Gwendolyn de Geest, RN, BSN, MA

Managing Responsive

Behaviors In Care

Alterations in Cognition• Delirium

• Dementia

• Depression

Maria Martin, VCC BSN student, 2011

Delirium

• Acute

• Reversible

• Physiological, psychosocial, environmental factors

Dementia

• Chronic, progressive

• Symptoms- loss of memory- poor judgment- mood swings- disorientation

Alzheimer’s Disease

• Dr. Alois Alzheimer

• 1906 – Auguste D.

• Frankfurt, Germany

• Plaques and Tangles

Aaron Copland90 yrs

Rita Hayworth68 yrs

Aaron Copland90 yrs

Sugar Ray Robinson

67 yrs

Burgess Meredith89 yrs

Barry Goldwater89 yrs

E.B. White86 yrs

AlzheimerDisease

Normal Brain

TIME July 17, 2000

Language

Memory

Language

Memory

GREEN

RED

GREEN

BLUE

RED

BLUE

BLUE

RED

BLUE

GREEN

GREEN

RED

Attention / Frontal Lobe Skills

The ThiefofMemory

• The person remains

• The person’s humanity remains

• Communicates with feelings, not words

Impact on Communication

Depression

• Chronic

• Reversible

• Often mistaken for dementia

• Reason for every behavior

• Check out approach

• Apraxia, Agnosia, Aphasia

Responsive Behaviors

Maria Martin, VCC BSN student, 2011

Apraxia

Loss of ability to take purposeful action even when muscles, senses, and vocabulary seem intact.

Agnosia

Inability to recognize objects by use of the senses.

Aphasia

Inability to use or understand language (spoken or written).

1. expressive aphasia

2. receptive aphasia

Intervention Strategies (1)• Calm approach

• Explore cause of behavior

• Understanding

• Education and support for family

Intervention Strategies (2)• Apraxia

- loss of independence

• Agnosia- environment

• Aphasia- frustration

Communication Strategies• Reminiscence

• Simple repetition

• Appropriate touch

• Distraction- catastrophic reaction

Nursing Process Application• Situation

86yr-old woman exhibits disturbed attention and confusion

• Nursing diagnosis ineffective coping related to organic

memory loss

Nursing Process Application• Nursing goal

minimize factors that contribute to inattention

• Nursing approach supportive, calm

Nursing Process ApplicationNursing intervention• Direct eye contact

• Use of appropriate touch

• Clear, simple direction

• Repeat messages slowly

• Modify environmental stimuli

• Assist family to understand

Evaluation of Successful Outcomes

• Does not occur through words

• Behavior

• Co-operation

• Positive response

References

• Arnold & Boggs, Interpersonal Relationships

• De Geest, G., Living Dementia Case-Study Approach

• Potter & Perry, Canadian Fundamentals of Nursing