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

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

2. 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)

3. 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

4. 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)

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

6. Management of the Patient with Cognitive Impairments BehaviorCaregiver 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

7. Management of the Patient with Cognitive Impairments, Continued: BehaviorCaregiver 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)

8. Management of the Patient with Cognitive Impairments, continued: BehaviorCaregiver 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?”)

9. Management of the Patient with Cognitive Impairments, continued: BehaviorCaregiver 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.

10. Management of the Patient with Cognitive Impairments, continued: BehaviorCaregiver 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)

11. Management of the Patient with Cognitive Impairments, continued: BehaviorCaregiver 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)