N212: Health Differences Across the Life Span 2

Health Differences Across the Lifespan 2 Study Guide

©2017 Achieve Test Prep Page 53 of 140 is the inability to carry out skilled and purposeful movements, or the inability to use objects properly. Agnosia is the inability to recognize familiar situations, people, or stimuli, not related to impairment in sensory organs. There is a disturbance in executive functioning (planning, organizing, sequencing, abstracting). The course of this disease is insidious and progressive, characterized by gradual onset and continuing cognitive decline. Cognitive deficits cause significant impairment in social or occupational functioning and represent a significant decline from the previous level of functioning. Dementia can be classified as Alzheimer’s type, vascular dementia, dementia due to other general medical conditions, substance induced persisting dementia, or multiple etiologies. Chapter Two: Care of Patients with Impaired Cognitive Function 2.1 Delirium Delirium is characterized by a disturbance in consciousness and a change in cognition that develops over a short period; it is acute in nature. It is a cognitive disorder with an organic etiology that is reversible. The condition may last hours or weeks, but usually resolves in a few days. Evidence from history, physical examination, or laboratory findings suggests that disturbances are caused by direct physiological consequences of a general medical condition, substance intoxication, substance withdrawal, or multiple etiologies. Signs and symptoms include recent memory loss and poor abstract thinking. Poor problem-solving ability, presence of hallucinations, delusion, and confusion are also signs. Implementation is to keep the patient in a quiet, structured environment with side rails up to keep the patient safe from injury. Nurses should express directions in simple and concrete manner. Delirium has a sudden onset and an identifiable cause. A thorough medical evaluation reveals abnormal lab results and an EEG (electroencephalogram) confirms cerebral dysfunction. More than one examination at different times of the day detects fluctuations in the level of consciousness. Treatment involves identifying the underlying cause and ruling out other reasons for delirium, such as depression, anxiety, dementia, or personality disorder. The patient will have cyclic alternating periods of coherence with periods of confusion, specifically with disorientation that worsens at the end of day, usually referred to as sundown syndrome. Alternating patterns of hyperactivity (typical of drug withdrawal) to hypoactivity (typical of metabolic imbalance) are also present. Hyperactive behaviors include rambling, bizarre or incoherent speech, restlessness, picking at clothes or bed linen, irritability, euphoria, calling out for help, striking out at others, bizarre and destructive behavior, combativeness, anger, and profanity. Hypoactive behaviors include limited, dull patterns of speech, lethargy, apathy, withdrawn behavior, reduced alertness or awareness of environment, cognitive changes (disorganized thinking, diminished ability to focus attention, easily distracted), visual or auditory hallucinations, frightening delusion, and sleep pattern disturbances (including vivid and terrifying dreams or nightmares). The predominant emotion is fear with a high level of anxiety. 2.2 Dementia Dementia is chronic in nature. It is associated with Alzheimer’s Disease, and is caused by brain pathology that causes global impairment of cognitive functioning, memory, and personality. Reversal is unlikely. Aphasia is an inability to understand or use language. Apraxia

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