FINALS

• Cognition


  The brain's ability to process, retain, and use information
• Cognitive abilities


  • Reasoning, judgment, perception, attention, comprehension, and memory
• Dementia


  Previously categorized adult cognitive disorders, now called neurocognitive disorders (NCDs) in DSM-5
• Delirium


  A syndrome that involves a disturbance of consciousness accompanied by a change in cognition
• Delirium usually develops over a short period, sometimes a matter of hours, and fluctuates, or changes, throughout the course of the day
• Clients with delirium


  • Have difficulty paying attention, are easily distracted and disoriented, and may have sensory disturbances such as illusions, misinterpretations, or hallucinations
• Groups most frequently diagnosed with delirium

  • Elderly patients
  • 10% to 15% of general surgical patients
  • 30% of open heart surgery patients
  • More than 50% of patients treated for fractured hips
  • 80% of terminally ill patients
• Most common causes of delirium

  • Physiological or metabolic
  • Infection
  • Drug related
• Primary treatment for delirium

  Identify and treat any causal or contributing medical conditions
• Dementia


  A disease process marked by progressive cognitive impairment with no change in the level of consciousness
• Cognitive disturbances seen in dementia

  • Aphasia (deterioration of language function)
  • Apraxia (impaired ability to execute motor functions despite intact motor abilities)
  • Agnosia (inability to recognize or name objects despite intact sensory abilities)
  • Disturbance in executive functioning (ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior)
• Stages of dementia

  • Mild: Forgetfulness
  • Moderate: Confusion and progressive memory loss
  • Severe: Personality and emotional changes, delusional, wandering, require assistance with ADLs
• Alzheimer's disease


  • A progressive brain disorder with gradual onset, causing increasing decline in functioning including loss of speech, loss of motor function, and profound personality and behavioral changes
• Lewy body dementia


  • Involves progressive cognitive impairment and extensive neuropsychiatric symptoms as well as motor symptoms, with common delusions and visual hallucinations
• Vascular dementia


  • Symptoms similar to Alzheimer's but with abrupt onset, rapid changes in functioning, plateaus, and more abrupt changes
• Frontotemporal lobar degeneration


  • A degenerative brain disease that particularly affects the frontal and temporal lobes, resulting in a clinical picture similar to Alzheimer's
• Prion diseases


  • Caused by a prion (protein) that can trigger normal proteins in the brain to fold abnormally, such as Creutzfeldt-Jakob disease
• HIV infection


  • Can lead to dementia and other neurologic problems, either directly from invasion of nervous tissue or from other AIDS-related illnesses
• Parkinson's disease


  • A slowly progressive neurologic condition characterized by tremor, rigidity, bradykinesia, and postural instability
• Huntington's disease


  • An inherited, dominant gene disease involving cerebral atrophy, demyelination, and enlargement of brain ventricles, with choreiform movements
• Traumatic brain injury


  • Can cause dementia as a direct pathophysiological consequence, with degree and type of impairment depending on location and extent of injury
• Korsakoff syndrome/dementia


  • Dementia resulting from long-term alcohol use, with amnesia and confabulation as common symptoms
• Nursing assessment of clients with dementia

  Frequent breaks, simple questions, allowing time to answer, mental status exam to assess cognitive abilities
• Clients display aphasia, apraxia, and loss of ability to solve problems or take action in new situations
• Dementia profoundly affects client's roles, relationships, and ability to live independently
• Clients with dementia often experience disturbed sleep-wake cycles, incontinence, and difficulty with self-care