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1. Recognize the "red flags" indicating potentially fatal outcomes.
2. Explain interventions to rapidly reverse the causes of AMS.
3. Differentiate between delirium, dementia and psychosis.
4. Identify the underlying causes of AMS.
5. Select between new tools for assessment and evaluation.
6. List the best diagnostic options to differentiate among possible causes.
7. Develop a treatment plan for the most common causes of AMS.
8. Analyze practice guidelines for prevention and management of pain, agitation and delirium.

Life-Threatening Causes of AMS: Prepare to Intervene

• Airway problems leading to hypoxia and CNS symptoms
• Gross assessment of disability: GCS or AVPU
• Rapid head to toe assessment
• Look for rapidly fixable causes
• History and physical… Asking the right questions
• Diagnostic work-up
• Coma and altered level of consciousness: Brain stem and cerebral hemispheres
• Predictive model for the risk of delirium in hospitalized older patients
• Intensive care delirium scanning checklist
• Confusion Assessment Method
• AACN Practice Alert
• Break down: Delirium, dementia and psychosis

Common Conditions Causing Delirium

• Medications - Adverse effects and interactions
  • Central acting agents
  • Sedative hypnotics
  • Anticonvulsants
  • Analgesics
  • GI agents
  • Antinauseants
  • Antibiotics
  • Psychotropic meds
  • Cardiac meds
  • OTC meds
  • Steroids
• Medications - withdrawal syndromes
• UTI
• Pneumonia
• Electrolyte disorders
• Endocrine crisis: Hyper/hypothyroid, adrenal, diabetic, Wilson's disease
• Korsakoff syndrome
• Transient global amnesia
• Pain agitation

10 Life-Threatening Conditions Causing Delirium

• Hypoxia
• Hypoglycemia
• Encephalopathy: Hypertensive and Werniche's
• Drug overdose
• Acute neuro: Meningitis, SAH and seizures
• CNS trauma
• Sepsis

Delirium: Don't Forget These Possibilities:

• The patient with delirium related to structural changes
• Subdural hematoma
• Brain tumor
• Normal pressure hydrocephalus
• Stroke
• Infectious disease and SEPSIS: The ticking time bomb
• Not to be missed: Meningitis, encephalitis

Psychosis: Into Madness

• Major depressive disorder
• PHQ-9 screening instrument
• Post-partum depression
• Bipolar
• Schizophrenia
• Schizoaffective
• Delusions, illusions, hallucinations
• Positive and negative clinical manifestations
• Pharmacology and other treatments
• Personality Disorders
• Schizotypal Disorder
• A case of global amnesia

Dementia: The Work-Up

• History
• Mini mental
• Sweet 16 Cognitive assessment tool
• Radiological diagnostic work-up
• Delirium plus dementia
• Alzheimer work-up
• Lewy body
• Chronic traumatic encephalopathy

Interventions for the Common Problems

• Memory loss and confusion
• Reduced concentration
• Hallucinations
• Agitation
• Sleep disturbance
• Inability to carry out ADLs

Expanding the Window of Care: Current Research

Joyce Campbell, MSN, CCRN, SCRN, FNP-BC, has been involved in the nursing field for 35 years. For over 25 years, she taught in an associate degree nursing program where her primary focus was the theory and clinical instruction of neuroscience nursing. In addition to teaching, she has been employed by Comprehensive Health System in Chattanooga, Tennessee for the past 30 years. At Erlanger, she has adopted many roles, including neurosurgical and trauma critical care staff nurse, educator and nurse practitioner. Currently, she serves on the neuroservice line committee and provides stroke education to staff and patients. Erlanger Southeast Regional Stroke Center, an accredited Primary Stroke Center, houses a leading-edge stroke care facility serving over 2000 stroke patients annually.

Through her work at Erlanger, Joyce is able to experience, first hand, the latest innovative strategies for extending the window of treatment for stroke patients. She holds a BSN from East Tennessee State University, an MSN from the University of Tennessee at Knoxville, and completed post-graduate studies at the University of Alabama at Birmingham. Joyce is an active member of the American Association of Critical Care Nurses, the American Association of Neuroscience Nurses, American Association of Nurse Practitioners, and the Chattanooga Association of Nurses in Advanced Practice, where she has served as president and is a member of the educational committee.

Speaker Disclosures:

Financial: Joyce Campbell has an employment relationship with Erlanger Southeast Regional Stroke Center. She receives a speaking honorarium from PESI, Inc. She has no relevant financial relationships with ineligible organizations.

Non-financial: Joyce Campbell is a member of the educational committee for the Chattanooga Association of Nurses in Advanced Practice.

Save time and $10 off the price of other submission methods – purchase & take the CE test online for $9.99 USD per participant. Additional processing fees apply for other submission methods (i.e. mail, fax, etc.). Please contact our Customer Service at 1-800-844-8260 for more details.

Listed below are the continuing education credit(s) currently available for this non-interactive self-study package. Please note, your state licensing board dictates whether self study is an acceptable form of continuing education. Please refer to your state rules and regulations.

Certificates of Successful Completion are available for email, download and/or printing from your online account immediately following the successful completion of the post-test/evaluation.

**Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners. For speaker disclosures, please see the faculty biography.

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Nurses/Nurse Practitioners/Clinical Nurse Specialists - Credit Expired: 10/11/2020
No CE available for this board.

California Nurses: PESI, Inc. is a provider approved by the California Board of Registered Nursing, Provider #:17118 for 6.0 self-study contact hours.

You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Florida Nurses: PESI, Inc. is an approved provider by the Florida Board of Nursing. Provider #: FBN2858. These materials qualify for 6.0 self-study contact hours.

Iowa Nurses: PESI, Inc. is an approved provider by the Iowa Board of Nursing. Provider #: 346. Nurses successfully completing these self-study materials will earn 6.3 self-study contact hours.

Copies of the evaluation may be sent to the IBON. You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

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Social Workers - National ASWB ACE
PESI, Inc., #1062, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. PESI, Inc. maintains responsibility for this course. ACE provider approval period: January 27, 2023 - January 27, 2026. Social workers completing this course receive 6.0 Clinical continuing education credits.

Course Level: Intermediate Format: recorded asynchronous distance. Full attendance is required; no partial credits will be offered for partial attendance.

Canadian Social Workers: Canadian provinces may accept activities approved by the ASWB for ongoing professional development.

California Social Workers: The California Board of Behavioral Sciences accepts CE programs that are approved by other approval agencies, including several that approve PESI and its programs. A full list of approval agencies accepted by the BBS can be found at www.bbs.ca.gov/licensees/cont_ed.html under “Where to find CE Courses.” This Intermediate level self-study activity consists of 6.0 clock hours of continuing education instruction.

Colorado Social Workers: PESI, Inc. is an approved provider with the Colorado Chapter of the National Association of Social Workers. Provider #1413. This course has been approved for 6.3 continuing education hours.

Florida Social Workers: PESI, Inc. is an approved provider with the Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling. Provider Number 50-399. This self-study course qualifies for 6.25 continuing education credits.

Illinois Social Workers: PESI, Inc. is an approved provider with the State of Illinois, Department of Financial and Professional Regulation, Division of Professional Regulation. License #: 159-000154. Successful completion of this self-study activity qualifies for 6.0 contact hours.

Kansas Social Workers: PESI, Inc. is an approved provider with the Kansas Behavioral Sciences Regulatory Board. Provider #14-006. This self-study course has been approved for 6.0 continuing education hours.

Minnesota Social Workers: PESI, Inc. is an approved provider with the State of Minnesota, Board of Social Work. Provider #: CEP-140. This self-study course has been approved for 6.0 continuing education hours. A certificate will be issued upon successful completion of a post-test.

Montana Social Workers: The Montana Board of Behavioral Health no longer pre-approves any courses or sponsors. Each licensee is responsible for taking courses which contribute to their competence and directly relate to their scope of practice as defined in board statute (MAR 24-219-32). Licensees must keep CE documentation for three years in case of an audit. This intermediate level self-study activity consists of 6.25 clock hours of instruction.

New York Social Workers: PESI, Inc. is recognized by the New York State Education Department's (NYSED) State Board for Social Work as an approved provider of continuing education for licensed social workers #SW-0008. This self-study activity will qualify for 7.5 contact hours. Full attendance is required; no partial credits will be offered for partial attendance.

Pennsylvania Social Workers: The Pennsylvania State Board of Social Workers, Marriage and Family Therapists and Professional Counselors accepts many national association CE approvals, several of which PESI offers. For a full list, please see your State Board regulations at https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/. This intermediate self-study activity consists of 6.25 clock hours of continuing education instruction.

Ohio Social Workers: PESI, Inc. is an approved provider with the State of Ohio Counselor, Social Worker and Marriage & Family Therapist Board. Provider approval #:RCST071001. Full attendance at this course meets the qualifications for 6.25 clock hours of continuing education credit. TBD

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Other Professions
This self-study activity qualifies for 6.25 clock hours of instructional content as required by many national, state and local licensing boards and professional organizations. Retain your certificate of completion and contact your board or organization for specific filing requirements.

Disclaimer: **Information obtained in this course should be used within your scope of practice.
**It is your ethical responsibility to report accurate hours to your licensing board.
**All self-study participants must complete and pass (80% or better) a post-test and evaluation prior to receiving a certificate of completion. If you require a copy of the test/evaluation for CE purposes, please print at the time you take the test. Or you may call our customer service department and a copy of your test/evaluation will be emailed to you. Please allow 30-45 days.

Case Managers, Nurses, Physician Assistants, Social Workers