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同学们好
今天我们要学习的内容是
《临终老年人谵妄护理》
我们先来看这样一个案例
患者男 75岁
诊断为晚期胃癌伴肝肺等全身多处转移
KPS体能评分为30分
恶液质 接受安宁疗护
2天前
患者突然出现兴奋 躁动
胡言乱语等症状
随后患者意识不清
陷入持续昏迷状态
患者为什么会突然出现这些症状呢
其实这种现象在生命末期极为常见
医学上称为临终谵妄
谵妄是一种复杂的精神障碍综合征
常表现为突然发生的意识状态
认知和行为障碍
临终前
由于各种原因可以导致患者进入谵妄状态
几个小时后往往会消失
有时候这种状态会反复出现
根据具体的表现
谵妄可以分为三种类型
过度活跃或激动的谵妄
过度低活性或安静的谵妄
以及混合型谵妄
过度活跃或激动的谵妄
特点在于突然表现的特别激动
产生幻觉
有时会表现的特别害怕
惊恐发作
说胡话就是对幻觉
包括幻视 幻听和幻想的
语言表达
经常会突然告诉身边的人
看到了已经故去很久的亲人
或者想到了过去很久以前的一些事情等等
有时候
这种胡话仅仅是喃喃自语
说胡话这种谵妄表现是最引人注目的
往往会引发身边亲人的不安
过度低活性或安静的谵妄
常表现为突然异常安静
甚至冷漠
不搭理身边的人
也不愿意跟身边的亲人说话
甚至可以表现为低意识水平的嗜睡状态
这种类型的谵妄往往不被人认识
如果有使用鸦片类
或者其他镇静药
常常会把这种状态
误认为是药物作用的结果
混合型谵妄
表现为以上两种谵妄状态的交替
谵妄状态还可以表现为
短期记忆和注意力受损
对环境 时间和地点认知定向障碍
突发性的情绪波动
睡眠障碍
如睡眠周期昼夜颠倒
身体异常活动等等
临终前为什么会出现谵妄状态呢
事实上
谵妄并非临终前必经的阶段或状态
往往是由一些原因导致的脑功能障碍
常见于以下原因
首先 药物
药物作用是临终谵妄产生的最常见的原因
鸦片类药物
抗癫痫药物
类固醇和抗焦虑药物
是最常引发谵妄状态的药物
其次
代谢原因
这是自然死亡过程中最常诱发谵妄状态的原因
临终老年人饥饿感和口渴感同步钝化
表现为长时间不想进食
容易引发或加剧代谢障碍
特别是电解质代谢紊乱
容易引发脑内神经和精神功能障碍
再次
身体疼痛或不适的刺激
比如 剧烈的疼痛
便秘 尿潴留
甚至尿管胃管等刺激
都有可能造成不适
诱发谵妄状态
感染和发烧
也容易引发谵妄发作
此外
脑缺血缺氧也是原因之一
临终老人通常存在一定程度血液循环障碍
加之贫血 呼吸困难等原因
容易导致脑缺氧
甚至发生脑水肿
也是导致谵妄状态的原因
当患者出现谵妄时我们应该如何护理呢
由于谵妄病因复杂
危险因素多
因此治疗强调要针对
病因的综合治疗措施
优先考虑非药物治疗
同时强调多学科干预
医护团队和家属共同参与
找出可治疗的原因
如疼痛 脑缺氧 气喘等
并给予对症处理
患者躁动不安时需要24小时专人守护
密切观察
保证老年人安全
今天我们介绍了临终老年人
谵妄的定义 表现 类型
因素及处理措施
希望同学们可以掌握
今天我们的课就讲到这里
谢谢
-1.1 Human Life Expectancy and Age Classification of the Elderly
--Human Life Expectancy and Age Classification of the Elderly
--【Vedio Recommendation】 How do we measure life expectancy ?
-1.2 Population Aging
--【Literature Recommendation】World Report on Ageing and Health: 2015
-1.3 Influence and Countermeasures of Population Aging
--Influence and Countermeasures of Population Aging
--【Literature Recommendation】World Population Ageing Highlights:2019
-1.4 Goals and Principles of Elderly Care
--Goals and Principles of Elderly Care
--【Book Recommendation】Evidence-Based Geriatric Nursing Protocols for Best Practice
-1.5 Theories Related to Elderly Care
--1.5.1 Personality Development Theory and Life Review
--1.5.2 Disengagement Theory and Activity Theory
--1.5.3 Self-efficacy and Chronic Disease Management
--【Vedio Recommendation】8 Stages of Development by Erik Erikson
--【Literature Recommendation】Activity Theory, Disengagement Theory, and Successful Aging
--【Book Recommendation】Self-Efficacy in Changing Societies
-1.6 Elderly Support and Elderly Care
--1.6.1 Concepts of Elderly Healthcare, Elderly Support and Elderly Care
--1.6.2 Home-based Elderly Care Model
--1.6.3 Institutional Elderly Care Model
--1.6.4 Integrated Medical and Nursing Care Model
--【Vedio Recommendation】Day in the Life of Home Care
--【Website Recommendation】Official Website of the National Institutes of Health
-Concept Map
--【Concept Map】General Introduction to Geronological Nursing
-【Test】CHAPTER 1
-2.1 Aging Changes in the Elderly
--2.1.1 Aging of the Respiratory System
--2.1.2 Aging of the Cardiovascular System
--2.1.3 Aging of the Digestive System
--2.1.4 Aging of the Urinary System
--2.1.5 Aging of the Endocrine System
--2.1.6 Aging of the Motor System
--2.1.7 Aging of the Nervous System
--2.1.8 Aging of the Sensory System
--【Literature Recommendation】Exercise Attenuates the Major Hallmarks of Aging
--【Book Recommendation】Hazzard's Geriatric Medicine and Gerontology
-2.2 Comprehensive Health Assessment of the Elderly
--Comprehensive Health Assessment of the Elderly
--【Literature Recommendation】Instruments to evaluate mental well-being in old age: a systematic review
-2.3 Principles of Elderly Health Assessment
--Principles of Elderly Health Assessment
-2.4 Assessment of the Functional Status of the Elderly
--Assessment of the Functional Status of the Elderly
--【Literature Recommendation】The Lawton Instrumental Activities of Daily Living (IADL) Scale
-2.5 Assessment of Cognitive Function in the Elderly
--Assessment of Cognitive Function in the Elderly
-2.6 Assessment and Adjustment of the Living Environment for the Elderly
--Assessment and Adjustment of the Living Environment for the Elderly
-Concept Map
--【Concept Map】Elderly Health Assessment(1)
--【Concept Map】Elderly Health Assessment(2)
-【Test】CHAPTER 2
-3.1 Overview of the Psychological Characteristics of the Elderly
--Overview of the Psychological Characteristics of the Elderly
-3.2 Influencing Factors of Psychological Changes in the Elderly
--Influencing Factors of Psychological Changes in the Elderly
-3.3 Common Psychological Issues and Their Management in the Elderly
--3.3.1 Common Psychological Issues and Their Management in the Elderly (1)
--3.3.2 Common Psychological Issues and Their Management in the Elderly (2)
--【Book Recommendation】Development Through the Lifespan
-3.4 Depression in the Elderly
--3.4.1 Overview of Depression in the Elderly
--3.4.2 Clinical Symptoms of Depression in the Elderly
--3.4.3 Caring for Elderly Patients with Depression
--【Documentary Recommendation】Depression:Out of the Shadows
-3.5 Elderly Patients with Dementia
--3.5.1 Identification of Dementia Symptoms in the Elderly
--3.5.2 Intelligence Rehabilitation of Elderly Patients with Dementia
--3.5.3 Safety Care of Elderly Patients with Dementia
--【Website Recommendation】The Global Voice on Demaentia
-Concept Map
--【Concept Map】Elderly Mental Health and Mental Health Care
-【Test】CHAPTER 3
-4.1 Precautions for Daily Care of the Elderly
--Precautions for Daily Care of the Elderly
-4.2 General Care of Elderly Skin
--4.2.1 Characteristics and General Care of Elderly Skin
--4.2.2 Skin Itching and Its Management in the Elderly
--【Website Recommendation】American Academy of Dermatology
-4.3 Clothing Hygiene for the Elderly
--Clothing Hygiene for the Elderly
--【Literature Recommendation】The Design Methods of Functional Clothing for the Elderly
-4.4 Dietary Care for the Elderly
--4.4.1 Nutritional Needs of the Elderly and Influencing Factors of these Needs
--4.4.2 Dietary Care for the Elderly
--【Book Recommendation】Nutrition Care of the Older Adult: a Handbook for Dietetics
--【Website Recommendation】Nutrition for older persons
-4.5 Sleep Guidance for the Elderly
--4.5.1 Sleep Characteristics of the Elderly
--4.5.2 Sleep Guidance for the Elderly
--【Book Recommendation】An Occupational Therapist's Guide to Sleep and Sleep Problems
--【Website Recommendation】American Academy of Sleep Medicine
-4.6 Exercises Guidance for the Elderly
--4.6.1 Evaluation of Exercise Intensity in the Elderly
--4.6.2 Precautions Elderly Undertaking Exercises
--【Website Recommendation】American College of Sport Medicine
--【Book Recommendation】Handbook of Activities for the Elderly
-Concept Map
--【Concept Map】Elderly Daily Care
-【Test】CHAPTER 4
-5.1 Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly
--Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly
--【Website Recommendation】How Drugs Work In the Elderly
-5.2 Common Adverse Drug Reactions and Their Causes in the Elderly
--Common Adverse Drug Reactions and Their Causes in the Elderly
-5.3 The Principles of the Use of Medications in the Elderly
--The Principles of the Use of Medications in the Elderly
-5.4 Prevention of Adverse Drug Reactions in the Elderly
--Prevention of Adverse Drug Reactions in the Elderly
-5.5 Medication Compliance in the Elderly
--Medication Compliance in the Elderly
-Concept Map
--【Concept Map】Medication Safety and Care for the Elderly
-【Test】CHAPTER 5
-6.1 Falls in the Elderly
--6.1.1 Epidemiological Characteristics of Elderly Falls
--6.1.2 Risk Factors for Falls in the Elderly
--6.1.3 Prevention of Falls in the Elderly
--【Website Recommendation】CDC STEADI(Stopping Elderly Accidents, Deaths & Injuries Tool Kit)
-6.2 Dysphagia in the Elderly
-6.3 Urinary Incontinence in the Elderly
--Urinary Incontinence in the Elderly
-6.4 Constipation in the Elderly
-6.5 Dry Mouth in the Elderly
--【Website Recommendation】Academy of Nutrition and Dietetics
-6.6 Elderly Nutritional Deficiencies
--Elderly Nutritional Deficiencies - emaciation
-6.7 Visual Impairment in the Elderly
--Visual Impairment in the Elderly
--【Website Recommendation】Senior Eye Exams
-6.8 Senile Deafness
-6.9 Elderly Delirium
-6.10 Elderly Frailty
--【Literature Recommendation】Frailty in elderly people/Frailty in older people
-6.11 Pneumonia in the Elderly
-6.12 Hypertension in the Elderly
--【Literature Recommendation】2018 Chinese Guidelines for Prevention and Treatment of Hypertension
-6.13 Stroke in the Elderly
-6.14 Stable Angina in the Elderly
--Stable Angina in the Elderly
-Concept Map
--【Concept Map】Nursing Care for the Elderly with Common Health Problems and Diseases
-【Test】CHAPTER 6
-7.1 Concept of Hospice Care
--【Website Recommendation】 Definition of Palliative Care,WHO
-7.2 Death Education
--【Book Recommendation】The Meaning of Death by Herman Feife
-7.3 Nursing for Pain in the Dying Elderly
--Nursing for Pain in the Dying Elderly
-7.4 Nursing for Major Bleeding in the Dying Elderly
--Nursing for Major Bleeding in the Dying Elderly
-7.5 Nursing for Delirium in the Dying Elderly
--Nursing for Delirium in the Dying Elderly
-7.6 Nursing for Dyspnea in the Dying Elderly
--Nursing for Dyspnea in the Dying Elderly
--【Website Recommendation】The Hospice and Palliative Nurses Association,HPNA
-7.7 Psychological Problems and Nursing in the Dying Elderly
--Psychological Problems and Nursing in the Dying Elderly
--【Book Recommendation】On Death and Dying ,by Elisabeth Kübler-Ross
-7.8 Grief Counseling for the Widowed Elderly
--Grief Counseling for the Widowed Elderly
--【Book Recommendation】I Wasn't Ready to Say Goodbye,by Noel·Brook,Blair·Pamela
-Concept Map
--【Concept Map】Hospice Care for the Elderly
-【Test】CHAPTER 7