Transcript MH 5.1 - Canadian Valley Technology Center

MH 5.1
Judith Wikel RN BSN MEd
MH 5.1 Problems in Late Adulthood, Cognitive
Impairment, Alzheimer’s Disease & Dementia


In this chapter will have the opportunity to learn
about normal age-related changes in cognition as
well as confusion and how it can be caused by
medication.
This chapter provides information on the signs and
symptoms of dementia, delirium, and Alzheimer’s
disease as well as mental health care goals for
clients with Alzheimer's disease and support groups
for caregivers.
Chapter 17

Cognition
 The
words cognition and cognitive describe activities of
the mind involved in thinking and thought processes.
Chapter 17 Confusion

The Five “Ds” of Confusion
 The
word confusion is a very general term that is
difficult to define. For health care providers, confusion
is a symptom of an underlying problem that requires
immediate attention.
Chapter 17 Confusion

The Five “Ds” of Confusion
 Confusion
 Damage
– from head injuries or conditions that cause a
lack of oxygen (hypoxia) to the brain can lead to
confusion.
 Depression – people who suffer a great losses can
experience confusion related to depression.
 When
one’s focus is inner sadness, outside stimuli can be
misinterpreted or misunderstood. The individual becomes
“labeled “confused” and the depression is ignored.
Chapter 17 Confusion

The Five “Ds” of Confusion
 Damage
 Depression
 Deprivation
 Dementia
 Delirium
 Please
refer to figure 17-1 on page 180 to foster
understanding.
Myths of Aging

Myths
 Elders
live in Nursing Homes
 Most
individuals with Alzheimer’s disease are care for in
their home.
 The
majority of elderly are rich
 The majority of elderly are poor
 12%
of older adults live in poverty
Alzheimer’s Disease

Alzheimer’s Disease – is a progressive,
degenerative disorder that affects brain cells and
results in impaired memory, thinking, and behavior.
Stages of Alzheimer’s Disease

Early stage
 Begins
with the loss of recent memory. Inability to learn,
to process, and to retain information. Individuals in the
early stage forget where they put things and begin to
have difficulty performing the activities of daily living.
 Family members begin to report strange behaviors and
mood swings.
Stages of Alzheimer’s Disease

Intermediate Stage – inability to recall any recent
events or process new information.
 Aphasia
– loss of language
 Apraxia – loss of ability to perform everyday actions,
activities
 Visual agnosia - loss of recognition of previously
known or familiar people and objects.
Family support becomes very important
nursing action.
Stages of Alzheimer’s Disease

Severe Stage – in ability to do anything…
 Clients
usually become incontinent
 Unable to walk
 Entirely dependent on others for care
 Memory, both recent and remote is completely lost
 Inability to swallow increases their risk for developing
pneumonia and malnutrition.
Stages of Alzheimer’s Disease

End Stage
 Client
slips into a coma and death from pneumonia or
other infection occurs.
Alzheimer’s Disease

Affective loss
 Alzheimer’s
disease slowly robs an individual of his or
her “personhood” (personality)
 Each decline is accompanied by a loss.
 Individuals with Alzheimer’s Disease become unable to
make even the simplest decisions or choices.
Sundown Syndrome

Sundown Syndrome - describes a group of
behaviors characterized by confusion, agitation,
and disruptive actions that occur in the late
afternoon or evening.
Alzheimer’s Disease


People with Alzheimer’s Disease may live from 2 to
20 years after diagnosis. The average is about 8
years.
Although they are in great emotional turmoil, family
members must cope with the reality of the disease
and begin planning for the future.
Nursing Management of the Patient
with Alzheimer's Disease.


Family support – families have a difficult time
adjusting to the changing personality and behavior
of the loved one.
Drug therapy is showing promise with medications
that improve cognition, behavior, and functioning in
some patients.
Communication and Alzheimer’s
Disease

Please refer to Box 17-7 on page 187
 Always
approach from the front –no surprise
appearances.
 Use familiar words and short, simple sentences.
 If the person is a pacer, walk with him or her, in step,
while you talk.
Orienting Environmental Cues for
Patient with Alzheimer’s Disease

Please refer to Box 17-8 on Page 188
 Keep
environment simple and “user friendly.”
 Put large signs that identify each room on the doors.
 Color-code hot and cold faucets red and blue.
 Keep rooms brightly lit with no glare.
Functional Assessment

Refer to Box 17-5 on page 187
A
Functional Assessment
 Daily
Functions
 Cognitive Status
 Medical Condition
 Behavioral Problems
 Psychological Status
 Psychosocial Status
After assessment nurse is able to determine the patients
ability to perform ADLs.
Therapeutic Interventions for
Alzheimer’s Disease

Refer to Table 17-4 on Page 189
 Validation
Therapy – Caregiver buys into client’s illusion
and plays along (validates it) until opportunity refocus
behaviors is present, based on the premise that the
client’s illusion cannot be changed, but it can be
directed.
 Audio presence intervention - Playing of tape-recorded
memories by family members to help decrease
agitation.
Medications and Alzheimer’s
Disease

Please refer to Drug Alert 17-2 on page 187.
Donepezil (Aricept)
 Side






effects
Nausea, vomiting, diarrhea
Dizziness
Headache
Insomnia
High or low blood pressure
Urinary problems
Medications and the Elderly
Population


Elderly patients may take numerous medications
and this can cause confusion.
Over the counter medications


cold medications, my cause confusion, disorientation,
and memory loss.
Metabolism is slower in older adults
 This
means drugs are eliminated more slowly and can
reach toxic levels is not closely monitored.
 The nurse must continuously assess for medication
interactions.
Nursing Responsibilities related to
Medications

Nurses have a special responsibility to ensure that
their older clients are using their medications
correctly.
 Refer
to Drug Alert 16-1 on page 174, read and focus
on the Planning section.
 Arrange
for the client to show you the steps in identifying
and taking the medications if necessary. The nurse should be
continuously monitoring for noncompliance related
medications.
Nursing Responsibilities related to
Medications

Age-related nursing interventions
 The
capacity of the brain to process, store, and retrieve
information begins to function less efficiently.
 When teaching elderly people, there are several things
to keep in mind.
 First,
assess any physical or sensory changes that may
interfere with their learning (and your teaching)
 Continued on next slide…
Nursing Responsibilities related to
Medications




Teach clients about their medications, refer to the
medications by name and shape rather than
color.
Face client, speak slowly and clearly in lower
tones.
Be patient and respectful.
Write out important points.
 Your
clients’ willingness and ability to learn will greatly
improve when using interventions.
Medicare

In the United States people 65 years and older are
coved by national health program called Medicare.
Hoarding

Hoarding
 The
act of collecting and saving assorted, seemingly
useless items.
Elder Abuse

Elder abuse is defined as any action that takes
advantage of an older person, his or her emotional
well-being or property.
 The
typical abused elder is a woman, at least 75
years of age, with physical or mental problems who
is living with a relative. This would be an example
of domestic abuse.
 Can you think of an example of
Exploitation?
Depression


Depression is probably the most common mental
health disorder of late adulthood.
Depression is commonly underdiagnosed and
undertreated.
Depression

Signs and symptoms of depression
 Please
refer to Box 16-4 on page 176
 Physical


Symptoms
Abdominal pain
Dry mouth
 Cognitive

agitatioin
 Emotional


Fatique
Lack of interest
 Behavioral
Mental Changes of Aging

Please refer to Table 16-1 on Page 171
 Attention
- Alertness, maintaining focus, noticing
 Crystallized intelligence - Specialized accumulated
knowledge (nursing, engineering, technical skills)
 Memory – Names and faces
Validation Therapy

Please refer to Box 16-5 on Page 176
 Eye
contact
 Touch
 Mirroring the client’s body movement
 Matching the client’s voice and rhythm patterns
 Empathy****
 Putting the client’s cues about feelings into words
 Accepting the client withour passing judgement
 Genuine, total listening
People Older than 45 years

Please refer to Box 16-3 on page 174
 Seventy-five
 13%
percent use some kind of medication
of population is over age 65.
Standards of Geriatric Care


The American Nurses Association (ANA) has
developed guidelines (standards) for nurses who
work with older adults.
These standards offer nurses a means for providing
and measuring the nursing care they deliver to
older adults.
Q&A

Refusing to throw away expired medications, saving
sugar packets from hospital meal trays, collecting
old newspapers and junk mail, and having a
refrigerator full of plates of half-eaten food are
examples of:
 A)
loss
 B) ageism
 C) memory loss
 D)hoarding
 The
answer is D) hoarding.
Q&A

One of the most common mental health problems
that the elderly face is which of the following?
 A)
depression
 B) ageism
 C) elder abuse
 D) hoarding
 The
answer is A) depression
Q&A

A typical victim of elder abuse would be:
 A)
a 69-year-old man living at home with his confused
wife.
 B) a 70-year-old blind woman living in assisted living
facility.
 C) a 79-year-old woman with diabetes living with her
daughter.
 D) a 72-year-old widow living in a mobile home park.
 The
answer is c.
MH 5.1
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Remember the PowerPoint is an outline to guide one
in areas to study for the test.
Read assigned material
Watch videos prn
Utilize objectives to foster understanding.
 Good
luck, JudithRN