Cognition PP

Cognition Exemplars

• Delirium

• Alzheimer’s

Introduction to Cognition

• Concept of Cognition: Ability of the brain to process, retain, and use information.

• Cognitive abilities include:

  • Reasoning

  • Judgement

  • Perception

  • Attention

  • Comprehension

  • Memory

Importance of Cognitive Abilities

• Key functions:

  • Making decisions

  • Solving problems

  • Interpreting the environment

  • Learning new information

Normal Physiology of Cognition

• Cognition relies on a normally functioning brain and nervous system.

• Neurons and neurotransmitters: Carry messages/impulses (signals).

• Most cognitive tasks occur in the cerebrum and limbic system.

• Requires:

  • Taking in data signal

  • Thinking about it

  • Acting on it

Understanding Normal Cognition

• Key aspects are:

  • Perception: Interpretation of stimuli/inputs

  • Attention: Ability to remain alert and aware

  • Memory: Retention, storing, and retrieval of information

  • Mental Processing: Includes communication, social cognition, motor coordination, executive function, intellectual function, adaptive behavior

Selected Alterations in Cognition

• Alterations in Attention:</br> ADD, ADHD

• Alterations in Memory:</br>

  • Amnesia

  • Short-term memory loss

  • Long-term memory loss

  • Agnosia

• Alterations in Perception:

  • Confusion

  • Psychosis

  • Delusions

  • Hallucinations

Altered Cognition

• Alterations in:

  • Executive function

  • Intellectual function

  • Learning disabilities

  • Some intellectual disabilities may be preventable (i.e., FAS, trauma, prematurity)

Nursing Assessment

• Immediate assessment required for any change in cognition.

• Procedures include:

  • General observation

  • Medical history

  • Physical examination and mental status exam

  • Diagnostic tests

Cognitive Disorders Defined

• Disruption or impairment in higher-level brain functions leading to daily life issues:

  • Forgetting family member names

  • Inability to perform household tasks

  • Neglect of personal hygiene

Delirium Overview

• Syndrome with disturbance of consciousness and cognition, developing rapidly (often within hours) and varying throughout the day.

Exemplar: Delirium

• Classified as a neurocognitive disorder with rapid onset, generally short-term and reversible.

• Features:

  • Abrupt mental status change

  • Disorganized thinking

  • Disorientation

  • Perceptual disturbances

  • Mood instability

• Prevention and management are essential, exact pathophysiology is unknown.

Clinical Presentation of Delirium

• Symptoms include:

  • Confusion

  • Disorientation

  • Disorganized thinking

  • Short attention span

  • Hallucinations and delusions

  • Fear, anxiety, paranoia

• Potential causes include:

  • Illness

  • Medications

  • Dehydration

  • Malnutrition

  • Infection

  • Head trauma

  • Alcohol withdrawal

  • Environmental lack of cues

Therapy for Delirium

• Treatment depends on etiology and development level.

• Biological causes:

  • IV hydration

  • Antibiotic administration

  • Safety precautions

  • Oxygen therapy

• Environmental causes:

  • Managing stimulation

  • Safety measures

  • Consistent routines

• Cognitive causes:

  • Reorientation

  • Anti-psychotic medications

  • Reassurance

• Importance of maintaining a safe environment regardless of cause.

Medications and Delirium

• Medications can underlie delirium; assess potential reactions before administration.

Nursing Care for Delirium

• Priorities:

  • Minimize risk factors

  • Early detection and assessment

  • Protect clients from injury

  • Provide a safe physical environment

Additional Nursing Care Considerations

• Assess potential for injury, such as falls

• Positioning close to nursing station for monitoring

• Reduce visual and auditory stimuli

• Ensure well-lit environments

• Use identification measures (ID bracelets)

Alzheimer's Disease Overview

• Characteristics:

  • Nonreversible type of dementia

  • Progressive development (over years)

  • Leading cause of death in the USA among older adults

  • Risk factors include: age, sex, genetics.

• Symptoms:

  • Memory loss

  • Judgement problems

  • Personality changes

  • Severe physical and cognitive decline over time

Stages of Alzheimer's Disease

• Severe (Late Stage):

  • Inability to converse

  • Needs assistance for ADLs

  • Incontinence

  • Loss of abilities (walking, eating)

  • Increased infection risk

• Moderate (Middle Stage):

  • Forgetting personal history

  • Task difficulties (e.g., bill payments)

  • Sleep pattern changes

  • Potential for incontinence and wandering

• Mild (Early Stage):

  • Able to perform ADLs

  • Noticeable short-term memory loss

  • Difficulty in organizing and concentrating

Nursing Interventions for Alzheimer's

• Actions include:

  • Assess cognitive status

  • Initiate bowel and bladder programs

  • Ensure safe environment

  • Frequent monitoring: visual checks, keep away from hazards

Continued Nursing Interventions

• Suggestions:

  • Incorporate frequent walks

  • Establish structured schedules for sleep

  • Provide means for communication (e.g., calendars)

  • Promote self-care as long as possible

  • Utilize music therapy

  • Maintain a calm environment

Medications for Alzheimer's

• Donepezil:

  • Prevents acetylcholine breakdown

  • Used for mild to severe Alzheimer’s

  • Improves thinking ability but does not cure.

More Medications for Alzheimer's

• Memantine:

  • Addresses memory loss

  • Recommended for later stages

  • Slows symptom progression

Medication Safety for Alzheimer's

• Adverse effects may include:

  • Nausea, vomiting, diarrhea

  • Monitor for fluid volume deficit

  • Promote adequate fluid intake

  • Risk of bradycardia and syncope

• Nursing Interventions:

  • Monitor for adverse effects

  • Educate families and caregivers

  • Assess client’s ability to swallow tablets

  • Administer Donepezil at bedtime