DEMENTIA.pptx

Nursing management and description of organic brain disorder - Dementia

1. W E L C O M E

2. Presented to:- Mrs. Devika Mishra mam (Clinical specialist, Psychiatric Nursing) C.O.N., Berhampur Presented by:- Miss Rupambika Biswal, Miss Sagarika Pradhan, Basic B.Sc. (N), 3 rd year.

3. DEMENTIA

4. CONTENTS:- Clinical features Diagnosis Treatment Modalities Nursing Management Summary Conclusion Bibliography Introduction Definition Classification Incidence Types Etiology Risk factors Stages

5. Introduction Cognition is that operation of the mind process by which we become aware of objects , thought and perception Organic brain / mental disorder is a general term refering to many physical disorder that causes impaired mental functioning resulting in abnormal behavioural and psychological symptoms

6. Definition:- According to WHO Dementia is, 'The progressive decline in cognitive functions (particularly affected areas like thinking, reasoning, memory, attention, language and problem solving) due to damage or disease in the brain beyond, what might be expected from normal aging.’

7. Classification of organic mental disorder F00--09- Organic, including symptomatic, mental dysfunction and Disorder F00 –Dementia in azheimer’s disease F01- Vascular dementia F02- Dementia in other disease classified elsewhere F03- Unspecified dementia F04- Organic amnestic syndrome F05- Delirium F06 –Other mental disorder due to brain damage , dysfunction and physical disease F07- Personality and behavioural disorder due to brain disease,damage and dysfunction

8. Incidence It Occurs more commonly in the elderly than in middle age.
It increases with age from 0.1% in the below 6 Of years of age and 15-20% in people above 80 years of age

9. Types of Dementia There are generally 10 types of Dementia. That are:- Alzheimer’s disease:- It is a progressive condition that causes neuronal loss in the part of the brain that responsible for learning, creating memories and expressing emotions. It’s the most common form of Dementia.

10. 2. Lewy- body Disease ( LBD ):- LBD is the 2 nd most common
type of Dementia. This progressive disease occurs when protein
deposits build up on the nerve cells of the brain stem. Signs of LBD
include the following: Muscle rigidity Uncontrollable behaviour issues Tremors Recurring hallucination Aggressive behaviour Difficulty in sleeping Cognitive loss

11. 3. Vascular Dementia:- This fo rm of Dementia occurs when blood flow to the brain is interpreted.It is often caused by a stroke, coronary heart disease or advanced diabetes . Early signs ofvascular Dementia includes the following: Difficulty in concentration Inability to communicate thought A decline in analytical Thinking

12. 4. Huntington’s Disease (HD) :- This form of Dementia is caused by an inherited defective gene. When a person has HD, there is a 50% likelihood that their children will develop it too. Signs of HD includes the following: Impaired judgement Speech problem Depression and Mood diaorders Forgetfulness Unsteady gait while walking

13. 5. Parkinson’s Dementia:- Parkinson’s disease often progress to parkinson’s Dementia. Dementia causes the patient to develop the following symptoms: Memory loss
Poor judgement Speech problem Difficulty with abstract thoughts

14. 6. Wernicke-korsakoff syndrome (WKS):- This syndrome is caused by lack of Vitamin B1 or thiamine .It is commonly seen in alcoholics, cancer patients,long term dialysis patients and people who are malnourished.Signs of WKS include the following: Dropping eyelid Double vision Hallucination Difficulty in processing information Aggressive behaviour

15. 7. Frontotemporal Dementia(pick’s disease) This form of Dementia affects the part of the brain that are responsible for one’s personality.Signs of this includes: Socially inappropriate behaviour
Impulsive behaviour Lack of empathy Lack of judgement A decline in personal hygiene

16. Creutzfeldt-Jakob Disease :- Creutzfeldt-Jakob disease is one of the rarest forms of dementia, with only one in a million being diagnosed with this condition. It progresses rapidly, and people often die within a year of diagnosis. Its symptoms are similar to other forms of dementia, including confusion, memory loss, agitation and depression. Those with Creutzfeldt-Jakob disease may also experience muscle twitching and stiffness. Mixed Dementia :- This form of dementia occurs when a patient experiences two or more types of dementia simultaneously.

17. Normal Pressure Hydrocephalus :- Normal pressure hydrocephalus (NPH) is a condition that causes fluid build-up in the brain’s ventricles, affecting its tissue and leading to dementia symptoms. Some potential causes of this condition includes injury, bleeding, infection, brain tumour and previous brain surgeries.
Those with the condition may experience poor balance, forgetfulness, mood swings, depression, frequent falls and loss of bowel or bladder control.

18. Etiology Significant loss of neurons and volume in brain regions devoted to memory and higher mental functioning Neurofibrillary tangels
Buildup of amyloid Accumulation of beta amyloid,an insoluble protein,which form sticky patches surrounded by debris of dying neurones Environmental factors like Infection,metals,toxins
Excessive amount of metal ions such as zinc and coppy ,in brain Deficiencies of vitamins B6,B12 and folate

19. Possible risk factor due to increase level of homocysteine ( an amino acid that interfere with nerve cell repair) Early depression Serious head injury Education level Increase risk in those with less education than in those who remain mentally active

20. Untreatable and Irreversible cause of Dementia Degenerating disorder of CNS
Alzheimer’s disease ( most common form of Dementing illness) Pick’s disease Huntington’s chorea
Parkinson’s disease

21. Treatable and reversible cause of dementia Vascular – Multi infract Dementia Intracranial space occupying lesions Metabolic diaorder like hepatic failure and renal failure Endocrine disorder like myxedema, Addison’s disease Infection like AIDS, meningitis, encephalitis etc
Intoxication- alcohol, heavy metals( lead, arsenic ), chronic barbiturates poisoning Anoxia- Anemia ,post anesthesia, Chronic respiratory failure Vitamin deficiency Especially deficiency of nicotin and thiamine

22. Stages are Stage 1 – Early stage Stage 2- Middle stage Stage 3-late stage

23. Stage 1 ( Early stage) 2 to 4 year of disease Forgetfullness Declining Interest in environment Hesitancy in initiating action Poor performance at work

24. Stage 2(middle stage) 2 to 12 years of disease Progressive memory loss Hesitate in response to questions Has difficulty in following simple instruction
Irritable, anxious Wandering Neglect personal hygiene Social isolation

25. Stage-3( Final stage ) After 12 years of disease onwards till death Marked loss of weight because of inadequate intake of food
Unable to communicate Does not recognize family Incontinence of urine and feces
Loses the ability to stand and walk
Death is usually causes by aspiration pneumonia

26. Clinical features Personality changes :- Lack of interest in day to day activities, easy mental fatigability,self centred, withdrawn, decreased self care. Memory impairment :- Especially recent memory is prominently affected. Cognitive impairment :- Disorientation,poor judgement, difficulty in abstraction, decreased attention span.

27. Affective impairment:- Labile mood, irritableness, depression. Behavioural impairment:- Stereotyped behaviour, alteration in sexual drives and activities, neurotic/psychotic behaviour. Neurological impairment:- Aphasia, apraxia,agnosia, seizure, headache.

28. Catastrophic reaction:- Agitation, attempt to compensate for defects by using strategies to avoid demonstrating failure in intellectual performance, such as changing the subject, cracking jokes,or otherwise diverting the interviewer. Sundowner syndrome :- It is characterized by drowsiness, confusion,ataxia: accidental falls may occur at night when external stimuli ,such as light and interpersonal orienting cues are diminished.

29. DIAGNOSIS:- Based on ICD 10 criteria. Following tests are used for diagnosis :- Cognitive assessment evaluation – Mini Mental Status Examination – Shows cognitive impairment Functional dementia scale (to indicate degree of dementia) Magnetic resonance imaging (MRI) of the brain shows structural and neurologic changes Spinal fluid analysis shows increased beta amyloid deposits.

30. TREATMENT MODALITIES:- Tacrine hydrochloride (Cognex) Donepezil hydrochloride (Aricept) Antipsychotic Agents :- Risperidone, quetiapine and Olanzapine. Antidepressant Agents and Mood Stabilizers :- Low doses of the selective serotonin reuptake inhibitors and other new antidepressive agents should be considered.

31. NURSING MANAGEMENT:- Assessment data for the patient with dementia should include a past health and medication history. Data to be included for nursing assessment: Disorientation Mood changes Fear Suspiciousness Self care deficit Social behaviour

32. Level of mobility, wandering behavior Judgement ability Sleep disturbances Apathy Speech or language impairments Hallucinations, illusions or delusions Bowel & bladder incontinence Any decline in nutritional status Recognition of family members Identify primary caregiver, support system and the knowledge base of the family members

33. NURSING DIAGNOSIS FOR DEMENTIA

34. Disturbed thought process may be related to impaired memory evidenced by memory loss. Goal :- patient’s impaired thought process will be maintained at a baseline level. Interventions :- Assess patient’s ability for thought processing in every shift. Observe patient for cognitive functioning and memory changes, disorientation, difficulty with communication or changes in thinking patterns. Label drawers, use written reminder notes, pictures or color-coding articles to assist patients. Provide positive reinforcement and feedback for positive behaviors.

35. Limit decision that patient makes. Be supportive and convey warmth and concern when communicating with patient . Provide opportunity for social interaction.
Instruct family members about the disease process, what can be expected and assist with providing a list of community resources for support.

36. 2. Risk for injury r/t disorientation, confusion, impaired decision making as evidenced by hallucination and delusion. Goal :- Patient will remain in a safe environment with no complications or injuries obtained. Interventions :- Assess patient’s surroundings for hazards and eliminate or minimize their sources. Divert attention to a patient when agitated or dangerous behaviors like getting out of bed by climbing the fence bed. Maintain adequate lighting and clear pathways. Assess patient for hyperorality. During the middle and later stages of dementia, the patient must not be left unattended. Instruct family to keep all the sharp, poisonous and hazardous things away from the patient. Also instruct family to ensure that patient has hearing aids, glasses if they have a sensory deficit.

37. 3. Impaired Verbal Communication m ay be related to Dementia as evidence by a phonia, dyslalia, dysarthria, inappropriate verbalizations, aphasia, dysphasia, apraxia, dyslexia. Goal :- Patient will be able to have effective speech and understanding of communication, or will be able to use another method of communication and make needs known. Interventions:- Monitor the patient for nonverbal communication, such as facial grimacing, smiling, pointing, crying, and so forth; encourage use of speech when possible. Attempt to anticipate patient’s needs. When communicating with patient, face patient and maintain eye contact, speaking slowly and enunciating clearly in a moderate or low-pitched tone.

38. Utilize pencil and paper to write messages. Encourage patient to control the length and rate of phrases, over articulate words, and separate syllables, emphasizing consonants. Provide consultation with speech therapists, as appropriate.

39. Other nursing interventions for Dementia includes:- Maintaining daily routine of the patient. Providing the patient with appropriate nutrition, fluid and maintaining their body weight of the patient Maintaining patient’s personal hygiene , toilet habits and incontinence The patient’s wandering symptom must be maintained by providing them with a identifying bracelet or card.

40. SUMMARY :- Introduction Definition Classification Incidene Types of Dementia Etiology Risk factors Stages Clinical features Diagnosis Treatment Modalities Nursing Management

41. DEMENTIA is one of the most common disease in the older age group. Also it may occur in any stage of childhood. Most of the patients with Dementia are misbehaved and isolated by their family members and the society. Hence, it’s the duty of the nurse to take the preventive measures for Dementia and make aware the patients and their family members about the sign and symptoms of Dementia. The nurse should also instruct the patient’s family members about how to take care of the patient at home.

42. BIBLIOGRAPHY:- Sreevani R , A Guide to Mental Health & Psychiatric Nursing,4 th edition, JAYPEE Publication,page no-304 to 309 K.P. Neeraja ,Essential of mental health and psychiatric Nursing,3 rd Edition. https://www.slideshare.net/pranayshelokar143/dementia-presentation-57420552 https://www.homage.com.au/health/dementia/