Disturbed Thought Processes and Disturbed Sensory Perception - NCP for Dementia

Definition of Dementia

Dementia is a decline in intellectual functioning which leads to loss of social independence. (William F. Ganong, 2010)

According to Grayson (2004) states that dementia is not just ordinary disease, but rather a collection of symptoms caused by multiple diseases or conditions resulting in changes in personality and behavior.


Etiology of Dementia

1. The main cause of dementia is Alzheimer's disease, the cause is not known for certain, but suspected Alzheimer's disease due to a genetic abnormality, or abnormalities of certain genes. In Alzheimer's disease, some parts of the brain decline, resulting in cell damage and reduced response to a chemical signal channel in the brain. Found in the brain of abnormal tissue (called senile plaques and tangled nerve fibers) and abnormal proteins, which can be seen at autopsy.
2. The second cause of dementia that is a stroke that row. Single stroke is small in size and cause mild weakness or weaknesses that arise slowly. This small strokes gradually cause damage to brain tissue, brain regions that were damaged due to blockage of blood flow called infarction. Dementia caused by small strokes called multi - infarct dementia. Most sufferers have high blood pressure or diabetes, both of which cause damage to blood vessels in the brain.

Signs and Symptoms of Dementia 

1. Damage to the whole range of cognitive functions.
2. Originally impaired short-term memory.
3. Personality and behavioral disorders (mood swings).
4. Neurological deficits and focal.
5. Irritability, hostility, agitation and seizures.
6. Psychotic Disorders : hallucinations, illusions, delusions and paranoia.
7. Limitations in ADL (Activities of Daily Living)
8. Regulate the use of financial difficulties.
9. Can not go home when traveling.
10. Forgot to put the important stuff.
11. Difficult bathing, eating, dressing and toileting.
12. Easy drop and poor balance.
13. Unable to eat and swallow.
14. Urinary incontinence.
15. Can run away from home and can not go home.
16. Decline in memory that continues to happen. In patients with dementia, "forget" become a part of daily life that can not be separated.
17. Impaired orientation of time and place, for example: forget the day, week, month, year, where people with dementia.
18. The decline and inability to arrange words into correct sentences, using words that are not appropriate for a condition, repeat the word or the same story many times
19. Excessive expression, for example, excessive crying when she saw a television drama, furious at small mistakes committed by others, fear and nervousness unwarranted. People with dementia often do not understand why these feelings arise.
20. The change of behavior, such as : indifferent, withdrawn and anxiety.

Nursing Diagnosis for Dementia

Disturbed Thought Processes

related to physiological changes (degeneration of neurons reversible)

characterized by:

• loss of memory,
• loss of concentration,
• not able to interpret the stimulation and assess reality accurately.

Goal: The client is able to recognize a change in thinking.

Outcomes:

• Able to demonstrate the cognitive ability to undergo the consequences of stressful events on the emotions and thoughts of self-own.
• Able to develop strategies to overcome negative self-perception.
• Able to recognize the behavior and the causes.

Interventions:

1. Develop a supportive environment and nurse-client relationship is therapeutic.
2. Maintain a pleasant and quiet environment.
3. Face-to-face when talking to clients.
4. Call client by name.
5. Use a rather low voice and speak slowly to the client.

Rational:

1. Reduce anxiety and emotional.
2. Excessive noise is a sensory neuron disorders that increase.
3. Raises concern, especially in clients with perceptual disorders.
4. The name is a form of self-identity and lead to the introduction of the reality and the client.
5. Improve understanding. Speech high and hard, stressful sparking angry confrontation and response.

Disturbed Sensory Perception

related to changes in perception, transmission or sensory integration (neurological disease, unable to communicate, sleep disorders, pain)

characterized by:

• anxiety,
• apathy,
• restless,
• hallucinations.

Goal: changes in sensory perception of the client can be reduced or controlled.

Outcomes:

• Decrease hallucinations.
• Developing strategies to reduce psychosocial stress.
• Demonstrate appropriate response stimulation.

Interventions :

1. Develop a supportive environment and nurse-client relationship is therapeutic.
2. Help clients to understand hallucinations.
3. Assess the degree of sensory or perceptual disorder and how it affects the client, including a decrease in vision or hearing.
4. Teach strategies to reduce stress.
5. Take a simple picnic, a walk around the hospital. Monitor activity.

Rational:

1. Improve comfort and reduce anxiety on the client.
2. Improving coping and decrease hallucinations.
3. Involvement of the brain showed asymmetric problem causing the client to lose the ability on one side of the body.
4. To decrease the need for hallucinations.
5. Picnic shows reality and provide sensory stimulation that decreases feelings of suspicion and hallucinations caused by feeling constrained.

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