Question

Identify a common perceptual, neurological, or cognitive issue and discuss contributing factors. Outline steps for prevention or health promotion for the patient and family.

Answer 1

Ans) Assess patients with perceptualp neurological or cognitive issue:

- Recognise the different characteristics of delirium and dementia and rule out the possibility of depression.
- It is vital that the all patients with a delirium are thoroughly investigated for the underlying cause so it can be treated.
- Use a validated screening tool for cognitive impairment. These tools enable you to determine a baseline, develop a person-centred care plan and implement risk management strategies. The most commonly used tools in hospitals include:
Abbreviated Mental Test (AMT)
Standardised Mini-Mental State Examination (SMMSE)
Clock Drawing Test (CDT).
Identify the presence of behavioural and psychological symptoms of dementia (BPSD) that respond to changes in the environment:
aggression
resistance to care
screaming/calling out/agitation
wandering
confusion
withdrawal.
- Always check your observations with the person’s family or carer to ascertain if these BPSD symptoms are long standing or new. This will assist in developing an intervention plan and in forming a diagnosis.
- If the patient is displaying signs of agitation, consider whether they may need to go to the toilet, if they are hungry or are in pain.
- Actively engage patients and families in all aspects of their care plan
- Families and carers offer a wealth of expertise and can often suggest care strategies to minimise risk of functional decline and the person’s level of distress.

- Involve the family and carer in the care planning process and provide them with written information about cognitive and memory difficulties.
- Establish the patient’s pre-morbid cognitive status. This will help you to determine intervention strategies.
- Be mindful that a diagnosis can be quite confronting for the individual and their family and carer.
- Screen the patient’s carer and family for carer stress and refer to appropriate inpatient and outpatient support services such as the Social Work team, Alzheimer’s Victoria and Carers Victoria.
- Communicate clearly by using the strategies outlined in the Improving communication factsheet.
Use these key points:
• introduce yourself
• always use the patient’s name when addressing them
• make sure you have eye contact at all times
remain calm and talk in a matter-of-fact way
keep sentences short and simple
• give time for a response
• take the time to explain what you are going to do and why you are doing it
• focus on one instruction at a time
repeat yourself ­– don't assume you have been understood
• don’t offer too many choices.
• Encourage the patient and family and carer to discuss advance care planning with each other and the care team.