Dementia, as defined in the article is “long term, irreversible loss of both short term and long term memory”, whereas delirium is described as “an acute confusional state, usually as a result of a physical state”. The authors further states that when assessing a patients cognition, safety of the patient is very important due to the risks associated with being in a confused state either acute or chronic. (Aird & McIntosh, 2004, p. 22) A quote included in the article by the famous Florence Nightingale says “…if you do not get into the habit of observation one way or another (including taking notes) you had better give up being a nurse, for it is not your calling”. Patients in a confused state are at an increased risk for falling victim to harm because their orientation and reasoning are skewed. According to the authors, delirious patients are more at risk for unintentional self harm and are 2-5 times more likely to die than unimpaired patients. (Aird & McIntosh, 2004, p. 22) Assessment tools discussed in the article such as the MMSE or Mini-Mental Status Examination, are useful in determining a “baseline” state, but may not be useful for long term analysis of a patient’s ability to reason if they are unable to pay attention for long periods of time. The MMSE tests 6 areas of cognition. These are: orientation such as place and time; registration where 3 objects will be given to the patient verbally for later recall, which is another area tested. The last 3 areas are attention, language and copying.
The Term Paper on Long Term Illness
In this assignment a focus on an individual with the long term illness/ condition of a stroke will be undertaken, examining the impact of the condition/illness from the perspective of the individual and their family and also the impact of person centred care upon nursing practice. The Nursing and Midwifery Council (NMC, 2008) Code of Professional Conduct Guidance has been maintained throughout ...
There is a total score at the end that includes a “cut-off” depending on age, but some critics of this examination state that a patient’s level of formal education and the test environment can alter the results making them inaccurate. (Aird & McIntosh, 2004, p. 624) Another tool is the GCS, or Glasgow Coma Scale which is widely used in assessing a patient for level of consciousness. The GCS covers three behaviors, eye opening, motor and verbal responses. Eye opening is a 4-point scale, verbal a 5-point and motor is worth 6 points.
A total score of 15 is achievable, the lower the score the more extreme the level of consciousness is. (Aird & McIntosh, p. 625).
The population that this article and its authors have discussed include every age, but particular focus is made on those who are chronically ill older adults with dementia and the group of patients in a state of confusion which would encompass any age and gender. Evaluation of Article This article was very well done and interesting. It outlined the major differences between states of confusion and the nursing implications behind them.
The article was interesting because in the emergency setting both types of confusion and cognitive impairments are seen regularly whether in stroke, trauma, withdrawal or elderly patients to name a few. The health assessment tools and strategies are very useful in any nursing setting, however in the emergency department the ability to correctly perform assessments in a timely manner due to the often grave nature of patients encountered is important. It was a nice refresher to read about the ins and outs of the MMSE and GCS with outside opinions for the use of these tools.
With the large amount of aging population having more research and tools for the assessment of confusion states would be beneficial for all healthcare workers, but nurses who are primarily at the bedside should be better educated because it is they who can notice the slightest difference in their patients which might make all the difference in an outcome of patient care or prevent events that might lead to injury and death. Conclusion In conclusion, this article was very well written and focuses on the key aspects of safe patient care for the confused patient.
The Essay on Mentally Ill Patients Hospitals State
The paper by Paul S. Appel baum, Crazy in the street is reflected on the implications of societies treatment to the mentally ill. He begins with in the past and present about the maltreatment of people suffering from psychotic illnesses. Where in New York City, these people find refuge in subway tunnels, and depend on cardboard fragments for comfort. These conditions are considered to be sprayed ...
While safety is at the top of any patient care environment, confused patients are at higher risk for poor outcomes and it is the nurse who sees the patient progress or worsen and is then able to pass this key information to the provider who can then intervene and collaborate to give the patient a more successful outcome, or at the very least keep the patient in a state that is equal to or greater than how they originally presented. References Aird, T. , & McIntosh, M. (2004).
Nursing tools and strategies to assess cognition and confusion. British Journal of Nursing, 13(19), 621-625.
