chapter 017.ppt cognitive

8/3/2019 Chapter 017.Ppt Cognitive

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Elsevier items and derived items 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Chapter 17Chapter 17

Cognitive DisordersCognitive Disorders


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Elsevier items and derived items 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2

DeliriumDelirium Clinical PictureClinical Picture

Disturbances in consciousnessDisturbances in consciousness

Change in cognitionChange in cognition

Develops over a short period of timeDevelops over a short period of time

Common in hospitalized patients, especiallyCommon in hospitalized patients, especiallyolder adultsolder adults

Always secondary to another physiologicalAlways secondary to another physiological

conditioncondition Is a transient disorderIs a transient disorder

If underlying condition corrected, completeIf underlying condition corrected, completerecovery should occurrecovery should occur


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DeliriumDelirium

AssessmentAssessment

Four cardinal featuresFour cardinal features

Acute onset and fluctuating courseAcute onset and fluctuating course InattentionInattention

Disorganized thinkingDisorganized thinking

Disturbance of consciousnessDisturbance of consciousness


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DeliriumDelirium

AssessmentAssessment Cognitive and perceptualCognitive and perceptual disturbancesdisturbances

IllusionsIllusions

HallucinationsHallucinations

Physical needsPhysical needs

MoodMood andand physical behaviorsphysical behaviors


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DeliriumDelirium

Nursing DiagnosesNursing Diagnoses Risk for injuryRisk for injury

Acute confusionAcute confusion

Deficient fluid volumeDeficient fluid volume Insomnia, Sleep deprivationInsomnia, Sleep deprivation

Impaired verbal communicationImpaired verbal communication

FearFear SelfSelf--care deficitcare deficit

Disturbed thought processDisturbed thought process


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DeliriumDelirium

Outcomes IdentificationOutcomes Identification Patient will return to premorbid level ofPatient will return to premorbid level of

functioning.functioning.

Patient will remain safe and free fromPatient will remain safe and free frominjury while in the hospital.injury while in the hospital.

Patient will be oriented to time, place,Patient will be oriented to time, place,and person.and person.

Patient will be free from falls and injury.Patient will be free from falls and injury.


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DeliriumDelirium

ImplementationImplementation Prevent physical harm due to confusion,Prevent physical harm due to confusion,

aggression, or fluid and electrolyte imbalance.aggression, or fluid and electrolyte imbalance.

Perform comprehensive nursing assessmentPerform comprehensive nursing assessmentto aid in identifying cause.to aid in identifying cause.

Assist with proper health management toAssist with proper health management to

eradicate underlying cause.eradicate underlying cause.

Use supportive measures to relieve distress.Use supportive measures to relieve distress.


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DeliriumDelirium

EvaluationEvaluation Patient will remain safe.Patient will remain safe.

Patient will be oriented to time,Patient will be oriented to time,place, and person by discharge.place, and person by discharge.

Underlying cause will be treated andUnderlying cause will be treated and

ameliorated.ameliorated.


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DementiaDementia

Progressive deterioration of cognitiveProgressive deterioration of cognitivefunctioning and global impairment offunctioning and global impairment ofintellectintellect

No change in consciousnessNo change in consciousness

Difficulty with memory, thinking, andDifficulty with memory, thinking, andcomprehensioncomprehension

Majority of dementias are irreversibleMajority of dementias are irreversible


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DementiaDementiaPrimary Versus SecondaryPrimary Versus Secondary

PrimaryPrimary

IrreversibleIrreversible

ProgressiveProgressive

Not secondary to any other diseaseNot secondary to any other disease

Example: Alzheimer's diseaseExample: Alzheimer's disease

SecondarySecondary

Result of some other pathological processResult of some other pathological process

Example: AIDSExample: AIDS--related dementiarelated dementia


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Alzheimers DiseaseAlzheimers Disease

EtiologyEtiology Biological factorsBiological factors

Cerebral atrophyCerebral atrophy

Neurofibrillary tanglesNeurofibrillary tangles

Neuritic plaquesNeuritic plaques

GeneticGenetic

Environmental factorsEnvironmental factors


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Nursing ProcessNursing Process AssessmentAssessment

ConfabulationConfabulation

PerseverationPerseveration

Cardinal symptoms observed in ADCardinal symptoms observed in AD

Amnesia or memory impairmentAmnesia or memory impairment

AphasiaAphasia

ApraxiaApraxia

AgnosiaAgnosia

Disturbances in executive functioningDisturbances in executive functioning


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Stages ofStages of

Alzheimer's DiseaseAlzheimer's Disease Stage 1 (Mild)Stage 1 (Mild) forgetfulnessforgetfulness

Stage 2 (Moderate)Stage 2 (Moderate) confusionconfusion

Stage 3 (Moderate to Severe)Stage 3 (Moderate to Severe) unable to identify familiar objectsunable to identify familiar objects

or peopleor people

Stage 4 (Late)Stage 4 (Late) endend--stagestage


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Alzheimers DiseaseAlzheimers Disease

Nursing DiagnosesNursing Diagnoses

Risk for injuryRisk for injury

Impaired verbal communicationImpaired verbal communication

Impaired environmentalImpaired environmentalinterpretation syndromeinterpretation syndrome

Impaired memoryImpaired memory

ConfusionConfusion

Caregiver role strainCaregiver role strain


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Alzheimer's DiseaseAlzheimer's Disease

Outcomes IdentificationOutcomes Identification

Areas to targetAreas to target

InjuryInjury

CommunicationCommunication Agitation levelAgitation level

Caregiver role strainCaregiver role strain

Impaired environmental interpretation:Impaired environmental interpretation:chronic confusionchronic confusion

SelfSelf--care needscare needs


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PlanningPlanning Geared towards persons immediateGeared towards persons immediate

needsneeds

Identify level of functioningIdentify level of functioning

Assess caregivers needsAssess caregivers needs

Plan and identify appropriatePlan and identify appropriatecommunity resourcescommunity resources


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ImplementationImplementation Counseling and communicationCounseling and communication

techniquestechniques

Health teaching and health promotionHealth teaching and health promotion

Referral to community supportsReferral to community supports

Pharmacological interventionsPharmacological interventions


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Pharmacological InterventionsPharmacological Interventions

for Alzheimers Diseasefor Alzheimers Disease TacrineTacrine ((CognexCognex))

DonepezilDonepezil (Aricept)(Aricept) RivastigmineRivastigmine (Exelon)(Exelon)

GalantamineGalantamine ((RazadyneRazadyne))

MemantineMemantine ((NamendaNamenda))

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