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NURSING CARE

OF
PATIENT
WITH
DEMENTIA

PRESENTED BY:
H. RUFUS RAJ,
LECTURER, ACON
DEFINITION
“Deprived of mind"

A progressive organic mental disorder


characterized by personality changes, confusion,
disorientation, and deterioration of intellect
associated with impaired memory and judgment

Dementia is a syndrome characterized by


dysfunction or loss of memory, orientation,
attention, language, judgment, and reasoning
INCIDENCE

Most often in older adults


Increases with aging
60% to 80% of the patients with dementia
having the diagnosis of Alzheimer’s disease
60,000 new cases are diagnosed in Canada
each year
ETIOLOGY
NEURO DEGENERATIVE
DISORDERS
METABOLIC OR TUMORS
ØAlzhiemer’s disease
TOXIC DISEASE vBrain tumors
vAlcoholism
ØFrontal lobe dementia vMetstatic tumors
ØDown syndrome vThiamine deficiency

ØParkinson’s disease vHyperthyroidism

ØHuntington’s disease
VENTRICULAR
vHypothyroidism
DISORDERS
vHyperglycemia

VASCULAR DISEASES Hydrocepalus


vHypercalcemia
qCardiac disease

qSubarachnoid hemorrhage SEIZURE DISORDERS


qSubdural hematoma
IMMUNOLOGIC
DISEASES DRUGS
§Multiple sclerosis
SYSTEMIC DISEASES ØDiuretics

Encephalopaty §Chronic fatigue


ØDigoxin
o

oWilson’s disease
syndrome ØAnticolinergics
oHepatic encephalopathy
§Infections
ØOpoids
§Meningitis
ØHypnotics
TRAUMA §Encephalitis
ØAntiypertensives
Head injury §Neurosyphilis
CLASSIFICATION

Slowly progressive dementia


Begins gradually and worsens progressively
over several years
Caused by neurodegenerative disease, that is,
by conditions affecting only or primarily the
neurons of the brain and causing gradual but
irreversible loss of function of these cells.
Eg. Alzheimer's disease, Vascular dementia
Rapidly progressive dementia
Possible causes include
Brain infection (viral encephalitis, subacute
sclerosing panencephalitis,
Tumors : lymphoma or glioma
Drug toxicity (e.g. anticonvulsant drugs)
Metabolic causes: liver failure or kidney failure
Brain injury: chronic subdural hematoma.
Pathophysiology
Vascular dementia or multiinfarct dementia

Ischemic, ischemic hypoxic & hemorrhagic lesions

Narrowing & blocking of arteries that supply the brain

Decreased blood supply to the brain


CLINICAL MANIFESTATIONS

MIDDLE (moderate) LATE (severe)


•Impaired ability to •Little memory
EARLY (mild)
•Forgetfulness
recognise family •Cannot understand

•Sort term memory


members words
•Agitation •Difficulty in
impairment •Lss of remote memory
•Loss of initiative & eating/swallowing
•Confusion •Repitious words
interest •Insomnia •Immobility
•Decreased judgement
•Delusions •Incontinence
•Geographic
•Hallucinations •Unable to perform self
disorientation •Apraxia
care activities
•Behavioural problems
DIAGNOSTIC EVALUATION

ASSESSMENT
MINI MENTAL STATUS EXAMINATION
Orientation to time
Registration
Naming
Reading

IMAGING STUDIES
MANAGEMENT

PREVENTIVE MEASURES
Treatment of risk factors
§ Hypertension
§ Diabetes
§ Smoking
§ Orthostatic hypertension
§ Cardiac dysrythmias
PHARMACOLOGICAL THERAPY:
Cholinestrase inibitorsAcetylcholinesterase
inhibitors: Tacrine (Cognex), donepezil
(Aricept), galantamine (Razadyne), and
rivastigmine (Exelon)
Donezepil
Amyloid deposit inhibitors: Minocycline and
Clioquinoline
Antidepressant drugs
Anxiolytic drugsbenzodiazepines like
diazepam (Valium)
NURSING
CARE
OF
PATIENTWITH
DELIRIUM
DEFINITION

Delirium is the state of temporary but acute


mental confusion , is a common, life threatening
& possibly preventable syndrome in older adults
Delirium is a common and severe
neuropsychiatric syndrome with core features of
acute onset and fluctuating course, attentional
deficits and generalized severe disorganization
of behavior
CORE FEATURES
Disturbance of consciousness (that is, reduced
clarity of awareness of the environment, with
reduced ability to focus, sustain, or shift
attention)
Change in cognition (e.g., problem-solving
impairment or memory impairment) or a
perceptual disturbance
Onset of hours to days, and tendency to
fluctuate.
INCIDENCE
§ Hospital setting: 15% to 53%
(postoperatively)
§ Intensive care setting: 70% to 87%
§ The highest prevalence of delirium is
generally seen in critically ill patients in the
intensive care unit or ICU ( ICU Psychosis)
FACTORS PRECIPITATING
Demograpic Functional status:
characteristics: Functional dependence Coexisting medical
65 years or older Immobility conditions:
Male gender History of falls Severe acute illness
Chronic renal or hepatic
Cognitive status: Sensory: disease
Dementia Sensory deprivation H/O stroke
Cognitive impairment Sensory overload Neurologic disease
H/O delirium Infection/sepsis
Depression Decreased oral intake: Fracture/Trauma
Dehydration Terminal illness
Environmental: Malnutrition HIV infection
ICU admission
Use of physical Drugs: Surgery:
restraints Sedative –hypnotics Orthopedic surgery
Pain (untreated) Opioids Cardiac surgery
Emotional stress Anticholinergic drugs Non cardiac surgery
Prolonged sleep Alcohol or drug
deprivation withdrawl
PATHOPYSIOLOGY

Precipitating factors (cholinergic deficiency,


excess release of dopamine, and both, incereased
or decreased serotonergic activity
Delirium persists for months and that it may
even be associated with permanent decrements
in cognitive function
CLINICAL MANIFESTATIONS

Inability to concentrate
Irritability
Insomnia
Loss of appetite
Restlessness
Confusion
Agitation
Misperception
DRUG THERAPY

Low dose anti-psychotics


Haloperidol,
Side effects- hypotension, extrapyramidal side
effects, tardive dyskinesia, athetosis, muscle tone
changes
Risperidone
Olanzapine
Quetiapine
Short acting benzodiazepines: lorazepam
COLLABRATIVE & NURSING
MANAGEMENT
The role of nurse includes prevention,
early recognition, & treatment
Recognizing patients who are at risk
Neurological disorders (Stroke ,
dementia, CNS infection, Parkinson’s
disease), sensory impairment &
advanced age.
Untreated pain
Eliminating the risk factors
Reorientation or behavioral interventions
Reorientating to time , place, & procedures
Scheduling the activities of patients
Enhancing communication
Use of restraints should be avoided
Recreation therapy
(Relaxation techniques, music therapy,
massage)
Interdisciplinary approach
Polypharmacy, pain, nutritional status
Prevention of complications of immobility,
LIST OF NURSING DIAGNOSES
1. Disturbed thought process related to effects of
Dementia as evidenced by loss of memory &
other cognitive deficits
2. Deficit in self-care (bathing, dressing, toileting)
related to memory deficit and neuromuscular
impairment as evidenced by inability to
independently and appropriately bath, dress or
toilet.
3. Risk for injury related to impaired judgment,
possible gait instability, muscle weakness &
sensory/perceptual alterations .
4. Wandering related to disease process as
h a n
T u
k y o