Cognitiv

e
Disorder
Facilitated
by: Mam
Presented

s
by: Group 1
Shamsa
 Group
Member
s
Areeba
Zulfiqar
Anum Azeema
Faraz
Latif
Rashida
Ismail

Samreen
Ismail
 Objectives

At the end of this session participants

will be able to

Define Discuss
cognitive Understand nursing
Discuss risk factors, Elaborate
disorders delirium its Explain interventions,
and etiology and sign and
onset treatment of health
categories of most common symptoms of
duration and delirium promotion and
cognitive causes of delirium
categories community
disorders delirium based care of
delirium
 Cognitive
Disorders
Delirium
Areeba
Zulfiqar
Present
er
Cognitive Disorders
Cognitive disorder is refer to any condition that significantly
impairs a persons' ability to think, remember, or process
information.
These disorders effect cognitive functions such as memory,
reasoning, perception and problem solving.
Categories Of Cognitive
Disorders
According to DSM-5 cognitive disorders fall under the
category of Neurocognitive Disorders (NCSs)
This now include:
Delirium
Major neurocognitive disorder (Dementia)
Mild neurocognitive disorder
Delirium
 Delirium
Delirium is cognitive disorder that involves a disturbance of
consciousness accompanied by a change in cognition or
mental status characterized by confusion, disorientation,
impaired attention.

Onset and duration:

Develop over a short period, sometimes matters of hours, and
fluctuates, or changes throughout the course of the day.
 Categories of
Delirium
Hyperactive delirium: Involves higher activity level such as
aggression, agitation, mood swings, poor sleep, psychosis
Hypoactive delirium: Involves lower activity level such as
reduced speaking and facial expressions, apathy, lethargy, lack of interest
Mixed delirium: Involve combine features of hyperactive and
hypoactive delirium. It tends to have following appearance:
Typical activity level: confuse not fully aware but activity level is similar to
usual
Shifting activity level: sometimes show hyperactive symptoms but then
change to hypoactive symptoms
 Cultural
Considerations
Different cultural backgrounds may not be familiar with the
information requested to assess memory e.g. name of former
president, some religions and do not celebrate birthdays so
client may have difficulty stating their date of birth.
The nurse should not mistake failure to know such information
for disorientations
Risk factors for Delirium
Risk factors for delirium
includes:
Increased severity of
physical illness
Older age
Hearing impairment
Decreased food and fluid
intake
Medications
Baseline cognitive
impairment
Etiology of Delirium
Delirium
almost
always
result from: Physiologi
Drug
c
withdrawa
disturbanc
l
e

Drug Metabolic
intoxicati disturban
on ce

Cerebral
Disease disturbanc
e
Most common causes
Sign and Symptoms
Assessment
Presente
r Rashid
a Ismail
Most Common Causes of
Delirium
Hypoxemia, Electrolyte disturbance / Dehydration, Renal or
Physiolog hepatic failure, Hypoglycemia or hyperglycemia , Sleep
deprivation , Thyroid or glucocorticoid disturbance,
ic or Thiamine or vitamin B12 deficiency, Vitamin C Niacin or
metabolic protein deficiency, Cardiovascular shock, Brain tumor /
: Head injury , Exposure to gasoline, paint solvents,
insecticides and related substances
Most Common Causes Of
Delirium
Systemic: sepsis, urinary tract infection, pneumonia
Infectio
n Cerebral: meningitis, encephalitis, HIV, syphilis

Intoxication: anticholinergic, lithium, alcohol,

sedatives and hypnotics
Drug
related Withdrawal: alcohol sedatives and hypnotics
Reaction to anesthesia, prescription medication, or
illicit(street) drugs
 Sign And
Symptoms
• Difficulty paying attention • Altered perceptions
• Easily distracted • Mood swings
• Disorientation • Tremors
• Confusion • Poor coordination
• Fluctuating alertness • Involuntary movements
• Disorganized thinking • Hallucinations
• Memory problem • Illusions
• Sleep disturbance
Assessment
History

General appearance and motor behaviour

Mood and affect

Thought process and content

Sensorium and intellectual processes

Judgment and insight

Roles and relationships

Physiologic and self care consideration

Treatment &
Outcomes Of
Delirium

Presenter Azeem
a Faraz
 Treatment Of Delirium
Identify and treat cause and any casual or contributing medical condition.
Example: infections, metabolic imbalance

Pharmacological
treatment
Hypoactive delirium need no specific pharmacologic treatment.

Antipsychotic Sedatives:
medication: Haloperidol
(Haldol) 0.5 to 1mg used to decrease Short acting benzodiazepines such as
agitation and psychotic symptoms lorazepam (Ativan) helpful for sleep.
also facilitate sleep. Avoid long acting sedatives as they
prolong delirium
Treatment Of Delirium

Non Pharmacological Treatment

Supportive care Preventive
• Reorientation measures
• Calm environment Avoid delirium triggers
(unnecessary medications)
• Nutrition and hydration
Cognitive stimulation
• Physical mobilization (engage patient in
• Sleep management conversations and familiar
• Close monitoring activities
• Prevent falls
 Nursing
Interventions &
Client/Family
Education Anu
Presenter m
Latif
Nursing
Interventions

Promote client's
safety

Promotin
Managin
g sleep
g clients
and
confusio
proper
n
nutrition

Controlling
environment to
reduce sensory
overload
Nursing
Interventions
Promote client's
safety
Teach the client to request assistance for activities (getting
out of bed, going to bed)
Provide close supervision to ensure safety during these
activities
Promptly respond to the client's call for assistance
Nursing Interventions

Managing clients
confusion
Speak to the client in calm manner in a clear low voice, use
simple sentences
Allow adequate time for the client to comprehend and
respond
Allow client to make decisions as much as he is able to
Provide orienting verbal cues when talking with the client
Use supportive touch if appropriate
Nursing Interventions

Controlling environment to
reduce sensory overload
 Keep environmental noise to minimum
 Monitor the client's response to visitors explain to the
family that client may need to visit quietly one on one
 Validate the client’s anxiety and fears, but do not reinforce
misperceptions
Nursing Interventions
Promoting sleep and
proper nutrition
Monitor sleep and elimination pattern
Monitor fluid and food intake, provide prompts or assistance to eat
and drink adequate amount of food and fluid
Provide periodic assistance to bathroom if the client does not make
requests
Discourage daytime napping to help sleep at night
Encourage some exercise during day like sitting in a chair, walking
in hall, or other activities the client can manage
 Client/Family
Education
Monitor chronic health conditions carefully
Visit physician regularly
Avoid alcohol and recreational drugs.
Maintain a nutritious diet
Get adequate sleep
Use safety precautions when working with paint solvents,insecticides,and
similar products.
Tell all physicians and health care providers what medication are taken,
including over the counter medicatins,dietary supplements and herbal
preparations.
Community Based Care
After cause of delirium is identified and treated client my not
regain all cognitive functions and confusion may persist so it may
be necessary for health care professionals to initiate
Referrals to home health, visiting nurses or a rehabilitation
program
Community based programs such as day care or residential care
Support groups to help client and family members deal with the
changes in personality and remaining cognitive or motor deficit
Summarization
Thank You