Dementia Flashcards
What is dementia?
Generic term indicating a progressive deterioration of memory and cognitive function.
Primary vs Secondary dementia
Primary: irreversible, progressive and not secondary t any orter disorders accounts for 60% of all dementias
Secondary: result of some other pathological process
RIsk factors
- Alzeimer’s disease
- Genetic
- Enviromental factors such as diet, education, age, head injury
Pathologic brain changes in patients with DAT
- Neuritic plaques, neurofibrillary tangles
- Deposits of B-amyloid protein
- Neuronal degeneration/loss
Vascular Dementia
Vascular dementia is often caused by an acute, specific event such as astroke or transient ischemic attack where the blood flow to the brain has been interrupted.
Vascular dementia behaviors
- Problems with short-term memory
- Wandering or getting lost in familiar surroundings
- Laughing or crying at inappropriate times
- Trouble concentrating, planning, or following through on activities
- Trouble managing money
- Inability to follow instructions
- Loss of bladder or bowel control
- Hallucinations or delusions
DAT behaviors
- Memory Impairment (short term first)
- Aphasia, Apraxia, Agnosia
- Poor judgement
- Decline from previous level of function
- Mood disturbances: anxiety, delusions, aggression, apathy, aggression
- Aggression may be physical or verbal
- Impulsivity
- Sleep disturbances, sundowning
- Screaming
- Depression
- Wandering
Early Stage
Forgetfulness
· Mild forgetfulness
· Difficulty processing new information
· Difficulty concentrating
· Orientation problems
· Communication- finding words
· Mood shifts
· Withdrawal/restlessness/anxiety
· Mild coordination problems
Middle Stage
Confusion
- Memory lapses worsen
- Difficulty recognizing people
- Disorientation, language problems increase
- Personality changes
- Wandering/pacing
- Delusions, disinhibition
- Assistance required for ADL
- Disrupted sleep, appetite
Late Stage
Ambulatory Dementia
- Loss of ability to remember, function
- Severe disorientation
- Mainly non verbal communication
- Range of feelings, may withdraw.
- Responds to touch, music
- Sleeps longer and often
- Becomes bed-ridden
- Incontinent
- Dysphagia
End Stage
- Not differentiated in all books)
- Towards the end:
- Does not recognize family
- Nonambulatory
- Hazards of immobility
- Forgets how to eat, chew, swallow
- Seizures p.363- No to padded tongue blade
Response to diagnosis
- Emotional Response
- Recognition of a problem
- See Doctor
- Shock and denial
- Fear, shame, loneliness, depression, anxiety, sadness
- Coping
Dementia Assessment
- Physiological needs, ADL, sleep
- Health teaching- patient and family
- Coping – issues. Assess remaining abilities
- Resources
- Safety issues
- Emotional issues - i.e. labile, agitation
- Communication
Risk for injury
- minimize sensory stimulation
- label all rooms and drawers
- install safety bars in bathroom
- supervise pt if smokes
- if seizure hx keep padded tounge blades at beside
Wandering
- if pt wanders during the night put matress on the floor to prevent falls
- have pt wear medical alert bracelt that cannt be removed
- wandering precautions
- if pt in hospital have him or her wear brightly colored vest with name, unit and phone number printed on back
Nutrition
- monitor food and fluid intake
- offer finger food increases input throughout the day
- weight person qweekly
Safety Issues r/t Dysphagia
- Provide finger food and small frequent meal to increase patient’s input
Communication
- One visual clue at a time
- Questions with yes or no answers
- Relevant info is remembered longer
- Simple words
- One instruction at a time
- Nonverbal, touch etc
Four Principle of Care
- Stay with the patient during the care episode.
- Altering the Pace of Care.
- Focus Care Beyond the Task.
- Relate well to patients in practice.
Catastrophic Reaction
- Overreaction to a stimulus, overstimulation, or perceived threat.
- Anger/crying/shouting/agitation and
- Aggression
- Quiet- restore calm, reassure, decrease stim
- Slow, simple approach.
- Determine precipitors and make plan
Interventions for Catastrophic Reaction
- provide quiet enviroment
- talk in a calm reassuing voice
- talk slowly
- maintain a calm posture and simple approach
