高龄医学科案例– delirium.ppt

* * * * * * * * * * * * * * * * * * * * Common causes of delirium (3) Brain disorders CNS infections: encephalitis, meningitis, brain or epidural abscess Epileptic seizures, especially nonconvulsive status epilepticus Head injury* Hypertensive encephalopathy Psychiatric disorders* Systemic organ failure Cardiac failure Hematologic: thrombocytosis, hypereosinophilia, leukemic blast cell crisis, polycythemiaLiver failure: acute, chronic Pulmonary disease, including hypercarbia and hypoxemiaRenal failure: acute, chronic 高齡醫學科案例 – delirium場景(4):醫病溝通 Patient remained agitated and confused after admission. For fall prevention and safety, he received restrain after family agreed. He did not want to be restrained and kicked the nurses. Family were anxious about his agitation and ask doctor what happen to him? What is delirium? Why he is so disoriented and yelling ? 六十五歲以上的老年人，其因急性病症住院，一旦發生急性譫妄，容易造成病患、家屬、以及醫療團隊溝通上的困難與衝突，以及急性病症治療之困難度 高齡醫學科案例 –delirium案例討論(4):醫病溝通 How to handle the agitated patient with dementia? How to care hospitalized patient with delirium? How to care older patient with stroke and dementia after discharge Explanation of the management and treatment plan to the patient and family about delirium 老年人急性譫妄的人際與溝通技巧與專業態度 (ICS, P) 與病患及家屬溝通討論急性譫妄的處置、治療與追蹤之計畫 (PC, CS) 衞教急性譫妄的危險因子的處置和預防. (PC, CS) 衞教急性譫妄之環境危險因子和功能復健的評估和預防. (PC, CS) 老年人急性譫妄的執業為基礎的學習和改進 ( P, PLI) 急性譫妄是老年病患發生急性病症的常見表現，一旦發生會導致許多不良的結果；應提出合乎風險利益、成本效益與實證醫學評估老年人急性譫妄處置和預防. (PLI, P) 高齡醫學科案例 –delirium場景(5):跨領域醫療團隊和長期照護 Geriatric team was consulted for further care plan Rehabilitation was consulted and PT, OT and ST was arranged for ADL improvement. Nutritionist was consulted for nutritional care for hypertension, DM and stoke Social worker was consulted for further home care and discharge plan 高齡醫學科案例 –deliriumand dementia案例討論(5):跨領域醫療團隊和長期照護 How to care older patient with stroke and dementia after discharge Geriatric team (跨領域高齡醫療團隊) Physician Nurse Physical therapist Occupation therapist Speech ther