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Cognitive Disorders (ATI Ch. 16)
Terms in this set (47)
Cognitive Disorders (group)
Are a group of conditions characterized by the disruption of thinking, memory, processing and problem solving. Requires a compassionate understanding of both the client and family.
2 types of cognitive disorders
delirium, neurocognitive disorders (mild or major),
is a subtype of neurocognitive disorder that is neurodegenerative, resulting in the gradual impairment of cognitive function. Depression in older adult mimics the early stages of Alzheimer's disease.
consist of physiological changes, including neurological (parkinson's, huntington), metabolic (hepatic, renal, fluid, electrolyte imbalances and nutritional deficiencies), cardiovascular disease, infections (HIV/AIDS) and substance use or withdrawal. This is the most common in older adult clients and clients in an intensive care unit.
neurocognitive disorder/alzheimers (risk)
consist of a disorder of the neurological system, advance age, prior head trauma, genetic factors, and a family history of Alzheimer's disease and/or trisomy (down syndrome)
rapid over a short period of time (hours or days)
neurocognitive disorder (onset)
gradual deterioration of function over months or years.
1 delirium (manifestations)
occurrence of impairments in memory, judgments, ability to focus, and ability to calculate; these impairments may fluctuate throughout the day. Level of consciousness is usually altered and may rapidly fluctuate. Personality change is rapid. 1
2 delirium (manifestations)
Restlessness, agitaiton, and fluctuating mood are common; sundowning (confusion during the night) may occur; behaviors may increase or decrease daily. Some perceptual disturbances may be present, such as hallucination and illusions. Vital signs may be unstable and abnormal due to medial illness. Delirium is reversible if diagnosis and treatment are prompt 2
1 Neurocognitive Disorder (manifestations)
impairment in memory, judgement, speech (aphasia), ability to recognize familiar objects (agnosia), executive functioning (managing daily tasks), and movement (apraxia); impairments do not change throughout the day. Level of consciousness is usually unchanged. 1
2 neurocognitve disorder (manifestations)
Restlessness, agitation are common; sundowning may occur; behaviors usually remain stable. personality change is gradual and vital signs are stable unless other illness is present. Neurocognitive disorders are irreversible and progressive. 2
caused secondary to another medical condition, such as infection or to substance use.
neurocognitive disorder (cause)
cognitive deficits are not related to another mental health disorder.
4 types of cognitive disorders
alzheimer's disease, traumatic brain injury, parkinson's disease and other disorders affecting the neurological system.
alzheimer's disease (stages)
it consist of 7 stages.
alzheimer's disease (stage 1)
no memory problems and no memory problems are evident to provider. No impairment (normal function)
alzheimer's disease (stage 2)
forgetfulness, especially of everyday objects (eyeglasses or wallet). No memory problems are evident to provider, friends or coworkers. Very mild cognitive decline, which may be normal age-related changes, or very early signs of Alzheimer's disease.
alzheimer's disease (stage 3)
mild cognitive decline, including problems with memory or concentration that may be measurable in clinical testing or during a detailed medical interview. includes losing or misplacing important objects, decreased ability to plan, short term memory loss noticeable to close relations. Decreers attention span, difficulty remembering words or names, difficulty in social or work situations.
alzheimer's disease (stage 4)
moderate cognitive decline (mild or early-stage Alzheimer's disease) that is clearly detected during a medical interview. Personality change: appearing withdrawn or subdued, especially in social or mentally challenging situations, obvious memory loss. Limited knowledge and memory of recent occasions, current events or personal history. Difficulty performing tasks that require paladin and organizing (bill or money). difficulty with complex mental arithmetic.
alzheimer's disease (stage 5)
moderately severe cognitive decline (moderate or mid-stage Alzheimer's disease) Increasing cognitive defects, disorientation and confusion as to time and place. Inability to recall important details, such as address and telephones number, but ability to remember information about self and family.
1 alzheimer's disease (stage 6)
severe cognitive decline (moderately severe or mid-stage Alzheimer's disease) continued worsening of memory difficulties. loss of awareness of recent events and surrounding, ability to real own name but not personal history. Evidence of significant personality changes (delusions, hallucinations, compulsive behaviors) wandering behaviors. 1
2 alzheimer's disease (stage 6)
assistance required for usual daily activities, such as dressing, toiling and other grooming. Disruption of normal sleep/wake cycle. Increased episodes of urinary and fecal incontinence. Violent tendencies with potential danger to self or others. 2
alzheimer's disease (stage 7)
very severe cognitive decline (severe or late-stage Alzheimer's disease). loss of ability to respond to environment, to speak, and to control movement. Unrecognizable speech, general urinary incontinence, inability to eat without assistance, and impaired swallowing. Gradual loss of all ability to move, super and coma. Death frequently related to chocking or infection.
cognitive disorder (3 types of defense)
denial, confabulation and perseveration. this is used by the client to preserve self-esteem and to compensate when cognitive changes are progressive.
is one of three types of defense mechanisms. The client and family members may refuse to believe that changes, such as loss of memory, are taking place, even when those chase are obvious to others.
is one of three types of defense mechanisms. The client may make up stories when questioned about events or activities that she does not remember. This may seem like lying, but it is actually an unconscious attempt to save self-esteem and prevent admitting that she does not remember the occasion.
is one of three types of defense mechanisms. The client avoids answering questions by repeating phrases or behavior. This is another unconscious attempt to maintain self-esteem when memory has failed.
alzheimer's disease (lab test)
chest and skull x-rays, EEG, ECG, liver function test, thyroid function test, neuroimaging, urinalysis and serum electrolytes.
alzheimer's disease (screening tools)
Functional dementia scale, Mental or mini-mental status examination, functional assessment screening tool, global deterioration scale and blessed dementia scale.
functional dementia scale
this tool will give the nurse information regarding the client's ability to perform self-care, the extent of the client's memory loss, mood changes, and the degree of danger to self and/or others.
blessed dementia scale
this tool provides the nurse with client behavioral information based on an interview with a secondary source such as a client's family member.
cognitive disorder (Care 1)
interventions are focused on protecting client from injury, as well as promoting client dignity and quality of life. Client needs to be close to the nurse station, low level of visual and auditory stimuli, well-lit environment, minimize contrast and shadows, room with windows orientation of time, ID bracelet, monitors and bed alarms, restraints as a last resort, monitor comfort level and assess for non-verbal indications of discomfort. 1
cognitive disorder (Care 2)
caution when administering PRN meds for agitation or anxiety. lower bed and remove scatter rugs to prevent fall, memory aids, clocks, calendars, photographs, seasonal decorations and familiar objects, eyeglasses, assistive hearing devices, daily routine, consistent caregiving, cover or remove mirrors to decrease fear and agitation. 2
cognitive disorder (communication)
calm, reassuring tone. Speak in positive rather than negatively worded phase. Do not argue or question hallucinations or delusions. Reinforce reality, orientation to time, place and person. Establish eye contact and use short, simple sentences when speaking to the client. One item of information at a time. Encourage reminiscence about happy times, familiar things. Instruct and activities into short timeframe. limit number of choices, minimize the need for decision and abstract thinking, avoid confrontation and encourage family visitation.
focuses on the treatment of the underlying disorder. Antipsychotic or anti anxiety medications may be prescribed.
neurocognitive disorder (meds)
Aricept, Exelon ad Razadyne. These medication increase acetylcholine at cholinergic synapses by inhibiting its breakdown by acetylcholinesterase, which increases the availability of acetylcholine at neurotransmitter receptor sites in the CNS.
neurocognitive disorder (therapeutic)
will improve clients ability to perform self-care and slow cognitive deterioration of Alzheimer's disease for clients in the mild to moderate stages.
neurocognitive disorder (adverse effects)
bradycardia, nausea and diarrhea for approximately 10% of the clients. Nurse need to monitor for GI adverse effects and for fluid volume deficits. Promote adequate fluid intake and provider might titrate dosage to reduce GI effects. Teach family to monitor pulse rate.
neurocognitive disorder (contraindications)
Cholinesterase inhibitors should be used with caution in cloth who have pre-existing asthma or other obstructive pulmonary disorder. Bronchoconstriction may be caused by an increase of acetylcholine.
neurocognitive disorder (interactions)
no concurrent use of NSAID's, such as aspirin, may cause GI bleeding. Antihistamines, TCA and conventional antipsychotics (medications that block cholinergic receptors) can reduce the therapeutic effects of donepezil. No cholinergic receptor blocking medication for clients taking cholinesterase inhibitor is not recommended.
neurocognitive disorder (considerations)
dosage should start low and gradually be increase until adverse effects are no longer tolerable or medication is no longer beneficial. monitor and education client and family about the adverse effects of medication. Medication needs to be tapered and monitor ability to swallow tablets. Donepezil is available in orally disintegrating table. Administer with food.
is a medication for cognitive disorder and has a long half-life and is administered once daily at bedtime. The other cholinesterase inhibitors are usually administer twice daily.
is a medication for cognitive disorder and blocks the entry of calcium into nerve cells, thus slowing down brain-cell death. This is only medication approved for moderate to sever stages of Alzheimer's disease. This may be used concurrently with a cholinesterase inhibitor, can be administer with or without food. Common adverse effects includes dizziness, headache, confusion and constipation.
estrogen therapy and ginkgo biloba
is a therapy for women and may prevent alzheimer's disease, but it is not useful in decreasing the effects of pre-existing cognitive deficits.
used by clients to enhance memory. this may lead to potential interactions, such as the risk for bleeding in clients taking anti platelet medications, as well as the risk for seizures in clients taking medications.
cognitive disorder (home safety)
remove scattered rugs, install door locks, lock water heater thermostat and turn water temp down to safe levels, good lighting, instal handrails on stairs, marked step edges with colored tape, place mattress on floor, remove cluster, keep clear, secure electrical cords to baseboards, lock cleaning supplies.
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