Exam 8 COGNITION Flashcards
Awareness
The degree a person is aware of their surroundings
must have awareness to have cognition
Cognition
The way we think, learn and make judgements.
Intellectual functioning-thinking, reasoning, use of language
——controlled by the cortex of the brain
Disorders that affect cognition and awareness
Anything that interrupts cognition - impaired thinking
- inadequate blood flow
- ventilation
- pulmonary circulation
- cardiac
- abnormal HGB levels - leads to hypoxia
Delirium
- Rapidly occurring, temporary, short term cognitive alterations
- may be anxious
- confused, disorientated, agitated
- resolves when the cause resolves
- like a high fever with a child - when the fever goes away the symptoms of delirium goes away
- With Elders
- —-Present with dehydration
- —-hospital psychosis
- —-Sundowners
Dementia
- Permanent Disorder
- Based on more serious damage to the brain
- Alzheimer’s
- Problems with memory
- problems with judgement, abstract thinking
- changes in personality
3 Types of cognitive problems that occur with Delirium and Dementia
- Hallucinations
- Illusions
- Delusions
Cognitive Disorders
Delirium Dementia Hallucinations Illusions Delusions
Hallucinations
Seeing or hearing something that is not there.
EX: I see a pink elephant
EX: Hearing voices
Visual, Auditory or Olfactory
Illusions
- Misinterpretations of real sights, sounds or smells.
- See a dog outside and think it is a Tiger
Delusions
Persistent false psychotic belief regarding self, or persons or objects outside self.
Alterations in Awareness
- Consciousness - able to talk and respond to stimuli - Alert
- Lethargy/ Somnolence/ Drowsiness - Sleepy appears to be resting- dozing can be with stimuli
- Stupor - Sleepy needs continual stimuli to stay awake
- Light Coma / Semi Comatose - no longer responds to verbal stimuli - may respond to physical stimuli
- Deep Coma/ Comatose - Totally unresponsive- responds to severe pain- no voluntary movement
- ——–protective reflexes are lost- gag, cough and blink are gone.
Assessment for Cognitive problems
- Interview - client and family
- —-If ever any problems with interview always go back to the orientation (person, place, time)
- Physical
- —-Grooming and hygiene
- Highest level to lowest level
- —-1.mental status, questions about physical problems - habits
- —-2.Vital signs
- —-3. Cranial nerve function
- —-4. Sensory function
- —-5. Motor function
- —-6. Reflexes - hand grips
- Vital signs
- —-changes with pulse pressure can indicate increased innercranial pressure
- —-Blood pressure meds can cause this too
- Assessment of level of consciousness/awareness—-? Alert
- Orientation - person, place, and time
- —-always go back to orientation if something is wrong
Assessment of Cognition
- Attention span
- —-serial 7s…….world backwards
- Memory
- —-what did you eat for breakfast
- Judgement
- —-See someone pick pocket- what would you do?
- Abstract thinking
- —-A rolling stone gathers no moss
- Emotional state
- —-Stressors
- Thought processes
- —-? disruptive thoughts and if they are able to control disruptive thoughts
- Perception
- —-Do they hear voices? Do they smell strange odors?
MMSE
- Orientation
- —-Person, place, time
- Registration
- —-Name 3 objects - later ask the patient what 3 objects you said
- Attention and calculation
- —-5 - serial sevens
- Recall
- —-3 - registration recall
- Language
- —-2-naming a pencil and a watch
- Total points
Praxis- planned coordinated movement
Aphasia
Impairment of language function due to brain involvement.
- Expressive
- Receptive
- Global
Dysarthria
Interference with annunciation and articulation
Impairment of motor nerves to muscles of speech
Nursing Diagnosis for Cognitive problems
High risk for Injury Altered Health maintenance Altered thought process Self-care deficits Anxiety
Planning and Implementation with cognitive problems
- –Reality orientation
- —-Adults benefit from this
- –Validation therapy
- —-Irreversible cognition impairment
Care for the client with speech impairment
- Need a way to communicate with the patient
- Speech therapist is your friend
- Communication
- –may be agitated, depressed or frustrated
- Do not shout
- Don’t talk down to them
- –Use simple words
- Maintain eye contact
- —–speak slowly and distinctly
- Follow speech therapist plan to help relearn speech
- A quiet well organized environment is best
- Simple symbol board
- Dry erase board
Care of a client with decreased awareness
- Protect from Injury
- —-heating pads
- —-do not inject or stick side effected
- —-bed in low position
- Supplement deficiencies
- Assess level of Awareness
- —Glasco Coma Scale is best way to do this
- —-Coma patient - tell them you are going to touch them
Types of Aphasia
- Expressive
- REceptive
- Global
Expressive Aphasia
- Problems expressing correct word for objects although understanding is intact
- EX: client may call a chair a television but they know that it is a chair
Receptive Aphasia
Problem understanding spoken or written word.
Have difficulty following directions.
Global Aphasia
Refers to having a problem with both Expressive and Receptive Aphasia
Very difficult to communicate with this patient
Reality Orientation
- Adults benefit from this
- Calendar with correct date
- Clock with correct time
- Pictures of Family
- Comforting touch
used with Delirium
Validation Therapy
- Used with Dementia
- I want to see my mother (when their mother is dead)
- ——-Ask them to tell you about their mother
- ——-Do not agree with a confused client
- ——-Do not argue with them
- Use short directions
- —-raise your arm
- Frequent observations - frequently check on them
- used for irreversible cognitive impariment
Dysphasia
Difficulty in swallowing
Depression
Being in an unfamiliar environment
Delusion
I went to see a James Bond movie and I think I am a Bond girl
Hallucinations
There is spiders all over the wall lets kill them.
Illusion
See a garden hose in the yard and think it is a snake!
Pain Response
- Talk louder and louder
- put thumb under—–press in
- pinch or squeeze the muscle b/t neck and shoulder
- sternal rub
- If no response after 20-30 seconds do not keep doing it.
Conscious States
Delirium Dementia Confusion Normal Consciousness Somnolence
Unconscious States
Asleep
Stupor
Coma
Vegetative State
