Chapter 23
Neurocognitive Disorders
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Clinical Picture of Delirium
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Alteration in level of consciousness
Disorientation
Anxiety
Agitation
Poor memory
Delusional thinking
Hallucinations
Delirium is a medical emergency
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Application of the Nursing Process
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Overall assessment
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Four cardinal features of delirium
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4.
Acute onset and fluctuating course
Reduced ability to direct, focus, shift, and sustain attention
Disorganized thinking
Disturbance of consciousness
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Nursing Process (Cont.)
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Cognitive and perceptual disturbances
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Illusions
Hallucinations
Physical needs
Moods and physical behaviors
Self assessment
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Nursing Process (Cont.)
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Diagnosis (Table 23-2)
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Risk for injury
Acute confusion
Risk for deficient fluid volume
Outcomes identification (Table 23-3)
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Nursing Process (Cont.)
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Implementation
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Prevent physical harm due to confusion, aggression,
or fluid and electrolyte imbalance.
Perform comprehensive nursing assessment to aid in
identifying cause.
Assist with proper health management to eradicate
underlying cause.
Use supportive measures to relieve distress.
Evaluation
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Dementia
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Progressive deterioration of cognitive functioning
and global impairment of intellect
No change in consciousness
Difficulty with memory, problem solving, and
complex attention
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Clinical Picture
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Mild neurocognitive disorders
Major neurocognitive disorders
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Due to:
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Alzheimer’s disease
Frontotemporal
Lewy bodies
Vascular
Traumatic brain injury
Substances
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HIV infection
 Prior disease
 Parkinson’s disease
 Huntington’s disease
 Medical condition
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Etiology of Alzheimer’s Disease
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Biological factors
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Neuronal degeneration
Risk factors
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Cardiovascular disease
Social engagement and diet
Head injury and traumatic brain injury
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Application of the Nursing Process
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Assessment
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General assessment
• Defense mechanisms
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Denial
Confabulation
Perseveration
Avoidance of questions
Self assessment
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Symptoms of Alzheimer’s Disease
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Memory impairment
Disturbances in executive functioning
Aphasia
Apraxia
Agnosia
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Stages of Alzheimer’s Disease
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Preclinical AD
Mild cognitive impairment (MCI)
Dementia due to AD
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Case Study
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A neighbor is concerned about her 85-year-old
mother, who has dementia.
She asks you to help her decide what to do
about her mother.
What are some important things to assess?
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Nursing Process (Cont.)
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Diagnosis (Table 23-2)
Outcomes identification (Table 23-3)
Implementation
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Person-centered care approach
Health teaching and health promotion
Pharmacological interventions
Integrative therapy
Evaluation
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Case Study (Cont.)
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What are some appropriate community
resources you could suggest to your neighbor to
help with her mother?
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Audience Response Questions
1. Acute onset of disordered thinking is most
associated with
A. delirium.
B. dementia.
C. depression.
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Audience Response Questions
2. A patient with dementia attempts to brush his
teeth with a spoon. Which problem is evident?
A. Aphasia
B. Apraxia
C. Agnosia
D. Perseveration
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