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CHAPTER 17

Cognitive Disorders. CHAPTER 17. Etiology. Delirium An underlying systemic illness, including infection, and endocrine disorder, trauma, and drug/alcohol abuse Dementia Classified as to the cause or area of brain damage Amnestic disorders

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CHAPTER 17

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  1. Cognitive Disorders CHAPTER 17

  2. Etiology • Delirium • An underlying systemic illness, including infection, and endocrine disorder, trauma, and drug/alcohol abuse • Dementia • Classified as to the cause or area of brain damage • Amnestic disorders • Head trauma, hypoxia, encephalitis, thiamine deficiency, and substance abuse

  3. Differentiating Types of Cognitive Disorders • Delirium • Acute confusional state characterized by disruptions in thinking, perception, & memory • Dementia • Chronic state characterized by declines in multiple cognitive areas, including memory • Amnestic disorders • Uncommon cognitive disorder characterized by amnesia

  4. Delirium – Clinical Picture • Disturbances in consciousness • Change in cognition • Develops over a short period of time • Common in hospitalized patients, especially older adults • Always secondary to another physiological condition • Is a transient disorder • If underlying condition corrected, complete recovery should occur

  5. Delirium Assessment • Four cardinal features • Acute onset and fluctuating course • Inattention • Disorganized thinking • Disturbance of consciousness

  6. Delirium Assessment • Cognitive and perceptual disturbances • Illusions • Hallucinations • Physical needs • Mood and physical behaviors • Attention span • Reasoning • Sleep and wake cycle

  7. Delirium Nursing Diagnoses • Risk for injury • Acute confusion • Deficient fluid volume • Insomnia, Sleep deprivation • Impaired verbal communication • Fear • Self-care deficit • Disturbed thought process

  8. DeliriumOutcomes Identification • Patient will return to premorbid level of functioning. • Patient will remain safe and free from injury while in the hospital. • Patient will be oriented to time, place, and person. • Patient will be free from falls and injury.

  9. Delirium Implementation • Prevent physical harm due to confusion, aggression, or fluid and electrolyte imbalance. • Perform comprehensive nursing assessment to aid in identifying cause. • Assist with proper health management to eradicate underlying cause. • Use supportive measures to relieve distress.

  10. Interventions for Delirium • Introduce self and call client by name at each contact • Maintain face-to-face contact • Use short, concrete phrases • Keep room well lit • Keep environmental noise low • Set limits on behavior • 1:1 staffing as needed

  11. Delirium Evaluation • Patient will remain safe. • Patient will be oriented to time, place, and person by discharge. • Underlying cause will be treated and ameliorated.

  12. Dementia Progressive deterioration of cognitive functioning and global impairment of intellect No change in consciousness Difficulty with memory, thinking, and comprehension Majority of dementias are irreversible

  13. DementiaPrimary Versus Secondary • Primary • Irreversible • Progressive • Not secondary to any other disease • Example: Alzheimer's disease • Secondary • Result of some other pathological process • Example: AIDS-related dementia

  14. Alzheimer’s Disease Etiology • Biological factors • Cerebral atrophy • Neurofibrillary tangles • Neuritic plaques • Genetic • Dementia of Alzheimer’s type • Dementia from Huntington’s disease • Dementia from Pick’s disease

  15. Alzheimer’s Disease Etiology • Environmental factor • Dementia from Creutzfeldt–Jakob disease

  16. Nursing Process • Assessment • Confabulation • Perseveration • Cardinal symptoms observed in AD • Amnesia or memory impairment • Aphasia • Apraxia • Agnosia • Disturbances in executive functioning

  17. Nursing Process • Poor judgment • Decline in previous abilities

  18. Stages ofAlzheimer's Disease • Stage 1 (Mild) – forgetfulness • Stage 2 (Moderate) – confusion • Stage 3 (Moderate to Severe) – unable to identify familiar objects or people • Stage 4 (Late) – end-stage

  19. Alzheimer’s Disease Nursing Diagnoses • Risk for injury • Impaired verbal communication • Impaired environmental interpretation syndrome • Impaired memory • Confusion • Caregiver role strain

  20. Alzheimer's Disease Outcomes Identification • Areas to target • Injury • Communication • Agitation level • Caregiver role strain • Impaired environmental interpretation: chronic confusion • Self-care needs

  21. Alzheimer's DiseasePlanning Geared towards person’s immediate needs Identify level of functioning Assess caregivers’ needs Plan and identify appropriate community resources

  22. Alzheimer's Disease Implementation Maintain optimal nutrition Counseling and communication techniques Health teaching and health promotion Referral to community supports Structure the environment to support cognitive functions Pharmacological interventions

  23. Pharmacological Interventionsfor Alzheimer’s Disease • Tacrine (Cognex) • Donepezil (Aricept) • Rivastigmine (Exelon) • Galantamine (Razadyne) • Memantine (Namenda) Slows the rate of cognitive decline Potent acetylcholinesterase inhibitors

  24. Common Medications for Cognitive Disorders • Dementia with Lewy Bodies • Escitalopram (Lexapro) Reduce symptoms of depression when present • Pick’s Disease • Valproic Acid (Depakote) Reduce problematic mood swings and agitated behavior • Vascular Dementia with psychosis • Quetiapine (Seroquel) Reduce or eliminate delusions and hallucination

  25. Amnestic Disorder • Characterized by short-and long-term memory deficits • Inability to recall previously learned information or past events • Inability to learn new materials • Cofabulation, apathy, bland affect • Amnestic disorder NOS: not enough supporting evidence to link a cause to the amnesia (medical or substance)

  26. Depression • Depression can be masked by symptoms suggestive of dementia • The term pseudodementia is used to describe the reversible cognitive impairments seen in depression • Pseudodementia is characterized by an abrupt onset, rapid clinical course, and client complaints about cognitive failures

  27. Caregiver Difficulties • Wandering behaviors • Sundowning disorientation • Activities of Daily Living • Medication management • Burnout and fatigue

  28. Caregiver Resources • Family meetings • Alzheimer’s Disease and Related Disorders Association (ADRDA) • Caregiver support groups • Identify community resources • ID bracelet for the client

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