010-Psychiatric-Mental Health Nursing, 5th Edition-Sheila L. Videbeck-160547861X-Lippincott Willi

460UNIT 4 • NURSING PRACTICE FOR PSYCHIATRIC DISORDERSAlzheimer’s Disease Association is listed in the phonebook. Area hospitals and public health agencies also canhelp caregivers to locate community resources.Caregivers should be able to seek and accept assistancefrom other people or agencies. Often, caregivers believethat others may not be able to provide care as well as theydo, or they say they will seek help when they “really needit.” Caregivers must maintain their own well-being andnot wait until they are exhausted before seeking relief.Sometimes family members disagree about care for the client.The primary caregiver may believe other family membersshould volunteer to help without being asked, butother family members may believe that the primary caregiverchose to take on the responsibility and do not feelobligated to help out regularly. Whatever the feelings areamong family members, it is important for them all toexpress their feelings and ideas and to participate in caregivingaccording to their own expectations. Many familiesneed assistance to reach this type of compromise.Finally, caregivers need support to maintain personal lives.They need to continue to socialize with friends and to engagein leisure activities or hobbies rather than focus solely on theclient’s care. Caregivers who are rested, happy, and have mettheir own needs are better prepared to manage the rigorousdemands of the caregiver role. Most caregivers need to bereminded to take care of themselves; this act is not selfish butreally is in the client’s best long-term interests.RELATED DISORDERSAmnestic disorders are characterized by a disturbance inmemory that results directly from the physiologic effects ofa general medical condition or the persisting effects of asubstance such as alcohol or other drugs (APA, 2000). Thememory disturbance is sufficiently severe to cause markedimpairment in social or occupational functioning and representsa significant decline from previous functioning. Confusion,disorientation, and attentional deficits are common.Clients with amnestic disorders are similar to those withdementia in terms of memory deficits, confusion, and problemswith attention. They do not, however, have the multiplecognitive deficits seen in dementia, such as aphasia,apraxia, agnosia, and impaired executive functions.Several medical conditions can cause brain damage andresult in an amnestic disorder—for example, stroke orother cerebrovascular events, head injuries, and neurotoxicexposures, such as carbon monoxide poisoning,chronic alcohol ingestion, and vitamin B 12or thiaminedeficiency. Alcohol-induced amnestic disorder results froma chronic thiamine or vitamin B deficiency and is calledKorsakoff’s syndrome.The main difference between dementia and amnesticdisorders is that once the underlying medical cause istreated or removed, the client’s condition no longer deteriorates.Treatment of amnestic disorders focuses on eliminatingthe underlying cause and rehabilitating the clientand includes preventing further medical problems. Someamnestic disorders improve over time when the underlyingcause is stabilized. Other clients have persistent impairmentof memory and attention with minimal improvement;this can occur in cases of chronic alcohol ingestion or malnutrition(Grossman, 2005). Nursing diagnoses and interventionsare similar to those used when dealing with thememory loss, confusion, and impaired attention abilities ofclients with dementia or delirium (see Nursing Interventionsfor Dementia).NURSING INTERVENTIONSfor Dementia• Promoting client’s safety and protecting from injuryOffer unobtrusive assistance with or supervision ofcooking, bathing, or self-care activities.Identify environmental triggers to help client avoidthem.• Promoting adequate sleep, proper nutrition andhygiene, and activityPrepare desirable foods and foods client can self-feed;sit with client while eating.Monitor bowel elimination patterns; intervene withfluids and fiber or prompts.Remind client to urinate; provide pads or diapers asneeded, checking and changing them frequently toavoid infection, skin irritation, unpleasant odors.Encourage mild physical activity such as walking.• Structuring environment and routineEncourage client to follow regular routine and habits ofbathing and dressing rather than impose new ones.Monitor amount of environmental stimulation, andadjust when needed.• Providing emotional supportBe kind, respectful, calm, and reassuring; pay attentionto client.Use supportive touch when appropriate.• Promoting interaction and involvementPlan activities geared to client’s interests and abilities.Reminisce with client about the past.If client is nonverbal, remain alert to nonverbal behavior.Employ techniques of distraction, time away, goingalong, or reframing to calm clients who are agitated,suspicious, or confused.