Psychiatric Mental Health Nursing by Videbeck

21 COGNITIVEDISORDERS 525

Table 21-2

DRUGSUSED TOTREATDEMENTIA

Name Dosage Range and Route Nursing Considerations

tacrine (Cognex)

donepezil (Aricept)

rivastigmine (Exelon)

galantamine (Reminyl)

Monitor liver enzymes for hepatoxic effects.

Monitor for flu-like symptoms.

Monitor for nausea, diarrhea, and insomnia.

Test stools periodically for GI bleeding.

Monitor for nausea, vomiting, abdominal pain,

and loss of appetite.

Monitor for nausea, vomiting, loss of appetite,

dizziness, and syncope.

40 –160 mg orally per day

divided into 4 doses

5–10 mg orally per day

3 –12 mg orally per day divided

into 2 doses

16 –32 mg orally per day divided

into 2 doses

Adapted from Drug facts and comparisons.(2002). 56th ed. St. Louis: A Wolters Kluwer Company.

psychotic symptoms of delusions, hallucinations, or
paranoia (Boyd, 2001). Lithium carbonate, carba-
mazepine (Tegretol), and valproic acid (Depakote)
help to stabilize affective lability and to diminish
aggressive outbursts. Benzodiazepines are used cau-
tiously because they may cause delirium and can
worsen already compromised cognitive abilities. These
medications are discussed in Chapter 2.

APPLICATION OF THE NURSING
PROCESS: DEMENTIA

This section focuses on caring for clients with pro-
gressive dementia, which is the most common type.
The nurse can use these guidelines as indicated for
clients with dementia that is not progressive.

Assessment

The assessment process may seem confusing and
complicated to clients with dementia. They may not
know or may forget the purpose of the interview. The
nurse provides simple explanations as often as clients
need them such as “I’m asking these questions so
the staff can see how your health is.” Clients may be-
come confused or tire easily, so frequent breaks in
the interview may be needed. It helps to ask simple
rather than compound questions and to allow clients
ample time to answer.
The Folstein Mini-Mental State Exam (Box 21-3)
is an example of a short instrument that provides
information about the client’s ability to recall facts,
follow directions, and process abstract information.
It does not replace a thorough assessment, but it gives
a cursory evaluation of the client’s abilities.

HISTORY

Considering the impairment of recent memory, clients
may be unable to provide an accurate and thorough
history of the onset of problems. Interviews with

family, friends, or caregivers may be necessary to

obtain data.

GENERAL APPEARANCE AND

MOTOR BEHAVIOR

Dementia progressively impairs the ability to carry

on meaningful conversation. Clients display apha-

sia when they cannot name familiar objects or peo-

ple. Conversation becomes repetitive as they often

perseverate on one idea. Eventually speech may be-

come slurred, followed by a total loss of language

function.

The initial finding with regard to motor behavior

is the loss of ability to perform familiar tasks (apraxia),

such as dressing or combing one’s hair, although

actual motor abilities are intact. Clients cannot imi-

tate the task when others demonstrate it for them. In

the severe stage, clients may experience a gait dis-

turbance that makes unassisted ambulation unsafe,

if not impossible.

Some clients with dementia show uninhibited

behavior including making inappropriate jokes, ne-

glecting personal hygiene, showing undue familiar-

ity with strangers, or disregarding social conven-

tions for acceptable behavior. This can include the

use of profanity or making disparaging remarks about

others although clients have never displayed these

behaviors before.

MOOD AND AFFECT

Initially clients with dementia experience anxiety

and fear over the beginning losses of memory and cog-

nitive functions. Nevertheless, they may not express

these feelings to anyone. Mood becomes more labile

over time and may shift rapidly and drastically for no

apparent reason. Emotional outbursts are common

and usually pass quickly. Clients may display anger

and hostility, sometimes toward other people. They