Chapter 16: Cognitive Disorders: Delirium, Dementia, and Amnestic Disorders Copyright © 2012, 2007...

Chapter 16:Chapter 16:

Cognitive Disorders: Cognitive Disorders: Delirium, Dementia, and Delirium, Dementia, and

Amnestic DisordersAmnestic Disorders

Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

22Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

DementiaDementia

Alzheimer’s disease most common formAlzheimer’s disease most common form Cause unclearCause unclear


Etiologic Theories of Alzheimer’s Etiologic Theories of Alzheimer’s DiseaseDisease

Vascular dementiaVascular dementia Angiopathy and blood-brain incompetence Angiopathy and blood-brain incompetence Neurotransmitter and receptor deficienciesNeurotransmitter and receptor deficiencies Abnormal brain proteins and their productsAbnormal brain proteins and their products Genetic defectsGenetic defects


Irreversible DementiasIrreversible Dementias

Alzheimer’sAlzheimer’s Vascular dementiaVascular dementia Parkinson’s dementiaParkinson’s dementia Pick’s diseasePick’s disease Creutzfeldt-Jakob diseaseCreutzfeldt-Jakob disease Diffuse Lewy body diseaseDiffuse Lewy body disease Progressive supranuclear palsyProgressive supranuclear palsy Down’s syndrome dementiaDown’s syndrome dementia


Reversible DementiaReversible Dementia

Vitamin BVitamin B1212 deficiency deficiency DepressionDepression


DeliriumDelirium

Short development timeShort development time Fluctuating consciousnessFluctuating consciousness Cognition impairedCognition impaired

Disorientation to time and placeDisorientation to time and place Inability to focusInability to focus Incoherent speechIncoherent speech

Continual aimless activityContinual aimless activity


Amnestic DisordersAmnestic Disorders

Memory disturbance (transient or chronic) Memory disturbance (transient or chronic)

related to: related to: Effects of a medical conditionEffects of a medical condition Persisting effects of substance use or toxin Persisting effects of substance use or toxin

exposure exposure


Alzheimer’s DiseaseAlzheimer’s DiseaseStage 1: MildStage 1: Mild

Insidious changesInsidious changes Recent memory impairmentRecent memory impairment

NeologismsNeologisms Cognitive losses in:Cognitive losses in:

CommunicatingCommunicating CalculatingCalculating RecognitionRecognition

Sensory/motor functions intactSensory/motor functions intact Self-awareness leads to depressionSelf-awareness leads to depression


Alzheimer’s DiseaseAlzheimer’s DiseaseStage 2: ModerateStage 2: Moderate

Cognitive decline increases (amnesia, Cognitive decline increases (amnesia, disorientation, apraxia, aphasia, agnosia, disorientation, apraxia, aphasia, agnosia, perseveration)perseveration)

Behavior problems (catastrophic reactions, Behavior problems (catastrophic reactions, wandering/pacing, sundowning) wandering/pacing, sundowning)

Self-care deficitSelf-care deficit Poor judgmentPoor judgment Sleep disturbanceSleep disturbance


Alzheimer’s DiseaseAlzheimer’s DiseaseStage 3: SevereStage 3: Severe

Loss of meaningful communicationLoss of meaningful communication Total dependence on caregiversTotal dependence on caregivers IncontinenceIncontinence Secondary illnesses related to immobilitySecondary illnesses related to immobility


Caregiver CriteriaCaregiver Criteria

Knowledge of diseaseKnowledge of disease Uses positive interactions during care givingUses positive interactions during care giving Plans and develops resources for self-carePlans and develops resources for self-care Legal and financial plans for client and selfLegal and financial plans for client and self Backup system in case of emergencyBackup system in case of emergency


AssessmentAssessment

Provide appropriate environment.Provide appropriate environment. Establish rapport.Establish rapport. Tools:Tools:

Mini-Mental State Examination (MMSE)Mini-Mental State Examination (MMSE) Dementia Mood Assessment Scale (DMAS)Dementia Mood Assessment Scale (DMAS) Blessed Dementia Rating Scale (BDRS)Blessed Dementia Rating Scale (BDRS)


Assessment of Assessment of Neurologic DeficitsNeurologic Deficits

Perception and organizationPerception and organization Attention spanAttention span LanguageLanguage MemoryMemory Emotional controlEmotional control Reasoning and judgmentReasoning and judgment


Mood and State of MindMood and State of Mind

Assessments required before:Assessments required before: Admission to a skilled nursing facility Admission to a skilled nursing facility Use of psychotropic medicationUse of psychotropic medication Use of restraintUse of restraint

Document:Document: Direct quotes from clientDirect quotes from client MSE results on regular basisMSE results on regular basis


Assessing for DepressionAssessing for Depression

Variable onset, abruptVariable onset, abrupt Reversible with treatmentReversible with treatment Clear sensoriumClear sensorium Normal attention spanNormal attention span Selective memory impairmentSelective memory impairment Intact thinking but displays:Intact thinking but displays:

HopelessnessHopelessness HelplessnessHelplessness


Assessment of Functional Ability Assessment of Functional Ability and Behaviorand Behavior

Functional ability:Functional ability: ADLsADLs IADLsIADLs

Behavior related to:Behavior related to: MoodMood Perceptual/cognitive deficitPerceptual/cognitive deficit Day/night reversalDay/night reversal Poor impulse controlPoor impulse control


Assessment of Physical Assessment of Physical ManifestationsManifestations

Altered nutritional statusAltered nutritional status AspirationAspiration Gait changesGait changes Feeling coldFeeling cold IncontinenceIncontinence


Nursing DiagnosesNursing Diagnoses

Cluster around:Cluster around: Safety and health risksSafety and health risks Perceptual/cognitive disturbancePerceptual/cognitive disturbance Disruption in coping abilitiesDisruption in coping abilities


Outcome IdentificationOutcome Identification

Consider:Consider: Client outcomesClient outcomes Caregiver outcomesCaregiver outcomes


PlanningPlanning

Consider:Consider: Short-term plansShort-term plans Long-term plansLong-term plans


ImplementationImplementation

Inform client/family/caregivers about plan.Inform client/family/caregivers about plan. Promote independence as long as possible.Promote independence as long as possible. Keep all interactions calm, reassuring.Keep all interactions calm, reassuring. Time activity to coincide with client calm state.Time activity to coincide with client calm state. Empathize with client’s feelings.Empathize with client’s feelings. Validate client’s feelings with words.Validate client’s feelings with words.


Implementation, cont’d.Implementation, cont’d.

Maintain client’s self-esteem.Maintain client’s self-esteem. Avoid negative responses to failures.Avoid negative responses to failures. Provide simple choices.Provide simple choices. Provide structured routines.Provide structured routines. Praise success.Praise success. Simplify communication.Simplify communication.


Implementation, cont’d.Implementation, cont’d.

Repeat as needed.Repeat as needed. Break tasks into separate components.Break tasks into separate components. Provide short, simple activities.Provide short, simple activities. Allow time to be alone.Allow time to be alone. Be flexible to reduce frustration.Be flexible to reduce frustration.


TreatmentTreatment

Interdisciplinary teamInterdisciplinary team MedicationMedication

Bedtime sedation, anxiety, aggression, dementiaBedtime sedation, anxiety, aggression, dementia Therapeutic activitiesTherapeutic activities


Levels of CareLevels of Care

Acute careAcute care Day careDay care In-home careIn-home care Residential careResidential care Skilled nursing facilitySkilled nursing facility HospiceHospice

Date post:	12-Jan-2016
Category:	Documents
Upload:	bertha-green
View:	212 times
Download:	0 times

Chapter 16: Cognitive Disorders: Delirium, Dementia, and Amnestic Disorders Copyright © 2012, 2007...

Documents