3. At the end of this session students will be able to
1. Define cognition and cognitive disorder.
2. Define dementia.
3. Indentify the types of dementia.
4. Recognize the symptom of dementia.
5. Elaborates the causes of dementia.
4. 6. Define Delirium.
7. Enlist the symptom of delirium.
8. Recognize the causes of delirium.
9. Explain the diagnostic procedure for dementia and
delirium.
10. Identify nursing care for dementia and delirium.
5. Mental process characterized
by knowing, thinking, learning,
and judgment.
Cognitive disorders include
delirium and dementia.
6. Cognitive disorder are those conditions in which the
predominant disturbance is a clinically significant
deficit in cognition or memory that represents a
significant change from a previous level of
functioning .
(American psychiatric Association ,2000,p,135)
7. A loss of previous levels of cognitive, executive, and
memory function in a state of full alertness; the
progressive decline in cognitive function due to
damage or disease in the brain beyond what might be
expected from normal aging.
8. Primary dementia = dementia itself is the major sign of
an organic brain disease not directly related to any
other organic illness
Alzheimer’s disease
Secondary dementia = caused by or related to another
disease or condition
HIV
Cerebral trauma
9. Amnesia--inability to learn new information or to
recall previously learned information
Agnosia--failure to recognize or identify objects
despite intact sensory function
Aphasia--language disturbance that manifest in both
understanding & expressing the spoken word
Apraxia--inability to carry out motor activities
despite intact motor function
10.
11. Impairment in abstract thinking, judgment, and impulse
control
Disregard of social conduct
Uninhibited and inappropriate behavior
Neglect of personal appearance and hygiene
12. May affect language
◦ difficulty naming objects
◦ vague, imprecise speech
◦ aphasia
Personality changes
Apraxia = inability to carry out motor activities despite
intact motor function
Irritability, mood instability, sudden outbursts
13. Unable to comprehend own limitations
◦ serious risk for accidents
◦ unable to work or care for personal needs independently
Wandering away from home or health care setting
14. Dementia of the Alzheimer’s type
Vascular dementia
Dementia due to HIV
Dementia due to head trauma
Dementia due to disease processes
Dementia due to other general medical conditions
Persistent dementia due to substance use
Dementia due to multiple etiologies
15. A mental state characterized by a disturbance of
cognition, which is manifested by confusion,
excitement, disorientation, and a clouding of
consciousness; hallucinations and illusions are
common.
It is characterized by a disturbance of consciousness
and a change in cognition that develops rapidly over a
short period of time.
17. Disorientation to time and place
Impairment of recent memory
Misperceptions of the environment
(hallucinations/illusions)
Disturbance in the sleep-wake cycle
State of awareness ranges from hyper vigilance
to stupor/semi-coma
Vivid dreams and nightmares
Fluctuations of psychomotor activity
◦ restlessness, hyperactivity
◦ vegetative state (i.e. catatonic stupor)
18. Emotional instability
◦ anxiety, depression, irritability, anger
◦ murmuring, moaning, calling out for help
◦ attempts to flee or attack others
Autonomic manifestations
◦ tachycardia
◦ sweating
◦ flushed face
◦ dilated pupils
◦ elevated blood pressure
19. General medical conditions
Substances
◦ medications
◦ toxins
Overdose of drugs or alcohol
Withdrawal from alcohol, drugs, or medication
Multiple etiologies
◦ more than one general medical condition
◦ combination of medical condition and substance use
20. 1
Dementia
◦ Chronic, slow
progression
◦ Irreversible disorder
◦ Impaired memory
◦ Global cognitive deficits
◦ Most commonly caused
by Alzheimer’s
◦ Does not require
immediate treatment
Delirium
◦ Rapid in onset (hours to
days), fluctuating course
◦ May be reversed
especially, if treated early
◦ Greatly impairs attention
◦ Focal cognitive deficits
◦ Most commonly caused
by systemic disease,
drug toxicity, or
metabolic changes
◦ Requires immediate
treatment
22. Brain Imaging/Lab Tests - CT or MRI,
cerebrospinal fluid (all used to confirm a
diagnosis or eliminate various possibilities)
Blood tests - used to diagnosis neurosyphilis.
Metabolic tests - determine treatable
disorders such as a vitamin B12 deficiency
EEG (electroencephalography) is used to
diagnose Creutzfeldt-Jakob disease.
23. Recent reviews indicated that the
GPCOG, MMSE and MIS are the most
appropriate screening tools for primary
care in that they are quick to use and have
high sensitivity and specificity to
diagnose cognitive impairment (>80%)
Ref: Brodaty et al, 2002; Brodaty et al 2005; Borson et al, 2000; Borson et al 2005; Buschke et al
2006; Lorentz et al 2002; Milne et al 2008.
24.
25. TEST
RESULTS
Psychological
and social aspects
Factors affecting
test performance
History
Informant
perspective
Medical tests,
scans etc
Response to
assessment
Findings and
recommendations
Functional
assessment;
other measures
Interpreting Results
26. Brief in duration
◦ 1 week to 1 month
Diminishing of
symptoms
◦ occurs upon recovery
from underlying cause
◦ 3 days to 1 week
common
◦ may take up to 2 weeks
May transition into a
more permanent
cognitive disorder
◦ dementia
Prognosis of Dementia
Progressive and
irreversible
27.
28. Altered thought processes r/t severe dehydration as e/b
hyper vigilance, distractibility, visual hallucinations,
and disorientation to time, place, and person.
Altered thought processes r/t barbiturate ingestion e/b
altered sleep patterns, delusions, disorientation, and
decreased ability to grasp ideas.
Altered thought processes r/t brain disorder e/b
inaccurate interpretation of environment, deficit in
recent memory, impaired ability to reason, and
confabulation.
29. Impaired verbal communication related to cognitive
impairment as evidenced by recent memory loss .
Impaired social interaction related to altered thought
process, as evidenced by loss of conformity to social
norms.
Self care deficit related to cognitive impairment.
Disturbed thought process related to cognitive
impairment.
Risk of injury related to fear and disorientation.
30. Care for physiological needs
Respond to hallucinations
Respond to wandering
Decrease agitation
Administer medications
Reinforce coping mechanisms
Communicate therapeutically
Provide health education, involving
family and community
Remember that
elderly people
are very
sensitive
to medications.
Administer with
care, and
monitor
closely.
31. Highest priority is to maintain quality life and attend to
physical needs
◦ Nutrition and fluid balance
◦ Ensure safety- May need restraint in acute care settings
◦ Sedatives may be needed for sleep deprivation
Communicate with clear messages and simple instructions
Maintain dignity
Decrease anxiety with dementia.
◦ Keep lights on if pt fears dark or shadows
◦ Orientate to time, place and person
32. Person wears identification
bracelet
Install special locks, safety
devices on doors, stove &
other potentially dangerous
objects
Check frequently for burns,
bruises, or abrasions
Assess for signs of abuse
Only use restraints after
other methods are
ineffective--need MD order
Look directly at person when
speaking
Identify yourself prior to
interaction
Use simple short phrases
Ask specific rather than general
questions
Distract if asking same question
repeatedly
Assist in word finding
Reassure that you intend to help
Avoid arguing
Convey patience and
understanding
Promote Safety Communication
33. Establish regular & predictable
routine
Breakdown complex tasks into
small simple steps
Consistent care by regular staff
Use large clock & calendar
distraction & stimulation, avoid
clutter & unnecessary objects
Post lists of daily activities
Person wear glasses & hearing
aid
Avoid medications if possible
Check person frequently
Decrease Confusion
34. Encourage regular exercise
Ensure nutrition &
hydration
Assist with ADLs
Assess frequently for
physical pain, constipation,
& discomfort
Evaluate agitation and
worsening behavior
carefully
Suggest day treatment for
clients living at home
Teach ways to manage
uncooperative behavior
Teach about causes and
course of dementia
Monitor & assess level of
stress on the family
Encourage use of social
support to decrease
caregiver stress
Help families mourn the
loss of their loved one
Physical & Emotional Wellbeing Family Education
Schober, Glod, Jones,
1998, p. 251
35. Stuart, G. & Laraia, M. (2005). Principles & practice of psychiatric
nursing (8th Ed.). St. Louis: Elsevier Mosby
Stuart, G. & Sundeen, S. (1995). Principles & practice of psychiatric
nursing (5th Ed.). St. Louis: Mosby
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