536 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
I NTERNET R ESOURCES
Resource Internet Address
◗Alzheimers Society of Canada http://www.alzheimer.ca
◗Alzheimer’s Disease Education and Referral http://www.alzheimers.org/
◗Support and Education for Patients, Caregiver, http://www.alzwell.com
Doctors, and Others
◗Alzheimer’s Association http://www.alz.org
◗Alzheimers Disease International http://www.alz.co.uk
◗The Alzheimer Page http://www.adrc.wustl.edu/alzheimerCritical Thinking Questions
1.The nurse is working in a long-term care set-
ting with clients with dementia. One of the
ancillary staff makes a joke about a client in
the client’s presence. The nurse tells the staff
person that is unacceptable behavior. The
staff person replies, “Oh, he can’t understand
what I’m saying, and besides, he was laughing
too. What’s the big deal?” How should this
nurse respond?
2.A client is newly diagnosed with dementia in
the early stages. Can the client make deci-
sions about advance medical directives? Why
or why not? At what point in the progression
of dementia can the client no longer make
quality-of-life decisions?dementia progresses; he or she can do so by discussing
the situation with colleagues or even a counselor.
Points to Consider When Working
With Clients With Dementia
- Remember how important it is to provide
dignity for the client and family as the
client’s life ends. - Remember that death is the last stage of life.
The nurse can provide emotional support for
the client and family during this period. - Clients may not notice the caring, patience,
and support the nurse offers, but these
qualities will mean a great deal to the
family for a long time.
➤ KEY POINTS
- Cognitive disorders involve disruption or
impairment in the higher functions of the
brain. They include delirium, dementia, and
amnestic disorders. - Delirium is a syndrome that involves dis-
turbed consciousness and changes in cogni-
tion. It usually is caused by an underlying,
treatable medical condition such as physio-
logic or metabolic imbalances, infections,
nutritional deficits, medication reactions or
interactions, drug intoxication, or alcohol
withdrawal. - The primary goals of nursing care for clients
with delirium are protection from injury,
management of confusion, and meeting their
physiologic and psychological needs. - Dementia is a disease involving memory
loss and multiple cognitive deficits such as
language deterioration (aphasia), motor
impairment (apraxia), or inability to name
or recognize objects (agnosia). - Dementia is usually progressive, beginning
with prominent memory loss (mild stage) and
confusion and loss of independent functioning
(moderate), followed by total disorientation
and loss of functioning (severe). - Medications used to treat dementia, tacrine
and donepezil, slow disease progression for
about 6 months. Other medications, such as
antipsychotics, antidepressants, or benzodi-
azepines, help manage symptoms but do not
affect the course of dementia. - A psychosocial model for providing care for
people with dementia addresses needs for