Psychiatric / Mental Health Nursing Cognitive Disorders

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Psychiatric / Mental Health NursingCognitive
Disorders

• West Coast University
• NURS 204

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What are cognitive disorders?

• Delirium
• Dementia
• Amnestic disorders

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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

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Theories

• Genetics
• Dementia of Alzheimers type
• Dementia from Huntingtons disease
• Dementia from Picks disease

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Theories - continued

• Infection
• Delirium
• Dementia from CreutzfeldtJakob disease
• Parkinsons disease
• Amnestic disorders
• Vascular insufficiency
• Brain tissue destroyed
• Symptoms absent until 100200 cc of brain tissue
  destroyed
• Underlying systemic illness or injury
• Delirium
• Amnestic disorders

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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

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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)

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Delirium and Dementia Differences

• Delirium
• Fluctuating consciousness
• Varying attentiveness
• Acute
• Rapid onset
• Cause is identifiable
• Generally reversible

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Delirium and Dementia Differences - continued

• Dementia
• Stable levels of consciousness
• Steady attentiveness
• Chronic
• Slow insidious onset
• Undetermined cause
• Generally irreversible

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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

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Assessment

• Delirium
• Fluctuating levels of consciousness
• Disorientation and sundowning
• Impaired reasoning
• Poor attention span
• Altered sleepwake cycle
• Alternating patterns of motor behavior

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Assessment - continued

• Dementia
• Memory impairment
• Cognitive impairment
• Aphasia
• Apraxia
• Agnosia
• Poor judgment
• Decline in previous abilities

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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
• 11 staffing as needed

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Interventions for Dementia

• Gently orient the client
• Educate family about home safety
• Maintain optimal nutrition
• Bowel and bladder training
• Utilize nonverbal forms of communication
• Structure the environment to support cognitive
  functions

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Supporting Optimal Memory Functioning

• Environmental reminders
• Reminiscence activities
• Triggers for semantic memory
• Support cognitive strengths
• Assist to cope with cognitive deficits

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Common Medications for Cognitive Disorders

• Dementia of the Alzheimers Type (DAT)
• Donepezil (Aricept)
• Galantamine (Reminyl)
• Rivastignime (Exelon)
• Slows the rate of cognitive decline
• Potent acetylcholinesterase inhibitors

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Common Medications for Cognitive Disorders

• Dementia with Lewy Bodies
• Escitalopram (Lexapro)
• Reduce symptoms of depression when present
• Picks Disease
• Valproic Acid (Depakote)
• Reduce problematic mood swings and agitated
  behavior
• Vascular Dementia with psychosis
• Quetiapine (Seroquel)
• Reduce or eliminate delusions and hallucination

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Caregiver Difficulties

• Wandering behaviors
• Sundowning disorientation
• ADLs
• Medication management
• Burnout and fatigue

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Caregiver Resources

• Family meetings
• Alzheimers Disease and Related Disorders
  Association (ADRDA)
• Caregiver support groups
• Identify community resources
• ID bracelet for the client

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Self-Awareness

• Caring for clients with cognitive disorders can
  be difficult and frustrating at times.
• Self-awareness inventory in your text
• The responses are designed to help you to become
  more successful in working with cognitively
  impaired clients and their families.

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Review Question

• Delirium is thought to be caused primarily by
• A. Genetics.
• B. Underlying systemic illness.
• C. Brain injury.
• D. Vascular insufficiency.

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Review Question

• A key characteristic of an amnestic disorder is
• A. Short-term and long-term memory loss.
• B. Hallucinations.
• C. Long-term memory loss.
• D. Short-term memory loss.

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Review Question

• A caregiver for a client diagnosed with dementia
  of the Alzheimers type is unable to effectively
  communicate with the client. Which of the
  following techniques would be most appropriate to
  teach the caregiver?
• A. Setting strict time limits and rephrasing
  misunderstood questions
• B. Using multiple memory cues and giving several
  directions at once
• C. Correcting errors by the client, and speaking
  in a loud clear voiced.
• D. Encouraging verbal and nonverbal
  communication, while maintaining a calm demeanor

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Review Question

• The home health nurse is instructing a family who
  cares for a patient with dementia alzheimers
  type about safety measure would include
• A. Putting locks on the outside of doors so the
  patient can not leave the room or house
• B. Purchasing a MedicAlert bracelet that
  identifies the client as having DAT
• C. Chemically restraining the patient to prevent
  agitation and confusion
• D. Restraining the patient in a chair or bed to
  prevent falls

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Review Question

• The actual cause of dementia associated with
  dementia of the Alzheimers Type is
• A. Diabetes
• B. Infection
• C. Unknown
• D. Head trauma
• E. Drug intoxication

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Review Question

• One of the difference between delirium and
  dementia is that clients with delirium
• A. Are very attentive
• B. Experience a slow, insidious onset of symptoms
• C. Have fluctuating consciousness
• D. Respond to questions appropriately and
  correctly