Alzheimer’s Delirium and Dementia Q 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.
Correct Answer: C. Orientation.
The initial, most basic assessment of a client with cognitive impairment involves determining his level of orientation (awareness of time, place, and person). The tools for reality orientation aim to reinforce the naming of objects and people as well as a timeline of events, past or present. Multiple studies have demonstrated that the use of reality orientation has improved cognitive functioning for people living with dementia when compared to control groups who did not receive it. As a rule, reality orientation must be mixed with compassion and used appropriately to benefit someone living with the confusion of dementia. Applying it without evaluating if it might cause emotional distress to the individual since there are some times when it would not be appropriate.
Option A: Confabulation is a type of memory error in which gaps in a person’s memory are unconsciously filled with fabricated, misinterpreted, or distorted information. When someone confabulates, they are confusing things they have imagined with real memories. A person who is confabulating is not lying. They are not making a conscious or intentional attempt to deceive. Rather, they are confident in the truth of their memories even when confronted with contradictory evidence.
Option B: Delirium is a type of cognitive impairment; however, other symptoms are necessary to establish this diagnosis. Delirium, also known as the acute confusional state, is a clinical syndrome that usually develops in the elderly. It is characterized by an alteration of consciousness and cognition with reduced ability to focus, sustain, or shift attention. It develops over a short period and fluctuates during the day. The clinical presentation can vary, but usually, it flourishes with psychomotor behavioral disturbances such as hyperactivity or hypoactivity with increased sympathetic activity and impairment in sleep duration and architecture.
Option D: The nurse may also assess for perseveration in a client with cognitive impairment but the questions in this situation would not elicit the symptom response. Perseveration according to psychology, psychiatry, and speech-language pathology, is the repetition of a particular response (such as a word, phrase, or gesture) regardless of the absence or cessation of a stimulus. It is usually caused by a brain injury or other organic disorder.