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ACE Nursing Education

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The following study examined the frequency of missed diagnosis of delirium and dementia, as well as the impact on caregivers. For instance, of the 145 patient studied, 51 (35%) were found to have delirium or dementia using evidence based tools such as the MMSE and the CAM for screening. In 33 of these 51 patients (65%), the symptoms had gone unrecognized. Read this article to learn more about the patient and caregiver needs when confusion is present. Click on the following link to go to the website, bring and read the article. Then, bring, answer and submit the following test to your manager to educator.

Lippincott's Nursing Center.com – resources for better care

Cognitively Impaired Older Adults

Mary D Nayler PhD, RN, FAAN; Caroline Stephens MSN,RN,APRN,BC
Katheryn H Bowles, PHD,RN; M Brian Bixby MSN,CRNP,RN
ANJ February 25 Vol 105(2):52-61

Post Test
  1. This sample population of this study was
    1. 145 older adult
    2. 15 cognitive impaired older adults and their caregivers
    3. 250 ACE unit patients
  2. According to this article two of the most common cognitive disorders are
    1. delirium and dementia
    2. dementia and depression
    3. delirium and depression
    4. diabetes and dementia
  3. The three assessment tools used in this study were (select 3)
    1. CAM
    2. MMSE
    3. BSDR S
    4. GDS
  4. What percent of patients screened have evidence of cognitive impairment?
    1. 5%
    2. 95%
    3. 18%
    4. 35%
  5. One finding of this study was that
    1. Care of cognitively impaired older adults can be far more complex that provided for cognitively intact older adults.
    2. It is much easier to take care of confused older adults than other adults.
    3. All caregivers cope well with their care giving responsibilities.
    4. 4 weeks after discharge is a vulnerable time for many caregivers.
T/F 6. Findings from this study support the supposition that family members and hospital staff often miss symptoms of cognitive impairment.

T/F 7. The authors note that the MMSE or CAM should be routinely administered to all older adults on hospital admission.

The department of internal medicine is developing evidence based clinical protocols which will be available in EPIC (as order sets) for use when admitting patients with these diagnoses. Their AIM is to standardize care and decrease length of stay and readmission rates.

Currently available protocols are:
  • CAP - Community Acquired Pneumonia Orderset
  • Congestive Heart Failure (CHF)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Diabetic Ketoacidosis Adult, ICU
  • General Medicine Admission
  • Immunodeficiency Flow Panel
  • MICU/CCU Admission Order Set
  • Oral Analgesic Medicaitons
  • Parenteral Opioids
  • Sepsis, Adult ICU
  • 111 - Stroke Alert
  • 112 - Stroke Activation
  • 300086 - Stroke Floor Admission
  • 3000000001 -  Stroke Critical care without tPA
  • 300088 Stroke - Transfer from Critical care to floor
  • 3004002 - Stroke Discharge

All protocols can be found in the EPIC order set section.

» For more information

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The department of Internal Medicine has a large role in the Meaningful Use Initiative. Our participation is key for the success of the initiative. Please visit the meaningful use website for important communication and updates from the Meaningful Use Initiative.

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