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    Cognitive Disorders

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    georgeloto12
    Delirium is a disturbance of consciousness and cognition that develops over a short period of time. It is characterized by disorientation, impaired attention and memory, and possible hallucinations. Common causes include metabolic imbalances, infections, drug side effects or withdrawal. Nursing assessments focus on orientation, mood, and thought processes. Goals are to prevent injury, promote orientation and balanced activity/rest, and ensure adequate nutrition and hydration. Interventions manage confusion, promote comfort and safety, and address underlying causes. Evaluation monitors treatment effectiveness and educates about preventing recurrence. Dementia is a progressive cognitive impairment involving memory loss and other deficits. It is usually permanent. Alzheimer's disease is the most common cause. Assessments

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    Cognitive Disorders

    Uploaded by

    georgeloto12
    186 views9 pages
    Delirium is a disturbance of consciousness and cognition that develops over a short period of time. It is characterized by disorientation, impaired attention and memory, and possible hallucinations. Common causes include metabolic imbalances, infections, drug side effects or withdrawal. Nursing assessments focus on orientation, mood, and thought processes. Goals are to prevent injury, promote orientation and balanced activity/rest, and ensure adequate nutrition and hydration. Interventions manage confusion, promote comfort and safety, and address underlying causes. Evaluation monitors treatment effectiveness and educates about preventing recurrence. Dementia is a progressive cognitive impairment involving memory loss and other deficits. It is usually permanent. Alzheimer's disease is the most common cause. Assessments

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    mental health

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    Delirium is a disturbance of consciousness and cognition that develops over a short period of time. It is characterized by disorientation, impaired attention and memory, and possible hallucinations. Common causes include metabolic imbalances, infections, drug side effects or withdrawal. Nursing assessments focus on orientation, mood, and thought processes. Goals are to prevent injury, promote orientation and balanced activity/rest, and ensure adequate nutrition and hydration. Interventions manage confusion, promote comfort and safety, and address underlying causes. Evaluation monitors treatment effectiveness and educates about preventing recurrence. Dementia is a progressive cognitive impairment involving memory loss and other deficits. It is usually permanent. Alzheimer's disease is the most common cause. Assessments

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    186 views9 pages

    Cognitive Disorders

    Uploaded by

    georgeloto12
    Delirium is a disturbance of consciousness and cognition that develops over a short period of time. It is characterized by disorientation, impaired attention and memory, and possible hallucinations. Common causes include metabolic imbalances, infections, drug side effects or withdrawal. Nursing assessments focus on orientation, mood, and thought processes. Goals are to prevent injury, promote orientation and balanced activity/rest, and ensure adequate nutrition and hydration. Interventions manage confusion, promote comfort and safety, and address underlying causes. Evaluation monitors treatment effectiveness and educates about preventing recurrence. Dementia is a progressive cognitive impairment involving memory loss and other deficits. It is usually permanent. Alzheimer's disease is the most common cause. Assessments

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    © All Rights Reserved
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    of 9

    Cognitive disorders

    Delirium
    Disturbance of consciousness accompanied by change in cognition; disoriented
    o Alert and oriented to person only
    o Typically have problems recalling on memory and time.
    Develops over a short period of time
    Easily distracted
    Difficulty concentrating
    Illusions, hallucinations
    Onset is rapid
    Brief duration
    Level of consciousness is impaired
    Slurred speech
    Anxious mood

    Causes of Delirium
    Metabolic
    InfectionUTI
    Low sodium
    o Normal is 135-145 mEq/L

    o Always check electrolytes!


    Drug related
    o Or, withdrawal from drugs and alcohol
    o Sedatives and benzodiazepines cause confusion
    Effects of anesthesia

    The nursing process: Assessment


    Interview with simple questions and explanations
    Frequent breaks
    History of onset; not reliable from client
    o Interview family members; ask: Is the how your mom typically acts?
    Mood/Affect
    o Frequently assess moods; moods change quickly
    Thought process/content
    o Many have visual hallucinations
    o Very restless; hard to keep in bed.

    Nursing process: Goals


    Free from injury
    o Fall precautions
    Demonstrate increased orientation

    o Use reality orientation and validate feelings


    Adequate balance of activity and rest
    o Help the patient keep days and nights straight
    Adequate nutrition
    o Often forget to eat; needs nutritional supplements
    Return to optimal level of functioning
    A goal needs a timeline to make it measurable!

    Nursing process: Intervention


    Patient safety
    Managing confusion
    o Often frightened at night.
    Promote comfort and rest
    Adequate fluids and nutrition
    o Always offer little sips of water!

    Nursing process: Evaluation


    Successful treatment of underlying causes for delirium returns client to former
    level of functioning
    Client and family education about avoidance of recurrence
    Monitor chronic health problems
    Careful use of medications

    No alcohol or other non-prescribed drugs

    Dementia

    Dementia
    More progressive, gradual, and permanent
    Involves multiple cognitive deficits
    o Primarily memory impairment
    Involves at least one of the following:
    o Asphasia (deterioration of language function)
    o Apraxia (impaired ability to execute motor functions)
    o Agnosia (inability to name or recognize objects)
    o Disturbance in executive functioning (ability to think abstractly and to plan,
    initiate, sequence, monitor, and stop complex behavior)
    May also present:
    o Echolalia (echoing what is heard)
    o Palilalia (repeating words or sounds over and over)

    Clinical course of Dementia


    Mild:
    o Forgetfulness

    o Difficulty finding words


    o Frequently loses objects and experiences anxiety about these losses.
    o Occupational and social settings are less enjoyable, and the person may
    avoid them.
    Moderate:
    o Confusion is present along with memory loss
    o The person cannot complete complex tasks but remains oriented to
    person and place.
    o Still recognizes familiar people.
    o Some assistance with care
    o Executive functioning suffers (especially with ADLs)
    Severe:
    o Personality and emotional changes occur
    o May be delusional, wander at night, forget the names of spouse and
    children and require assistance in ADLs.
    o Most live in ECF.

    Causes of Dementia
    Decreased metabolic activity
    Genetic component
    Infection
    Alzheimers disease (#1)

    Creutzfeld-Jacob disease (CNS disorder; develops at 40-60 years. Causes by


    infectious particle that is resistant to boiling)
    Parkinsons disease
    Huntingtons disease (inherited gene; brain atrophy, demyelination, and
    enlargement of the brain ventricles. Begins in late 30s)
    Vascular Dementia (#2)
    o Symptoms similar to Alzheimers, but more abrupt, followed by rapid
    changes in functioning; a plateau; more abrupt changes, another plateau,
    and so on.
    o Caused by decreased blood supply to the brain.

    Culture
    Native Americans and Eastern countries hold elders in a position of authority,
    respect, power, and decision making for family; this does not change despite
    memory loss or confusion.
    May feel they are being disrespectful and reluctant to make decisions or plans for
    elders with dementia.

    Treatment for Dementia


    Underlying cause
    o Example: Vascular dementia can be helped by diet, exercise, control of
    hypertension or diabetes.
    Psychopharmacology
    o Cognex and Aricept are cholinesterase inhibitors and have shown
    therapeutic effects; slow the progress of dementia. They do not reverse
    damage already done.

    Must have liver function tests done with Cognex.


    Flu-like symptoms, diarrhea, sleep disturbances are common.
    o Tegretol and Depakote help stabilize mood and diminish aggressive
    outbursts.
    These doses are often -2/3 less lower than prescribed for
    seizures, therefore, does not need to be in the therapeutic level
    for blood work.
    o Benzodiazepines may cause delirium and can worsen already
    compromised cognitive abilities.

    Nursing process: Assessment


    History
    o Remember, interview family
    Motor behavior and general appearance
    o Display aphasia
    o Conversation repetitive
    o Apraxia (such as combing hair)
    o Gait disturbance
    o Uninhibited behavior; never have displayed these behaviors before.
    Mood and Affect
    o Grieve at first
    o Emotional outbursts are common
    o Pattern of withdrawal; lethargic, apathetic, look dazed and listless.

    Thought process and content


    o Executive functioning impaired
    o Have to stop working
    o Client may accuse others of stealing lost objects
    Sensorium and Intellectual Processes
    o First affects recent and immediate memory, eventually impairs the ability to
    recognize family members and oneself.
    o Confabulation: clients make up answers to fill in memory gaps; often
    inappropriate words or fabricated ideas (SCREW YOU, ASSHOLE).
    o Visual hallucinations are common.
    Judgment and insight
    o Underestimate risk
    Self concept
    o Initially grieve, and then slowly lose sense of self.
    Roles and Relationships
    Physiologic and self-care considerations
    o Altered sleep-wake cycle
    o Some clients ignore internal cues such as hunger or thirst
    o Neglect bathing and grooming; become incontinent.

    Read the Nursing Diagnoses and Nursing Goals on your own. Too damn lazy to
    type out.

    Nursing Process: Interventions


    Demonstrate caring attitude
    Keep clients involved; relate to environment
    Validate clients feelings of dignity
    Offer limited choices
    Reframing (offering alternate points of view to explain events)
    See page 487theres a good table there about interventions.
    SAFETY!
    o Physical and Chemical restraint should be the last option

    Nursing process: Evaluation


    Goals change as disease progresses
    Reassessment is vital!
    Client always needs assessed, goals and interventions constantly revised
    Evaluation is a continuing process.
    Remember short term goals; all goals need a time frame.

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