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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)