| Yelling, Screaming, and Delusions |
| Nanette Lavoie-Vaughan, M.S.N., APN |
COURSE DESCRIPTION:
This presentation will utilize DSM IV criteria, American Geriatric
Psychiatry guidelines and CMS guidelines along with case
presentations to educate the NP on the appropriate diagnosis
and treatment of psychiatric conditions and dementia and the
use of psychotropic drugs for treatment of symptoms and
behavioral manifestations of dementia. Tools for documentation
of assessment, selection of drug, response to treatment and
attempts to titrate will be provided. Tips for managing crisis
intervention in the long-term care setting and education of the
staff will also be included.
OBJECTIVES:
At the completion of this session, the participant will be able to:
1. Apply the OBRA guidelines to practice.
2. Identify 3 drugs in each category that are appropriate for use in the
elderly.
3. Identify components of psychotropic drug management
documentation to avoid F tags.
4. Complete a case study to diagnose and treat a long-term care
resident with acute and chronic psychiatric issues.
OUTLINE:
I. Statistics
II. Common Concerns
III. Thoughts to Consider
IV. General Considerations
V. Agitation
VI. Delirium
VII. Environmental Factors
VIII. Combined Diagnoses
IX. Sundowning
X. Aggression
XI. Drug Categories
XII. OBRA guidelines
XIII. Anti-psychotics
XIV. Anxiolytics
XV. Antidepressants
XVI. Sedative/Hypnotics
XVII. Documentation
XVIII. F tags
XIX. Treatment strategies
XX. Environmental interventions
XXI. Staff education
XXII. Case study
XXIII. Pearls for Practice
XXIV. From the field- updates on drugs/surveys
CASE STUDY
Ida is an 86 y/o who was admitted with diagnoses of dementia
with depression and anxiety, HTN, CAD, DM and chronic UTIs.
Her psychotropic medications included:
Risperdal 1 mg bid
Xanax 0.5 mg bid and q6h prn
Zyprexa 0.5 mg qhs
Remeron 15 mg qhs
Zoloft 50 mg qhs
Aricept 10 mg qhs
She had a UTI on admission and this was treated with Cipro 500
mg qd for 7 days. She displayed crying, repetitive statements of
“what do I do” and “where do I go,” pacing, obsession with her
roommate, wandering and physical aggression during care.
Her other medications included:
Norvasc 10 mg qd
Glucophage 500 mg bid
ASA 81 mg qd
Plavix 75 mg qd
Reglan 5 mg ac and hs
She had been hospitalized prior to admission for acute delirium.
She previously lived in an assisted living facility and was not able
to return due to her behavior. Her MMSE on initial assessment
was 10/30.
This presentation will utilize DSM IV criteria, American Geriatric
Psychiatry guidelines and CMS guidelines along with case
presentations to educate the NP on the appropriate diagnosis
and treatment of psychiatric conditions and dementia and the
use of psychotropic drugs for treatment of symptoms and
behavioral manifestations of dementia. Tools for documentation
of assessment, selection of drug, response to treatment and
attempts to titrate will be provided. Tips for managing crisis
intervention in the long-term care setting and education of the
staff will also be included.
OBJECTIVES:
At the completion of this session, the participant will be able to:
1. Apply the OBRA guidelines to practice.
2. Identify 3 drugs in each category that are appropriate for use in the
elderly.
3. Identify components of psychotropic drug management
documentation to avoid F tags.
4. Complete a case study to diagnose and treat a long-term care
resident with acute and chronic psychiatric issues.
OUTLINE:
I. Statistics
II. Common Concerns
III. Thoughts to Consider
IV. General Considerations
V. Agitation
VI. Delirium
VII. Environmental Factors
VIII. Combined Diagnoses
IX. Sundowning
X. Aggression
XI. Drug Categories
XII. OBRA guidelines
XIII. Anti-psychotics
XIV. Anxiolytics
XV. Antidepressants
XVI. Sedative/Hypnotics
XVII. Documentation
XVIII. F tags
XIX. Treatment strategies
XX. Environmental interventions
XXI. Staff education
XXII. Case study
XXIII. Pearls for Practice
XXIV. From the field- updates on drugs/surveys
CASE STUDY
Ida is an 86 y/o who was admitted with diagnoses of dementia
with depression and anxiety, HTN, CAD, DM and chronic UTIs.
Her psychotropic medications included:
Risperdal 1 mg bid
Xanax 0.5 mg bid and q6h prn
Zyprexa 0.5 mg qhs
Remeron 15 mg qhs
Zoloft 50 mg qhs
Aricept 10 mg qhs
She had a UTI on admission and this was treated with Cipro 500
mg qd for 7 days. She displayed crying, repetitive statements of
“what do I do” and “where do I go,” pacing, obsession with her
roommate, wandering and physical aggression during care.
Her other medications included:
Norvasc 10 mg qd
Glucophage 500 mg bid
ASA 81 mg qd
Plavix 75 mg qd
Reglan 5 mg ac and hs
She had been hospitalized prior to admission for acute delirium.
She previously lived in an assisted living facility and was not able
to return due to her behavior. Her MMSE on initial assessment
was 10/30.
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