1/46. dementia. Part 3: communication.People with dementia often have difficulty communicating. nurses should ensure these difficulties are not due to physical problems such as a lost hearing aid. Taking time to understand them can help nurses to communicate effectively with people with dementia.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/46. The role of occupational therapy in dementia-C.O.P.E. (Caregiver options for practical experiences).occupational therapy is a profession that enables individuals to regain, maintain or promote function after an illness, injury or disability occurs. The basis of the profession's philosophy derives from a recognition of the importance of meaningful activity (occupation) in people's lives to support function, quality of life and the debilitating effects of inactivity. occupational therapy enhances the abilities of individuals to engage in the following performance areas: (1) activities of daily living (eg eating, bathing, toileting, functional mobility) and instrumental activities of daily living (eg meal preparation, shopping, managing one's finances); (2) work and productive activities (eg care of others, educational and vocational activities); and (3) leisure to meet a variety of needs that are culturally meaningful to individuals and their significant others. In order to determine the etiologies of dysfunction in one or more performance areas, occupational therapists assess the following components of performance: sensorimotor, neuromusculoskeletal, motor, cognitive, and psychosocial. This assessment becomes the basis for tailoring treatment to individuals' needs and interests. When deficits and strengths in performance components and performance areas have been identified, occupational therapists work with clients/patients and their caregivers to reduce the barriers in daily functioning and facilitate maximum engagement in their environments, the human and physical context for daily living.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/46. Helping families understand and communicate with family members who suffer from dementia.Most clients suffering from dementia are cared for in their homes by family members or significant others. These caregivers anguish about their family members' mental deterioration. As one caregiver said, "How do we keep our hearts open in hell? And why should we try?" Caregiving is as much about the emotional impact on family caregivers as it the physical.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/46. The many faces of confusion. Timing and collateral history often hold the key to diagnosis.Recognition of a patient's state of confusion is only the beginning of a clinical odyssey that can implicate a huge spectrum of diagnostic possibilities. Among these are delirium, depression, dementia, and sensory deprivation. However, with appropriate physical examination and laboratory studies, collateral history, and clarification of time course for the symptom complex, the cause of confusion need not remain confusing.- - - - - - - - - - ranking = 1.7539495067351keywords = physical, physical examination (Clic here for more details about this article) |
5/46. Alternative medicine. Achieving balance between herbal remedies and medical therapy.The case patient was taking multiple herbal preparations as well as the prescription hypnotic zolpidem. The combination was probably increasing the patient's confusion, agitation, and aggression. The treatment team reached a compromise with the daughter after providing her with education and support. They continued the wheat germ oil and a multivitamin supplement, which appeared safe, even if of limited value. The patient continued taking valproate, 125 mg bid, which reduced her physical aggression and improved resistance to care. All other herbal remedies and zolpidem were discontinued. Balancing traditional therapies with requests for herbal remedies is a common challenge for physicians. The most successful intervention occurs when doctors familiarize themselves with herbal preparations and educate patients and families about the treatments.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/46. Case study approach to removing physical restraint.The pathway to discarding the use of restraints on older people with a dementing illness is cluttered with misinformation. While exploring the reasons restraints are used as an intervention on an older person with a dementing illness, we find duty of care is an important aspect. This paper presents the process that occurred when an aged care facility used an education and consultation approach in an attempt to remove the need for physical and chemical restraint. This case involved the family of an older person with a dementing illness and staff of the aged care facility.- - - - - - - - - - ranking = 5keywords = physical (Clic here for more details about this article) |
7/46. Blue rubber bleb nevus syndrome in a patient with ataxia and dementia.Blue rubber bleb nevus syndrome (BRBNS), an uncommon disorder characterized by cavernous hemangiomas, most often of the skin and gastrointestinal tract, is usually diagnosed during childhood and young adulthood. We made this diagnosis in an octogenarian referred to a geriatric medicine clinic because of concerns about his ability to live independently. ataxia, dementia, focal neurologic signs, and bluish/purplish vascular nodules on his lips, buccal mucosa, tongue, chest, and neck were noted on physical examination. magnetic resonance imaging (MRI) revealed an old left parietal infarction, multiple cavernous hemangiomas most densely concentrated in the subcortical structures and cerebellum, and areas of hemosiderin deposition. skin biopsy findings were consistent with hemangioma. The physical examination, MRI, and skin biopsy made a diagnosis of BRBNS likely. The patient's ataxia, dementia, and other neurologic signs can be explained by previous hemorrhage from the vascular malformations in his brain. Blue rubber bleb nevus syndrome is an uncommon cause of a relatively common geriatric syndrome presentation.- - - - - - - - - - ranking = 3.5078990134702keywords = physical, physical examination (Clic here for more details about this article) |
8/46. The effects of dementia in the surgical patient.dementia is a progressive, degenerative disease of the brain that affects as many as 4 million Americans today. The risk of adverse events related to medical or surgical treatment is significant when even a mild cognitive impairment is not identified. An accurate diagnosis will facilitate a plan of care that will assure the patient's physical, emotional, and spiritual needs are met.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/46. Cognitive dysfunction after isolated brain stem insult. An underdiagnosed cause of long term morbidity.Cognitive dysfunction adversely influences long term outcome after cerebral insult, but the potential for brain stem lesions to produce cognitive as well as physical impairments is not widely recognised. This report describes a series of seven consecutive patients referred to a neurological rehabilitation unit with lesions limited to brain stem structures, all of whom were shown to exhibit deficits in at least one domain of cognition. The practical importance of recognising cognitive dysfunction in this group of patients, and the theoretical significance of the disruption of specific cognitive domains by lesions to distributed neural circuits, are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/46. Esophageal hernia in dementia: surgeon's role for mixed-type esophageal hernia in an elderly woman with dementia.The mixed-type esophageal hernia is an indication for operation to prevent stomach volvulus and perforation. However, preventive operation is meaningful depending on the physical status. We encountered an 84-year-old, demented, bed-ridden woman of mixed-type esophageal hernia complicated with severe reflux esophagitis. First, the patient was conservatively treated by intravenous hyperalimentation and H2 blocker but, with onset of delirium, she removed the venous route twice. Subsequently, she was tightly restrained to the bed to avoid removing the line. Ethical deliberation for the patient tightly fixed to the bed and intravenous alimentation for her life prompted us to reconsider hernia operation after discussion with surrogate decision makers. The patient recovered uneventfully after operation, and movement without intravenous route or without any restraints was maintained by oral feeding assisted by gastrostomy feeding. In the coming decade, when senior patients are expected to increase, such operations can be forwarded to respect the patients' quality of life.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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