1. 1
Cognitive & Neurologic
Delirium & Dementia
NURS 4100 Care of the Older Adult
Fall 2013
Joy Shepard, PhD(c), MSN, RN, CNE, BC

2. 2
Objectives
 Describe the cognitive and neurologic effects of
aging
 Identify signs and symptoms of cognitive and
neurologic disorders in older adults
 Differentiate delirium from dementia
 Identify factors that cause delirium in older adults
 Lists causes of dementia in older adults
 Describe the symptoms, unique features, and
related nursing care for Alzheimer’s Dementia

3. 3
Key Terms
 Intelligence – Ability to think & learn new
things
 Level of consciousness – Degree of cognitive
function involving arousal mechanisms
 Alert, responsive to voice, responsive to pain, or
unresponsive

Most sensitive indicator of deterioration ofMost sensitive indicator of deterioration of
neurological statusneurological status
 Memory – Ability to retain or store information
and retrieve it when needed

4. 4
Key Terms
 Orientation – Awareness with regard to
person, place, time, and situation
 Perception – Ability to experience,
recognize, organize and interpret
sensory stimuli
 Sensation – Ability to receive and
process stimuli received through sensory
organs

5. 5
Cognition – Mental Process of
Knowing
 Mental activities: information
 Receiving
 Comprehending
 Storing
 Retrieving
 Using
 Includes
 Sensation & perception
 Attention
 Memory
 Problem-solving

6. 6
Age-Related Changes Affecting
Cognitive & Neurologic Functioning

7. 7
Normal Changes of Aging –
Cognitive & Neurologic

8. 8
Question
 Normal age-related changes in the
nervous system can include all of the
following EXCEPT:
 (A) Changes in sleep patterns
 (B) Delayed reaction time
 (C) Increased perception of pain
 (D) Reduced blood flow to the brain
 (E) Slower reflexes

9. 9
Aging & Cognitive Function
 Not characterized by cognitive &
mental disorders
 Mental health & cognition remain
stable
 Functional changes: usually no
significant impairment

10. 10
Aging & Cognitive Function
 Cognitive skills negatively affected by age
 Remembering
 Solving complex problems
 Paying attention
 Reaction time
 Information processing

11. 11
Effects of Aging on the
Neurologic System
 Loss of nerve cell mass
 Atrophy: brain & spinal cord
 Number of nerve cells declines
 Nerve conduction: slower
 Response & reaction times: slower
 Reflexes: weaker

12. 12
Effects of Aging on the
Neurologic System
 Some plaques, tangles, & atrophy of brain
 Free radicals accumulate
 Decrease in cerebral blood flow
 Intellectual performance unchanged
 Slowing in central processing
 Delay in time required to perform tasks

13. 13
Effects of Aging on the
Neurologic System
 Verbal skills maintained
 Number and sensitivity of sensory
receptors, dermatomes, and neurons
decrease
 Dulling of tactile sensation
 Decline in function of cranial nerves
affecting taste and smell

14. 14
Aging & Cognitive Function:
Intellectual Function
 Basic intelligence maintained
 Verbal comprehension & arithmetic
 Crystallized intelligence (wisdom) – improves with age
 Accumulation of knowledge over lifespan
 Application of skills/ knowledge to solving problems
 Wisdom, practical knowledge
 Tasks using well-practiced skills or familiar information not
affected by age
 Wisdom, knowledge of ways of world, accumulation of
practical expertise = strength

15. 15
Aging & Cognitive Function:
Intellectual Function
 Fluid intelligence (creativity) – declines with age
 Information processing system (speed with which
information can be analyzed)
 Ability to plan, organize, or think abstractly
(executive function)
 Ability to learn new concepts
 Attention, memory capacity
 Complex tasks

16. 16
Aging & Cognitive Function:
Memory
 Short-term (recent) memory – reduced (mild
forgetfulness)
 New information forgotten more rapidly
 More difficulty retaining information in the
presence of interference or shifting attention
 Memory aids, cues, or reminders can assist
 Long-term (remote) memory – remains intact

17. 17
Question
 Cognitive functions that are negatively affected by
normal aging include (Select all that apply):
 A. Remembering
 B. Solving complex problems
 C. Vocabulary
 D. Paying attention
 E. Arithmetic
 F. Reaction time
 G. Speed of information processing
 H. Wisdom, judgment

18. 18
Question
 When teaching older adults, the nurse should
(Select all that apply):
 A. Allow more time for processing information
 B. Include shorter, more frequent sessions
 C. Provide a dim environment to reduce stimuli
 D. Limit background noise
 E. Provide information that is concrete rather than abstract
 F. Make sure there are as few distractions as possible
 G. Present one idea at a time
 H. Provide instructor-paced, rather than learner-paced sessions

19. 19
Question
 The mental process most sensitive
to deterioration with aging is:
 A. Creativity
 B. Judgment
 C. Intelligence
 D. Short-term memory

20. 20
Symptoms That Should Be
Investigated
 Memory & intellectual difficulties
 Change in sleep patterns
 Delusions, hallucinations, disordered
thinking
 Loss of emotional responsiveness (flat
affect)

21. 21
Impaired Cognition

22. 22
Impaired Cognition
 Fear of loss of cognitive function
 Losses that result from impaired cognition
 Aging increases the risk for:
 Delirium: acute and reversible
 Dementia: chronic and irreversible
 Differences between delirium & dementia

23. 23
How Does Delirium Differ from
Dementia?
Delirium
 Rapid onset
 Fluctuates; worse at
night
 Altered LOC
 Easily distracted;
attention impaired
Dementia
 Chronic, insidious
 Symptoms progressive
but stable
 LOC usually not
affected
 Tries hard to do task;
great effort to recall

24. 24
Question
 Is the following statement true or
false?
 A major difference between delirium
and dementia is that delirium alters a
person’s level of consciousness
whereas dementia does not

25. 25
Delirium

26. 26
Definition of Delirium
 State of temporary, but acute mental confusion
 Syndrome – Rarely caused by a single factor; often result
of interaction of patient’s underlying condition with
precipitating event
 Characterized by disorganized thinking, difficulty in
concentrating, and sensory misperceptions that last from 1
to 7 days
 Reduced level of consciousness
 Difficulty focusing, shifting or sustaining attention
 Cognitive change
 Deficit of language, memory, orientation, perception; not attributed to
dementia

27. 27
Definition of Delirium
Cont’d…
 Develops rapidly (hrs to days)
 Varies (fluctuates) during the day
 Disturbances: attention, perception, thinking,
memory, psychomotor behavior, sleep-wake
 General medical condition directly causes it
 A key distinction between delirium and dementia is
that the person who exhibits sudden cognitive
impairment, disorientation, or sensory misperceptions
is more likely to have delirium rather than dementia.

28. 28
Recognition of Delirium
 Impaired attention,
distractibility
 Prominent disorientation
 Disorganized & distorted
thinking (fearfulness,
paranoia)
 Inability to recall recent
events
 Incoherent speech
 Inability to sleep
 Disorders of perception
 Terrifying hallucinations,
vivid dreams
 Intense emotional
disturbances
 Strange, absurd
fantasies & delusions
 Psychomotor behavior:
lethargic, agitated, or
mixed

29. 29
Confusion Assessment Method
(CAM) DELIRIUM

30. 30
Delirium = Acute Confusion
 Occurs frequently in older adults
 Delirium begins with confusion, can proceed to
stupor or excessive activity
 Time limited (hrs to days)
 Fluctuates over the course of day
 Reversible…
 …With prompt treatment
 Treat underlying cause(s), coexisting factors
 Variable outcome
 Can range from full recovery to death

31. 31
Delirium: Acute State of
Confusion
 A medical emergency
 High morbidity & mortality rate (20-30%),
longer hospital stay, increased risk nursing
home placement
 Delirium has a fatality rate as high as Acute MI
or Sepsis (Cleveland Journal of Medicine, Nov 2004)
 Reversible if Dx and Tx in time!!!

32. 32
Delirium – Risk Ractors
 Advanced ageAdvanced age higher risk!!!
 Cognitive impairment or dementia
(older people with dementia are
especially susceptible to delirium)
 Hx of previous episodes of
delirium
 Multiple medical conditions
 Multiple medications
 Severe stress (from events like a
move to a new environment,
recent surgery or recent injury)

33. 33
Delirium: One of the Most Commonly
Encountered Medical Disorders in
Medical Practice!!!
 10-40% of elderly general medical patients will
experience a LIFE THREATENING
CONFUSIONAL STATE
 Up to 40% of long-term care residents
 40-60% of surgical patients
 Up to 80% of patients in ICUs (“ICU Psychosis”)
 Do not accept symptoms as “normal”
 REQUIRES CONTINUOUS NURSING CARE

34. 34
Delirium – Causes (Box
33-1, p. 443)
Drugs Particularly anticholinergics, sedative-hypnotics,
benzodiazepines, barbiturates, opioids; many
medications (polypharmacy)
Electrolyte imbalance Especially from dehydration; Na+, K+
Lack of drugs Stopping certain medications, alcohol withdrawal
Infection Particularly urinary or respiratory tract infections (UTI
or pneumonia); blood or wound infection after an injury
or surgery
Reduced sensory input Such as poor or uncorrected vision and hearing
Intracranial Such as from a stroke
Urinary or fecal problems Such as inability to empty bladder or bowel
Myocardial (heart) and lungs Heart attack, pneumonia, or other condition causing
lack of oxygen in the blood and the brain

35. 35
UTI & Pneumonia
 UTI
 Positive leukoesterace on urinalysis
 Positive nitrites
 WBCs in urine
 Danger of evolving into urosepsis (can occur very
rapidly)
 Confusion
 Pneumonia – Anorexic, LOC changes

36. 36
Delirium – Nursing Care
 Roles of nurse: prevention, early
recognition, and treatment
 Focused on eliminating
precipitating factors
 Prevention of harm
 Establishing medical stability
 Minimizing stimulation (cluster care)
 Consistency in care
 Teaching and support

37. 37
Sundowner Syndrome
(Box 33-2, p. 448)
 Nocturnal confusion
 Confusion “as the sun
goes down”
 Increased with
unfamiliar surrounding
 Often disturbed sleep
patterns
 May result from excess
sensory stimulation or
deprivation

38. 38
Prevention/Management
of Sundowner’s
 Keep familiar objects in view
 Provide physical activity during the day
 Avoid napping during day
 Use a nightlight in room
 Provide human contact and touch for
reassurance
 Control noise and visitors in evening
 Meet basic needs for fluids, food, toileting

39. 39
Question
 An 84-year-old patient with a diagnosis of delirium is admitted to theAn 84-year-old patient with a diagnosis of delirium is admitted to the
hospital. In addition to being acutely confused, the patient is vomiting andhospital. In addition to being acutely confused, the patient is vomiting and
jaundiced, and has bruises and petechiae on his trunk.jaundiced, and has bruises and petechiae on his trunk.
 To evaluate the cause of the patient’s delirium, laboratory analyses ofTo evaluate the cause of the patient’s delirium, laboratory analyses of
blood are ordered. The results are as follows: serum creatinine 1.0, bloodblood are ordered. The results are as follows: serum creatinine 1.0, blood
urea nitrogen 10, potassium 3.21, sodium 138, glucose 80, INR 5.3, Hgburea nitrogen 10, potassium 3.21, sodium 138, glucose 80, INR 5.3, Hgb
7.0, Hct 21, serum albumin 2.1, elevated ALT / AST, and elevated7.0, Hct 21, serum albumin 2.1, elevated ALT / AST, and elevated
bilirubin.bilirubin.
 Based on these laboratory results, the nurse should record which of theBased on these laboratory results, the nurse should record which of the
following nursing diagnoses on the patient’s care plan?following nursing diagnoses on the patient’s care plan?
 A. Acute Confusion r/t Hyperkalemia
 B. Deficient Fluid Volume r/t Vomiting
 C. Disturbed Sensory Perception r/t Hepatic encephalopathy
 D. Ineffective Cerebral Tissue Perfusion r/t Hypoglycemia

40. 40
Dementia

41. 41
Dementia – Impaired Cognitive
Function
 Syndrome – dysfunction or loss of memory, orientation,
language, reasoning, and judgment
 Progressive, irreversible deterioration in the following
areas:
 Memory, orientation, language, reasoning, problem-solving,
sociability, mood, personality, & functionality
 Deterioration of cognitive function eventually becomes
extreme enough to INTERFERE with social and
occupational functioning
 Judgment and moral/ethical behaviors decline
 Disorganization of the personality
 Both chronic and terminal (fatal) illness

42. 42
Dementia – Impaired Cognitive
Function
 Profound effect on MEMORY
 Begins with difficulty remembering recent
events (short-term memory impairment)
 Deterioration progresses over time
 ATTENTION is preserved until late in the
disease
 ~8 million older adults affected
 Not a “Normal” Part of Aging

43. 43
Mini-Cog Assessment
Instrument DEMENTIA

44. 44
Dementia: Clinical Diagnosis
 Dx of dementia – at least two cognitive
deficits:
 Short-term memory
 Aphasia – impairment in use of language
 Apraxia – impairment in coordinated movements
 Agnosia – loss of ability to recognize common objects
 Impaired ability to plan, organize, sequence, or think
abstractly (executive dysfunction)
 Delirium must be ruled out

45. How Common is Dementia?
 < 65 years Rare
 Less than 4% of all cases of dementia
 65 – 85 years 10%
 At age 65, risk increases 1% per year
 86 – 100+ years 50%
 At age 86, risk increases 11% per year

46. 46
Causes of Dementia for
People 71 Years of Age & Older
 70% Alzheimer’s Disease
 17% Vascular dementia
 13% Other dementias, including
Lewy body dementia
 Source: Alzheimer’s Association

47. 47
Alzheimer’s Disease (AD)

48. 48
Alzheimer’s Dementia (AD)
 Organic brain disease: affects memory, thinking & behavior
 5th
leading cause of death (65 and above)
 1 in 3 seniors dies with AD or another dementia
 Most common form of dementia
 One in eight older adults (12.5%)
 Aging biggest risk factor
 ~50% > 85 years old may develop AD
 Lasts 2-20 yrs with average duration 8 yrs
 Not a normal part of aging!

49. 49
Alzheimer’s Dementia (AD)
 5.4 million Americans diagnosed with AD (1 in 9 older Americans!)5.4 million Americans diagnosed with AD (1 in 9 older Americans!)
 Projected 7.7 million by 2030
 Projected 16 million Americans by 2050
 80% of people with AD live at home until latest
stages, being cared for mainly by family
 15 million unpaid family/friend caregivers
 Annual expenditures: $203 billion (an additional
$216 billion when considering lost wages)
 1.2 trillion by 2050
 http://youtu.be/BXnZt5VMjZY
 http://www.alz.org/downloads/Facts_Figures_2011.pdf

50. 50

51. 51

52. 52

53. 53
Alzheimer’s Effects on the Brain
 Nerve cells in brain affected:
 1. Neuritic plaques with beta-amyloid protein (amyloid plaques)
 2. Neurofibrillary tangles deep in the brain (cortex)
 3. Loss of connections between nerve cells (neurons) and cell
death
 Loss of neurons and synapses
 Beta-amyloid protein fragments – cluster outside cells in
brain to form sticky clumps/ plaques (early in AD)
 Tau protein tangles – aggregates inside brain cells,
forming twisted strands of neurofibrillary tangles (later in
AD, more direct effect on cognitive function)

54. 54
Alzheimer’s Effects on the Brain
 Changes in neurotransmitter systemsChanges in neurotransmitter systems
 Serotonin and acetylcholine
 Disrupts three processes that keep neurons healthyDisrupts three processes that keep neurons healthy 
memory failure + personality changes + difficulty with ADLsmemory failure + personality changes + difficulty with ADLs
 Communication
 Metabolism
 Repair
 Results:Results:
 Loss of memory
 Thinking & language skills
 Behavioral changes

55. 55
Alzheimer’s Effects onAlzheimer’s Effects on
the Brainthe Brain
http://www.alz.org/brain/10.asp

56. 56
How Alzheimer’s Spreads in the
Brain
http://www.alz.org/brain/08.asp

57. 57
Risk Factors of Alzheimer’s
Disease
 1. Age - Likelihood of developing AD doubles every 5 yrs after
age 65. After age 85, risk reaches ~50 %
 2. Family hx/ genetics
 3. Head injury
 4. Heart health – Same risk factors as vascular dz (diabetes,
HTN, high cholesterol)
 5. Latino & African American ethnicity
 6. Lifestyle (healthy aging) – Weight; tobacco & alcohol,
physical exercise, healthy diet (whole grains, fruits &
vegetables, low in saturated fat), regularly exercise the brain
(learning a new language, puzzles, word searches)
 http://www.alz.org/alzheimers_disease_causes_risk_factors.asp

58. 58
Possible Causes of
Alzheimer’s Disease
 Majority of cases: complex interactions betweenMajority of cases: complex interactions between
genetic and environmental factorsgenetic and environmental factors (important
point!)
 GeneticsGenetics – Multiple genetic factors
 Chromosomal abnormalities
 Insulin-resistant neurons in brain
 Environmental factorsEnvironmental factors
 Free radicals
 Aluminum and mercury?

59. 59
Symptoms of Alzheimer’s
Disease
 Progressive, degenerative, and fatal (5th
leading cause of
death)
 Terminal diagnosis
 Symptoms develop gradually and progress at different
rates among individuals
 Staging of Alzheimer’s disease
 Global Deterioration Scale/Functional Assessment Staging (GDS/FAST),
p. 415
 Personal awareness: early stages of dz
 Dx: based on symptoms/ medical evaluation
 10 Warning Signs of Alzheimer's Disease

60. 60
The difference between Alzheimer's
and typical age-related changes
Signs of Alzheimer's Typical age-related changes
Poor judgment and decision making
Making a bad decision once in
a while
Inability to manage a budget Missing a monthly payment
Losing track of the date or the season
Forgetting which day it is and
remembering later
Difficulty having a conversation
Sometimes forgetting which
word to use
Misplacing things and being unable to
retrace steps to find them
Losing things from time to time
http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp

61. 61
Question
 According to the Alzheimer's Association, about
how many people in the United States over the
age of 65 have Alzheimer's disease?
 A. 5.4 million
 B. 6.5 million
 C. 7.1 million
 D. 8.6 million

62. 62
Question
 The average time period from
diagnosis of Alzheimer's disease to
death is
 A. 6 years
 B. 8 years
 C. 10 years
 D. 12 years

63. 63
Question
 The most common early symptom of
Alzheimer's is difficulty remembering newly
learned information.
 True or false?

64. 64
Ron Reagan on Father’s
Alzheimer’s
http://www.cnn.com/video/#/video/bestoftv/2011/04/28/lkl.reagan.alzhe
imers.cnn?iref=videosearch
Ron Reagan talks to Larry King about his father's
struggle with Alzheimer's disease.

65. 65
Stages of Alzheimer’s Disease

66. 66
Stages of Alzheimer’s (p.
446)
 Stage 1: Normal Adult
 Stage 2: Normal Older Adult
 Stage 3: Mild Cognitive Impairment/ Early AD
 Stage 4: Mild AD
 Stage 5: Moderate AD
 Stage 6: Moderately Severe AD
 Stage 7: Severe/ Terminal AD
http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp

67. 67
Stage 3: Mild Cognitive
Impairment/ Early AD
 Cognitive impairments
recognized by others
 Word or name-finding
 Names of new people
 Impaired performance in
work/ social settings
 Forgetting recently
learned information
 Losing/ misplacing
valuable object
 Decline in ability to plan/
organize
http://www.alz.org/alzheimers_disease_stages_
of_alzheimers.asp#stage3
Mild memory impairment
Anxiety
Easily flustered in social
situations

68. 68
Stage 4: Mild AD
 Withdrawal, denial,
depression
 Flat affect
 Decreased ability to
perform IADLs/ complex
tasks
 Cognitive impairment
apparent on exam
 Diagnosis of Alzheimer’s
http://www.alz.org/alzheimers_disease_stages_
of_alzheimers.asp#stage4

69. 69
Stage 5: Moderate/ Mid-Stage
AD
 Major gaps in memory
 Deficits in cognitive
function
 Disoriented to time and
place
 May become lost in
unfamiliar locations
 Some assistance with
IADLs becomes essential
 Clothing selection
http://www.alz.org/alzheimers_disease_st
ages_of_alzheimers.asp#stage5

70. 70
Stage 6: Moderately Severe
AD
 Severe loss of cognitive function & memory
 Recent memory
 Names of spouse & family
 Inability perform many ADLs
 Dressing, toileting
 Some urinary/ fecal incontinence
 Personality changes
 Sundowning
 Agitation, resistive to care
 Wandering
 Disruption sleep/ wake cycle
 Institutionalization
http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp#stage6

71. 71
Stage 6: Moderately Severe
AD

72. 72
Stage 6: Moderately Severe
AD

73. 73
Stage 7: Severe/ Terminal AD
 Final stage
 Recent/ remote
memories lost
 Loss verbal &
psychomotor skills
 Impaired swallowing
 Incontinence
 Total assistance
http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp#stage7

74. 74
Question
 When assessing a client with early-stage
Alzheimer's disease, the nurse should expect to
find which of these symptoms?
 A. Incontinence
 B. Aphasia
 C. Awareness of cognitive losses
 D. Total dependence for all activities of daily living
(ADLs)

75. 75
New Diagnostic Guidelines for
Alzheimer’s Disease (04/19/2011)

76. 76
New Diagnostic Guidelines
for AD
 Three stages of disease
 1. Preclinical AD (biomarkers) –
intended purely for research purposes
 2. Mild cognitive impairment (MCI)
 3. AD dementia
 http://download.journals.elsevierhealth.com/pdfs/journals/1552-
5260/PIIS1552526011001002.pdf

77. 77
New Diagnostic Guidelines
for AD
 First update in 27 yrs
 Inclusion of AD biomarkers
 PET scan, MRI scan, spinal taps
 Actual disease present decade or more
before dementia appears
 New guidelines = two to threefold increase
in number of people dx with AD

78. 78
Treatment for Alzheimer’s Disease

79. 79
Treatment of Alzheimer’s
Disease
 Variety of nursing interventions,
interdisciplinary approach
 No treatment to prevent or cure the disease
 Treatments for cognitive symptoms
 Treatments for behavioral symptoms
 Clinical trials: improve function/ slow disease
progression
 Antioxidants, anti-inflammatory agents, folic acid,
vitamins B6 and B12, gene therapy, and vaccine

80. 80
Tx for Cognitive Symptoms:
Medications
 Medications (Aricept, Namenda): slow progress but
do not change disease course
 Temporarily delay worsening of symptoms (6-12
mos)
 Cholinesterase inhibitors
 Donepezil (Aricept) – all stages
 Rivastigmine (Exelon) – mild to moderate
 Galantamine (Reminyl) – mild to moderate
 Glutamine regulator
 Memantine (Namenda) – mild to moderate
http://www.alz.org/alzheimers_disease_standard_prescriptions.asp#2

81. 81

82. 82
Tx for Behavioral and Psychiatric
Symptoms: Non-Drug
 Behavioral problems occur in about 90% of
people with AD.
 Repetitiveness, delusions, illusions,
hallucinations, agitation, aggression, altered
sleeping patterns, wandering, and resisting care
 Nursing strategies for difficult behavior:
 Monitoring personal comfort, redirection,
distraction, and reassurance
http://www.alz.org/alzheimers_disease_standard_prescriptions.asp#3

83. 83
Tx for Behavioral and Psychiatric
Symptoms: Non-Drug
 *Monitor personal comfort – check for pain, hunger, thirst,
constipation
 Do not confront or argue facts
 Redirect attention
 Calm environment
 Simplify environment & routine
 Familiar routines
 Ensure adequate rest
 *Safety
 Locks on doors/ gates
 No guns/ car keys out of reach
http://www.alz.org/alzheimers_disease_standard_prescriptions.asp#3

84. 84
Tx for Behavioral and Psychiatric
Symptoms: Medications
 Antidepressant medications:
 Citalopram (Celexa)
 Sertraline (Zoloft)
 Anxiolytics:
 Lorazepam (Ativan)
 Antipsychotic medications:
 Haloperidol (Haldol)
 Ziprasidone (Geodon)
http://www.alz.org/alzheimers_disease_standard_prescriptions.asp#3

85. 85
Question
 The wife of a client taking donepezil (Aricept) asks
the nurse when her husband’s Alzheimer’s disease
will be cured. The nurse’s best response is:
 A.“This medication takes about 6 weeks to cure
Alzheimer’s.”
 B. “Your husband will be cured in 2 weeks.”
 C. “This medication slows the degeneration of the disease.
It doesn’t cure it.”
 D. “This medication alone doesn’t cure Alzheimer’s; you
have to take two other medications to cure the disease.”

86. 86
Nursing Care

87. 87
Caring for Persons With
Dementia: Safety
 Ensuring patient safety
 Environmental safety
 Poor judgment/ misperceptions
 Consistent, controlled environment
 Items to trigger memory
 Wandering behavior

88. 88
Caring for Persons With
Dementia: Physical Care
 Close observation/ attention: physical
needs
 Eating and drinking
 Bathing and skin care
 Consideration of inability to communicate
needs
 Infection
 Consistency in caregivers

89. 89
Caring for Persons With
Dementia: Resistance/ Agitation
 Be alert to cues
 Distract
 Direct eye-contact
 Safe environment
 Be calm, clear
 Do not rush Pt

90. 90
Caring for Persons With
Dementia: Respect
 Need to promote:
 Individuality
 Independence
 Freedom
 Dignity
 Connection

91. 91
Caring for Persons With
Dementia: Support for Family
 Don’t overlook the caregivers!
 Physical, emotional, and
socioeconomic difficulties of caregiving
 Education on basic care needs
 Feelings accompanying caregiver role
 Community resources

92. 92
Safe Environment & Support
 Tour home with caregiver to identify safety
issues and develop a plan to rectify them
 Make home safe with modifications
 Similar strategies as ones used to prevent injury
to toddlers to provide safer physical
environment
 Support family/ caregiver
 Caregiver role strain
CPSC Home Safety
Tips

93. 93
Advance Directives and
Proxy Establishment
 While patients have decision-making capacity,
include them in discussions
 Initiate discussion about desired treatment
modalities
 Select a healthcare proxy
 Inform proxy about desired care to be provided
when patient is unable to make decisions
 As dementia progresses, likely to be
institutionalized

94. 94
Nursing Process

95. 95
Nursing Diagnoses/ Care Plan
(pp. 450-452) – Review!Review!
 Self-Care Deficit
 Risk for Injury
 Disturbed Sleep Pattern
 Impaired Verbal Communication
 Disturbed Thought Processes
 Interrupted Family Processes
 Caregiver Role Strain

96. 96
Planning and
Outcome Identification
 The client will
 Remain safe and free from injury
 Experience a level of arousal that promotes
the meaningful perception of stimuli
 Remain oriented to time, place, person, and
situation to maximum extent possible
 Perform self-care activities appropriate to
own functional capability