Both Positive Mental Health and Psychopathology Should Be Monitored in Psychotherapy Confirmation For The Dual-Factor Model in Acceptance and Commitment Therapy.
WHAT IS IT? Acute syndrome characterized by a sudden onset impaired attention that fluctuates together with altered consciousness and impaired cognition. Types of Delirium: THERAPIES Hyper- inactivity or reduced motor activity, sluggishness, abnormal drowsiness or seeming to be in a daze. ROLE: Orientation- Hypo- typically characterized by psychomotor agitation and - Encourage communication and reorient patient repetitively hypervigilance (least common), hallucinations - Staff and family members should reassure patients of time and place at every opportunity Mixed-patients fluctuate between hyper and hypo; see this - Procedures should be explained before they are type most commonly in acute care patients done - Validate the patient- never argue or contradict thoughts RISK FACOTRS - Daily news paper (current events) - Daily schedules/ Orientation board Non modifiable Potentially Modifiable - Find out from family what person's normal daily schedule is and try to mimic Over the age of 65 Polypharmacy Pre-existing cognitive impairment Immobility Environment- (dementia) Sensory impairment - Well lit during the day-time, blinds open Gender (males) Urinary catheterization Length of hospital stay - Ambulate or mobilize patient early and often Comorbidities (hypertension, (walk to windows) depression, alcohol use) Inadequately controlled pain Sleep deprivation or disturbance - Have familiar objects from patients home in the Severity of illness Anemia room Infection Hypoxia or hypercarbia Ex. pillow, blanket (touch, smell), pictures (visual) Hearing and/or visual impairment Poor nutrition Recent coma - Music/ TV show interests (getting idea of what Dehydration their normal is) Prior institutionalization Electrolyte abnormalities Mechanical Ventilation - Clocks, calendars (where Pt can easily see) - Remove clutter - Low stim Pathophysiology Mechanisms are not fully understood but may involve: Early Mobilization!!!!! Reversible impairment of cerebral oxidative metabolism Multiple neurotransmitter abnormalities Meet sensory needs- Generation of cytokines - Visual and hearing aids *Stress of any kind upregulates sympathetic tone and - Weighted blankets if agitated downregulates parasympathetic tone, impairing cholinergic function and thus contributing to delirium. The elderly are particularly Cognitive therapy- vulnerable to reduced cholinergic transmission, increasing their risk - Mind working games of delirium. Ex: cross words, card games, hang man *Regardless of the cause, the cerebral hemispheres or arousal - Weighted seek and find pads mechanisms of the thalamus and brain stem reticular activating system become impaired. Sleep hygiene- - Lights off at night, on during the day - Control excess noise at night (ear plugs) - Eye masks Clinical parameters- - Maintain systolic BP > 90 mmHG - Maintain O2 saturdayions > 90%- education of spirometer - Managing nutrition/hyrdation - Preventing constipation
Both Positive Mental Health and Psychopathology Should Be Monitored in Psychotherapy Confirmation For The Dual-Factor Model in Acceptance and Commitment Therapy.