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同学们大家好

今天我们一起来学习一下

什么是谵妄

什么是谵妄呢

谵妄也被称为急性意识错乱

精神状态改变

和中毒性代谢性脑病

又称为急性脑综合征

常表现为意识障碍

行为无章

注意力无法集中

通常起病急

病情波动较为明显

常见于老年患者

伴随着认知功能下降

觉醒度改变

感知觉异常日夜颠倒等

可以说谵妄不是一种疾病

而是由多种原因导致的临床综合征

目前

临床上最常见于急诊入院

和ICU的患者

促发或影响谵妄的因素有多种

对谵妄的影响程度也各不相同

一类是易患因素

与患者基础状况直接相关

由患者的既往健康背景所决定

比如患者既往存在老年痴呆

高龄 酗酒 高血压等

另一类是躯体 心理的急性疾病损伤

及治疗干预措施而造成的脑功能异常

如严重的感染 创伤

休克 呼吸衰竭 体外循环等等

据调查

急诊入院患者中

80岁以上的患者总体谵妄发生率可达34.8%

而围手术期 侵入性操作

睡眠剥夺等均可诱发谵妄

当患者出现认知功能障碍

及精神症状波动时

在排除外向的相关器质性病变后

则可以考虑存在谵妄的可能

目前临床常用的

谵妄诊断方法包括

谵妄评定方法

精神障碍诊断和统计手册

谵妄分级量表98修订版

和记忆谵妄评定量表等

其中

CAM是最广泛应用的谵妄评定方法

其敏感度和特意度较高

适用于非神经精神科医师和护理人员使用

此外

护理谵妄筛查量表

也是快速 方便 易用的筛查量表

该量表只有5个条目

需要护理人员对存在

定向力障碍

言语交流异常

行为异常

幻听

和精神运动型迟缓的患者

每8小时评估1次

国外早在20世纪90年代

开始探讨谵妄的多因素学科综合干预

包括

多学科资讯

护士引导的多学科干预

家属参与的非药物干预等等

研究结果表明

多因素评估和多学科干预

可以有效预防老年住院患者谵妄的发生

改善谵妄的预后

为优化老年患者谵妄的处理

提供实证依据

我们来看一下

主要包括哪些具体的措施

一 实施认知干预

增强患者的感知能力

早期开始进行认知干预

包括定向力的训练

室内提供挂钟 挂历

显示时间 日期

鼓励患者进行益智活动

如打牌 下棋 拼图等等

同时鼓励亲属和朋友探望

延长探视的时间

二 保持正常睡眠的周期

睡眠质量差是老年人谵妄的独立危险因素

避免在夜间睡眠时间进行治疗护理活动

调整夜间给药的时间避免打扰睡眠

睡眠时要减少走廊的噪音

维持良好的睡眠环境

三 缓解疼痛

疼痛会给患者带来诸多的心理

生理影响

引发焦虑 抑郁 躁狂 失眠

健忘的情绪以及行为改变

若疼痛得不到缓解可能诱发大脑缺氧

缺血等代谢紊乱

进而诱发谵妄

正确评估患者的疼痛水平

对不能言语沟通的患者

使用身体特征 表情等

进行评估

对任何怀疑存在疼痛的患者

都要控制疼痛

避免治疗不足或过多的治疗

四 合理饮食和营养

必要时可以邀请营养师共同参与

改善已经出现的营养不良等情况

独立进食困难者可以注意

辅助喂食技巧

鼓励患者多喝水

如若需要限制入量

可以考虑相关专科的会诊意见

并保持出入量的平衡

鼓励进食蔬菜 水果等

高纤维素食

定时排便

五 注重用药护理

对于服用多种药物的老人

可以在临床药师的参与下

评估药物

尽量减少药物的种类

避免会引起

或加重谵妄症状的药物

如哌替啶 抗精神病药

苯二氮卓类药物

需要注意的是

老年患者谵妄的治疗

即使低剂量的氟哌啶醇

也可能导致低血压

呼吸抑制 心律失常

因此生命体征监护和吸氧

是必要的

六 非药物疗法

目前最常用的为音乐疗法

可以利用音乐艺术调节人的情绪

促使疾病治愈的一种治疗方法

护理人员通过指导患者听

有利于身心健康的音乐

从而更好地提供一个

有利于老年人精神 心理

身体 社会等康复的轻松环境

研究表明

音乐疗法能够缓解患者的焦虑

抑郁情绪

减轻交感神经的过度紧张

及各种压力反应

减少和预防谵妄的发生

要做好老年患者用药谵妄的预防

和护理工作

首先

要通过各种方式

向护理人员普及谵妄相关知识

使其认识谵妄的不良结局

同时开展谵妄评估工具使用的培训

加强护理人员谵妄综合干预的能力

再者

老年人及其家属

必须知晓谵妄的危险因素及其严重性

引起重视

在多学科团队和各专科人员

充分的沟通 协调 发挥 落实综合干预的措施下

降低老年谵妄的发生率

维护和改善老年人功能状态和生活质量

好了

以上就是本次章节的全部内容

谢谢大家

Gerontological Nursing课程列表:

CHAPTER 1: General Introduction to Geronological Nursing

-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

--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

--【Literature Recommendation】Obstacles and Policies of the Social Capital Participates in the Combination of Medical Care and Pension: A Literature Review

-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

-【Case Discussion】CHAPTER 1

CHAPTER 2: Elderly Health Assessment

-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

--【Literature Recommendation】Age-friendliness of living environments from the older person’s viewpoint: development of the Age-friendly Environment Assessment Tool

-Concept Map

--【Concept Map】Elderly Health Assessment(1)

--【Concept Map】Elderly Health Assessment(2)

-【Test】CHAPTER 2

-【Case Discussion】CHAPTER 2

CHAPTER3: Elderly Mental Health and Mental Health care

-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

--【Website Recommendation】

--【Documentary Recommendation】Depression:Out of the Shadows

--【Literature Recommendation】Management of depression in older adults:A review depression in older people

-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

-【Case Discussion】CHAPTER 3

CHAPTER4: Elderly Daily Care

-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

-【Case Discussion】CHAPTER 4

CHAPTER5:Medication Safety and Care for the Elderly

-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

--【Literature Recommendation】The American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

-5.4 Prevention of Adverse Drug Reactions in the Elderly

--Prevention of Adverse Drug Reactions in the Elderly

--【Literature Recommendation】Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies

-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

-【Case Discussion】CHAPTER 5

CHAPTER6:Nursing Care for the Elderly with Common Health Problems and Diseases

-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

--Dysphagia in the Elderly

-6.3 Urinary Incontinence in the Elderly

--Urinary Incontinence in the Elderly

-6.4 Constipation in the Elderly

--Constipation in the Elderly

--【Literature Recommendation】Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management

-6.5 Dry Mouth in the Elderly

--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

--Senile Deafness

-6.9 Elderly Delirium

--Elderly Delirium

-6.10 Elderly Frailty

--Elderly Frailty

--【Literature Recommendation】Frailty in elderly people/Frailty in older people

-6.11 Pneumonia in the Elderly

--Pneumonia in the Elderly

-6.12 Hypertension in the Elderly

--Hypertension in the Elderly

--【Literature Recommendation】2018 Chinese Guidelines for Prevention and Treatment of Hypertension

-6.13 Stroke in the Elderly

--Stroke in the Elderly

-6.14 Stable Angina in the Elderly

--Stable Angina in the Elderly

--【Literature Recommendation】2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes

-Concept Map

--【Concept Map】Nursing Care for the Elderly with Common Health Problems and Diseases

-【Test】CHAPTER 6

-【Case Discussion】CHAPTER 6

CHAPTER7 Hospice Care for the Elderly

-7.1 Concept of Hospice Care

--Concept of Hospice Care

--【Website Recommendation】 Definition of Palliative Care,WHO

-7.2 Death Education

--7.2.1 Death Education (1)

--7.2.2 Death Education (2)

--【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

--【Journal Recommendation】

-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

-【Case Discussion】CHAPTER 7

FINAL EXAM

-Final Exam

Elderly Delirium笔记与讨论

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