妄症的评估与处置

长照体系内谵妄症的评估与处置内容摘要：

current behavior, mood, cognition and function • Review the history, observe the patient in various situations, and identify and document pertinent details about how the patient looks, thinks, and acts • Assessment process should be coordinated among staff from various disciplines involved 32 Key Elements in Evaluating Mental Status 33 Step 2: Identify and clarify problematic behavior and altered mental function – Symptoms, current diagnoses, history and medications • Review the patient’s medical, surgical, family and social history。 pertinent behavioral history。 baseline functional status。 and any prior diagnostic workup and management 34 • Check available transfer information and any pertinent consultation reports for related diagnoses (delirium, dementia, bipolar disorder, or psychosis) • Review current orders for treatments and medications that address cognition, mood, problematic behavior, or psychiatric disorders, and for medications with anticholinergic properties or side effects, which are known to adversely affect behavior and mental function 35  Define behavioral issues – Nature and relevant factors – Severity – Course  Identify delirium – Require a high index of suspicion – Should be considered in any patient who has a change in behavior or mental function, regardless of whether they also have dementia – Use screening instruments (., CAM) 36 Step 3: Assess the patient for individual risk factors for problematic behavior and delirium – Having dementia is the most mon risk factor for the development of delirium • Avoid using indwelling urinary catheters and minimize use of other medical devices (., intravenous catheters) that may restrict mobility or function • Avoid using restraints 37 • Minimize the number and reduce the dose of medications with central nervous system effects or potential side effects • Pay careful attention to fluid and electrolyte balance in older patients who are taking diuretics。 who have diarrhea, pneumonia, or urinary tract infection。 or who are otherwise at risk for dehydration • Identify and manage treatable causes of anemia 38 • Optimize sensory function (., provide corrective lenses for impaired vision, hearing aides) • Optimize sleep (., address reversible causes of sleep impairment, minimize nighttime noises) • Avoid unnecessary isolation or restriction (., for infection control purposes) 39 Assessment Step 4: Determine the urgency of the situation and the need for additional evaluation and testing • Simply giving medications to try to control behavior, or routinely requesting the immediate transfer of patients to the emergency room or hospital, are often not helpful • Some situations may require more urgent evaluation and management 40 Assessment Step 4: Determine the urgency of the situation and the need for additional evaluation and testing • Simply giving medications to try to control behavior, or routinely requesting the immediate transfer of patients to the emergency room or hospital, are often not helpful • Some situations may require more urgent evaluation and management 41 Situations Requiring Urgent Evaluation  Medical issues – Markedly abnormal vital signs (systolic BP 90, PR 50 or 120, RR30, temp ℃ or ℃ ) – Newonset respiratory distress, with increasing hypoxia and dyspnea – Signs of serious underlying condition possibly causing delirium (., symptoms of stroke)  Psychiatric symptoms – Escalating physically aggressive behavior or threats of violence – Intermittent or persistent change to self or others 42 Step 5: Identify the cause(s) of problematic behavior and altered mental function • A systematic approach – A detailed description of current behavior, function and mental status in proper context – Careful physical assessment by nursing staff, supplemented by a practitioner assessment and pertinent laboratory testing as needed 43 • Consider unmet fort needs, environmental issues and nonspecific behavioral and psycholo。