Which of the following will nurse Dory use when communicating with a client who has a cognitive impairment *?

Amnestic disorders are a series of disorders that involve loss of memories formerly established, loss of the ability to construct and establish new memories, or loss of the ability to gain or grasp new information. There are various types of amnesia, including retrograde amnesia, anterograde amnesia, transient global amnesia, and infantile amnesia. Learn more about amnestic disorders and its nursing care management, interventions, assessment in this study guide.

• What are Amnestic disorders? 
• Causes of Amnestic disorders
• Clinical Manifestations
• Assessment and Diagnostic Findings
• Medical Management
  • Pharmacological Management
• Nursing Management
  • Nursing Assessment
  • Nursing Diagnosis
  • Nursing Care Planning and Goals
  • Nursing Interventions
  • Evaluation
  • Documentation Guidelines
• Practice Quiz: Amnestic Disorders

What are Amnestic disorders? 

Amnestic disorders are characterized by an inability to learn new information [short-term memory deficit] despite normal attention and an inability to recall previously learned information [long-term memory deficit].

• Amnesia refers to a specific deficit in new learning and memory.
• Retrograde amnesia refers to a loss of memory for events before the onset of lesion or condition.
• Anterograde amnesia refers to an inability to acquire new information or experiences occurring during the period of impairment.
• Transient global amnesia occurs with confusion or agitation that comes and goes repeatedly over the course of several hours.
• Infantile amnesia is a common phenomenon wherein most people can’t remember the first three to five years of life.
• Amnestic disorders can occur in isolation, but in practice, they are most commonly seen within the more global syndromes of delirium or dementia.

Causes of Amnestic disorders

In general, amnestic disorders are caused by structural or chemical damage to parts of the brain. The DSM-V identifies the following categories as etiologies for the syndrome of symptoms known as amnestic disorders:

• Amnestic disorder due to a general medical condition. The symptoms may be associated with head trauma, cerebrovascular disease, cerebral neoplastic disease, cerebral anoxia, herpes simplex encephalitis, poorly controlled insulin-dependent diabetes, and surgical intervention to the brain; transient amnestic syndromes can also occur from epileptic seizures, electroconvulsive therapy, severe migraine, and drug overdose.
• Substance-induced persisting amnestic disorder. This type of amnestic disorder is related to the persisting effects of substances such as alcohol, sedatives, hypnotics, anxiolytics, and other medications, and environmental toxins; the term “persisting” is used to indicate that the symptoms persist long after the effects of substance intoxication or substance withdrawal has subsided.

Clinical Manifestations

The following symptoms have been identified with amnestic disorders:

• Disorientation. Disorientation to place and time may occur with profound amnesia.
• Inability to recall events. There is an inability to recall events from the recent past and events from the remote past.
• Confabulation. The individual is prone to confabulation. That is, the individual may create imaginary events to fill in the memory gaps.
• Other symptoms. Apathy, lack of initiative, and emotional blandness are common.

Assessment and Diagnostic Findings

Laboratory studies may be helpful for ruling in or excluding specific diagnoses that cause amnestic disorder symptoms.

• ABG. Oxygen saturation, or ABG with carbon monoxide level, may be diagnostic.
• Drug toxin levels. When alcohol, drugs and/or toxins are suspected, consider serum ethanol, salicylate, acetaminophen, carbon monoxide, and other specific drug or toxins level as indicated.
• CT scan. A head CT scan without intravenous contrast should be obtained if CNS infection, trauma, or a cerebral vascular accident is suspected.

Medical Management

Medical management of a patient with amnestic disorders and emergency care include:

• Patient’s safety. Prehospital care workers involved in the transport of an acutely confused, combative, or delirious patient must ensure the safety of the patient and the staff.
• Supportive care. Treat suspected overdose-induced delirium based on ingestion history and/or toxidromes; such treatment may range from simple observation and supportive care, activated charcoal, gastrointestinal lavage, sedation, specific antidotes to intoxication and life support.
• Identify underlying cause. The treatment of amnestic disorders is dependent on the identification of the underlying cause, which may not be elucidated during an ED stay.
• Consultations. Specific cases may require consultation with neurosurgery, neurology, or medicine subspecialists.

Pharmacological Management

Medications typically used in the treatment of amnestic disorders include:

• Sedatives. These agents are used to calm acute agitation, to control the behavior of combative patients, and to facilitate procedures.
• Glucose supplements. Monosaccharides absorbed from intestines after PO absorption of dextrose results in rapid increase of blood glucose concentrations.
• Neuroleptics. These agents have more robust calming effects than benzodiazepines in acutely agitated patients; they act fast when given IV.
• Atypical antipsychotics. These are newer neuroleptics with a lowered risk of extrapyramidal syndrome and improved efficacy for the negative symptoms of psychosis because of their enhanced serotonergic activity as compared to older-style neuroleptics.
• Antidotes. These agents are used when the toxic agent is known and has an antidote or as a coma cocktail in patients who are stuporous or comatose.

Nursing Management

The nursing management of a client with amnestic disorders include the following:

Nursing Assessment

Assessment of a client with amnestic disorders include:

• Psychiatric interview. The psychiatric interview must contain a description of the client’s mental status with a thorough description of behavior, flow of thought and speech, affect, thought processes and mental content, sensorium and intellectual resources, cognitive status, insight, and judgement.
• Serial assessment. Serial assessment of psychiatric status is necessary for determining fluctuating course and acute changes in mental status, interviews with family members should be included and can be crucial in the treatment of infants and young children with cognitive disorders.

Nursing Diagnosis

Nursing diagnosis for persons with amnestic disorders include:

• Risk for trauma related to chronic alteration in structure or function of brain tissue secondary to the aging process, multiple infarcts, HIV disease, head trauma, chronic substance abuse, or progressively dysfunctional physical condition.
• Chronic confusion related to alteration in structure or function of brain tissue secondary to long-term abuse of drug or toxic substances.
• Self-care deficit related to cognitive impairment.
• Low self-esteem related to loss of capacity for remembering.

Nursing Care Planning and Goals

The major nursing care planning goals for patients with amnestic disorders are:

• Client will voluntarily spend time with staff and peers in day-room activities.
• Client will exhibit increased feelings of self-worth as evidenced by voluntary participation in own self-care and interaction with others.

Nursing Interventions

The nursing interventions for Amnestic disorders are:

• Encourage expression of feelings. Encourage client to express honest feelings in relation to loss of prior level of functioning; acknowledge pain of loss; support client through process of grieving.
• Assist with memory deficit. Devise methods in assisting client with memory deficit; these aids may assist client to function more independently, thereby increasing self-esteem.
• Encourage communication. Encourage client’s attempts to communicate; if verbalizations are not understandable, express to client what you think he or she intended to say.
• Reminisce events with client. Encourage reminiscence and discussion of life review; also encourage discuss present-day events; sharing picture albums, if possible, is especially good.
• Encourage group participation. Encourage participation in group activities; caregiver may need to accompany client at first, until he or she feels secure that group members will be accepting, regardless of limitations in verbal communication.
• Provide client support. Offer support and empathy when client expresses embarrassment at inability to remember people, events, and places.
• Encourage independence. Encourage client to be as independent as possible in self-care activities; provide written schedule of tasks to be performed.

Evaluation

Outcome criteria include:

• Client initiates own self-care according to written schedule and willingly accepts assistance as needed.
• Client interacts with others in group activities, maintaining anxiety level in response to difficulties with verbal communication.

Documentation Guidelines

Documentation in client with amnestic disorders include:

• Individual findings, including factors affecting, interactions, nature of social exchanges, specifics of individual behavior.
• Cultural and religious beliefs, and expectations.
• Plan of care.
• Teaching plan.
• Responses to interventions, teaching, and actions performed.
• Attainment or progress toward the desired outcome.

Practice Quiz: Amnestic Disorders

Quiz time about the topic! Please visit our nursing test bank page for more NCLEX practice questions.

1. Nurse Isabelle enters the room of a client with a cognitive impairment disorder and asks what day of the week it is; what the date, month, and year are; and where the client is. The nurse is attempting to assess:

A. Confabulation.
B. Delirium.
C. Orientation.
D. Perseveration.

1. Answer: C. Orientation. 

• Option C: The initial, most basic assessment of a client with cognitive impairment involves determining his level of orientation [awareness of time, place, and person].
• Options A and D: The nurse may also assess for confabulation and perseveration in a client with cognitive impairment but the questions in this situation would not elicit the symptom response.
• Option B: Delirium is a type of cognitive impairment; however, other symptoms are necessary to establish this diagnosis.

2. Which of the following will Nurse Dory use when communicating with a client who has cognitive impairment.

A. Complete explanations with multiple details.
B. Pictures or gestures instead of words.
C. Stimulating words and phrases to capture the client’s attention.
D. Short words and simple sentences.

2. Answer: D. Short words and simple sentences.

• Option D: Short words and simple sentences minimize client confusion and enhance communication.
• Options A and C: Complete explanations with multiple details and stimulating words and phrases would increase confusion in a client with short attention span and difficulty with comprehension.
• Option B: Although pictures and gestures may be helpful, they would not substitute for verbal communication.

3. 80-year-old Mr. Stevens is accompanied to the clinic by his son, who tells the nurse that the client’s constant confusion, incontinence, and tendency to wander are intolerable. The client was diagnosed with chronic cognitive impairment disorder. Which nursing diagnosis is most appropriate for the client’s son?

A. Risk for other-directed violence.
B. Disturbed sleep pattern.
C. Caregiver role strain.
D. Social isolation.

3. Answer: C. Caregiver role strain.

• Option C: The son’s description exemplifies some of the problems commonly encountered by a primary caregiver who is caring for someone with a cognitive impairment disorder.
• Options A, B, and D: Although the other nursing diagnoses are possibilities; the scenarios do not provide enough information to validate any of these.

4. A family member expresses concern to a nurse about behavioral changes in an elderly aunt. Which would cause the nurse to suspect a cognitive impairment disorder?

A. Decreased interest in activities that she once enjoyed.
B. Fearfulness of being alone at night.
C. Increased complaints of physical ailments.
D. Problems with preparing a meal or balancing her checkbook.

4. Answer: D. Problems with preparing a meal or balancing her checkbook.

• Option D: Making a meal and balancing a checkbook are higher level cognitive functions that, when unable to be performed, may signal onset of a cognitive disorder.
• Options A, B, and C: Although the remaining behaviors may occur, they are not associated only with cognitive impairment and may indicate depression or other problems.

5. In clients with a cognitive impairment disorder, the phenomenon of increased confusion in the early evening hours is called:

A. Aphasia.
B. Agnosia.
C. Sundowning.
D. Confabulation.

5. Answer: C. Sundowning.

• Option C: Sundowning is a common phenomenon that occurs after daylight hours in a client with a cognitive impairment disorder.
• Options A, B, and D: The other options are incorrect responses, although all may be seen in this client.

Which if the following will the nurse use when communicating with a client with cognitive impairment?

Which goal is a priority for a client with a dsm iv tr diagnosis of delirium and the nursing diagnosis?