1. Neurocognitive Disorders
Chapter 23
Neurocognitive Disorders
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

2. Clinical Picture of Delirium
Alteration in level of consciousness
Disorientation
Anxiety
Agitation
Poor memory
Delusional thinking
Hallucinations
Delirium is a medical emergency
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

3. Application of the Nursing Process
Overall assessment
Four cardinal features of delirium
1. Acute onset and fluctuating course
2. Reduced ability to direct, focus, shift, and sustain attention
3. Disorganized thinking
4. Disturbance of consciousness
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

4. Nursing Process (Cont.)
Cognitive and perceptual disturbances
Illusions
Hallucinations
Physical needs
Moods and physical behaviors
Self assessment
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

5. Nursing Process (Cont.)
Diagnosis (Table 23-2)
Risk for injury
Acute confusion
Risk for deficient fluid volume
Outcomes identification (Table 23-3)
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

6. Nursing Process (Cont.)
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.
Evaluation
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

7. Dementia
Progressive deterioration of cognitive functioning and global impairment of intellect
No change in consciousness
Difficulty with memory, problem solving, and complex attention
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

8. Clinical Picture Mild neurocognitive disorders
Major neurocognitive disorders
Due to:
Alzheimer’s disease
Frontotemporal
Lewy bodies
Vascular
Traumatic brain injury
Substances
HIV infection
Prior disease
Parkinson’s disease
Huntington’s disease
Medical condition
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

9. Etiology of Alzheimer’s Disease
Biological factors
Neuronal degeneration
Risk factors
Cardiovascular disease
Social engagement and diet
Head injury and traumatic brain injury
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

10. Application of the Nursing Process
Assessment
General assessment
Defense mechanisms
Denial
Confabulation
Perseveration
Avoidance of questions
Self assessment
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

11. Symptoms of Alzheimer’s Disease
Memory impairment
Disturbances in executive functioning
Aphasia
Apraxia
Agnosia
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

12. Stages of Alzheimer’s Disease
Preclinical AD
Mild cognitive impairment (MCI)
Dementia due to AD
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

13. Case Study
A neighbor is concerned about her 85-year-old mother, who has dementia.
She asks you to help her decide what to do about her mother.
What are some important things to assess?
1. Evaluate the person's current level of cognitive and daily functioning.
2. Identify any threats to the person's safety and security and arrange their reduction.
3. Evaluate the safety of the person's home environment (e.g., with regard to wandering, eating inedible objects, falling, engaging in
provocative behaviors toward others).
4. Review the medications (including herbs, complementary agents) the patient is currently taking.
5. Interview family members to gain a complete picture of the person's background and personality.
6. Explore how well the family is prepared for and informed about the progress of the person's dementia, depending on cause (if known).
7. Discuss with family members how they are coping with the patient and their main issues at this time.
8. Review the resources available to the family. Ask family members to describe the help they receive from other family members, friends,
and community resources. Determine whether caregivers are aware of community support groups and resources.
9. Identify the needs of the family for teaching and guidance (e.g., how to manage catastrophic reactions, lability of mood, aggressive
behaviors, and nocturnal delirium and increased confusion and agitation at night [sundowning]).
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

14. Nursing Process (Cont.)
Diagnosis (Table 23-2)
Outcomes identification (Table 23-3)
Implementation
Person-centered care approach
Health teaching and health promotion
Pharmacological interventions
Integrative therapy
Evaluation
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

15. Case Study (Cont.)
What are some appropriate community resources you could suggest to your neighbor to help with her mother?
Transportation services
Supervision and care when the primary caregiver is out of the home
Referrals to day care centers
Information on support groups in the community
Meals on Wheels
Information on respite and residential services
Telephone numbers for help lines
Home health services
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

16. Audience Response Questions
Acute onset of disordered thinking is most associated with
delirium.
dementia.
depression.
ANS: A
Acute onset and fluctuating levels of awareness are key findings in delirium.
REF: 6, 11
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

17. Audience Response Questions
A patient with dementia attempts to brush his teeth with a spoon. Which problem is evident?
Aphasia
Apraxia
Agnosia
Perseveration
ANS: B
Apraxia is the loss of purposeful movement in the absence of motor or sensory impairment.
REF: 22
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.