Cognitive Impairments: There are many causes of cognitive impairment. Here are a few that you’ll most often encounter:  

Cognitive Impairments - Etiology/Distinguishing Characteristics: Right Hemisphere CVA: Flat affect, (ie, minimal facial expressions, monotone voice) Impulsivity, (eg, during transfers, walking, etc) Limited insight into their deficits Left neglect, (ie, poor recognition of or ignoring anything left of midline) (These behaviors are rare in patients with left hemisphere CVA)

Cognitive Impairments - Etiology/Distinguishing Characteristics, Continued: Traumatic Brain Injury Agitation Aggressive behaviors Inappropriate sexual behaviors Poor judgment, (eg, overstuffing mouth with food, climbing out of bed, etc.) Disorientation and memory deficits

Cognitive Impairments - Etiology/Distinguishing Characteristics, continued: Dementia Calling out/yelling Confusion/disorientation Wandering Agitation/combativeness Perseveration, (ie, patient repeats the same movement, says the same thing or keeps talking about the same topic repeatedly)

Etiology/Distinguishing Characteristics, continued: Alcohol/Drug Withdrawal Agitation Lethargy Combativeness Confusion

Management of the Patient with Cognitive Impairments Behavior Caregiver Response Aggression --Look for the trigger, (ie, is the patient overstimulated, in pain or uncomfortable?) --Stay calm --Distract/redirect the patient (ie, “Do you want something to drink?”) --Find out if they need to use the bathroom --Do not take any behaviors personally

Management of the Patient with Cognitive Impairments, Continued: Behavior Caregiver Response Wandering/Agitation --Allow the patient to move --Frequent walks with staff, if possible --Minimize restraints and tubes whenever possible, (instead, use distant supervision in a chair at nurse’s station vs in bed with restraints on)

Management of the Patient with Cognitive Impairments, continued: Behavior Caregiver Response Memory Loss/Disorientation --Provide orientation daily, (eg, “Good morning, Mr. ____, today is January 1, 2009. You’re at San Francisco General Hospital. My name is Mary.”) --Review memory book and/or calendar with patient --Encourage discussion of recent events, (eg, “You had dialysis this morning. Are you feeling better now?”)

Management of the Patient with Cognitive Impairments, continued: Behavior Caregiver Response Impulsivity --You may need to slow the patient down during meals and only place one food item at a time in front of the patient at meals. Impulsivity is also often seen during transfers or with the patient wanting to get out of bed and/or go home.

Management of the Patient with Cognitive Impairments, continued: Behavior Caregiver Response Left neglect --Stand to the patient’s left side --Encourage the patient to look left --Assist with meals, (eg, make sure the patient sees the food and/or drink on the left side of the meal tray)

Management of the Patient with Cognitive Impairments, continued: Behavior Caregiver Response Inappropriate Sexual Behavior --Ignore it --Redirect, (eg, if the patient tries to hug or kiss you, offer to give a high five or a hand shake instead)