Download Dementia and Nursing Process Application (cont.)

Chapter 24
Cognitive Disorders
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Overview
• Cognition
– Brain’s ability to process, retain, use information
– Processes: reasoning, judgment, perception,
attention, comprehension, memory
• Cognitive disorders: disruption or impairment in higherlevel brain functions
– Categories: delirium, dementia, amnestic disorders
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Delirium
• Syndrome involving disturbance of consciousness with
change in cognition
• Etiology: usually from identifiable physiologic, metabolic,
cerebral disturbance or disease or from drug intoxication
or withdrawal (see Box 24.1)
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Delirium (cont.)
• Treatment and prognosis: transient; clearing with
treatment of underlying cause
– Psychopharmacology: sedation
– Other medical treatments
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Delirium and Nursing Process Application
• Assessment
– History: medical history; medications (see Box 24.2)
– General appearance, motor behavior: disturbed
psychomotor behavior; possible speech problems
– Mood, affect: rapid, unpredictable shifts
– Thought processes, content
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Delirium and Nursing Process Application
(cont.)
• Assessment (cont.)
– Sensorium, intellectual processes: altered LOC that
fluctuates; attention deficits
– Judgment, insight: impaired
– Roles, relationships: inability to fulfill roles
– Self-concept: fear, feelings of being threatened
– Physiologic, self-care: sleep problems, failure to
perceive internal body cues
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Question
• Is the following statement true or false?
• There is usually an identifiable cause for the development
of delirium.
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Answer
• True
• Rationale: Delirium is usually due to an identifiable
physiologic, metabolic, or cerebral disturbance or disease
or caused from drug intoxication or withdrawal.
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Delirium and Nursing Process Application
(cont.)
• Data analysis/nursing diagnoses
– Risk for injury
– Acute confusion
• Outcome identification
– Freedom from injury
– Increased orientation, reality contact
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Delirium and Nursing Process Application
(cont.)
• Intervention
– Promoting patient safety
– Managing patient’s confusion: orienting cues;
speaking in low, clear voice; avoiding sensory
overload
– Promoting sleep, proper nutrition
• Evaluation
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Delirium and Community-Based Care
• Referrals for continued cognitive problems
– Home health-care/visiting nurses
– Rehabilitation program
– Adult day care
– Residential care
– Support groups
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Dementia
• Multiple cognitive deficits; primarily memory plus any of
the following:
– Aphasia (echolalia, palilalia)
– Apraxia
– Agnosia
– Disturbance in executive function
• Differentiation from delirium (see Table 24.1)
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Dementia (cont.)
• Onset, clinical course:
– Stages
• Mild
• Moderate
• Severe
• Etiology: variable causes; decreased metabolic activity
found postmortem
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Dementia (cont.)
• Types of dementia:
–
–
–
–
–
–
–
Alzheimer’s disease
Vascular dementia
Pick’s disease
Creutzfeldt-Jakob disease
Parkinson’s disease
Huntington’s disease
Dementia due to head trauma
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Dementia (cont.)
• Treatment and prognosis
– Underlying cause
– Usually progressive
– Medications for degenerative dementias:
cholinesterase inhibitors (see Table 24.2)
– Symptomatic treatment for behaviors
• Antidepressants
• Antipsychotics (see Box 24.3)
• Mood stabilizers
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Question
• Is the following statement true or false?
• A patient with dementia experiences changes in his or
her level of consciousness.
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Answer
• False
• Rationale: Patients with dementia do not typically
experience altered levels of consciousness but do exhibit
multiple cognitive deficits along with aphasia, apraxia,
agnosia, or a disturbance in executive functioning.
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Dementia and Nursing Process Application
• Assessment
– Mental status exam
– History
– General appearance, motor behavior: apraxia,
uninhibited behavior
– Mood, affect: increasing labile mood; rapid shifting
– Thought processes, content: impaired abstract
thinking, delusions of persecution
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Dementia and Nursing Process Application
(cont.)
• Assessment (cont.)
– Sensorium, intellectual processes: loss of intellectual
function; memory deficits; confabulation
– Judgment, insight: poor, limited
– Self-concept
– Roles, relationships
– Physiologic, self-care: disturbed sleeping; incontinence,
hygiene deficits
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Dementia and Nursing Process Application
(cont.)
• Data analysis/nursing diagnoses
– Risk for injury
– Chronic confusion
• Outcome identification
– Freedom from injury
– Involvement in surroundings, others in environment
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Dementia and Nursing Process Application
(cont.)
• Intervention
– Safety
– Sleep, proper nutrition, hygiene, activity
– Environmental, routine structure
– Emotional support (supportive touch)
– Interaction, involvement (reminiscence therapy,
distraction, time away, going along)
• Evaluation
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Dementia and Community-Based Care
• Many in community for most of their lives
• Family homes
• Adult day care centers
• Residential facilities
• Specialized Alzheimer’s units
• Referrals for programs, services
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Mental Health Promotion
• Research to identify risk factors for dementia (elevated
levels of plasma homocysteine)
• Measures to decrease risk for Alzheimer’s disease
– Regular participation in brain-stimulating activities
– Leisure-time physical activity during midlife
– Participation with large social network
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Question
• A patient makes up answers to fill in memory gaps. The
nurse identifies this as which of the following?
–
A. Echolalia
–
B. Palilalia
–
C. Aphasia
–
D. Confabulation
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Answer
•
D. Confabulation
• Rationale: Confabulation is the making up of answers to
fill in gaps in the memory.
– Echolalia is echoing or repeating what is heard;
palilalia is repeating words or sounds over and over.
Aphasia refers to a deterioration in language
function.
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Role of the Caregiver
• Majority: women (adult daughters or wives)
• Needs of caregivers:
– Education about dementia, care needed by patient
– Assistance in dealing with own feelings of loss
– Respite to care for own needs
– Support groups
– Assistance from agencies
– Support to maintain personal life
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Related Disorders
• Amnestic disorder: disturbance in memory due to
physiologic effects of general medical condition or
persisting effects of substance
– Confusion, disorientation, attention deficits common
– Lack multiple cognitive deficits seen in dementia
– Treatment or removal of underlying medical cause →
no further deterioration
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Self-Awareness Issues
• Inability to “teach” patient with dementia
• Feelings of frustration or hopelessness
• Knowledge that there is progressive deterioration until
death, with no hope for improvement
• Importance of dignity for patient, family
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