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BY : Tri Anjaswarni, S.Kp. M.Kep.

Disampaikan dalam mata kuliah Mental Health Nursing pada Program Studi Ilmu
Keperawatan Fakultas Kedokteran Universitas Brawijaya Malang

Learning Ojectives
After studying this chapter the student should be able to :
1. Describe the continuum of adaptive and maladaptive cognitive responses
2. Indentify behavior associated with cognitive responses
3. Analyze predisposing factors, precipitating stressor and appraisal of stressors
related to cognitive responses
4. Describe coping resources and coping mechanisms
5. Formulate nursing diagnoses
6. Identify expected outcome and short-term nursing goal with maladaptive
cognitive responses
7. Analyzes nursing intervention
8. Evaluation nursing care

Define of Cognitive
Abilities in reasoning, memory, judgment, orientation, perception
and attention

These functions allow a person to make sense of experience and

interact productively with the environment.
Cognitive activities is dependen on intellegence, education,
experince, and culture

Maladaptive coping responses leave the affected person in :

A state of confusion unable to understand and learn from
Unable to realte current to past events or to interact reasonably with
the people in his or her life
Behavioral and Biological
Correlates of Learning and Memory
Working Memory : Prefrontal Cortex :
The ability ti keep in mind recent Mediates working memory and
events or the moment-to-moment decesion-making, patient with demage
results of mental processing, such as this area havie problems with
remembering a telephone number planning, solving problems, and
until you have finished keying it in maintaining attention (=Higher mental
processes called executive function)
Long-term Memory

Declarative Hipocampus : Procedural 1. Striatum,

Memory : Mediates the Memory : Motor Cortex,
Accessible to ability to turn Memory of Cerebellum
consciousness new memories skills and 2. Amygdala :
and can be into long term procedures Emotional
declared as memories associations
facts and events 3. Cerebellum :

Continuum Of Cognitive Responses

Adaptive Responses Maladaptive Responses

Decisiveness Periodic indecisiveness Inability to make decisions

Intact memory Forgetfulness Impaired memory and judgment
Complete Orientation Mild transient confusion Disorientation
Accurate perception Distractibility Serious misperception
Focused attention Occasional misperception Inability to focus attention
Coherent, Logical Occasional unclear Difficulties with logical
Thought thinking reasoning

A. Assessment
1. Behavior
a. Associated with Dellirium
Define & Behavior Selected Nursing Diagnoses
Is the behavioral response to widespread Hyperthermia related to
disturbances in cerebral metabolsm; it infection
usually represents a sudden decline from a Fluid volume deficit related
previous level of functioning, and is usually to decreased fluid intake
considered a medical emergency Risk for injury realted to fear
It is a syndrome with many possible causes and disorientation as
Results : evidenced by agitated
disturbances in conciousness (reduced behavior
clarity or awareness of the environment) Impared verbal
Attention (impaired ability to direct and communication related to
maintain mental focus, resulting in altered brain cheistry as
problems with processing stimuli into evidenced by incoherent
information) speech
Cognition (recent memory impairment, Sensory-perceptual alteration
disorientation to time and person, or (visual) related to altered
language disturbance) brain chemistry, as
Perception (misinterperception, illusion, evidenced by the
hallucinations). hallucination
Altered thought process
related to brain chemistry, as
evidenced by disorientation

b. Associated with Dementia

Define & Behavior Selected Nursing Diagnoses
Is a maladaptive cognitive response that Impaired verbal
features a loss of intellectual abilities and communication as evidenced
interferes with the patients usual social or by recent memory loss and
occupatioanal activities. confabulation.
Includes : an impairment of memory. Impaired social interaction
Judgment, and abstract thought. related to altered thought
The patien does not have the clouding of process, as evidenced by loss
awareness of conformity to social
Terjadi pada semua umur ttp terbanyak norms
terjadi pada usia tua (senility) Self care deficit
Disturbing Behavior characteristics : (bathing/hygiene) related to
Aggressive psychomotor behavior cognitive impairment as
evidenced by a failure to
Nonaggresive psychomotor behavior perform personal hygiene
Verbally aggressive behavior activities without reminders
Passive behavior Self care deficit (dressing)
Functionally impaired behavior (loss of related to cognitive
ability to perform self care) impairment
Altered thought processes
related to cognitive
impairment as evidenced by
disorientation and memory

Another behavior related to memory loss is confabulation (confused persons

tendency to make up a response to a question when he or she cannot remember
the answer).
Alzheimers disease (AD) is the most common type of demensia and account
for approximatly 65 % of cases of demensia.
As AD progress, patients often develop aphasia, apraxia, agnosia, and amnesia:
Aphasia is difficulty finding the right word.
Apraxia is an inability to perform familiar skilled activities
Agnosia is a difficulty in recognizing well-known objects, including people.
Amnesia is significant memory impairment in the absence of clouded
consciousnes or other cognitive symtoms.

Association of areas of brain pathology to behavior changes in Dementia

Anatomical Structure Function

Occipital lobe Visual processing
Frontal Lobe Organization of words into fluent speech
Parietal Lobe Association area for integrating sensory input
Temporal lobe Recognition and comprehension of sensory input,
hearing, memory, thought, perception, and
Limbic system Emotion, storage of short-term memory, mood.

2. Predisposing Factors

3. Precipitating Stressors
a. Associated with delirium
Central nervous system disorder
Metabolic disorder
Cardopulmonary disorder
System illness
Sensory deprivation or stimulation

b. Associte with dementia

4. Appraisal of Stressors

5. Coping Resources

6. Coping Mechanisms

B. Nursing Diagnoses

C. Goal

D. Intervention and Implementation

E. Evaluation