Nursing Knowledge 1000-Module 7 Cognition

Describe the signs and symptoms of vascular dementia

-Impairment of memory, thinking and reasoning -Development can be abrupt/insidious... with memory loss, apathy & inability to manage daily routines -Difficult with motor skills/balance -Heart disease/stroke increase its likelihood

cause of delirium

-stroke, tumors, infection, fluid and electrolyte, imbalance, acute inflammatory disorders, drug reactions, toxins, sensory deprivation

an Acute, fluctuating state of confusion is seen with; A. Delirium B. Dementia

A. Delirium

A student nurse was asked which of the following best describes dementia. Which of the following best describes the condition? A. Unrecognized until deficits become obvious B. Part of the natural aging process C. Always resultant of a TIA or stroke D. Difficulty coping with physical and psychological change

A. Unrecognized until deficits become obvious

Description and onset of delirium

Acute, fluctuating state of confusion Fast

82-year-old Mr. Robeson together with his daughter arrived to the medical-surgical unit for diagnostic confirmation and management of probable delirium. Which statement by the client's daughter best supports the diagnosis? A. "Maybe it's just caused by aging. This usually happens by age 82." B. "The changes in his behavior came on so quickly! I wasn't sure what was happening." C. "Dad just didn't seem to know what he was doing. He would forget what he had for breakfast." D. "Dad has always been so independent. He's lived alone for years since mom died."

B. "The changes in his behavior came on so quickly! I wasn't sure what was happening."

A patient is admitted to the mental health unit with a diagnosis of vascular dementia. Which of the following describes the brain alteration involved in this disorder? A. Good blood flow to brain tissue B. Hypoxic damage to brain tissue C. Enlargement of the ventricles D. Decreased choline acetyltransferase

B. Hypoxic damage to brain tissue

Difficulty calculating change is a sign of: A. Perception B. Language C. Executive Functions D. Learning

B. Language

Your grandmother rude Jude is ticked off because she was kicked out of a store for cutting in line, this is a sign of which type of cognitive impairment; A. Perception B. Social Cognition C. Executive Functions D. Learning

B. Social Cognition

80-year-old Mr. Stevens is accompanied to the clinic by his son, who tells the nurse that the client's constant confusion, incontinence, and tendency to wander are intolerable. The client was diagnosed with chronic cognitive impairment disorder. Which nursing diagnosis is most appropriate for the client's son? A. Risk for other-directed violence B. Disturbed sleep pattern C. Caregiver role strain D. Social isolation

C. Caregiver role strain

Your patient complains of being hungry all time and stats that he sometimes forgets to eat, this is a sign of which type of cognitive impairment A. Learning and Managing B. Social Cognition C. Executive Functions D. Learning

C. Executive Function

Nurse Isabelle enters the room of a client with a cognitive impairment disorder and asks what day of the week it is; what the date, month, and year are; and where the client is. The nurse is attempting to assess: A. Abstract thinking B. Awareness C. Orientation D. Education

C. Orientation

Which can be has the potential to be treated; dementia or Delirium?

Delirium, if you treat the root cause. There is no cure for dementia, manage stressors

Describe normal age related changes to cognition

Neuronal dendrites atrophy ... leading to fewer synapses & neurotransmitters Cerebral blood flow & metabolism are reduced, impacting mental functions Changes to the peripheral nervous system may effect visual acuity, hearing & balance Cognitive function may be impacted as follows: a) verbal fluency, b) logical analysis, c) selective attention, d) object naming & e) complex visuospatial skills Weight of the brain decreases with age, as does # of neurons Less effective neurotransmitter

What is an example of abstract thinking?

Recognizing that apples and oranges are both fruits

In clients with a cognitive impairment disorder, the phenomenon of increased confusion in the early evening hours is called:

Sundowning

Duration of delirium vs dementia

hours to less than a months vs years until death

Definition of cognition

the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.

Assessment methods of cognition

§Interview / ask: risk factors, health history, LOO, etc. §Data from: client, family member / friend, directly observed by nurse §Observe: LOC, general appearance (e.g. hygiene, clothing, make-up), behaviour, gait, posture & movement, facial expression, voice (e.g. tone, flow, rate of speech)

Basic cognitive function of Perception in driving

´Being able to interpret the environment using sensory input ´Brain/eyes = a)no threats coming towards them, b) scan for familiar landmarks ´Brain/ears = honking of a car's horn or people shouting cautionary directions

Basic cognitive function of Pattern recognition in driving

´Brain recognizing & using patterns to predict what could happen next ´Allows for logic to be applied to common activities ´Driving through intersections = automatic...know when & how to proceed through intersection...how much to turn steering wheel & step on the gas pedal...memory bank

Symptoms of impaired cognition

´Cannot stay awake / poor sleep ´Being confused to time, place and / or person ´Frustration, denial and / or anger at self for changes ´Inability to complete ADLs / IADLs ´Decreased quality of life (e.g. social isolation) ´Safety concerns: getting lost, hurting self, hurting others, etc.

Mechanism of Vascular Dementia

´Cerebrovascular occlusion secondary to atherosclerosis can compromise blood flow to brain tissue leading to cerebral infarction (stroke) ´Prolonged elevations of blood pressure cause remodeling rarefaction of small arteries & arterioles of arterioles & capillaries ´These effects compromise brain tissue perfusion & lead to loss of integrity & function of brain tissue

Basic cognitive function of Attention while driving

´Consciousness ... fully conscious person is aware of their surroundings & reacts to stimuli in the environment ´Stimuli: familiar landmarks, objects, and / or vague memories of having been through that intersection before ... only happens when fully conscious & able to pay attention to the task at hand ´Juggle operation of a MV + wayfinding = full attention

Who is at risk for vascular dementia?

´Elderly Age is the strongest risk factor for vascular dementia ´Men are at slightly higher risk than women ´It is common in older adults over 70 years of age ... particularly with HTN ´Stroke, diabetes & heart disease elevate the risk for vascular dementia ´All factors that predispose to cardiovascular disease & diabetes increase one's risk

What is Vascular Dementia?

´Form of dementia caused by cerebrovascular disease & frequently resulting from multiple small brain infarctions ´Associated with impairment of memory, thinking & reasoning ´2nd most common cause of dementia following Alzheimer's Disease

Diagnosing Dementia

´Impairment in 2 of these cognitive domains: memory, language, visuospatial or perceptual motor, and / or executive function ´Functional decline in activities or work performance ´There is no other explanation for the cognitive changes

Signs of impaired cognition

´Lethargic, sleepiness, needs significant stimulus to respond, fluctuating attention span ´Confused: unsure of person, place or time ´Amnesia, poor short-term and / or long-term memory ´Body odour, soiled / mismatching clothing, wearing clothing inappropriate for season ´Gait: slow movements while walking, dragging feet, shuffling, uncoordinated ´Eyes: avoiding / indirect eye contact, fleeting, cannot keep eyes open during conversation

Risk factors for impaired cognition

´Personal: substance abuse, high-risk activities ´Work: head injury ´Environment: pesticides, lead, etc. ´Congenital / genetics: substances, cerebral palsy, Down syndrome, Huntington disease Diseases: stroke, diabetes, CV, etc

What are the six domains of cognitive function

1. Perceptual motor function - Perceptual deals with obtaining information and motor refers to the outcome of movement 2. Language - Language learning and cognition are strongly related to one another, and when language acquisition is delayed, it may affect the ability to learn concepts and develop spatial skills and other areas of cognitive development. 3. Learning and memory - Memory broadly refers to the retention and recall of past experiences and learning 4. Social cognition - is a sub-topic of various branches of psychology that focuses on how people process, store, and apply information about other people and social situations. It focuses on the role that cognitive processes play in social interactions. 5. Complex attention - Attention is a focus on a particular area of conscious content. It implies selection as well as the ability to direct cognitive effort 6. Executive function - refers to the higher thinking processes that allow for flexibility, adaptability, and goal directedness. Executive function determines the contents of consciousness, supervises voluntary activity, and is future oriented

Your great aunt Trudy keeps mistaking her morning meds with her nighttime meds, this is a sign of which type of cognitive impairment A. Learning and Managing B. Social Cognition C. Executive Functions D. Learning

A. Learning and Managing