Working with patients who are cognitively impaired presents an ongoing communication challenge. For instance, they likely will have trouble following any instructions about their care, including how and when to take prescriptions. Make sure someone can closely monitor care management, and try to
involve a care partner whenever possible. This content is provided by the NIH National
Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date. Content reviewed: May 17, 2017 Related Articles
In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills in order of support systems to:
Assisting the Family to Plan Care for the Client with Impaired CognitionImpaired cognition is associated with a number of different etiologies including trauma, electrolyte disorders, Alzheimer's disease and a number of other causes. Some clients may be affected with a temporary decrease in their level of cognition, as often occurs among clients affected with delirium, and other clients may be affected with a permanent cognitive impairment such as occurs with closed head injuries and cerebral tumors, and still more can be affected with progressive impairments of their cognition as occurs with Alzheimer's disease, the most commonly occurring form of dementia. Regardless of the etiology of the cognitive impairment, it is often quite difficult for the family to adapt and cope with these changes. Nurses support and assist these family members, and the client, in terms of their coping and adaptation. When a cognitive deficit is temporary, the family members may need nothing more than assurances that the medical problem that is causing this change is being treated and to, at the present time, support the client. Family members who are affected with a permanent impairment of cognition may need the assistance of the nurse, and other members of the health care team, to cope with this loss and adjust to the future and all of the changes associated with it. The changes and the stressors associated with a permanent impairment of cognition vary according to the severity of the impairment. At times the client and the family members may have only minor, but permanent, changes to cope with and, at other times, the severity of the cognitive impairment may be so severe that the family is no longer able to care for the person in the home. Progressive cognitive disorders, although they can progress to a severe and incapacitating level, its slow progression often give the client and family members an opportunity to adjust and cope in a gradual way as the disease progresses. This is often the case for clients and family members affected with irreversible, progressive Alzheimer's disease. The stages of Alzheimer's disease are the:
According to the Global Deterioration Scale, also referred to as the Reisberg Scale, Alzheimer's disease is staged according to seven stages. These stages include:
Nurses assist affected family members by emotionally supporting them and their needs. They also assist the family in terms of their caring for the loved one affected with a cognitive disorder, such as Alzheimer's disease, when the family member is willing as well as cognately and physically able to do so. Some of the content that should be included in the family's education are:
Some of the symptom related interventions relating to cognitive disorders include:
Encouraging the Client's Involvement in the Health Care Decision-Making ProcessClients are the center of care. Clients, therefore, must be encouraged by the nurse to fully participate in and be totally involved in the entire nursing process and all health care decision making. As fully detailed in the previous section entitled "Informed Consent", the client must be fully knowledgeable about all treatments, all alternatives, and the benefits and risks associated with these treatments and all possible alternatives in order to make knowledgeable decisions relating to their health care decision. Evaluating the Client's Feelings About the Diagnosis/Treatment PlanNurses assess and evaluate the client feelings and opinions about all diagnoses and treatment plans. In terms of all diagnoses, the nurse must assess and evaluate their feelings about their diagnosis. For example, a client may feel anger when they are diagnosed with a terminal physical disease diagnosis; they may experience depression, grief and loss when they are faced with the loss of a limb; they may experience feelings of guilt and remorse when they are affected with a substance related diagnosis, particularly when this abuse or addiction has destroyed the family unit and other relationships; and they may experience shame when they are diagnosed with a psychiatric mental health disorder because of the social stigma attached to it. Clients also have feelings and opinions about their treatment plans. Some may be very accepting and cooperative with the plan because they believe that they can solve their health related problem and concern by following it, other clients may not adhere to their treatment plan because they believe that it will not be helpful, and still more may be apathetic about it. All of these feelings and beliefs must be identified by the nurse and then the nurse must intervene to assist the client in terms of their feelings about their diagnosis and their treatment plan. RELATED CONTENT:
SEE – Psychosocial Integrity Practice Test Questions
Alene Burke, RN, MSN Alene Burke RN, MSN is a nationally recognized nursing educator. She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. She worked as a registered nurse in the critical care area of a local community hospital and, at this time, she was committed to become a nursing educator. She got her bachelor’s of science in nursing with Excelsior College, a part of the New York State University and immediately upon graduation she began graduate school at Adelphi University on Long Island, New York. She graduated Summa Cum Laude from Adelphi with a double masters degree in both Nursing Education and Nursing Administration and immediately began the PhD in nursing coursework at the same university. She has authored hundreds of courses for healthcare professionals including nurses, she serves as a nurse consultant for healthcare facilities and private corporations, she is also an approved provider of continuing education for nurses and other disciplines and has also served as a member of the American Nurses Association’s task force on competency and education for the nursing team members. Latest posts by Alene Burke, RN, MSN (see all) |