Student NUR 111 Cognition - Confusion 2024

Page 1: Introduction

• Experience online cognition

• Cognitio search science experience

• Science knowledge in business

• Nur111 Fall semester

Page 2: Cognition

• Definition: A complex set of mental processes through which individuals acquire, store, retrieve, and utilize information.

Page 3: Metacognition

• Meaning: The ability of humans to think about their own thinking processes.

Page 4: Importance of Cognition

• Basic consequences of cognition include:

  • Survival and adaptation enhancement

  • Effective functioning as a social being

  • Engagement in meaningful and purposeful activities

• There is significant variation in cognitive functioning among healthy individuals.

Page 5: Role of the Nervous System

• The nervous system governs cognitive functions, enhancing abilities such as:

  • Awareness/Perception

  • Remembering/Memory

  • Attention

  • Reasoning/Problem Solving

  • Decision Making

  • Communication

Page 6: Cognitive Abilities

Perception

• Definition: Interpretation of stimuli or inputs.

• Influenced by:

  • External stimuli (environmental)

  • Internal stimuli (personal)

• Variability across the lifespan.

  • Orientation dimensions:

    • Person

    • Place

    • Time

    • Situation

Attention

• Definition: Brain's ability to remain alert and focused.

• Key components:

  • Reticular activating system

  • Neurotransmitters (dopamine/norepinephrine)

  • Variation in attention span is normal.

Page 7: Memory Defined

Types of Memory

• Sensory Memory: Initial stage, retains visual & auditory input for a few seconds.

• Short-term Memory: Active processing, seconds-long storage, can be rehearsed into long-term memory.

• Long-term Memory: Information stored indefinitely; includes:

  • Declarative memories:

    • Semantic memory: Facts and concepts

    • Episodic memory: Personal experiences

  • Nondeclarative memories: Skills.

Page 8: Communication & Social Cognition

• Essential for effective cognitive function:

  • Ability to receive, interpret, and express communication.

• Social cognition: Processing and applying social information accurately and effectively.

• Motor coordination involved in executing complex tasks relates to cognition.

• Praxis: Control of deliberate, smooth, coordinated movements.

Page 9: Executive Function

• Encompasses mental skills used in planning and executing complex tasks, such as:

  • Selective focus

  • Emotional regulation

  • Problem-solving capabilities

  • Organization in speech and motor activity

• Intelligence is assessed via psychometric tests and relates to:

  • Adaptive behaviors necessary for daily function:

    • Conceptual skills

    • Social skills

    • Practical skills

Page 10: Cognitive Function Evaluation

• Any changes in an individual’s cognitive abilities should be evaluated.

• Aging can affect cognitive functions leading to potential decreases.

Page 11: Aging and Cognitive Abilities

• Cognitive ability in interpreting the environment is impacted byimpairment of senses.

• Cognitive decline is not a normal aspect of aging but can be affected by external factors.

• Increased time is often needed for learning and motivation is crucial.

Page 12: Impairing Factors

• Common factors impacting cognitive ability:

  • Stress

  • Grief

  • Oxygenation impairment

  • Head injury

  • Obstructive sleep apnea

  • Stroke

  • Embolism

  • Substance abuse (alcohol/drugs)

  • Medications

Page 13: Impact of Aging on Cognition

• Components involved in cognition:

  • Perception

  • Learning

  • Memory: sensory, short-term, long-term

• Aging-related cognitive decline:

  • Brain mass reduction

  • Slowing metabolism

  • Decreased blood flow to the brain

  • Thickening of protective membranes

• Evaluation of cognitive changes important to identify other contributing factors.

  • Lifelong mental activity aids in maintaining cognitive functions.

Page 14: Core Cognitive Aspects

• Key areas affected by cognition:

  • Perception

  • Intellectual Function

  • Attention

  • Learning

  • Executive Function

  • Memory

  • Motor Skills

  • Communication

  • Coordination

  • Social Cognition

Page 15: Alterations in Cognition

• Types of cognitive alterations:

  • Delusions: False beliefs, cannot be corrected by logic.

  • Hallucinations: Experiences without real external stimulus.

  • Confusions: Misinterpretation of sensory inputs and experiences.

  • Illusions: Distorted perceptions arising from the imagination.

Page 16: Pediatric Cognitive Disorders

• Learning disabilities include:

  • Dyslexia

  • Dyscalculia

  • Dysgraphia

  • Dyspraxia

• These conditions are often neurological and require tailored Individualized Education Plans (IEPs).

Page 17: Intellectual Disability

• Defined as significant limitations in intellectual functioning and adaptive behavior, typically an IQ below 70-75.

• Causes often include prenatal conditions and external factors.

• Common conditions associated with intellectual disability include:

  • Down Syndrome

  • Fragile X Syndrome

  • Fetal Alcohol Syndrome

Page 18: Additional Causes of Cognitive Impairment

• Other significant causes:

  • Traumatic brain injury

  • Poisoning

  • Hypoxia

  • Infections

  • Environmental deprivation

  • External maternal infections

  • Metabolic errors

Page 19: Down Syndrome

• Caused by an extra copy of the 21st chromosome (Trisomy 21).

• Results in:

  • Intellectual disability and physical impairments

  • Higher risk of congenital heart defects

  • Average life expectancy around 55 years

Page 20: Fragile X Syndrome

• Related to single abnormality on the X chromosome.

• Associated with:

  • Intellectual disability

  • Behavioral issues (e.g., ADHD)

  • Autistic behaviors and developmental delays

• Most individuals in good health but some may require treatment for seizures.

Page 21: Fetal Alcohol Syndrome

• Resulting from ethyl alcohol's impact on fetal development.

• Characterized by:

  • Growth deficits

  • Distinctive facial abnormalities

  • Central nervous system abnormalities

  • Higher prevalence in Native American and Alaskan Native populations (10x higher rate).

Page 22: Intellectual Disabilities Overview

• Individuals may show:

  • Generalized developmental delays

  • Need for supervision in personal care tasks.

Page 23: Understanding Confusion

• Confusion is an alteration in cognition affecting clarity of thought, focus, and decision-making abilities.

Page 24: Influences on Confusion

• Factors that may impact the development of confusion include:

  • Developmental considerations

  • Cultural background

  • Internal and external health influences, including chronic conditions.

Page 25: Diagnosing Confusion

• Common terminologies associated with confusion:

  • Lost

  • Confused

  • Unsure

  • Unclear

  • Perplexed

  • Disoriented

  • Bewildered

Page 26: Dementia vs. Delirium

Dementia

• Onset: Slow and subtle.

• Progression: Gradual deterioration of cognitive functions.

• Memory: Generally worsens over time.

• Communication: Increasing difficulty in early stages, leading to eventual uncommunicative states.

Delirium

• Onset: Sudden and severe.

• Progression: Brief but may last for months.

• Communication: Can become slurred or disorganized.

Page 27: Mental Status Assessment

• Assessment strategies include:

  • Observing the client directly

  • Noting speech and language abilities

  • Assessing orientation and alertness

  • Evaluating memory; ability to calculate; abstract thinking; mood; and emotional state.

Page 28: Common Mental Status Assessments

• Assessment Methods:

  • Confusion Assessment Method (CAM)

  • Cornell Scale for Depression in Dementia

  • General Health Questionnaire

  • Geriatric Depression Scale (GDS)

  • Hamilton Rating Scale for Depression

  • Mini-Mental State Examination (MMSE)

  • Short Portable Mental Status Questionnaire

  • Patient Health Questionnaire (PHQ)

Page 29: Nursing Diagnoses Related to Confusion

• Common diagnoses:

  • Acute or chronic confusion

  • Impaired memory

  • Impaired verbal communication

  • Disturbed sleep patterns

  • Self-care deficits

  • Risk for caregiver role strain

Page 30: Role of Nurses

• Critical tasks for nurses include:

  • Ensure clear communication

  • Identify caregivers

  • Provide reorientation efforts

  • Foster a therapeutic environment

  • Adjust sensory stimulation

  • Advocate for patients' needs

Page 31: Continuing Nurse's Role

• Responsibilities include:

  • Ensure protection of patients

  • Assist with activities of daily living (ADLs)

  • Provide simple explanations for tasks/procedures

  • Maintain a calm communication style

Page 32: Recommended Interventions

• Key interventions involve:

  • Creating a calming and safe environment

  • Promoting orientation (utilizing clocks, calendars)

  • Managing sensory stimulation in the environment

  • Ensuring pain management

  • Encouraging family visitation

  • Keeping familiar objects close to the patient

Page 33: Pharmacological Treatments

• For Agitation, Delirium, Dementia, and Delusions:

  • Atypical antipsychotics (e.g., risperidone, olanzapine)

• For Treatment of FAS & Fragile X Syndrome:

  • Cerebral stimulants (e.g., methylphenidate, amphetamine)

• For Alzheimer’s Treatment:

  • Acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine)

  • NMDA receptor antagonist (memantine)

• For Depression and Anxiety:

  • Mood stabilizers and antidepressants (sertraline, citalopram, fluoxetine)