Cognitive Disorders: Exam 3 Flashcards
the brains ability to process, retain, and use information.
cognition
a disruption or impairment in these higher-level functions of the brain
cognitive disorder
previously categorized in DSM-5 as adult cognitive disorders that include: dementia, delirium, and amnestic disorders.
Neurocognitive disorders (NCDS)
Reconceptualized in the DSM-5 as:
Delirium
Major NCD
Minor NCD
Subtype: dementia
A consciousness disturbance with changes in cognition that develops over a short period of time. Once the medication wears off the client will begin to remember what happen and will question about what they have done. They may have sensory problems, the cause is usually treatable or self limiting. It can be something that is induced and or inhaled. (paint fumes, gas smell)
Delirium
Predisposing factors include serious
medical, surgical, or neurological conditions
Other etiological implications for delirium
Substance intoxication and withdrawal
Medication-induced delirium
Progressive cognitive impairment. Multiple cognitive deficits.
Dementia
Dementia: Initially memory, later the following may be seen:
Aphasia: deterioration of language function
Apraxia: impaired motor function despite intact mobile abilities
Agnosia: inability to recognize or name objects despite intact sensory ability
Disturbance in executive function: client loses the ability to think abstract. pain, initiate, sequence and monitor and stop complex behavior.
What are the stages of dementia?
Mild
Moderate
Severe
forgetfulness is the hallmark. It exceeds the normal, occasional forgetfulness experienced with aging
mild onset of dementia
Confusion is apparent, along with progressive memory loss. The person can no longer perform tasks but remains oriented to person and place.
moderate dementia
personality and emotional changes occur. The person may be delusional, wander at night, forget names of spouse and children, and requires assistance with ADLs
severe dementia
What is the etiology of dementia?
Causes vary and at times no definitive diagnosis can be made until a postmortem exam is completed
Metabolic activity is decreased in the brains of clients with dementia
A genetic component has been identified in some: Huntingdon disease and Alzheimer disease (abnormal APOE gene)
Infections
-HIV
-Creutzfeldt-Jacob disease
inherited disease dominate gene, primary involves cerebral atrophy (demyelination, enlargement of brain ventricles, facial contortions, twisting, turning, and tongue movement.
Huntingdon disease
What are the common types of dementia?
Alzheimer disease
Lewy body dementia
Vascular dementia
Pick disease
Prion disease (Creutzfeldt-Jacob disease)
Dementia related to HIV infection
Parkinson disease
What causes dementia?
Dementia due to traumatic brain injury & Huntington disease
What are related disorders of dementia?
Substance or medication induced mild or major neurocognitive disorder
Korsakoff syndrome: long term alcohol use that results in dementia.
Previously known as amnestic disorder since amnesia and confabulation (make up stuff to fill in the gaps in their memory) are common
Delirium vs. Dementia
Delirium:
Acute and fluctuating
Usually resolved by treating the underlying medical condition
Prognosis involves complete resolution of the impairments
Dementia:
Progressive
No treatments found to reverse, current therapies only temporarily slow the progress
Progressive deterioration until death
What is the nursing process?
Assessment
Diagnosis
Planning
Implementation
Evaluation
What is the assessment for Delirium?
History: obtain information related to:
Medical illness
Alcohol
Other drugs (prescribed, over-the-counter, illicit drugs)
General appearance and motor behavior:
Disturbed psychomotor behavior
Possible speech problems
Mood and affect
Rapid, unpredictable shifts
Thought process and content
May be fragmented
Sensorium and intellectual processes
Decreased awareness of environment
Judgment and insight
Impaired judgment
Roles and relationships
Inability to fulfill roles
Self-concept
Fear
Feel threatened
Physiological and self-care
Sleep problems
Fail to perceive internal body cues
What is the nursing diagnosis for delirium?
Risk for injury (PRIORITY)
Altered thought process
Outcomes
The client will:
Be free from injury
Demonstrate increased orientation, reality contact
Return to optimal level of functioning
What are the interventions for delirium?
Promote client safety
Manage confusion:
Face client while speaking
Phrase questions and directions in short simple sentences
Orienting cues
-Call client by name
-Refer to time of day
-Refer to expected activity
Promote sleep, proper nutrition
Provide supervision, the nurse should check clients at intervals, use frequent verbal orientations (help with the frightening experiences related to delirium) Make sure the information board is updated!
What is the assessment for Dementia?
Mental status examination
History:
Clients may be unable to provide accurate and thorough history
Interviews with family, friends, or caregivers may be necessary; bc the patient may not be able to give history themselves
General appearance and motor behavior:
Aphasia
Apraxia
Uninhibited behavior: ex: sexually inappropriate behavior
Mood and affect:
Increasingly labile mood
Emotional outburst
Thought process and content
Impaired abstract thinking
Delusions of persecution: they feel like you as the nurse are torturing them
Sensorium and intellectual processes:
Loss of intellectual function
Memory deficits: recent memory is lost first, may not remember the days of the week, but can remember back to things when they were younger.
confabulation
Judgment and insight:
Poor judgment
Unrealistically appraise abilities: increases risk of falls
Self-concept:
Sadness: a lot of times dementia is mistaken as depression
Loss of self-awareness
Roles and relationships:
Profoundly affected
Physiological and self-care:
Disturbed sleep
Incontinence
Hygiene deficit
What is the nursing diagnosis for dementia?
Risk for injury
Impaired memory
Disturbed sleep pattern
Outcomes
The client will:
Be free from injury
Respond positively to memory cues
Maintain an adequate balance of activity and rest
Deuteriation until they become decerebrate, complete deuteriation starting with their memory. Goal of treatment is to meet their needs at that current moment. Overall arching goal, you will have to learn how to meet their needs when they need their needs met.
What are the interventions for dementia?
Safety
Protect against injury
Meet physiological needs
Managing risk posed by
Delusions
hallucinations
Sleep, proper nutrition, hygiene, activity
Help meet basic physiological needs
Monitor food and fluid intake
Monitor elimination patterns
Provide mild physical activity
At night when the sun goes down they become more agitated, keep them active during the day to wear them out, so they will sleep once nighttime hits. If you see one of these patients sleeping during the day u want to wake them up bc they get angry at night and you want them awake up all day so they will sleep once night hits.
Environmental
Encourage client to follow their usual routine
Monitor response to daily routines and adjust as necessary
Monitor and manage tolerance of stimulation
Emotional support
Provide empathetic caring
Convey reassurance
Use supportive touch (evaluate each client’s response)
There is no cure for dementia, these meds don’t treat dementia, but they slow down the aggressive decline. The meds wont make it better, you wont see improvement, but you will see there is a slow down the disease. May want to use finger foods, because the client may be at the point they cannot use utensils. What they may be able to do this week, they may not be able to do next week due to the decline. Create that bridge to reality, it cannot be created, it will cause the dementia patient to become agitated with you for doing that.
Interaction and involvement
Provide a wide variety of activities such as
Music
Dancing
Pet therapy
Plan activities that
Reinforce the client’s identity
Engages them in the business of living
Tailor activities to the client’s interests and abilities
Avoid routine group activities
Clients often need the involvement of another person to:
Sustain attention in the activity
Enjoy it more fully
What are the risk factors for dementia?
elevated levels of plasma homocysteine
Measures to decrease risk for Alzheimer disease
Folate, vitamin B12 and betaine reduce plasma homocysteine
Regular participation in brain-stimulating activities
Leisure-time physical activity
Large social network
Meeting the Needs of the Caregiver
Role of caregiver
Mostly women
Adult daughters
Wives
Needs of caregiver
Education about dementia
Assistance in dealing with own feelings of loss
Respite to care for own needs
Support groups
Assistance from agencies
Support to maintain personal life
What are the common signs for care-giving burnout?
easily flustered or frustrated
extremely tired
Uninterested in things they use to enjoy
forgetful or foggy
quick to anger
anxious or depressed
hopeless or helpless
