Psychiatric Mental Health Nursing by Videbeck

520 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS

DEMENTIA

Dementiais a mental disorder that involves multi-
ple cognitive deficits, primarily memory impairment
and at least one of the following cognitive disturbances
(APA, 2000):

• Aphasia,which is deterioration of language
  function


• Apraxia,which is impaired ability to
  execute motor functions despite intact
  motor abilities


• Agnosia,which is inability to recognize or
  name objects despite intact sensory abilities


• Disturbance in executive functioning,
  which is the ability to think abstractly and

to plan, initiate, sequence, monitor, and stop

complex behavior

These cognitive deficits must be sufficiently severe to

impair social or occupational functioning and must

represent a decline from previous functioning.

Dementia must be distinguished from delirium;

if the two diagnoses coexist, the symptoms of de-

mentia remain even when the delirium has cleared.

Table 21-1 compares delirium and dementia.

Memory impairment is the prominent early sign

of dementia. Clients have difficulty learning new

material and forget previously learned material. Ini-

tially recent memory is impaired, for example, for-

getting where certain objects were placed or that

food is cooking on the stove. In later stages, demen-

continued from page 519

The client has the right to be informed of any

restrictions and the reasons limits are needed.

Compliance with treatment is enhanced if the

client is emotionally invested in it.

The client must become aware that his or her

perceptions are not shared by others.

When given feedback in a nonjudgmental way,

the client can feel validated for his or her feelings,

while recognizing that others do not respond to

similar stimuli in the same way.

Clients with organically based problems tend to

fluctuate frequently in terms of their capabilities.

Decision-making increases the client’s participa-

tion, independence, and self-esteem.

Activities that are routine or part of the client’s

habits do not require continual decisions about

whether or not to perform a particular task.

When the client has knowledge about the cause(s)

of confusion, he or she can seek assistance when

indicated.

If limits on the client’s behavior or actions are

necessary, explain limits, consequences, and

reasons clearly within the client’s ability to

understand.

Involve the client in making plans or decisions as

much as he or she is able to participate.

Give the client factual feedback on his or her

misperceptions, delusions, or hallucinations

(e.g., “That is a chair.”).

In a matter-of-fact manner, convey to the client

that others do not share his or her interpretations

(e.g., “I don’t see anyone else in the room.”).

Assess the client daily or more often if needed for

his or her level of functioning.

Allow the client to make decisions as much as he

or she is able.

Assist the client to establish a daily routine

including hygiene, activities, and so forth.

Teach the client about underlying cause(s) of

confusion and delirium.

Adapted from Schultz, J. M. & Videbeck, S. L. (2002). Lippincott’s Manual of Psychiatric Nursing Care Plans (6th ed.). Philadelphia:

Lippincott Williams & Wilkins.