Saint Mary’s University

Bayombong, Nueva Vizcaya

School of Health & Natural Sciences

NURSING DEPARTMENT
Course No. NCM 117 Lecture
Subject: Care of Client with Maladaptive Patterns of Behavior, Acute and Chronic
Yr. Level: BSN 3
Contact Hours/Credit Units: 4 fours/week(4units)_____________________________________

CHAPTER 21

COGNITIVE DISORDER

l. Introduction

Cognitive disorders are a group of conditions characterized by the disruption of thinking,

memory, processing, and problem solving.

ll. Learning Objectives

1. Apply the moral and ethical-legal principles in dealing with the care of client with cognitive
disorder.
2. Obtain a comprehensive psychiatric history and conduct a thorough assessment of mental
status of a client with cognitive disorder.
3. Formulate a holistic nursing care plan for client with cognitive disorder.
4. Execute a safe, appropriate mental health activity for client with cognitive disorder.
5. Utilize effectively the therapeutic use of self in caring client with cognitive disorder.

lll. Core Content of the Chapter

Cognitive Disorders- disorder that affects consciousness, memory, perception, orientation and
attention.

Types of CD
1. Delirium – An acute confusional state that develops within a short period of time, that last for a
week or less.
Clinical Features: hyperactive/hypoactive
- Sleep disturbances
- Easily destructed
- Irritable
- Myoclonus
- Disorganized thinking and speech
- Cannot register new information
- Restless
- Lucid intervals
- Disoriented to time and place
- Illusion, delusion, hallucination
 - Tremors
- Sundowners syndrome the closer to evening and “sun down” the more confused and
agitated. (sleep/awake cycle maybe completely reversed) it also can be (alert and becomes
confused, agitated and restless as night time approaches)

Causes of Delirium:
1. Illness - heart failure, pneumonia, uremia, malnutrition, dehydration, cancer, CVA, brain
damage, fatigue, brain infection (encephalitis & meningitis),s ystemic infection with fever,
epilepsy, post op reaction, electrolyte imbalances, poisons.
2. Drugs/alcohol (most frequent cause) - anticholinergic with antidepressants, antihistamine,
antispasmodic, analgesics, steroids, sedatives, diuretics

Nursing Management:
1. Treat the underlying cause
2. Provide reality orientation
3. Safe environment
*quiet
*well lighted room with visible clock and calendar.
*decrease environmental stimuli
*using simple words
*avoid exposure to insecticide, solvents
*keep side rails up

2. Dementia – It is a brain dysfunction that is characterized by a gradual, progressive, chronic

deterioration of intellectual function.
- alteration in memory
- alteration in abstract thinking
- alteration in judgment
- alteration in perception

Causes of Dementia:
1. Genetics
2. Decreased cerebral bld. Flow. Shock, hypertension, CHF, CV attack
3. Brain hypoxia: copd chronic obstructive pulmonary disease, asthma acethylcholine loss
4. Aluminum
5. Vitamin deficiency: alcoholism, anemia
6. advance age
7. DM, electrolyte imbalances, end stage of UTI, renal failure
8. Trauma, tumors

Symptoms:
1. Stage 1 (1 to 3 years)
Forgetfulness, inappropriately dressed, disoriented to time, decreased concentration,
impaired judgement
2. Stage 2 (lasting approximately 2 to 10 years)
Over reacting to minor stressors, tantrums, wandering, hallucination delusion,
aggressive behaviour, hyperorality, pacing around, echolalia, finger tapping,
confabulation, Agraphia (inability to read/write),
Agnosia (inability to recognize people/stimuli)
Auditory agnosia (can’t recognize sounds)
Astereognosia (tactile agnosia, can’t recognize familiar objects when placed on hand)
 Alexia (visual, can’t recognize objects and it’s use by sight)

3. Stage 3 (lasting approximately 8 to 10 years before death occurs)

Kluver-Bucy syndrome (hyperorality and development of binge eating)
Hyperetamorphosis (compulsive touching, and examining objects in the surroundings)
Deterioration of mobility
Decrease response to environment
Severe decline of cognitive function
May scream, say one word and frequently becomes mute

Nursing Management:
1. Safe environment (falls and wandering)
2. Decrease stimulus
3. Ask one question at a time
4. Wait patiently for the response
5. Maintain eye contact
6. Use clear and simple words
7. Speak slowly and clearly
8. Repeat question if asked, but do not rephrase
9. Reorient to reality

3. Alzheimer’s Disease (Ad) - Is an age related, progressive disorder of the CNS. Chronic cognitive
dysfunction. A disease of the brain that causes gradual death of the cells, cerebral cortex then
progressive irreversible.

5 A’s of AD:
1. Anomia - inability to remember names of things.
2. Apraxia - misuse of objects because of failure to identify them.
3. Agnosia - inability to recognize familiar object, taste, sounds and other sensations.
4. Aphasia - inability to express oneself through speech.
5. Amnesia - inability to recall.

Causes:
1. Decrease acetylcholine and serotonin
2. Degenerative brain cells
3. Tangles and plaques in the nerve cell fibers
4. Slow acting virus
5. Hereditary – occurs before age 65.
6. Elevated aluminum in the brain
7. Calcium imbalances

Risk Factors:
1. Advance age
2. Vascular factors
3. Family history
 10 warning signs / indicators for AD:
1. Memory loss 6. Difficulty performing familiar task
2. Problems with language 7. Disorientation to time and place
3. Poor or decrease judgment 8. Problems with abstract thinking
4. Misplaced belongings 9. Changes in mood or behavior
5. Changes in personality 10. Loss of initiative

Nursing Management:
1. Safe environment
2. Offer visual or verbal cues
3. Orient to reality
4. Encourage to do things for themselves
5. Focus interaction

Medication:
1. Aricept
2. Vitamins

4. Parkinson’s Disease – It is a progressive, chronic and degenerative disease that affects

the extrapyramidal system.

Manifestations:
1. Tremors
2. Bradykinesia
3. Rigidity

Cause:
1. Imbalances of dopamine and acetylcholine

Nursing Management:
1. Facilitate swallowing
2. Increase fiber in client’s food.
3. Safe environment
4. Improving communication
5. Improving mobility

Medication:
1. Anticholinergic drugs

Comparison DELIRIUM DEMENTIA

Onset rapid gradual
Duration brief progressive deterioration
Judgment impaired impaired
Mood fearful, weeps, irritable, anxious depressed, anxious, angry outburst
Memory impaired impaired & destroyed
Thoughts temporarily disorganized impaired & eventually lost
Perception visual, tactile, delusion paranoid, hallucination, illusion
Speech hesitant, slow, incoherent, slurred difficulty finding words to say
IV. Activity:
Short Quiz
Long Quiz

V. Bibliography:
Videbeck, S. (2020). Psychiatric-Mental Health Nursing. Wolters
Keltner, N., Bostrom C., & McGuiness T. (2012). Psychiatric Nursing. Elsevier Inc.

Prepared by:

Mrs. Rosalie C. Carreon, RN, MSN

Nursing Department