1. Contemporary Psychiatric-Mental Health Nursing Third Edition Contemporary Psychiatric-Mental Health Nursing Third Edition CHAPTER Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Cognitive Disorders 14

2. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Learning Objectives 1. Describe the characteristics of and risk factors for cognitive disorders. 2. Distinguish between delirium and dementia in terms of symptoms, course, treatment, and prognosis. 3. Apply the nursing process to the care of clients with cognitive disorders. 4. Identify methods for meeting the needs of people who provide care to clients with dementia. 5. Provide education to clients, families, caregivers, and community members to increase knowledge and understanding of cognitive disorders. 6. Evaluate your feelings, beliefs, and attitudes regarding clients with cognitive disorders.

3. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff What are Cognitive Disorders? Delirium Dementia Amnestic disorders

4. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Etiology Delirium –An underlying systemic illness Dementia –Classified as to the cause or area of brain damage Amnestic disorders –Head trauma, hypoxia, encephalitis, thiamine deficiency, and substance abuse

5. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Theories Genetics –Dementia of Alzheimer’s type  Binswanger’s disease –Dementia from Huntington’s disease –Dementia from Pick’s disease

6. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Theories (cont'd) Infection –Delirium –Dementia from Creutzfeldt–Jakob disease –Parkinson’s disease –Amniotic disorders

7. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Theories (cont'd) Vascular insufficiency—Binswanger’s Disease –Brain tissue destroyed –Symptoms absent until 100–200 cc of brain tissue destroyed Underlying systemic illness or injury –Delirium –Amnestic disorders

8. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff DELIRIUM is a syndrome that involves a disturbance of consciousness accompanied by a change in cognition. Delirium usually develops over a short period, sometimes a matter of hours, and fluctuates, or changes, throughout the course of the day

9. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff S&S Difficulty paying attention, are easily distracted and disoriented, and may have sensory disturbances such as illusions, misinterpretations, or hallucinations. An electrical cord on the floor may appear to them to be a snake (illusion). They may mistake the banging of a laundry cart in the hallway for a gunshot (misinterpretation). They may see “angels” hovering above when nothing is there (hallucination). Experience disturbances in the sleep–wake cycle, changes in psychomotor activity, and emotional problems such as anxiety, fear, irritability, euphoria, or apathy

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11. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Etiology Delirium almost always results from an identifiable physiologic, metabolic, or cerebral disturbance or disease or from drug intoxication or withdrawal

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13. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Treatment Sedation to prevent inadvertent self-injury may be indicated. An antipsychotic medication, such as haloperidol (Haldol), may be used to decrease agitation. Sedatives and benzodiazepines are avoided because they may worsen delirium. Clients with impaired liver or kidney function could have difficulty metabolizing or excreting sedatives. The exception is delirium induced by alcohol withdrawal, which usually is treated with benzodiazepines

14. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Dementia is a mental disorder that involves multiple cognitive deficits, primarily memory impairment, and at least one of the following cognitive disturbances.

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16. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Treatment Treat the underlying cause;For example, the progress of vascular dementia, the second most common type, may be halted with appropriate treatment of the underlying vascular condition (e.g., changes in diet, exercise, control of hypertension, or diabetes). Improvement of cerebral blood flow may arrest the progress of vascular dementia in some people

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18. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Amnestic disorders Are characterized by a disturbance in memory that results directly from the physiologic effects of a general medical condition or the persisting effects of a substance such as alcohol or other drugs

19. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff S&S The memory disturbance is sufficiently severe to cause marked impairment in social or occupational functioning and represents a significant decline from previous functioning. Confusion, disorientation, and attentional deficits are common

20. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff 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

21. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Differentiating Types of Cognitive Disorders (cont'd) Amnestic disorders –Uncommon cognitive disorder characterized by amnesia

22. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Delirium and Dementia Differences Delerium –Fluctuating consciousness –Ability to pay attention/respond –Short-lived –Rapid onset –Can be linked to a cause –May be reversible

23. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Delirium and Dementia Differences (cont'd) Dementia –Stable levels of consciousness –Steady attentiveness –Chronic –Slow insidious onset –Undetermined cause –Generally irreversible

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25. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff difference between dementia and amnestic disorders The main difference between dementia and amnestic disorders is that once the underlying medical cause is treated or removed, the client’s condition no longer deteriorates

26. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff 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

27. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Assessment Delirium –Fluctuating levels of consciousness –Disorientation and sundowning is a psychological phenomenon associated with increased confusion and restlessness in patients with some form of dementiadementia –Impaired reasoning –Poor attention span –Altered sleep–wake cycle –Alternating patterns of motor behavior

28. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Assessment (cont'd) Dementia –Memory impairment –Cognitive impairment Aphasia, which is deterioration of language function. Apraxia, which is impaired ability to execute motor functions despite intact motor abilities

29. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Agnosia, which is inability to recognize or name objects despite intact sensory abilities Disturbance in executive functioning, which is the ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior –Poor judgment –Decline in previous abilities

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31. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff 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

32. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Interventions for Delirium (cont'd) Keep environmental noise low Set limits on behavior 1:1 staffing as needed

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37. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff 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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42. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Supporting Optimal Memory Functioning Environmental reminders Reminiscence activities: involves exchanging memories with the old and young, friends and relatives with HCPs Triggers for semantic memory Support cognitive strengths Assist to cope with cognitive deficits

43. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Caregiver Difficulties Wandering behaviors Sundowning disorientation ADLs Medication management Burnout and fatigue

44. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Caregiver Resources Family meetings Alzheimer’s Disease and Related Disorders Association (ADRDA) Caregiver support groups Attorney Identify community resources ID bracelet for the client

45. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff 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.