Gwendolyn de Geest, RN, BSN, MA Managing Responsive Behaviors In Care

Alterations in Cognition Delirium Dementia Depression

Maria Martin, VCC BSN student, 2011

Delirium Acute Reversible Physiological, psychosocial, environmental factors

Dementia Chronic, progressive Symptoms - loss of memory - poor judgment - mood swings - disorientation

Alzheimer’s Disease Dr. Alois Alzheimer 1906 – Auguste D. Frankfurt, Germany Plaques and Tangles

Aaron Copland 90 yrs Rita Hayworth 68 yrs Aaron Copland 90 yrs Sugar Ray Robinson 67 yrs Burgess Meredith 89 yrs Barry Goldwater 89 yrs E.B. White 86 yrs

Alzheimer Disease Normal Brain TIME July 17, 2000 Language Memory Language Memory

GREEN RED GREEN BLUE RED BLUE RED BLUE GREEN RED Attention / Frontal Lobe Skills

The Thief of Memory

The person remains The person’s humanity remains Communicates with feelings, not words Impact on Communication

Depression Chronic Reversible Often mistaken for dementia

Reason for every behavior Check out approach Apraxia, Agnosia, Aphasia Responsive Behaviors

Maria Martin, VCC BSN student, 2011

Apraxia Loss of ability to take purposeful action even when muscles, senses, and vocabulary seem intact.

Agnosia Inability to recognize objects by use of the senses.

Aphasia Inability to use or understand language (spoken or written). 1.expressive aphasia 2.receptive aphasia

Intervention Strategies (1) Calm approach Explore cause of behavior Understanding Education and support for family

Intervention Strategies (2) Apraxia - loss of independence Agnosia - environment Aphasia - frustration

Communication Strategies Reminiscence Simple repetition Appropriate touch Distraction - catastrophic reaction

Nursing Process Application Situation  86yr-old woman exhibits disturbed attention and confusion Nursing diagnosis  ineffective coping related to organic memory loss

Nursing Process Application Nursing goal  minimize factors that contribute to inattention Nursing approach  supportive, calm

Nursing Process Application Nursing intervention Direct eye contact Use of appropriate touch Clear, simple direction Repeat messages slowly Modify environmental stimuli Assist family to understand

Evaluation of Successful Outcomes Does not occur through words Behavior Co-operation Positive response

References Arnold & Boggs, Interpersonal Relationships De Geest, G., Living Dementia Case-Study Approach Potter & Perry, Canadian Fundamentals of Nursing