Cognitive Impairment

COGNITIVE IMPAIRMENT (DEMENTIA AND DELIRIUM)HS3169 Adult Nursing 3Care of the older adultLecture1Read: Brunner & Suddarth Te!t"##$ #% Med&'a()ur*&'a( Nur&n* (+,th ed) --. ,+/ 0 ,,12 +345+33/. 2O"6e't&7e+. De%&ne de8ent&a.,. E!-(#re the -re7a(en'e #% de8ent&a &n S&n*a-#re./. Ident&%9 the t9-e and 'aue #% de8ent&a.:. De'r&"e the 98-t#8 #% de8ent&a.;. De'r&"e the 8ana*e8ent #% de8ent&a.5. De%&ne de(&r&u8.&thde8ent&a t#da9 & /1=111 and & -r#6e'ted t#&n'reae a the -#-u(atn a*ed. Un%#rtunate(9= there & *enera((9 a (a'$ #% -r#-erundertand&n* #% the 98-t#8 #r the "urden that"#th de8ent&a -at&ent and the&r 'are*&7er ha7e t# h#u(der. 56Year2005201020152020202520302035204020452050Pre7a(en'e (111) ,, /1 :1 ;/ 53 3, ++3 +:5 +h&'h & 'aued "9 8u(t&-(e tr#$e &n the "ra&n. BTrau8at&' "ra&n &n6ur9 'aued "9 8#t#r 7eh&'(e a''&dent %a((= et'. BIn%e'tn #% the 'entra( ner7#u 9te8 u'h a 8en&n*&t&. BChr#n&' a('#h#( #r dru* ue. !Caue #% de8ent&a '#nt.BDe-ren. BCerta&n t9-e #% h9dr#'e-ha(u= an e!'e a''u8u(atn #% %(u&d &n the "ra&n that 'an reu(t %r#8 de7e(#-8enta( a"n#r8a(&t&e= &n%e'tn= &n6ur9= #r "ra&n tu8#r. BA tud9 ha h#>n a (&n$ "et>een h&*h "(##d -reure and de7e(#-&n* de8ent&a. An et&8ated ;@ #% th#e #7er the a*e #% 5; ha7e de8ent&a= r&&n* t# ,1@ #7er the a*e #% 41. "T9-e #% de8ent&aBDe8ent&a 'an "e -(&t &nt# t># "r#ad 'ate*#r&e ))"aed #n >h&'h -art #% the "ra&n & a%%e'ted. BCortical de#entias ar&e %r#8 the 'ere"ra( '#rte!= the #uter (a9er #% the "ra&n that -(a9 a 'r&t&'a( r#(e &n th&n$&n* a"&(&t&e (&$e 8e8#r9 and (an*ua*e. Pe#-(e >&th '#rt&'a( de8ent&a t9-&'a((9 h#> e7ere 8e8#r9 (# and a-ha&a )) the &na"&(&t9 t# re'a(( >#rd and undertand (an*ua*e. 9T9-e #% de8ent&aBSu$cortical de#entias reu(t %r#8 d9%un'tn &n the -art #% the "ra&n that are "eneath the '#rte!.. V&'t&8 #% th& d&eae are (&$e(9 t# h#> 'han*e &n the&r -er#na(&t9 and attentn -an= and the (#>&n* d#>n #% the&r th&n$&n*. BThere are 8an9 'ae #% de8ent&a >here "#th -art #% the "ra&n tend t# "e a%%e'ted= u'h a 8u(t&)&n%ar't de8ent&a.10A(Ahe&8er d&eaeBM#t '#88#n 'aue #% de8ent&aBPreen'e #% neur&t&' -(a*ue '#nta&n&n* de-#&t #% "eta)a89(#&d -r#te&n &n the "ra&n.B In'reaed #% "eta)a89(#&d -r#te&n 'aue ner7e 'e(( t# d&e= neur#%&"r&((ar9 tan*(e &n the '#rte! and de*eneratn #% neur#n and 9na-e.BTh& reu(t &n 'e(( da8a*e and e7entua((9 'e(( death &n the -art #% the "ra&n that '#ntr#( 8e8#r9= th#u*ht and (an*ua*e.1112%la&ues and 'angles The %#r8atn #% a89(#&d -(aDue and neur#%&"r&((ar9 tan*(e are th#u*ht t# '#ntr&"ute t# the de*radatn #% the neur#n (ner7e 'e(() &n the "ra&n and the u"eDuent 98-t#8 #% A(Ahe&8er? d&eae.13Brain With Alzheimer's DiseaseThe cross-section on the left represents a normal brain and the one on the right represents a brain with Alzheimer's disease. Beta)a89(#&d -r#te&n &n the "ra&n.14Sta*e #% de8ent&aEar(9 ta*e: Pat&ent a--ear %#r*et%u( #r #''ana((9 re-eat h&8e(%. S#8et&8e the9 "eha7e #dd(9 and "e'#8e >&thdra>n= (ethar*&' #r a*&tated. M&-(a'&n* th&n*. La'$ #% 8#t&7atn t# >#r$. 15Sta*e #% de8ent&a(iddle stage: In th& ta*e= the 'han*e "e'#8e 8#re n#t&'ea"(e. The 8e8#r9 (a-e are 8#re #"7u. Beha7ur "e'#8e -r#"(e8at&' and 8a9 &nter%ere >&th n#r8a( da9)t#)da9 a't&7&t&e. BE!a8-(e are >ander&n* and *ett&n* (#t= re-eat&n* >#rd= ne*(e't&n* -er#na( h9*&ene= (#&n* tra'$ #% t&8e and e7ent= %#r*ett&n* the na8e #% '#88#n #"6e't and %a8&(&ar -e#-(e= &rr&ta"&(&t9 and a*&tatn= und#>n 9ndr#8e (&n'reaed "eha7ur -r#"(e8 a%ter the un *#e d#>n).16Sta*e #% de8ent&aBLate stage) Pat&ent & una"(e t# re'#*n&Ae %a8&(9 8e8"er. Need he(- &n -er#na( 'are u'h a "ath&n*= *#&n* t# the "athr##8= dre&n* and eat&n*. S-ee'h 8a9 "e d&%%&'u(t t# undertand and 8a9 n#t '#8-rehend >hat & "e&n* a&d.1!Mana*e8ent #% de8ent&a+. Redu'e en7&r#n8enta( '#n%unA--r#a'h -at&ent &n a -(eaant= 'a(8 >a9Intr#du'e 9#ure(% t# the -at&ent and *reet her Eee-theen7&r#n8ent&8-(eand-(ea&n*=re8#7ea(( un>anted uten&( %r#8 the r##8. Ma&nta&nare*u(arda&(9(&7&n*'hedu(e=#thatthe -at&ent >&(( *et t#u'h >&th the da&(9 (&7&n* a't&7&t&e. Pr#7&de 8e8#r9 de7&'e (&$e= (&t #% a't&7&t&e= re8&nd&n* n#te= (a"e( #n &te82 -&'ture= d&a*ra8 et'. >&(( a&t the -at&ent t# re8e8"er.1"Mana*e8ent #% de8ent&a,. In'reaed en7&r#n8enta( 'ue (It will enhance orientation to time place and person by filling memory gaps and serving as reminders) Ident&%9 9#ure(% >hen &ntera't&n* >&th the -at&ent Addre -at&ent "9 na8e %a'&(&tate #r&entatn t# e(%O%%eren7&r#n8enta('ue%#r#r&entatnt#t&8e=-(a'eand -er#nBr&n*the-at&entnearthe>&nd#>andh#>h&8the urr#und&n*Inter-reten7&r#n8enta(t&8u(atna-art#%the '#n7eratn(e.*.-rrt#>&t'h#nthe(&*ht(ate&nthe e7en&n*= te(( the -at&ent that the da9 & *#&n* t# "e #7er and >e need (&*ht= hen'e >&t'h #n the (&*ht) 19Mana*e8ent #% de8ent&a/. Redu'e an!&et9 -r#7#$&n* &tuatn &n da&(9 r#ut&neEee- rea(&t9 #r&entatn= n#n)threaten&n* "ut a''e-ta"(e t# the -at&ent (repeat the answer if the patient asks again and again)Be -at&en'e >&th %#r*et%u(neMa&nta&n a da&(9= re*u(arr#ut&ne # that the '(&ent& a"(et#re'a((the da&(9 a't&7&t&eS&8-(e tru'tured t&8u(&are ea&ett#&nter-ret(e.g.callthepatientbynamejust before lunch, tell him the exact time and about the lunch)Be>&ththe-at&entand(&tent#h&8>hatheFhea'tua((9>&ht# '#88un&'ate >&th 9#uA7#&d &tuatn that ha7e u-et -at&ent &n the -atD# n#t tr9 t# rea#n >&th the -at&ent (Patient is unable to conduct abstract thinking) 20Mana*e8ent #% de8ent&a:. Ma&ntenan'e #% a "a(an'e #% (ee- and a't&7&t9Redu'en&*ht)t&8ed&tra'tnu'han#&e=nur&n* -r#'edure #r 8&dn&*ht 8ed&'atn et'. Ta$e 8eaure8ent t# &n'reae a%et9Pr#7&de adeDuate n&*ht)(&*htEnhan'e '#8%#rt &% a>a$e at n&*htA7#&d ue #% retra&nt De&*n a "a(an'ed 'hedu(e #% a't&7&t9 F (ee- In'reaeda9t&8e>a$e%u(neanden'#ura*eh#rt ret than (#n* t&8e retEn'#ura*ere*u(are!er'&eanda't&7&t9-r#*ra8t# 8#"&(&Ae6#&nt(ailyactivityandexercisereduceagitationandproduce soothening and a calming effect)21Mana*e8ent #% de8ent&a;. Ma&ntenan'e #% #-t&8a( (e7e( #% nutr&tn M#n&t#r %##d &nta$e and #"er7e %##d ha"&tN#te >e&*ht (# #r *a&nPr#7&de re*u(ar 8ea(t&8e 'hedu(eEn'#ura*e adeDuate %(u&d &nta$ePr#7&de "a(an'ed d&et. I% the '(&ent & una"(e t# %eed h&8e(%= %eed the -at&ent2 dur&n* %eed&n* narrate h#rt t#r&e >h&'h t&8u(ate a--et&te a >e(( a '#n'entratnMa&nta&n a 'a(8 and -(eaant at8#-hereO%%er a 8enu 'h#&'e &% -#&"(eO%%er %a8&(&ar %##d (Pleasant mealtime if favourite and familiar food is served, the client will eat well with enjoyment). 22Mana*e8ent #% de8ent&aBN# 'ure %#r de8ent&a un(e the &t & due t# #8e Gtreata"(e under(9&n* 'aue.BPre7entn & the "et. BL&7e an a't&7e (&%e= "#th 8enta((9 and -h9&'a((9 and t# 8ana*e tre >e((.BMed&'atn >h&'h 8&*ht '#ntr&"ute t# -re7ent the #net #% de8ent&a= &n'(ud&n* h9-ertenn 8ed&'atn t# -re7ent tr#$e= -9'h#t&' dru*= ant&de-reant t# -re7ent e7ere de-ren.23Med&'atn %#r de8ent&aBCh#(&neterae &nh&"&t#r) redu'e the enA98at&' de*radatn #% a'et9('h#(&ne &n the 9na-e thu enhan'&n* neur#n t# neur#n '#88un&'atn.BIe D#ne-eA&( Ch#(&neterae &nh&"&t#r.2425*oll thera+ and et thera+ can hel to cal# disoriented atientsMana*&n* d&%%&'u(t "eha7ur #% de8ent&a ) A(Ahe&8er D&eae A#'&atn (S&n*a-#re).BD# n#t e!-e't the -er#n t# re8e8"er.BD#nt a9= H D#nt 9#u re8e8"erIJBKhen the 7&'t&8 "e'#8e a*&tated tr9 t# d&tra't h&8Fher >&th an#ther a't&7&t9.BBe %(e!&"(e 0 &% the "eha7ur & n#t har8%u( t# an9#ne #r h&8e(%Fhere(% (et &% "e.BS&8-(&%9 a't&7&t9 a heFhe >&(( #n(9 "e a"(e t# %#'u &% &t & te- "9 te-.26Mana*&n* d&%%&'u(t "eha7ur #% de8ent&a) A(Ahe&8er D&eae A#'&atn (S&n*a-#re).BCreate r#ut&ne %#r da&(9 a't&7&t&e t# de'reae an!&et9.BO%%er -ra&e and reaure t# re&n%#r'e *##d "eha7ur. Ue thera-eut&' '#88un&'atn.BRe8#7e th&n* that tr&**er #%% d&%%&'u(t "eha7ur.BEn'#ura*e 'are*&7er t# 6#&n u--#rt *r#u- t# (earn t# '#-e.2!Sa%et9 8eaure +.Se'ure area >&th 'h&(d)-r##% (#'$ # that the -er#n 'ann#t >ander %r#8 the h#8e. ,. Ca7e the -er#n >ear &dent&%&'atn "ra'e(etF(an9ard #r ha7e &n%#r8atn &n -#'$etF>a((et. In'(ude na8e= -h#ne nu8"er #% 'are*&7er= addre and n#tatn ?8e8#r9 (#.? /. D# n#t (ea7e the -er#n at h#8e a(#ne.:. Se'ure the $&t'hen:Eee- %(a88a"(e #"6e't a>a9.L#'$ u- $n&7e.Ue a%et9 (at'he #n 'u-"#ard.2"De(&r&u8BDe(&r&u8 & a udden #r a"ru-t 'han*e &n'#*n&t&7e%un'tnand"eha7ur (a'ute '#n%una( tate) 'hara'ter&Aed "9 %(u'tuatn &n en#r&u8BC#88#n*er&atr&'9ndr#8ea%%e't&n* the &'$ #r %ra&( #(der -at&ent29C(&n&'a( 8an&%etatn #% de(&r&u8BSudden #netBDr&entatnBDr#>&neBM&&nter-retatnBParan#&d &deaBCa((u'&natnBRa8"(&n* &n'#herent -ee'hBRet(ene= n#&9Fa**re&7e "eha7ur30Caue #% de(&r&u8 &n e(der(9BBra&n drder (tu8#r= "(eed&n*= tr#$e)BP#t #-erat&7e tateBC#nt&-atnBDe-renBDeh9dratnBDru* BC9-#!&aBAnae8&a BIn%e'tnBMeta"#(&' drderBRena( and (&7er %a&(ureBEnd#'r&ne drderBUntreated -a&nBUr&nar9 retentnBV&ta8&n B de%&'&en'9BA('#h#( #r dru* >&thdra>a(31Mana*e8ent #% de(&r&u8BDe(&r&u8 & treata"(e.BDeter8&ne the 'aue and treat &t.BDru* 0 ha(#-er&d#( &% ha((u'&nated #r -aran#&d.BA7#&d retra&nt a 8u'h a -#&"(e.BA((a9 %ear 0 -r#7&de reauran'e.BPr#7&de a Du&et and 'a(8 en7&r#n8ent.BEee- the -(a'e and -e#-(e %a8&(&ar.BD# n#t 'han*e the "ed -#&tn.BEn*a*ed the he(- #% %a8&(9 'are*&7er.3233Ho, does deliriu# differs fro# de#entia)There are t># 8a&n 'r&ter&a:+. De(&r&u8 #''ur #7er a h#rt -erd #% t&8e= uua((9 da9 #r e7en h#ur >herea de8ent&a #''ur #7er >ee$= 8#nth= #r 9ear. ,. De(&r&u8 (at %#r a 8ere %e> da9 #r >ee$ >h&(e de8ent&a & (#n* (at&n*.Ke"&tehtt-:FF>>>.a(Ahe&8er.#r*.*F&nde!.ht8htt-:FF>>>/.ntu.edu.*Fh#8e,11/F'he>11+,F',,