[PDF] AGITATION 18 sept. 2019 Causes. - Assessment. -





Previous PDF Next PDF



AGITATION

18 sept. 2019 Causes. - Assessment. - Impact on patient family and MDT Team. - Medical



Understanding agitation

When a person with a mood disorder is agitated friends and family members—or even doctors—can't always tell what underlying condition has caused it. In other 



Retrospective Study on Agitation Provoked by Memantine in Dementia

treatment onset; previous episodes of agitation caused by other drugs; type and frequency of comorbidities; distribution of concurrent medications; evidence 



Emergence agitation in pediatric anesthesia: current features

purpose of this paper is to discuss the possible causes of postoperative agitation in children providing a foundation for better methods of identifying and 



Managing Delirium and Agitation in the Older Emergency

16 juil. 2019 Agitation and delirium are common reasons for older adults to seek care in the emergency department (ED). Providing care for this.



Alzheimers Association

environmental influences and some medications can cause behavioral symptoms or make them worse. These symptoms include: • Sleep disturbances. • Agitation 



Changed behaviours and dementia 8 - Agitated behaviours

This help sheet discusses some of the causes of agitated behaviours which can be a very concerning symptom of dementia and suggests ways to prevent and manage 



Location of Acute Infarcts and Agitation and Aggression in Stroke

6 oct. 2016 behavior causes damage to individuals or property; atti- ... symptoms15 mixing agitation with anger and hostility



Agitation dans les démences

On doit chercher et traiter les causes réversibles de ces symptômes et décoder le message caché derrière le comportement manifesté. Il faut considérer tout 



Guidelines for the management of Behavioural and Psychological

Behavioural and Psychiatric Symptoms of Dementia (BPSD) are a core part of the syndrome of dementia. These include agitation aggression



Acute Agitation - ACEP

ED the cause of agitation is often undifferentiated and can be a consequence of alcohol intoxication drug intoxication psychiatric illness or underlying medical illness Early efforts in the ED should include identifying and treating any reversible causes but in many cases of behavioral disturbance intervention is indicated to reduce the



Agitation and Restlessness: What Causes It? - WebMD

agitation in the medical setting Step 1: Assess situation and cause of agitation • Delirium (make sure underlying medical cause is being addressed) • Intoxication (central nervous system [CNS] stimulant vs depressant) • Primary psychiatric disorder (e g psychosis mania) • Undetermined cause



Managing Delirium and Agitation in the Older Emergency - ACEP

Infections neurologic disorders and metabolic orelectrolyte disorder are 3 of the most common causes ofacute alterations in mental status among older patients 9Adverse medication effects are another common cause Alist of medications that are high risk for causingconfusion altered mental status or delirium is shown in Table 1



Guidelines for the Management of Agitation & Delirium

In addition agitation can be caused by: Pain Urinary retention Anxiety Depression/psychiatric illness Existential distress Drugs in order of use Step 1 Lorazepam or Midazolam Step 2 Benzodiazepine + Levomepromazine Step 3 Midazolam + Levomepromazine + Phenobarbital 6 1 Lorazepam Lorazepam can be given SL PO PR SC IM or IV

Can a medical condition cause agitation?

Agitation is a sense of inner tension and restlessness. When it happens, you may get annoyed easily or feel like you need to move around. It’s a normal emotion. But it’s more likely to show up when you’re under a lot of stress. It can also happen if you use drugs or withdraw from alcohol. But sometimes, a medical condition can cause agitation.

What causes agitation without delirium?

Both have a number of possible underlying causes and these overlap. Agitation without delirium can occur as a result of anxiety or psychological/spiritual distress and commonly due to unrelieved constipation or urinary retention. This policy advocates a ‘THINK DELIRIUM’and STEPWISE approach.

Is agitation the same as aggression?

You may act angry or violent at the same time. But agitation isn’t the same as aggression. It’s also different than akathisia. That’s a movement disorder often caused by antipsychotic medication. It’s normal to get worried if you or a loved one is agitated a lot. But your doctor can help you find and treat the cause.

Can hypothyroidism cause agitation?

Treatment for your hypothyroidism should ease your agitation. Your doctor will give you medicine to bring your hormone levels back to normal. Hormone changes before your period can make you feel tense. But you may get really overwhelmed and agitated if you have premenstrual dysphoric disorder (PMDD).

AGITATION

SEPTEMBER 18TH 2019

JULIA NEWELL & KATHERINE HARVEY

S P E C I A L I S T PA L L I A T I V E C A R E C L I N I C A L N U R S E S P E C I A L I S T S

R O YA L H A L L A M S H I R E & W E S T O N PA R K H O S P I T A L , S H E F F I E L D 1 AIMS - Definition of terms -Causes -Assessment -Impact on patient, family and MDT Team -Medical, nursing and holistic care management -Sedation & agitation 2

WHAT IS

AGITATION?

Definition of AGITATION in English

/agitation)

AGITATION: A state of anxiety or nervous

excitement

Synonyms: Discomposure, disquiet, distress,

concern, worry, trouble, alarm, upset. 3

Discuss

DEFINITIONS

Restlessness:

- Finding or affording no rest, uneasy, agitated. Constantly in motion and fidgeting.

- Restlessness and agitation occurs in 42% of patients in the last 48 hours of life (Twycross & Lichter, 1995).

Agitation:

- Shaking, moving, unsettled ² can be both mental and/or physical.

Delirium:

- Disordered state of mind with incoherent speech - distressing hallucinations and paranoia may feature.

- Delirium develops in 80-90% of dying patients at some stage in the last week of life (Twycross et al, 2009).

4

WHAT IS TERMINAL

AGITATION?

-Agitation is a term that describes anxious, restless and occasionally aggressive behaviour. -Terminal agitation means agitation that occurs in the last few days of life. -KRX PM\ MOVR OHMU PHUPLQMO MJLPMPLRQ NHLQJ GHVŃULNHG MV" Terminal restlessness, terminal anguish, confusion at the end of life or terminal delirium. - These terms all have different meanings but do overlap. 5

Discuss

WHAT CAUSES

TERMINAL AGITATION?

Terminal agitation happens to people

who are already compromised by advanced illness.

A diagnosis of terminal agitation can

only be made if reversible conditions are excluded or are failing to respond to treatment. 6

POSSIBLE

CAUSES

OF

AGITATION?

Medication

Alcohol intoxication or

withdrawal Pain

Constipation

Urinary

Retention

Nicotine withdrawal

Nausea

Brain tumour

Sepsis

Organ failure

Deranged bloods

Hypoxia

Infection

Spiritual

distress

Emotional

distress Fear

Anxiety

Dyspnoea

Terminal agitation

7

Neurological

deficit Discuss

Insomnia

HOW DO I KNOW IF

SOMEONE HAS TERMINAL

AGITATION?

-Distressed behaviour -Confusion -Calling out; could be shouting or screaming -Hallucinations -Trying to get out of bed or wandering -Sleeping during the day but active at night -Unable to concentrate or relax - Jerking or twitching -Fidgeting -Despite interventions on-going deterioration * Remember always consider reversible factors and individual assessment of patient; these symptoms also present in palliative patients who may not be in the terminal agitation phase. 8

Discuss

ASSESSMENT

-Holistic assessment (Physical, Psychological, Spiritual, Social) -What does the patient want? -Does the patient know what they want? -If unable to discuss who is the right person to involve to understand this? -Start with obvious things ² but what is obvious? -Treat obvious causes and reassess regularly.

-Discuss case with the MDT and involve other professionals where appropriate i.e. Chaplain, pharmacist, therapists etc.

-Ensure patient is in a safe environment ² may not always be their preferred place of care but how do you assess within this environment?

-Support family and friends ² remain calm, patient and empathise. 9

WHAT DO YOU THINK CAN HELP A

PATIENT WITH AGITATION?

POMP \RX MUH OMYLQJ GLVPUHVVHG PORXJOPV·B ([SUHVVLRQ RI POHLU PORXJOPV and feelings may help you manage their agitation. - Try simple methods first, repositioning, playing music, talk in gentle and reassuring manner. -Try to provide a calm and safe environment that suits the persons needs. -Take a thorough history; have they started new medications? Been unable to take medications? If agitation limits taking medications what options are there? -Try making sure a clock is visible to help orientate the patient in time. -Have familiar objects nearby; photos and ornaments can be reassuring. -Provide reassurance to family & friends explaining what's happening; encourage them to use the same techniques with their loved ones to reduce agitation and distress. May help carers cope, especially in caring for terminal agitation. 10

Discuss

MEDICATION F+2HF(6"

How do you decide between a benzodiazepine and anti-psychotic to help in agitation? 11

0(GHF$7H21 F+2HF(6"

12

Indication Drug Comments

Acute confusional

states

Titrates doses

accordingly

Haloperidol 1.5mg

(po/sc at night +/- every four to six hours when required).

Olanzapine 2.5mg PO

stat and at bedtime

Risperidone 500mcg

PO twice daily

Max 10mg / 24hours ²

take care with side effects.

Terminal Restlessness

End of Life Care

Haloperidol 1.5-5mg PO

or sc +/- Midazolam 2.5-

10mg SC stat.

Levomepromazine

6.25mg ² 25mg PO or

SC may be used if

period of sedation required

More sedating than

haloperidol

WHAT IF SOMEONE NEEDS SEDATION?

-6RPHPLPHV ROHQ M SMPLHQPV MJLPMPLRQ ŃMQ·P NH UHOLHYHG N\ simple measures, medication is required to sedate them.

-Sedation means using medication to lower a persons consciousness so that they are calm or even asleep.

-There are many ethical issues to consider when making a decision about sedation. It may mean the patient is no longer able to eat, drink or communicate. The patients medical team, the patient themselves, and their close family or friends should be involved in open discussions around this.

-Common worry about sedation is that is makes death come more quickly.

Sedation does not hasten death but it can bring relief from distressing symptoms and allow a more peaceful death.

-It is vital to discuss this with your patient, their carer, family and friends and address their concerns and worries.

13

KEY POINTS

-Terminal agitation is anxious, restless or distressed behaviour that can occur at the end of life. -Keep calm and avoid confrontation. -Even when prognosis is days rather than weeks, underlying causes should be considered, and treated appropriately. -There are many potential causes of agitation and many of them can be reversed, involve MDT, patient and family to reach these decisions. -Try non-drug methods to relieve agitation first. -If your patient requires sedation, try to address any concerns that they or their family and friends might have. Clarify perceptions and validate those that are accurate. -Consider appropriate dosage of medication used ² anticipate and plan availability before reaches crisis point. 14

Thank-you for listening

Any Questions?

15

REFERENCES AND RESOURCES

zone/symptom-control/agitation Sheffield Palliative Care Formulary 5th Edition, NHS Sheffield. 16quotesdbs_dbs35.pdfusesText_40
[PDF] figure géométrique définition

[PDF] fiche les solides gs

[PDF] solides maternelle

[PDF] figure geometrique liste

[PDF] les différentes écritures dun nombre ce1

[PDF] schéma fécondation humaine

[PDF] schéma fécondation nidation

[PDF] expression francaise a mimer

[PDF] expressions françaises drôles

[PDF] les gestes de salutation dans le monde

[PDF] physiopathologie de lépilepsie

[PDF] cours epilepsie ppt

[PDF] epilepsie cours

[PDF] epilepsie signes cliniques

[PDF] nom des excipients ? l'origine d'effets secondaires