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Chapter 93 Dementias and Related Disorders. Impairment of Mental Functioning. Confusion Delirium Mild cognitive impairment (MCI) Amnestic MCI Nonamnestic MCI Dementia Progressive dementia Pseudodementia. Question. Is the following statement true or false?
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Impairment of Mental Functioning • Confusion • Delirium • Mild cognitive impairment (MCI) • Amnestic MCI • Nonamnestic MCI • Dementia • Progressive dementia • Pseudodementia
Question Is the following statement true or false? A nurse needs to learn about the history of onset of cognitive dysfunction to decide if the client has confusion, delirium, or dementia.
Answer True When first meeting an individual who has a cognitive dysfunction, the nurse may find it difficult to determine if the disruption is owing to confusion, delirium, or dementia. Learning about the history of onset and observing the client’s level of consciousness and cognitive abilities can help differentiate the condition.
Types of Dementia • Alzheimer’s disease • Multi-infarct dementia • Parkinson’s disease • Wernicke-Korsakoff syndrome • Frontotemporal temporal dementia (FTD), Pick’s disease • Creutzfeldt-Jakob disease (infectious) • Huntington’s disease (HD, hereditary) • Dementia caused by AIDS
Types of Dementia (cont’d) • Crack-related dementia; dementias caused by other illegal drugs • Normal-pressure hydrocephalus • Brain trauma • Metabolic disorders (e.g., diabetes mellitus or end-stage renal disease) • Drug overdose (toxic dementia) • Dementia of tertiary syphilis (Bayle’s disease)
Dementia’s Common Terminology • Confabulation • Delusional • Dysphagia • Emotional liability • Paranoid • Agnosia • Akinesia • Aphagia • Aphasia • Apraxia • Compulsions
Alzheimer’s Disease • Theories of causes • Risk factors • Age, genetics, diet, environment • Education and continual use of mental abilities • Diseases that affect cerebral blood flow, such as stroke, heart disease, and hypertension • Low levels of the vitamin folate
Alzheimer’s Disease (cont’d) • Physiologic changes • Major changes occur in the brain • Cerebral cortex atrophy • Loss of neurons • Changes in brain cells
Alzheimer’s Disease (cont’d) • Description • Common symptoms • Memory loss, inability to learn and retain new information • Loss of judgment and planning skills • Personality and mood changes • Decreased reasoning and abstract thinking skills • Loss of language skills • Inability to care for self
Alzheimer’s Disease (cont’d) • Pharmacologic treatment • The goals • To prevent the development of AD • To slow the onset of symptoms • To reduce the symptoms
Diagnosis of Dementia • History • Physical and neurologic examination • Laboratory tests • CT scan, MRI, PET scan, and EEG • Psychometric testing • Functional assessment
Question Is the following statement true or false? If a person with dementia who resides in a long-term care facility wants to go home, it is important for the nurse to convince this person that the facility is his or her home.
Answer False The person with dementia who resides in a long-term care facility may want to go home. The nurse should not try to convince the resident that this is his or her home. It is not the “home” the resident knows. The nurse can make statements, such as “You are staying here. You are safe here.” Distracting the person by initiating an activity may also help.
Nursing Process • Data collection • Physical assessment • Psychological assessment • Determination of abilities to perform functional ADLs • Determination of abilities to perform complex or instrumental ADLs • Determination of support systems
Nursing Process (cont’d) • Planning and implementing • Assisting with daily care • Assisting with communication • Assisting with behavior management • Assisting caregivers • Evaluation
Question Is the following statement true or false? When communicating with a person with dementia, a nurse should restrain the person.
Answer False Restraints should be used only as a last resort. Restraining a client with dementia often causes more aggression. If the client becomes combative or hostile, have a safe place or room the client can stay and be monitored but not physically restrained.
