The Canadian nurse
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The authors use a case study to illustrate the risks of delirium in older adult patients and discuss ways to prevent, identify and manage its occurrence. An estimated 60 to 80 per cent of hospitalized frail older adults experience at least one preventable episode of delirium, often leading to prolonged hospitalization, functional decline, increased morbidity and eventual nursing home placement or death. Delirium is a medical emergency, characterized by acute onset and a fluctuating course that is demonstrated by abrupt changes in mental status and function. ⋯ Although delirium is amenable to expert nursing care, it is unrecognized or misdiagnosed in up to 70 per cent of older patients. Delirium results from the interplay of multiple forces associated with illness in the older adult, including drugs, substance abuse, metabolic disturbances, nutritional deficiencies, fluid disturbances, acute trauma or illness, infection and impaired physical or functional ability A proactive strategy for delirium prevention and treatment targets defined risk factors and the management of physiologic factors that precipitate delirium. It includes assessment, therapeutic environmental modification, standardized protocols for physiological interventions and staff education.
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About 20 per cent of pregnant women experience antenatal depression (AD), which not only has deleterious effects on the woman and her baby but also increases the risk of developing postpartum depression. Nurses who understand the prevalence, signs and symptoms, and risk factors associated with AD can help to identify it and prevent the sequelae. The signs and symptoms of depression in pregnancy do not differ from depression at at any other time. ⋯ Most of the standard treatments for depression can be used in pregnant women, with the exception of some antidepressant medications. Supportive therapies--exercise, adequate nutrition, adequate sleep, and support from family and friends--are also indicated. Screening of women with known risk factors is crucial, but the authors suggest that the high overall prevalence of depressive symptoms during pregnancy indicates a need for universal screening.