Transcript Document

Cognitive Impairments:
There are many causes of cognitive impairment. Here
are a few that you’ll most often encounter:
Cognitive Impairments Etiology/Distinguishing Characteristics:
Right Hemisphere CVA:
•Flat affect, (ie, minimal facial expressions, monotone
voice)
•Impulsivity, (eg, during transfers, walking, etc)
•Limited insight into their deficits
•Left neglect, (ie, poor recognition of or ignoring
anything left of midline)
•(These behaviors are rare in patients with left
hemisphere CVA)
Cognitive Impairments Etiology/Distinguishing Characteristics,
Continued:
Traumatic Brain Injury
•Agitation
•Aggressive behaviors
•Inappropriate sexual behaviors
•Poor judgment, (eg, overstuffing mouth with food,
climbing out of bed, etc.)
•Disorientation and memory deficits
Cognitive Impairments Etiology/Distinguishing Characteristics,
continued:
Dementia
•Calling out/yelling
•Confusion/disorientation
•Wandering
•Agitation/combativeness
•Perseveration, (ie, patient repeats the same movement,
says the same thing or keeps talking about the same
topic repeatedly)
Etiology/Distinguishing Characteristics,
continued:
Alcohol/Drug Withdrawal
•Agitation
•Lethargy
•Combativeness
•Confusion
Management of the Patient with
Cognitive Impairments
Behavior
Caregiver Response
Aggression
--Look for the trigger, (ie, is
the patient overstimulated, in
pain or uncomfortable?)
--Stay calm
--Distract/redirect the
patient (ie, “Do you want
something to drink?”)
--Find out if they need to use
the bathroom
--Do not take any behaviors
personally
Management of the Patient with
Cognitive Impairments, Continued:
Behavior
Caregiver Response
Wandering/Agitation
--Allow the patient to move
--Frequent walks with staff, if
possible
--Minimize restraints and tubes
whenever possible, (instead, use
distant supervision in a chair at
nurse’s station vs in bed with
restraints on)
Management of the Patient with
Cognitive Impairments, continued:
Behavior
Caregiver Response
Memory Loss/Disorientation
--Provide orientation daily, (eg,
“Good morning, Mr. ____, today
is January 1, 2009. You’re at
San Francisco General
Hospital. My name is Mary.”)
--Review memory book and/or
calendar with patient
--Encourage discussion of
events, (eg, “You had dialysis this
morning. Are you feeling better
now?”)
recent
Management of the Patient with
Cognitive Impairments, continued:
Behavior
Caregiver Response
Impulsivity
--You may need to slow the
patient down during meals
and only place one food item
at a time in front of the
patient at meals.
Impulsivity is also often seen
during transfers or with the
patient wanting to get out of
bed and/or go home.
Management of the Patient with
Cognitive Impairments, continued:
Behavior
Caregiver Response
Left neglect
--Stand to the patient’s
left side
--Encourage the patient
to look left
--Assist with meals, (eg,
make sure the patient
sees the food and/or
drink on the left side of the
meal tray)
Management of the Patient with
Cognitive Impairments, continued:
Behavior
Caregiver Response
Inappropriate Sexual Behavior
--Ignore it
--Redirect, (eg, if the patient
tries to hug or kiss you, offer
to give a high five or a hand
shake instead)