Chap 24
Cognitive
Disorders
Week 1
Overview
Cognition
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Brain’s ability to process, retain, use information
Processes: reasoning, judgment, perception,
attention, comprehension, memory
Neurocognitive disorders: disruption or impairment in
higher level brain functions
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Delirium, major NCD, mild NCD, subtypes; dementia
Delirium
❖ Syndrome involving disturbance of
consciousness with change in cognition
❖ Usually develops over short period (hours to
days)
❖ Etiology: almost always results from
identifiable physiological, metabolic, or
cerebral disturbance or disease or from drug
intoxication or withdrawal (see Box 24.1)
Treatment
Find root cause
An antipsychotic?
Recently sedated?
Drug toxicity?
Substance abuse?
UTI in elderly?
Nursing Process
Assessment
● Patient History
● Appearance and motor
behavior/speech
● Mood and affect
● Thought Process and
Content
● Sensorium and
intellectual processes
● Judgement/insight
● Roles/relationships
● Self concept
● Physiological and self
care
Nursing Diagnoses
●
Outcome Identification
https://nurses
tudy.net/delir
ium-nursingcare-plans/
Click link for
some great nursing
diagnoses in
delirium
Freedom from
injury
● Increased
orientation,
reality contact
● Balance of
activity and rest
● Adequate
nutrition and
fluid balance
Return to optimal
level of
functioning
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Interventions
Promoting client safety
Managing client’s confusion: orienting cues;
speaking in low, clear voice; use of touch;
avoiding sensory overload
Promoting sleep, proper nutrition
Then reevaluate… always an ongoing assessment
Delirium and Community-Based
Care
❖ Referrals for continued cognitive
problems
o Home health care/visiting nurses
o Rehabilitation program
o Adult day care
o Residential care
o Support groups
Dementia
Progressive cognitive
impairment; multiple
cognitive deficits;
initially memory, later the
following may be seen
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Different from delirium
Aphasia
Apraxia
Agnosia
Disturbance in executive
function
Dementia
Onset and clinical course:
Etiology:
many causes; decreased metabolic
activity found postmortem
Slow onset and in stages
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Mild
Moderate
Severe
Types of dementia
Alzheimer disease
Lewy body dementia
Vascular dementia
Frontotemporal lobar
degeneration (Pick disease)
Prion diseases (CreutzfeldtJakob disease)
Dementia related to HIV infection
Parkinson disease
Huntington disease
Dementia due to traumatic brain
injury
Treatment and Prognosis
Treatment and prognosis
Importance of identifying underlying
cause
Progressive types—progressive
deterioration until death
Medications for degenerative
dementias: cholinesterase
inhibitors (see Table 24.2)
Symptomatic treatment for
behaviors
Antidepressants
Antipsychotics
Dementia
Assessment
Mental status examination
History: client may be unable to
provide accurate history.
Mood and affect: increasingly
labile mood; emotional outbursts
General appearance and motor
behavior: aphasia; apraxia;
uninhibited behavior
Thought process and content:
impaired abstract thinking;
delusions of persecution
Dementia
Assessment
Sensorium and intellectual
processes: loss of intellectual
function; memory deficits;
confabulation (the creation of
false memories in the absence of
intentions of deception)
Judgment and insight: poor
judgment; unrealistically
appraise abilities
Self-concept: sadness; loss of
self-awareness
Roles and relationships:
profoundly affected
Physiological and self-care:
disturbed sleep; incontinence;
hygiene deficits
Diagnoses and
Outcomes
Risk for injury
Disturbed sleep pattern
Chronic confusion
Freedom from injury
Involvement in surroundings
Interact with others in
environment
Interventions
Safety
Sleep, proper nutrition,
hygiene, activity
Environmental, routine structure
Emotional support
Interaction and involvement
EVALUATE EVALUATE… ONGOING
Dementia and
CommunityBased Care
At least half of all
nursing home residents have
Alzheimer disease or
another dementia-causing
illness
Home care
Adult day care
Respite care
Residential facilities
Skilled nursing home
Placement
Referrals for programs and
services
Mental Health Promotion
Research to identify risk factors for dementia
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Elevated levels of plasma homocysteine
Measures to decrease risk for Alzheimer disease
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Regular participation in brain-stimulating activities
Leisure-time physical activity during midlife
Large social network
Caregiver Role
Majority are women (adult daughters or wives)
Needs of caregivers:
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Education about dementia, required client care
Assistance in dealing with own feelings of loss
Respite to care for own needs, role strain
Support groups
Assistance from agencies
Support to maintain personal life
Self Awareness
Teaching clients with dementia can be frustrating.
Feelings of frustration or hopelessness
Discuss frustrations with others.
May be difficult to deal with feelings about people who will
never “get better and go home”
Importance of dignity for client and family