Professional Documents
Culture Documents
Introduction
Disorders discussed in which a clinically significant deficit in cognition or memory exists.
Introduction (cont.)
The number of people with these disorders is growing because more people now survive into the high-risk period for dementia, which is middle age and beyond.
Delirium
Characterized by a disturbance of consciousness and a change in cognition that develop rapidly over a short period.
Delirium
Symptoms
Difficulty sustaining and shifting attention Extreme distractibility Disorganized thinking Speech that is rambling, irrelevant, pressured, and incoherent
Delirium (cont.)
Symptoms
Impaired reasoning ability and goaldirected behavior Disorientation to time and place Impairment of recent memory Misperceptions about the environment, including illusions and hallucinations
Delirium (cont.)
Symptoms
Psychomotor activity that fluctuates between agitation, purposeless movements, and a vegetative state Emotional instability
Delirium (cont.)
Symptoms include autonomic manifestations such as;
Tachycardia Sweating Flushed face Dilated pupils Elevated blood pressure
Delirium (cont.)
Usually begins abruptly. It can have a slower onset if the underlying etiology is systemic illness or metabolic imbalance. Duration is usually brief and subsides completely on recovery from the underlying determinant.
Predisposing Factors
Delirium due to a General Medical Condition Substance-Induced Delirium Substance-Intoxication Delirium Substance-Withdrawal Delirium Delirium due to Multiple Causes
Dementia
Defined as a syndrome of acquired persistent intellectual impairment with compromised function in multiple spheres of mental activity.
Dementia (cont.)
Symptoms
Impairment exists in abstract thinking, judgment, and impulse control. Conventional rules of social conduct are disregarded. Personal appearance and hygiene are neglected.
Dementia (cont.)
Symptoms
Language may or may not be affected. Personality change is common.
Dementia (cont.)
Reversible dementia is a function of the underlying pathological condition and of the availability and timely application of effective treatment.
Dementia (cont.)
As the disease progresses, signs include:
Apraxia Irritability and moodiness, with sudden outbursts over trivial issues Inability to care for personal needs independently Wandering away from the home area
Predisposing Factors
Dementia of the Alzheimers type
Onset is slow and insidious and the course of the disorder is generally progressive and deteriorating. Refinement of diagnostic criteria now enables clinicians to use specific clinical features to identify the disease at an accuracy rate approaching 85%.
Acetylcholine alterations Accumulation of aluminum in body Alterations in the immune system Head trauma Genetic factors
Amnestic Disorders
Amnestic disorders are characterized by an inability to:
Learn new information despite normal attention Recall previously learned information
depending on underlying pathological process. Duration and course may be quite variable and are also correlated with extent and severity of the cause.
Predisposing Factors
Amnestic Disorder due to a General Medical Condition.
Head trauma Cerebrovascular disease Cerebral neoplastic disease Cerebral anoxia Herpes simplex virus-related encephalitis
Assessment
History: Areas of concern to be addressed
Orientation to person, place, time, and situation Appropriateness of social behavior Current and past use of medications, drugs, and alcohol Possible exposure to toxins Client and family history of specific illnesses
Assessment (cont.)
Physical Assessment
Assessment for diseases of various organ systems that can induce confusion, loss of memory, and behavioral changes
Assessment (cont.)
Physical Assessment
Neurological examination to assess mental status, alertness, muscle strength, reflexes, sensory perception, language skills, and coordination
Assessment (cont.)
Physical Assessment
Psychological tests to differentiate between dementia and pseudodementia (depression)
Nursing Process
Diagnostic Laboratory Evaluations
Include blood and urine to test for
Various infections Hepatic and renal dysfunctions Diabetes or hypoglycemia Electrolyte imbalances Metabolic and endocrine disorders Nutritional deficiencies Presence of toxic substances
Diagnosis/Outcome Identification
Risk for trauma related to impairments in cognitive and psychomotor functioning Risk for self-directed violence related to depressed mood Risk for other-directed violence related to impairment of impulse control
Outcomes
The client:
Has not experienced physical injury Has not intentionally harmed self or others Has maintained reality orientation to the best of his or her capability Discusses positive aspects about self and life Fulfills activities of daily living with assistance
Nursing Process
PLANNING AND IMPLEMENTATION Provides a plan of care for the client with a cognitive disorder
Client/Family Education
Nature of the illness
Possible causes What to expect Symptoms
Delirium
Determination and correction of the underlying causes Staff to remain with client at all times to monitor behavior and provide reorientation and assurance
Delirium
Room with low stimulus level Low-dose neuroleptic agents to relieve agitation and aggression
Dementia
Primary consideration is given to etiology, with focus on identification and resolution of potentially reversible processes.
Pharmaceutical Agents For agitation, aggression, hallucinations, thought disturbances, and wandering: Risperdal Zyprexa Seroquel Geodon
Medical Treatment Modalities (cont.) Pharmaceutical Agents For anxiety (should not be used routinely for prolonged periods):
Chlordiazepoxide (Librium) Alprazolam (Xanax) Lorazepam (Ativan) Oxazepam (Serax)
THE END