COGNITIVE IMPAIRMENT (DEMENTIA AND DELIRIUM)HS3169 Adult Nursing 3Care of the older adultLecture1Read: Brunner & Suddarth Te!t"##$ #% Med&'a()ur*&'a( Nur&n* (+,th ed) --. ,+/ 0 ,,12 +345+33/. 2O"6e't&7e+. De%&ne de8ent&a.,. E!-(#re the -re7a(en'e #% de8ent&a &n S&n*a-#re./. Ident&%9 the t9-e and 'aue #% de8ent&a.:. De'r&"e the 98-t#8 #% de8ent&a.;. De'r&"e the 8ana*e8ent #% de8ent&a.5. De%&ne de(&r&u8.&thde8ent&a t#da9 & /1=111 and & -r#6e'ted t#&n'reae a the -#-u(atn a*ed. Un%#rtunate(9= there & *enera((9 a (a'$ #% -r#-erundertand&n* #% the 98-t#8 #r the "urden that"#th de8ent&a -at&ent and the&r 'are*&7er ha7e t# h#u(der. 56Year2005201020152020202520302035204020452050Pre7a(en'e (111) ,, /1 :1 ;/ 53 3, ++3 +:5 +h&'h & 'aued "9 8u(t&-(e tr#$e &n the "ra&n. BTrau8at&' "ra&n &n6ur9 'aued "9 8#t#r 7eh&'(e a''&dent %a((= et'. BIn%e'tn #% the 'entra( ner7#u 9te8 u'h a 8en&n*&t&. BChr#n&' a('#h#( #r dru* ue. !Caue #% de8ent&a '#nt.BDe-ren. BCerta&n t9-e #% h9dr#'e-ha(u= an e!'e a''u8u(atn #% %(u&d &n the "ra&n that 'an reu(t %r#8 de7e(#-8enta( a"n#r8a(&t&e= &n%e'tn= &n6ur9= #r "ra&n tu8#r. BA tud9 ha h#>n a (&n$ "et>een h&*h "(##d -reure and de7e(#-&n* de8ent&a. An et&8ated ;@ #% th#e #7er the a*e #% 5; ha7e de8ent&a= r&&n* t# ,1@ #7er the a*e #% 41. "T9-e #% de8ent&aBDe8ent&a 'an "e -(&t &nt# t># "r#ad 'ate*#r&e ))"aed #n >h&'h -art #% the "ra&n & a%%e'ted. BCortical de#entias ar&e %r#8 the 'ere"ra( '#rte!= the #uter (a9er #% the "ra&n that -(a9 a 'r&t&'a( r#(e &n th&n$&n* a"&(&t&e (&$e 8e8#r9 and (an*ua*e. Pe#-(e >&th '#rt&'a( de8ent&a t9-&'a((9 h#> e7ere 8e8#r9 (# and a-ha&a )) the &na"&(&t9 t# re'a(( >#rd and undertand (an*ua*e. 9T9-e #% de8ent&aBSu$cortical de#entias reu(t %r#8 d9%un'tn &n the -art #% the "ra&n that are "eneath the '#rte!.. V&'t&8 #% th& d&eae are (&$e(9 t# h#> 'han*e &n the&r -er#na(&t9 and attentn -an= and the (#>&n* d#>n #% the&r th&n$&n*. BThere are 8an9 'ae #% de8ent&a >here "#th -art #% the "ra&n tend t# "e a%%e'ted= u'h a 8u(t&)&n%ar't de8ent&a.10A(Ahe&8er d&eaeBM#t '#88#n 'aue #% de8ent&aBPreen'e #% neur&t&' -(a*ue '#nta&n&n* de-#&t #% "eta)a89(#&d -r#te&n &n the "ra&n.B In'reaed #% "eta)a89(#&d -r#te&n 'aue ner7e 'e(( t# d&e= neur#%&"r&((ar9 tan*(e &n the '#rte! and de*eneratn #% neur#n and 9na-e.BTh& reu(t &n 'e(( da8a*e and e7entua((9 'e(( death &n the -art #% the "ra&n that '#ntr#( 8e8#r9= th#u*ht and (an*ua*e.1112%la&ues and 'angles The %#r8atn #% a89(#&d -(aDue and neur#%&"r&((ar9 tan*(e are th#u*ht t# '#ntr&"ute t# the de*radatn #% the neur#n (ner7e 'e(() &n the "ra&n and the u"eDuent 98-t#8 #% A(Ahe&8er? d&eae.13Brain With Alzheimer's DiseaseThe cross-section on the left represents a normal brain and the one on the right represents a brain with Alzheimer's disease. Beta)a89(#&d -r#te&n &n the "ra&n.14Sta*e #% de8ent&aEar(9 ta*e: Pat&ent a--ear %#r*et%u( #r #''ana((9 re-eat h&8e(%. 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Redu'e en7&r#n8enta( '#n%unA--r#a'h -at&ent &n a -(eaant= 'a(8 >a9Intr#du'e 9#ure(% t# the -at&ent and *reet her Eee-theen7&r#n8ent&8-(eand-(ea&n*=re8#7ea(( un>anted uten&( %r#8 the r##8. Ma&nta&nare*u(arda&(9(&7&n*'hedu(e=#thatthe -at&ent >&(( *et t#u'h >&th the da&(9 (&7&n* a't&7&t&e. Pr#7&de 8e8#r9 de7&'e (&$e= (&t #% a't&7&t&e= re8&nd&n* n#te= (a"e( #n &te82 -&'ture= d&a*ra8 et'. >&(( a&t the -at&ent t# re8e8"er.1"Mana*e8ent #% de8ent&a,. In'reaed en7&r#n8enta( 'ue (It will enhance orientation to time place and person by filling memory gaps and serving as reminders) Ident&%9 9#ure(% >hen &ntera't&n* >&th the -at&ent Addre -at&ent "9 na8e %a'&(&tate #r&entatn t# e(%O%%eren7&r#n8enta('ue%#r#r&entatnt#t&8e=-(a'eand -er#nBr&n*the-at&entnearthe>&nd#>andh#>h&8the urr#und&n*Inter-reten7&r#n8enta(t&8u(atna-art#%the '#n7eratn(e.*.-rrt#>&t'h#nthe(&*ht(ate&nthe e7en&n*= te(( the -at&ent that the da9 & *#&n* t# "e #7er and >e need (&*ht= hen'e >&t'h #n the (&*ht) 19Mana*e8ent #% de8ent&a/. Redu'e an!&et9 -r#7#$&n* &tuatn &n da&(9 r#ut&neEee- rea(&t9 #r&entatn= n#n)threaten&n* "ut a''e-ta"(e t# the -at&ent (repeat the answer if the patient asks again and again)Be -at&en'e >&th %#r*et%u(neMa&nta&n a da&(9= re*u(arr#ut&ne # that the '(&ent& a"(et#re'a((the da&(9 a't&7&t&eS&8-(e tru'tured t&8u(&are ea&ett#&nter-ret(e.g.callthepatientbynamejust before lunch, tell him the exact time and about the lunch)Be>&ththe-at&entand(&tent#h&8>hatheFhea'tua((9>&ht# '#88un&'ate >&th 9#uA7#&d &tuatn that ha7e u-et -at&ent &n the -atD# n#t tr9 t# rea#n >&th the -at&ent (Patient is unable to conduct abstract thinking) 20Mana*e8ent #% de8ent&a:. Ma&ntenan'e #% a "a(an'e #% (ee- and a't&7&t9Redu'en&*ht)t&8ed&tra'tnu'han#&e=nur&n* -r#'edure #r 8&dn&*ht 8ed&'atn et'. 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