dementia community final

8/7/2019 dementia community final

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DEMENTIA

DONE BY:AMAL AL-HRBI,

Alaa Horani,

MASHAEL AL-BUTHIE

1431-1432H


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Objectives

Attheend of this lecturethestudent will be ableto:

Define dementia Mention causes of dementia Describe signs and symptoms List different investigation done for

cognitive impairment Explore the pharmacological therapies Apply nursing process to care for

client with cognitive impairment


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Outlines

Intr u ti n

e initi nC usesSi n n s t s

Investi ti nTre t entNursin i n sissu r


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Dementia :

Is not a specific disorder or disease . It is asyndrome (group of symptoms) associated with aprogressive loss of memory and other intellectualfunctions that is serious enough to interfere withperforming the tasks of daily life. Dementia can

occur to anyone at any age from an injury or fromoxygen deprivation, although it is most commonly

associated with aging.


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Causes :

Dementia can be caused by nearly forty differentdiseases and conditions, ranging from dietarydeficiencies and metabolic disorders to headinjuries and inherited diseases. he possible

causes of dementia can be categorized as follows:

Primary dementia : hese dementias are characterized bydamage to or wasting away of the brain tissue itself.


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Causes (continued) :

They include Alzheimer's disease (AD), frontal lobe dementia (FLD),and Pick's disease .


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Multi-infarct dementia (MID) : Sometimescalledvascular dementia , thistypeis

caused byblood clots in the small bloodvessels of the brain. Whenthe clots cutoffthe bloodsupplytothe braintissue, thebrain cells aredamaged andmaydie.


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Dementia related to infectious diseases .

Dementia may also be associated with

depression, low levelsofthyroidhormone, orniacinor vitamin B 12 deficiency. Dementiarelatedtothese conditionsisoften reversible.


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ementia related to abnormalities inthe structure of the brain. These mayinclude a buildup of spinal fluid in the

brain (hydrocephalus); tumors; or bloodcollecting beneath the membrane that

covers the brain (subdural hematoma).


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Signs & Symptoms :

Symptoms of dementia vary depending on the cause and thearea of the brain that is affected. Memory loss is usuallythe earliest and most noticeable symptom . other symptoms

include :


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Investigations :

Medical History: The doctors enquire about theindividuals general health and past medical history to knowand understand if the individual is facing any difficulty in

performing his/her routine activities. In this process the doctor may discuss with his/her family,

friends and colleagues to collect more information.

BasicMedic

al e

sts:

Routine basic diagnostic tests such as( blood tests, thyroid and liver function tests, glucose tests) , Depression screening may also can be done and spinalfluid collected is for testing.


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Investigations (continued) :

NeurologicalExam: This is an importanttest toassess theproperfunctioning of nervous systemas a wholeand brain inparticularto identify thedisorders . Thephysician may testfor( reflexes, coordination and balance, muscletoneandstrength, eyemovement, speech and sensation.

Mini-MentalStateExam (MMSE): This is one of the mostcommon tests used to assess mental function of the patient .Itinvolves various questions typically framed to examine themental skills required to performday-to-day routine activities.The questions may be as follows: ( To remember and recall thenames of three common objects such as lock, pen and pennyafter a few minutes , To state the currentdate, day of theweek, year and season ) .


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Investigations (continued) : Brain maging: Doctors may use various

scans to identify strokes, tumors or otherproblems that may cause dementia . Brainscans identify changes in brain structure andfunctions .

Structural maging: This technique furnishesthe information such as shape, position orvolume of brain tissue. These techniquesinclude magnetic resonance imaging (MRI)andcomputed tomography ( T).

Functional maging: This technique revealsthe working of cells in various regions of brainby showing how actively the cells use sugar oroxygen . The techniques include positronemission tomography ( PET) and functionalMRI ( fMRI ) .

Brain maging: Doctors may use various

scans to identify strokes, tumors or otherproblems that may cause dementia . Brainscans identify changes in brain structure andfunctions .

Structural maging: This technique furnishesthe information such as shape, position orvolume of brain tissue. These techniquesinclude magnetic resonance imaging (MRI)andcomputed tomography ( T).

Functional maging: This technique revealsthe working of cells in various regions of brainby showing how actively the cells use sugar oroxygen . The techniques include positronemission tomography ( PET) and functionalMRI ( fMRI ) .


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Investigations (continued) :

Electroencephalograms (EEGs): Inthis technique, electrodes are placedat various places over the scalp todetect and record electrical activities

and abnormalities.

SinglePhoton-EmissionComputedomography (SPEC ): is used to

detect the distribution of blood inbrain and Magneto Encephalography(MEG) is used to show theelectromagnetic fields produced bythe brain's neuronal activity.


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Treatment of Dementia :

Some cases of dementia are caused by medical conditionsthat can be treated, fully or partly restoring mentalfunction. When dementia cannot be reversed, the goal oftreatment is to make life as easy as possible for the

person and the caregivers.


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Medications to specifically treat

Alzheimer's:

Fall into a category called cholinesteraseinhibitors.

These medicines slow down the breakdown of

the neurotransmitter acetylcholine, which isreduced in the brains of people withAlzheimer's disease.

Acetylcholine is important for the formation

of memories, Other category is works by regulating the

activity of a neurotransmitter calledglutamatethat plays a role in learning andmemory.


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Doctors may also prescribe other

drugs, such as:

vitamins a deficiency of vitaminB12.

Thyroid hormones hypothyroidism .

surgeryremove a brain tumor or toreduce pressure on the brain.

Stop or change medicines that arecausing memory loss or confusion.

Medicines e.g antibiotic to treat aninfection, such as encephalitis , thatis causing changes in mental state.

Antidepressants

treat depression .


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Nursing diagnosis :1-Impaired Memory

Assessment data nterventions

1. Inability to recall factualinformation or events2. Inability to learn new materialor recall previously learnedmaterial .

3. Inability to determine if abehavior was performed4. Agitation or anxiety regardingmemory loss .

GOALS :

Demonstrate decreased agitationor anxietyUse long-term memory effectivelyas long as it remains intactVerbalize or demonstratedecreased frustration withmemory loss

Provide opportunities for recall of pastevents, on a one-to-one basis or in asmall group.Encourage the client to use writtencues such as a calendar, lists, or a

notebook.Provide verbal connections about usingimplements. For example, Here is awashcloth to wash your face, Here isa Spoon you can use to eat yourdessert.

Assist with tasks as needed, but donot rush to do things for the clientthat he or she can still doindependently


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Nursing diagnosis (continued) :2-Impaired Environmental Interpretation Syndrome


1. Disorientation in known andunknown environments2. Inability to reason

3. Inability to concentrate

GOALS :Be free of injuryIncrease reality contact within hisor her limitations

Demonstrate decreased agitationor restlessness

Check the client frequently at night.Do not isolate the client. It may be helpful toplace the client in a room near the nursingstation to facilitate interactionAssess the clients disorientation or confusionregularly.Refer to the date, time of day, and recentactivities during your interactions with theclient.Correct errors in the clients perceptions of

reality in a matter-of-fact manner. Do not laughat the clients misperceptionsEncourage visits from the clients friends andfamily, and assess their effect on the clientsconfusion and memory


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Nursing diagnosis (continued) :3-Impairead Social Interaction


1. Socially inappropriate behaviorDecreased social interaction

GOALS :y Interact with others in the

immediate environmenty Demonstrate decreased socially

inappropriate behavior

y Intervene as soon as you observeinappropriate behaviorPraise the clientfor appropriate behavior.

y Introduce activities during a time of

the day when the client seems mostable to concentrate and participate.y Increase the length or complexity of

the activity or task gradually if theclient tolerates increased stimulation.

y Involve the client with people from the

community, such as volunteers, forsocial interactionsy Identify groups outside the hospital in

which the client can participate in thefuture.


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Nursing diagnosis (continued) :4-SELF-CARE DEFICIT

Assessmentdata

Interventions

1. Inability tofulfill ADLs

GOAL :y participate in

ADLs withassistancefromcaregiver.

y Provide a simple, structured environmentto minimizeconfusion:1. Identify self-care deficits and provide assistance as required.2. Allow plenty of time for client to perform tasks.3. Provide guidance and support for independent actions by talking

the client through the task one step at a time.4. Provide a structured schedule of activities that does not change

from day to day.5. Ensure that ADLs follow home routine as closely as possible.6. Provide for consistency in assignment of daily caregivers.

y In planning for discharge:1. Perform ongoing assessment of clients ability to fulfill nutritional

needs, ensure personal safety, follow medication regimen, andcommunicate need for assistance with those activities that he orshe cannot accomplish independently. lient safety and securityare nursing priorities.

2. Provide information to assist caregivers with this responsibility.3. Ensure that caregivers are aware of available community support

systems from which they can seek assistance when required.


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CO PARISONOF LIRIU ANDDEMENTIA :( SUMMERY )

Indicator Delirium dementia

set Rapid-reversible-acute

Gradual irreversible-chronic

Duration Brief (hours to days) Progressivedeterioration

Level of

consciousness

Impaired, fluctuates ot affected

Memory Short-term memoryimpaired

Short- then long-term memoryimpaired, eventually

destroyed


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Speech May be slurred,rambling,pressured,irrelevant

Normal in early stage,progressive aphasia inlaterstage

Thoughtprocesses

Temporarilydisorganized

Impaired thinking,eventual loss ofthinking abilities

Perception Visual or tactilehallucinations,

Delusions-illusions

Often absent, but canhave paranoia,

hallucinations,illusionsMood Anxious, fearful

if hallucinating;weeping, irritable

Depressed and anxiousin early stage

COMPARISONOF DELIRIUMANDDEMENTIA :( SUMMERY ) (continued)


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Reference:

http://www.emedicinehealth.com/dementia_medication_overview/page3_em.htm

http://www.ehow.com/about_5269887_pharmacologic-

treatment-dementia.html http://alzheimers.emedtv.com/dementia/dementia-treatment-p2.html

http://www.omnimedicalsearch.com/conditions-

diseases/dementia-symptoms.html http://www.minddisorders.com/Del-Fi/Dementia.html

http://www.medicinenet.com/dementia/page8.htm

http://www.webmd.com/alzheimers/tc/dementia-treatment-

overview?page=3


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