Gail Notes

Cognitive disorders: A group of disorders that are characterized by the disruption of or deficit in cognitive functioning.

Etiology: Has an organic cause.

1. Primary brain disease
2. The brains response to influences of systemic disturbances
3. The brain tissues reaction to an exogenous substance
4. Residual effects or withdrawal of an exogenous substance

Effects 5% of American population over 65

Delirium: AKA acute brain syndrome, acute confusion, acute psychosis, ICU psychosis. Hallmark sign is rapid onset of cognitive dysfunction. It interferes with social/occupational activities.

Clinical features of delirium:

1. Disordered cognition- Thinking, perception, and memory.
1. Thinking- disorganized, confused, and absent problem-solving abilities.
2. Perceptual- hallucinations and illusions.
3. Memory- short term memory is affected
2. Attention deficit- cannot focus or shift attention readily.
3. Reduced level of consciousness- may present itself in a fluctuating continuum. Alert yet easily distracted to barely able to rouse.

1. Alzheimer’s Disease:

The most prevalent of dementias and more frequent in women. There is a relationship between Alzheimer’s and downs syndrome, Parkinson’s disease, older age of mother, incidence of head injury, incidence of depression, and hypothyroidism. Etiology is unknown but there is a higher incidence of aluminum deposits in the brain. Also abnormally high antibody titers.

2. Vascular dementia:

Second most common form of dementia. Cognitive deficits arise from multiple infarcts in the cortex and white matter of the brain. Carotid arteries are 90% closed. Risk factors are parallel of those with stroke. Including, HTN, smoking, hyperlipidemia, diabetes and atrial fibrillation. Often verified by CT scan, MRI.

3. Parkinson’s disease:

Nuerodegenerative illness that progresses slowly. Involuntary muscle movement at rest accompanied by overall slowness and rigidity. Eldopa is the DOC. Language is intact but memory and executive functioning are not.

4. Huntington’s chorea: Autosomal dominant trait (50% inherit and 50% carry). Manifests between he ages of 35-45 years. Onset to death is approximately 15 years. Dance like movements that are intensified during stress. Attention deficit, slow thinking, memory deficit, deficiency in judgment. No Agnosia, Apraxia, aphasia. @ The age of 20-30 the frontal lobe begins to deteriorate and the client becomes labile, easily frustrated, irritable, hostile, and aggressive.
5. Picks disease: Resembles Alzheimer’s but occurs less frequently. Equally in men and women early to mid 50’s. Atrophy of the frontal and temporal brain portions
6. Creutzfeldt-Jakob Disease: Thought to be caused by a virus it targets the CNS. Has three distinct phases.
1. Dementia present in which mental changes are most pronounced.
2. Jerking followed by generalized myoclonus. Ataxia, dysarthia, and other cerebellar signs are present.
3. Coma, infections and respiratory problems.

1. Wernicke-Korsakoff Syndrome: Compulsion for ingestion of alcohol supercedes the need for nutritional needs. Thiamine (B-1) deficiency that directly interferes with the production of glucose. Interferes with brain/blood barrier for glucose. This is found in the 40-70 year old alcoholic with a steady and progressive alcohol intake.

1. Sensorium and attention deficits:

Stems from the client’s inability to use the information form the five senses. Confusion that affects attentiveness to the environment and ultimately to the level of consciousness. As LOC decreases the client is unable to concentrate.

2. Disorientation:
3. Perceptual and memory disturbances: recent memory loss
4. Sundown effect: behaviors worsen after sunset.
5. Degenerative impairments-

ASSESSMENT:

Focus on words and behavior. Client’s family is a reliable source for information (ask about sundown effect). Assess attention span, memory, LOC, orientation to person, place, and time.

Nursing diagnosis:

Altered thought process R/T decreased ability to interpret external stimuli.

Risk for violence to self or others R/T awareness or mental orientation.

Impaired social interaction

Plan of care should involve client’s family

Goals: to eliminate organic etiology if possible

To prevent acceleration of symptoms

To preserve the clients dignity

Interventions: Provide glasses/hearing aids if needed

Client does own ADLs even if messy

Decrease stimuli

Promote socialization

Question:

Which client is most likely to exhibit hyperalert and hypoalert state?

A client 18 hours post surgery.

SoutheasternNurse