Dementia Flashcards
Neurocognitive
a term that is used to describe cognitive functions closely linked to particular areas of the brain that have to do with thinking, reasoning, memory, learning, and speaking
Dementia Definition
disease process marked by progressive cognitive impairment with no change in level of consciousness
Dementia: Onset
gradual and insidious
Dementia: Duration
progressive deterioration
Dementia: Speech
normal in early stage
-progressive aphasia in later stage
(deterioration of language functioning)
Dementia: Thought Process
impaired thinking, eventually loss of thinking abilities
Dementia: Perception
often absent
- can have paranoia, hallucinations, illusions
- agnosia: inability to recognize name of objects
Dementia: Mood
depressed and anxious in early stage
- labile mood
- restless
- pacing
- angry outbursts in later stages
Dementia: Executive Function
inability to think abstractly, and to plan, initiate, sequence, monitor, and stop complex behavior
Dementia: Memory
short and then long-term memory impaired. eventually destroyed
Aphasia
deterioration on language functioning
Apraxia
impaired ability to execute motor functions despite intact motor abilities
Agnosia
inability to recognize or name objects despite intact sensory abilities
Prominent Early Sign of Dementia?
Memory Impairment
-recent memory is impaired, then affects remote memory
Clients May Exhibit: Echolalia
echoing what is heard
Clients May Exhibit: Palilalia
repeating words or sounds over and over
Onset and Clinical Course: Mild
- Forgetfulness is hallmark
- exceeds the normal occasional forgetfulness that is part of aging
- has difficulty finding words, frequently loses objects, and begins to experience anxiety over loses
- may avoid occupational and social settings
- a modest impairment of performance that does not prevent independent living but may require some accommodation and assistance
Onset and Clinical Course: Moderate
- confusion is apparent, along with progressive memory loss
- no longer can perform complex tasks but remains oriented to person and place
- still recognizes familiar people
- towards the end of the stage, the person loses the ability to live independently and requires assistance because of disorientation to time and loss of information such as address and telephone number
Onset and Clinical Course: Severe
- personality and emotional changes occur
- may be delusional, wander at night, forget the names of spouse or children, and acquire assistance with ADLs
- most live in nursing facilities, unless extraordinary community support is available
Drugs to Slow Process of Dementia
- Donepezil
- Rivastigmine
- Galantamine
- Razadyme
- Memantine
- doses of meds are one-half to two-thirds lower than usually prescribed
Application of the Nursing Process: Assessment
- frequent breaks may be needed because the client can become confused easily
- ask simple questions
- allow clients ample time to answer
- mental status examination
Levels of Neurotransmitters
acetylcholine, dopamine, norepinephrine, and serotonin are decreased
Application of The Nursing Process: History
- considering impairment of recent memory, clients may be unable to provide an accurate and thorough history of onset of problems
- interviews with family, friends, or caregivers may be necessary
General Appearance and Motor Behavior
- display aphasia (deterioration of language functioning) when they cannot name familiar objects or people
- conversations become repetitive because they often perseverate on one idea
- speech may become slurred followed by a total loss of language functioning
- apraxia
- cannot imitate tasks even when others demonstrate
- unhibited behavior; inappropriate jokes, neglecting hygiene, undue familiarity with strangers
Mood and Affect
- anxiety and fear over beginning loses of memory and cognitive functions
- labile mood over time and may shift rapidly and drastically for no reason
- emotional outbursts; pass quickly
- may display hostility or anger
- display catastrophic emotional reactions in response to environmental changes that clients may not perceive or understand accurately or when they cannot respond adaptively
Catastrophic Emotional Reactions
verbal or physical aggression, wandering at night, agitation, or other behaviors that seem to indicate loss of control
Thought Processes and Content
- inability to think abstractly, loss of ability to plan, sequence, monitor, initiate, or stop complex behavior
- loses ability to solve problems or take action in new situations because he/she cannot think about what to do
- inability to generalize knowledge from one situation to another; cannot recognize similarities or differences in situations
Sensorium and Intellectual Process
- lose intellectual function; complete loss of abilities
- memory deficits; first affects recent and immediate memory and eventually impairs ability to recognize close family and even oneself
- in mild and moderate clients make up answers to fill in memory gaps (confabulation)
- agnosia; another hallmark
- lose visual spatial relations; evidenced by deterioration to write and draw simple objects
- attention and concentration increasingly impaired
Sensorium: Mild
disorientation to time
Sensorium: Moderate
disorientation to time and place
Sensorium: Severe
disorientation to self
Judgment and Insight
- poor judgment from cognitive impairment
- insight is limited
- client may be aware of problems with memory and cognition and may worry he/she is “losing my mind”
- these concerns diminish and have little or no awareness of the more serious deficits that have developed
- accuse others of stealing possessions that the clients themselves have lost or forgotten
Self-Concept
- angry or frustrated with themselves for losing objects or forgetting important things
- express sadness at their bodies for getting old and at loss of functioning
- soon, clients lose that awareness of self which gradually deteriorate until they can look in a mirror and fail to recognize their own reflection
Roles and Relationships
- work performance suffers
- roles as spouse, partner, or parent deteriorate as clients lose the ability to perform routine tasks or recognize familiar people
- eventually cannot meet basic needs
- inability to participate in meaningful conversation or social events
- become confined to the house
- close family members assume caregiver roles; role reversal
Physiological and Self-care Considerations
- disturbed sleep-wake cycles
- ignore internal cues such as hunger or thirst
- may experience bladder or bowel incontinence; difficulty cleaning after elimination
- neglect bathing and grooming
- likely to require complete care from someone else to meet these needs
Nursing Diagnosis
- risk for injury, disturbed sleep pattern, risk for deficient fluid volume
- risk for impaired nutrition: less than body requirements, chronic confusion, impaired environmental interpretation syndrome, impaired memory, impaired social interaction, impaired verbal communication, ineffective role performance
Outcomes
do not involve regaining or maintaining abilities to function
- reassess overall health status and revise treatment outcomes periodically as condition changes
- focus on psychosocial care that maximizes the clients strengths and abilities as long as possible
Nursing Interventions
- promoting clients safety and protecting from injury
- promoting adequate sleep, proper nutrition and hygiene, and activity
- structuring environment and routine
- providing emotional support
- promoting interaction and involvement
Nursing Intervention: Promoting Clients Safety and Protecting from Injury
- offer unobstructive assistance with or supervision of cooking, bathing, or self-care activities
- identify environmental triggers to help client avoid them
Nursing Interventions: Promoting Adequate Sleep, Proper Nutrition and Hygiene, and Activity
- prepare desirable foods and foods patent can self-feed; sit with client while eating
- monitor bowel elimination patterns; intervene with fluids and fiber or prompts
- remind client to urinate; provide pads or diapers as needed, checking and changing them frequently to avoid infection, skin irritation, and unpleasant odors
- encourage mild physical activity; walking
Nursing Interventions: Structuring Environment and Routine
- encourage client to follow regular routine and habits of bathing and dressing rather than imposing new ones
- regular exercise
- monitor amount of environmental stimulation, and adjust when needed
Nursing Interventions: Providing Emotional Support
- Be kind, respectful, calm, and reassuring; pay attention to client
- use supportive touch when appropriate
Nursing Interventions: Promoting Interaction and Involvement
- plan activities geared to clients interests and abilities
- reminisce with the patient about the past; uses remote memory which is not affected as severely
- if nonverbal, remain alert to nonverbal behavior
- employ techniques of distraction, time away, going along, or reframing to calm clients who are agitated, suspicious, or confused
Warning: Anti-psychotics
- can cause delirium
- increased risk of mortality in elderly patients treated for dementia related psychosis
