NCM 116 – Care of Clients with Maladaptive SEM 02
Patterns of Behavior, Acute and Chronic FINALS
Lecturer: Dr. Cefer S. Sales, RN, MD, MHM, CHA
UNIT 4 – CHAPTER 24: COGNITIVE DISORDERS
TOPIC OUTLINE → Getting stuck on an idea rather than responding
I. Introduction to questions
II. Delirium → Being easily distracted
III. Dementia → Withdrawn, with little or no activity or little
response to surroundings
INTRODUCTION • Poor thinking skills
→ Poor memory, such as forgetting recent events
• Cognition is the brain’s ability to process, retain, and
→ Not knowing where they are or who they are
use information. Cognitive abilities include reasoning,
→ Trouble with speech or recalling words
judgment, perception, attention, comprehension, and
→ Rambling or nonsense speech
memory. These cognitive abilities are essential for
→ Trouble understanding speech, reading or writing
many important tasks, including making decisions,
• Behavior and emotional changes
solving problems, interpreting the environment, and
→ Anxiety, fear or distrust of others, Depression
learning new information.
→ A short temper or anger
• A Cognitive Disorder is a disruption or impairment in
→ A sense of feeling elated
these higher-level functions of the brain. Cognitive
→ Lack of interest and emotion, quiet and withdrawn
disorders can have devastating effects on the ability to
→ Quick changes in mood and Personality changes
function in daily life. They can cause people to forget
→ Seeing things that others don't see
the names of immediate family members, be unable to
→ Being restless, anxious or combative
perform daily household tasks, and neglect personal
→ Calling out, moaning or making other sounds
hygiene.
→ Slowed movement or being sluggish
→ Changes in sleep habits
DELIRIUM
• Delirium is a syndrome that involves a disturbance of CULTURAL CONSIDERATIONS
consciousness accompanied by a change in cognition. People from different cultural backgrounds may not
Delirium usually develops over a short period, be familiar with the information requested to assess
sometimes a matter of hours, and fluctuates, or memory, such as the name of former U.S. presidents.
changes, throughout the course of the day. Clients Other cultures may consider orientation to placement and
with delirium have difficulty paying attention, are easily location differently. Also, some cultures and religions,
distracted and disoriented, and may have sensory such as Jehovah’s Witnesses, do not celebrate birthdays,
disturbances such as illusions, misinterpretations, or so clients may have difficulty stating their date of birth.
hallucinations. The nurse should not mistake failure to know such
→ An electrical cord on the floor may appear to them
information for disorientation.
as a snake (illusion). They may mistake the
banging of a laundry cart in the hallway for a
TREATMENT AND PROGNOSIS
gunshot (misinterpretation). They may see
“angels” hovering above when nothing is there • The primary treatment for delirium is to identify and
(hallucination). At times, they also experience treat any causal or contributing medical conditions.
disturbances in the sleep–wake cycle, changes in Delirium is almost always a transient condition that
psychomotor activity, and emotional problems clears with successful treatment of the underlying
cause.
such as anxiety, fear, irritability, euphoria, or
apathy. Psychopharmacology
• Sedation to prevent inadvertent self-injury may be
ETIOLOGY indicated. Antipsychotic medication, such as
Delirium almost always results from an identifiable Haloperidol (Haldol), may be used in doses of 0.5 to
physiological, metabolic, or cerebral disturbance or 1 mg to decrease agitation and psychotic symptoms,
disease or from drug intoxication or withdrawal. Often, as well as to facilitate sleep.
delirium results from multiple causes and requires a • Historically, short- or intermediate-acting
careful and thorough physical examination and laboratory Benzodiazepines, such as Lorazepam (Ativan), have
tests for identification. been used, but Benzodiazepines may worsen
delirium, especially in the elderly. Their use should be
reserved for treatment of sedative-hypnotic
withdrawal.
Other Medical Treatment
• IV fluids or even total parenteral nutrition may be
necessary if a client’s physical condition has
deteriorated and he or she cannot eat and drink.
NURSING MANAGEMENT
• Do not allow the client to assume responsibility for
decisions or actions if he or she is unsafe.
SYMPTOMATOLOGY • If limits on the client’s actions are necessary, explain
Patterns of Behavior, Acute and Chronic FINALS
Lecturer: Dr. Cefer S. Sales, RN, MD, MHM, CHA
UNIT 4 – CHAPTER 24: COGNITIVE DISORDERS
TOPIC OUTLINE → Getting stuck on an idea rather than responding
I. Introduction to questions
II. Delirium → Being easily distracted
III. Dementia → Withdrawn, with little or no activity or little
response to surroundings
INTRODUCTION • Poor thinking skills
→ Poor memory, such as forgetting recent events
• Cognition is the brain’s ability to process, retain, and
→ Not knowing where they are or who they are
use information. Cognitive abilities include reasoning,
→ Trouble with speech or recalling words
judgment, perception, attention, comprehension, and
→ Rambling or nonsense speech
memory. These cognitive abilities are essential for
→ Trouble understanding speech, reading or writing
many important tasks, including making decisions,
• Behavior and emotional changes
solving problems, interpreting the environment, and
→ Anxiety, fear or distrust of others, Depression
learning new information.
→ A short temper or anger
• A Cognitive Disorder is a disruption or impairment in
→ A sense of feeling elated
these higher-level functions of the brain. Cognitive
→ Lack of interest and emotion, quiet and withdrawn
disorders can have devastating effects on the ability to
→ Quick changes in mood and Personality changes
function in daily life. They can cause people to forget
→ Seeing things that others don't see
the names of immediate family members, be unable to
→ Being restless, anxious or combative
perform daily household tasks, and neglect personal
→ Calling out, moaning or making other sounds
hygiene.
→ Slowed movement or being sluggish
→ Changes in sleep habits
DELIRIUM
• Delirium is a syndrome that involves a disturbance of CULTURAL CONSIDERATIONS
consciousness accompanied by a change in cognition. People from different cultural backgrounds may not
Delirium usually develops over a short period, be familiar with the information requested to assess
sometimes a matter of hours, and fluctuates, or memory, such as the name of former U.S. presidents.
changes, throughout the course of the day. Clients Other cultures may consider orientation to placement and
with delirium have difficulty paying attention, are easily location differently. Also, some cultures and religions,
distracted and disoriented, and may have sensory such as Jehovah’s Witnesses, do not celebrate birthdays,
disturbances such as illusions, misinterpretations, or so clients may have difficulty stating their date of birth.
hallucinations. The nurse should not mistake failure to know such
→ An electrical cord on the floor may appear to them
information for disorientation.
as a snake (illusion). They may mistake the
banging of a laundry cart in the hallway for a
TREATMENT AND PROGNOSIS
gunshot (misinterpretation). They may see
“angels” hovering above when nothing is there • The primary treatment for delirium is to identify and
(hallucination). At times, they also experience treat any causal or contributing medical conditions.
disturbances in the sleep–wake cycle, changes in Delirium is almost always a transient condition that
psychomotor activity, and emotional problems clears with successful treatment of the underlying
cause.
such as anxiety, fear, irritability, euphoria, or
apathy. Psychopharmacology
• Sedation to prevent inadvertent self-injury may be
ETIOLOGY indicated. Antipsychotic medication, such as
Delirium almost always results from an identifiable Haloperidol (Haldol), may be used in doses of 0.5 to
physiological, metabolic, or cerebral disturbance or 1 mg to decrease agitation and psychotic symptoms,
disease or from drug intoxication or withdrawal. Often, as well as to facilitate sleep.
delirium results from multiple causes and requires a • Historically, short- or intermediate-acting
careful and thorough physical examination and laboratory Benzodiazepines, such as Lorazepam (Ativan), have
tests for identification. been used, but Benzodiazepines may worsen
delirium, especially in the elderly. Their use should be
reserved for treatment of sedative-hypnotic
withdrawal.
Other Medical Treatment
• IV fluids or even total parenteral nutrition may be
necessary if a client’s physical condition has
deteriorated and he or she cannot eat and drink.
NURSING MANAGEMENT
• Do not allow the client to assume responsibility for
decisions or actions if he or she is unsafe.
SYMPTOMATOLOGY • If limits on the client’s actions are necessary, explain
