INTRODUCTION
Organic States are neurological disorders where there are physiological changes in the brain. Organic states may be either ACUTE or CHRONIC. As people live longer, and with the breakdown of Extended Family. Chronic Organic States are becoming a major Social and Health care problem in many countries.
ACUTE ORGANIC STATES
[Toxic- Confessional State/Acute Delirious Reaction]
Onset is Sudden with a fairly Rapid Recovery. In most cases there will be Complete Recover)'. In some cases there will be Permanent Brain Damage.
ETIOLOGY:
1. INFECTION: Acute system, infections, meningitis, encephalitis.
2. IINTOXICASION: Alcohol, Drugs, Reaction to medication
3. METABILIC DISORDER: Electrolyte Imbalance, Liver and Renal Failure, Hypo or Hyper Glycaemia
4. TRAUMA: Head Injury
5. SPACE OCCUPYING LESION: Tumor
6. CARDIOVASCULAR DISORDER : CVA, Anemia, Anoxia
7. NERVOUS SYSTEM DISORDER : Multiple Sclerosis
PRESENTATION
The dominant symptoms are Clouding of Consciousness. Confusion and Restlessness. Illusions and Hallucinations may be present.
TREA TMENT
Treatment is for the disorder causing the Delirium.
NURSING CARE
Nursing care involves Reducing the amount of Stimuli the patient receives. Making as Few Changes to the Environment and caring Personnel as possible and constant Reassurance and Explanation. Subdued lighting is much better than bright light or complete darkness. Complete or near darkness encourages Illusions.
CHRONIC ORGANIC STATES[Dementia]
In this condition there is a Progressive and Irreversible Deterioration of Brain Function. The structure of the brain is damaged.
ETIOLOGY
1. INFECTION: Syphilis. Encephalitis. Jakob-Cremzfld Disease. HIV/ AIDS.
2. POISONS: Chronic Alcohol Use. Lead. Mercury.
3. BRAIN DAMAGE: Trauma. Multi-Infarct Dementia. CV A.
4. GENETIC: Huntington's Chorea.
5. DEGENERATIVE: Alzheimer's. Pick's Disease.
INFECTION
Cerebral Syphilis [GPI] is now very rare following the development of Antibiotics.
Jakob-Creutzfeld Disease is caused by a Slow Virus. It is not common and its mode of transmission is not clear. It has been transmitted by organ transplant.
POISONS
Chronic Alcohol Use leads to Korsakoff’s Psychosis because of a deficiency of Vitamin B from Malnutrition and Gastritis.
BRAIN DAMAGE
Multi-Infarct Dementia is one of the major causes of Dementia and is discussed in detail below.
GENETIC
Huntington's Chorea is a rare condition passed on by a Non-Sex Linked Dominant Gene
What % of Children will Inherit the Disorder ??1.
The disorder normally appears when the patient is in his/her 40's. There is Dementia with Choroid Movements and Ataxia. The disorder may last from 15-20 years before death occurs. Death may be from Suicide. Choking or Pneumonia.
DEGENERA TIVE
Alzheimer's and Pick's Disease are discussed below.
MULTI-INFARCT TYPE DEMENTIA
This disorder used to be called Arteriosclerotic Dementia as the dementia was thought to be caused by narrowing of the arteries in the brain. Now it is known that small areas of the brain are destroyed [INFARCTS] when the blood supply is cut off by small blood clots [EMBOLI].
It is more common in Men and age of Onset is late 60's to 70's. Onset is Sudden and may follow a mild stroke. The signs and symptoms depend on the area of the brain affected by the Infarct. It develops in a Steplike way with each deterioration following a period of Clouding of Consciousness. Depressive symptoms are common and Suicide is a Risk.
Treatment of disorders such and Diabetes Mellitus and Hypertension is Very Important. Treatment with low daily dosages of Aspirin is now common.
DEGENERATIVE TYPE DEMENTIA
ALZHEIMER'S DISEASE is due to a Degeneration of the Brain Cells. The brain Atrophies and cells are lost from the Cerebral Cortex and other areas. Onset may be PRESENILE [50 to 60's] or SENILE [70 to 80's]. PICK'S DISEASE is similar in presentation to Alzheimer's and the difference is usually discovered at Post Mortem.
PRESENTATION
MEMORY
Memory Loss is very severe. At first this tends to be for Recent Events [Anterograde]. Later this becomes so severe that they may not even able to remember their own names. This becomes e:\'1remely dangerous when they begin to cook and forget that they have a saucepan on the cooker.
CONFUSION & DISORIENTATION
Is related to memory loss with total disorientation to Time, Place and Person. They will often lose track of night and day and dress themselves for shopping in the middle of the night. Giving them heavy Night Sedation only increases their confusion the next day.
INTELLECTUAL DETERIORATION
They become rigid and unable to Accept or Adapt to new situations. Their Judgment becomes Faulty and they may make serious money or moral mistakes.
EMOTIONAL LABILITY
They easily move from laughter to tears and may over react to situations. Deep depression may occur in the early stages.
TREATMENT
At present time there is no treatment for the Chronic Organic States. Associated disorders such as Hypertension or Alcoholism have to be controlled.
NURSING CARE
Individuals have to be assessed properly and a Rating Scale will be given to you to try out. Individual care programmes must be worked out for each patient. The nurse has to remember that these patients have led long and responsible lives, often they have brought up families and are used to respect. They may find it very difficult to be organized by nurses who are younger than their daughters.
The Dementia may be complicated by physical deficits caused by aging [Mobility, Hearing and other Special Senses). Part of the assessment will include these physical deficits. If the patient has difficulty in seeing or hearing, glasses and hearing aids need to be acquired. Anorexia may be due to unusual food or bad teeth. Before arranging a "Soft Diet" the patient's likes and dislikes for food should be discovered and dental care arranged.
Always take time to explain and lead the patient rather than pulling them. Remember that the reason the hospital exists [and you are employed] is for the patient. and not for the staff. If the routine means that patients have to be rushed to get washed and dressed for breakfast. then the routine needs to be changed.
Whenever approaching the patient use Reality Orientation. Tell them who you are. talk them through any walks to the toilet or garden or bed. Routine should be stimulating but fairly rigid with few daily changes. Family contact should always be maintained even if the patient does not appear to respond to visits.
In many countries such patients are maintained as long as possible at home with the aid of HOME HELPS, NURSING VISITS MODIFIED HOMES, SHELTERED HOMES DAY CENTRES, MEALS-ON- WHEELS.
KEY POINTS
1. Organic States are neurological disorders where there are physiological changes in the brain. Organic states may be either ACUTE or CHRONIC.
2. In Acute Organic States Onset is Sudden with a fairly Rapid Recovery.
3. The dominant symptoms are clouding of Consciousness, Confusion and Restlessness. Illusions all Hallucination may be present.
4. Treatment is for the disorder causing the Delirium.
5. Nursing care involves Reducing the amount of Stimuli. making as Few Changes to the Environment and Personnel as possible.
6. In Chronic Organic States there is a Progressive and Irreversible Deterioration of Brain Function. The structure of the brain is damaged.
7. Multi-Infarct Type Dementia used to be called Arteriosclerotic Dementia as the dementia was thought to be caused by narrowing of the arteries in the brain. Now it is known that small area of the brain are destroyed when the blood supply is cut off by small blood clots.
8. The signs and symptoms depend on the area of the area of the brain affected by the Infarct. It develops in a Step like way with each deterioration following a period of Clouding of Consciousness.
9. Alzheimer's Disease is due to a Degeneration of the brain Cells. The brain Atrophies and cells are lost from the Cerebral Cortex and other areas. Onset may be Pre-Senile (50 to 60's) or Senile (70 to 80's).
10. Memory loss is very sever. At first this tends to be for Recent Events Confusion is related to memory loss with total disorientation to Time, Place and Person.
11. They become Rigid and unable to Accept or Adapt to new situations. They easily move from laughter to tears and may over react to situations. Deep depression may occur in the early stages.
12. Individuals have to be assessed properly and individually. The Dementia may be complicated by physical deficits caused by aging [Mobility, Hearing and Other Special Senses].
13. Take time to explain and lead the patient rather than pulling them. When approaching the patient use Reality Orientation. Tell them who you are, talk them through any walks to the toilet, garden or bed.
14. Routine should be stimulating but fairly rigid with few daily changes. Family contact should always be maintained even if the patient does not appear to respond to visits.
15. 1 n many countries patients are maintained as long as possible at home with the aid of Home Helps, Nursing Visits, Modified Homes, Sheltered Homes, Day Centers and Meals on Wheels.
ACUTE ORGANIC STATES
[Toxic- Confessional State/Acute Delirious Reaction]
Onset is Sudden with a fairly Rapid Recovery. In most cases there will be Complete Recover)'. In some cases there will be Permanent Brain Damage.
ETIOLOGY:
1. INFECTION: Acute system, infections, meningitis, encephalitis.
2. IINTOXICASION: Alcohol, Drugs, Reaction to medication
3. METABILIC DISORDER: Electrolyte Imbalance, Liver and Renal Failure, Hypo or Hyper Glycaemia
4. TRAUMA: Head Injury
5. SPACE OCCUPYING LESION: Tumor
6. CARDIOVASCULAR DISORDER : CVA, Anemia, Anoxia
7. NERVOUS SYSTEM DISORDER : Multiple Sclerosis
PRESENTATION
The dominant symptoms are Clouding of Consciousness. Confusion and Restlessness. Illusions and Hallucinations may be present.
TREA TMENT
Treatment is for the disorder causing the Delirium.
NURSING CARE
Nursing care involves Reducing the amount of Stimuli the patient receives. Making as Few Changes to the Environment and caring Personnel as possible and constant Reassurance and Explanation. Subdued lighting is much better than bright light or complete darkness. Complete or near darkness encourages Illusions.
CHRONIC ORGANIC STATES[Dementia]
In this condition there is a Progressive and Irreversible Deterioration of Brain Function. The structure of the brain is damaged.
ETIOLOGY
1. INFECTION: Syphilis. Encephalitis. Jakob-Cremzfld Disease. HIV/ AIDS.
2. POISONS: Chronic Alcohol Use. Lead. Mercury.
3. BRAIN DAMAGE: Trauma. Multi-Infarct Dementia. CV A.
4. GENETIC: Huntington's Chorea.
5. DEGENERATIVE: Alzheimer's. Pick's Disease.
INFECTION
Cerebral Syphilis [GPI] is now very rare following the development of Antibiotics.
Jakob-Creutzfeld Disease is caused by a Slow Virus. It is not common and its mode of transmission is not clear. It has been transmitted by organ transplant.
POISONS
Chronic Alcohol Use leads to Korsakoff’s Psychosis because of a deficiency of Vitamin B from Malnutrition and Gastritis.
BRAIN DAMAGE
Multi-Infarct Dementia is one of the major causes of Dementia and is discussed in detail below.
GENETIC
Huntington's Chorea is a rare condition passed on by a Non-Sex Linked Dominant Gene
What % of Children will Inherit the Disorder ??1.
The disorder normally appears when the patient is in his/her 40's. There is Dementia with Choroid Movements and Ataxia. The disorder may last from 15-20 years before death occurs. Death may be from Suicide. Choking or Pneumonia.
DEGENERA TIVE
Alzheimer's and Pick's Disease are discussed below.
MULTI-INFARCT TYPE DEMENTIA
This disorder used to be called Arteriosclerotic Dementia as the dementia was thought to be caused by narrowing of the arteries in the brain. Now it is known that small areas of the brain are destroyed [INFARCTS] when the blood supply is cut off by small blood clots [EMBOLI].
It is more common in Men and age of Onset is late 60's to 70's. Onset is Sudden and may follow a mild stroke. The signs and symptoms depend on the area of the brain affected by the Infarct. It develops in a Steplike way with each deterioration following a period of Clouding of Consciousness. Depressive symptoms are common and Suicide is a Risk.
Treatment of disorders such and Diabetes Mellitus and Hypertension is Very Important. Treatment with low daily dosages of Aspirin is now common.
DEGENERATIVE TYPE DEMENTIA
ALZHEIMER'S DISEASE is due to a Degeneration of the Brain Cells. The brain Atrophies and cells are lost from the Cerebral Cortex and other areas. Onset may be PRESENILE [50 to 60's] or SENILE [70 to 80's]. PICK'S DISEASE is similar in presentation to Alzheimer's and the difference is usually discovered at Post Mortem.
PRESENTATION
MEMORY
Memory Loss is very severe. At first this tends to be for Recent Events [Anterograde]. Later this becomes so severe that they may not even able to remember their own names. This becomes e:\'1remely dangerous when they begin to cook and forget that they have a saucepan on the cooker.
CONFUSION & DISORIENTATION
Is related to memory loss with total disorientation to Time, Place and Person. They will often lose track of night and day and dress themselves for shopping in the middle of the night. Giving them heavy Night Sedation only increases their confusion the next day.
INTELLECTUAL DETERIORATION
They become rigid and unable to Accept or Adapt to new situations. Their Judgment becomes Faulty and they may make serious money or moral mistakes.
EMOTIONAL LABILITY
They easily move from laughter to tears and may over react to situations. Deep depression may occur in the early stages.
TREATMENT
At present time there is no treatment for the Chronic Organic States. Associated disorders such as Hypertension or Alcoholism have to be controlled.
NURSING CARE
Individuals have to be assessed properly and a Rating Scale will be given to you to try out. Individual care programmes must be worked out for each patient. The nurse has to remember that these patients have led long and responsible lives, often they have brought up families and are used to respect. They may find it very difficult to be organized by nurses who are younger than their daughters.
The Dementia may be complicated by physical deficits caused by aging [Mobility, Hearing and other Special Senses). Part of the assessment will include these physical deficits. If the patient has difficulty in seeing or hearing, glasses and hearing aids need to be acquired. Anorexia may be due to unusual food or bad teeth. Before arranging a "Soft Diet" the patient's likes and dislikes for food should be discovered and dental care arranged.
Always take time to explain and lead the patient rather than pulling them. Remember that the reason the hospital exists [and you are employed] is for the patient. and not for the staff. If the routine means that patients have to be rushed to get washed and dressed for breakfast. then the routine needs to be changed.
Whenever approaching the patient use Reality Orientation. Tell them who you are. talk them through any walks to the toilet or garden or bed. Routine should be stimulating but fairly rigid with few daily changes. Family contact should always be maintained even if the patient does not appear to respond to visits.
In many countries such patients are maintained as long as possible at home with the aid of HOME HELPS, NURSING VISITS MODIFIED HOMES, SHELTERED HOMES DAY CENTRES, MEALS-ON- WHEELS.
KEY POINTS
1. Organic States are neurological disorders where there are physiological changes in the brain. Organic states may be either ACUTE or CHRONIC.
2. In Acute Organic States Onset is Sudden with a fairly Rapid Recovery.
3. The dominant symptoms are clouding of Consciousness, Confusion and Restlessness. Illusions all Hallucination may be present.
4. Treatment is for the disorder causing the Delirium.
5. Nursing care involves Reducing the amount of Stimuli. making as Few Changes to the Environment and Personnel as possible.
6. In Chronic Organic States there is a Progressive and Irreversible Deterioration of Brain Function. The structure of the brain is damaged.
7. Multi-Infarct Type Dementia used to be called Arteriosclerotic Dementia as the dementia was thought to be caused by narrowing of the arteries in the brain. Now it is known that small area of the brain are destroyed when the blood supply is cut off by small blood clots.
8. The signs and symptoms depend on the area of the area of the brain affected by the Infarct. It develops in a Step like way with each deterioration following a period of Clouding of Consciousness.
9. Alzheimer's Disease is due to a Degeneration of the brain Cells. The brain Atrophies and cells are lost from the Cerebral Cortex and other areas. Onset may be Pre-Senile (50 to 60's) or Senile (70 to 80's).
10. Memory loss is very sever. At first this tends to be for Recent Events Confusion is related to memory loss with total disorientation to Time, Place and Person.
11. They become Rigid and unable to Accept or Adapt to new situations. They easily move from laughter to tears and may over react to situations. Deep depression may occur in the early stages.
12. Individuals have to be assessed properly and individually. The Dementia may be complicated by physical deficits caused by aging [Mobility, Hearing and Other Special Senses].
13. Take time to explain and lead the patient rather than pulling them. When approaching the patient use Reality Orientation. Tell them who you are, talk them through any walks to the toilet, garden or bed.
14. Routine should be stimulating but fairly rigid with few daily changes. Family contact should always be maintained even if the patient does not appear to respond to visits.
15. 1 n many countries patients are maintained as long as possible at home with the aid of Home Helps, Nursing Visits, Modified Homes, Sheltered Homes, Day Centers and Meals on Wheels.
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