Chapter 17

Cognitive Disorders

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

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Delirium Assessment
Cognitive and perceptual disturbances
Illusions Hallucinations

Physical needs Mood and physical behaviors

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Delirium Nursing Diagnoses

Risk for injury Acute confusion Deficient fluid volume Insomnia, Sleep deprivation Impaired verbal communication Fear Self-care deficit Self Disturbed thought process
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Delirium Outcomes 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.
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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.
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Delirium Evaluation
Patient will remain safe. Patient will be oriented to time, place, and person by discharge. Underlying cause will be treated and ameliorated.

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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

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Dementia
Primary 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 AIDSElsevier items and derived items 2010, 2006 by Saunders, an imprint of Elsevier Inc. 10

Alzheimers Disease Etiology

Biological factors
Cerebral atrophy Neurofibrillary tangles Neuritic plaques

Genetic Environmental factors

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Nursing Process
Assessment
Confabulation Perseveration

Cardinal symptoms observed in AD

Amnesia or memory impairment Aphasia Apraxia Agnosia Disturbances in executive functioning
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Stages of Alzheimer'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 endElsevier items and derived items 2010, 2006 by Saunders, an imprint of Elsevier Inc. 13

Alzheimers Disease Nursing Diagnoses

Risk for injury Impaired verbal communication Impaired environmental interpretation syndrome Impaired memory Confusion Caregiver role strain
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Alzheimer's Disease Outcomes Identification

Areas to target Injury Communication Agitation level Caregiver role strain Impaired environmental interpretation: chronic confusion Self-care needs SelfElsevier items and derived items 2010, 2006 by Saunders, an imprint of Elsevier Inc. 15

Alzheimer's Disease Planning

Geared towards persons immediate needs Identify level of functioning Assess caregivers needs Plan and identify appropriate community resources
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Alzheimer's Disease Implementation

Counseling and communication techniques Health teaching and health promotion Referral to community supports Pharmacological interventions

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Pharmacological Interventions for Alzheimers Disease

Tacrine (Cognex) Cognex) Donepezil (Aricept) Rivastigmine (Exelon) Galantamine (Razadyne) Razadyne) Memantine (Namenda) Namenda)

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