长照体系内谵妄症的评估与处置.ppt

Time course of cognitive changes, including baseline cognitive status and the acuity of change. Information gathered from reliable informants, including the family, caregivers or nurses. Treatment Step 9: Establish a working diagnosis and validate conclusions Identify the rationale for and goals of treatment – Why is the patient’s behavior problematic? – Why does the patient’s behavior require an intervention? – How was the likely cause determined? – How will the proposed interventions address the causes or factors contributing to the problematic behavior in order to moderate it? – How will the proposed interventions improve the patient’s well-being and quality of life? * Determine the need for transfer – Many cases can be managed effectively in a facility, to the patient’s benefit – Hospitalization is only sometimes helpful and may be traumatic for the patient * * Step 10: Initiate a care plan for treatment – A: What are the antecedents to the behavior? B: What is the behavior? C: What are the consequences of the behavior? * Address key aspects of the patient’s care – Risk assessment – Cause identification and management – Need for staff support and for informing the patient and family – Prevention and management of coexisting conditions and complications – Changes to the current treatment regimen – Monitoring parameters * Step 11: Provide symptomatic and cause-specific management Symptomatic interventions are often helpful in combination with cause-specific approaches – Prevent and manage complications and functional problems – Address relevant ethical issues – Treat underlying causes – Treat delirium and psychosis aggressively – Address wandering and sleep disturbances – Address apathy and mood disorders – Address sexually inappropriate behavior * – Symptomatic (mostly nonpharmacologic) approaches to addressing problematic behavior ? Address pain and discomfort ? Minimize sleep disruption ? Encourage indepen