MH 5.1 - Canadian Valley Technology Center
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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
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