VAD

Abbreviation for vascular access device; ventricular assist device.

dementia

(di-men'cha) [L. dementia, madness] A progressive, irreversible decline in mental function, marked by memory impairment and, often, deficits in reasoning, judgment, abstract thought, registration, comprehension, learning, task execution, and use of language. The cognitive impairments diminish a person's social, occupational, and intellectual abilities. In the U.S., 4.5 million people are afflicted by dementia. The prevalence is esp. high in the very elderly: about 20% to 40% of those over 85 are demented. Dementia is somewhat more common in women than in men. It must be distinguished by careful clinical examination from delirium, psychosis, depression, and the effects of medications. See: Alzheimer disease; Huntington chorea; Parkinson disease; table

Symptoms

The onset of primary dementia may be slow, taking months or years. Memory deficits, impaired abstract thinking, poor judgment, and clouding of consciousness and orientation are not present until the terminal stages; depression, agitation, sleeplessness, and paranoid ideation may be present. Patients become dependent for activities of daily living and typically die from complications of immobility in the terminal stage.

Etiology

Dementia may result from many illnesses, including AIDS, chronic alcoholism, Alzheimer disease, vitamin B₁₂ deficiency, carbon monoxide poisoning, cerebral anoxia, hypothyroidism, subdural hematoma, or multiple brain infarcts (vascular dementia).

Treatment

Some medications, e.g., donepezil, nemantidine, and tacrine, improve cognitive function in some patients.

Patient care

Demented patients deserve respectful and dignified care at all stages of their disease. Caregivers assist the demented with activities of daily living and with the cognitive and behavioral changes that accompany the disease. A variety of nursing interventions may reduce the risk of inadvertently precipitating behavioral symptoms. Health care professionals should reinforce the patient's abilities and successes rather than disabilities and failures. Caregivers can help the patient make optimal use of his or her abilities by reducing the adverse effects of other health conditions, sensory impairments, and cognitive defects while maximizing social and environmental factors that support functional capacity. Daily routines should be adjusted to focus on the person rather than the task, e.g., the comfort of bathing rather than the perceived need to bathe in a certain way at a certain time.

Interaction and communication strategies should be adjusted to ensure that the message delivered is the one perceived (obtain attention, make eye contact, speak directly to the individual, match nonverbal communication and gestures to the message, slow the pace of speech, use declarative sentences, use nouns instead of pronouns). Commands including the word “don’t” and questions beginning with “why” should be avoided. Tasks should be broken down into manageable steps. Reassurance and encouragement are provided to assist the patient to act more independently. Reality grounding is not necessary for such a patient; thus, if the patient asks to see his mother (who is dead), reminding him of her death may reinforce the pain of that loss. It may be better to redirect the conversation, asking the patient to talk about his mother, instead. Written agreements and reminders may not be as useful as they would be in the care of other patients, for a demented patient may not remember what has been negotiated and agreed upon in the past. The patient’s environment should be adjusted to provide needed safety. Finding the correct balance between doing too much or too little may be difficult for the caregiver, who should recognize that the balance may shift day to day and that patience and flexibility are more helpful. Caregivers must be aware that the patient will have moments of lucidity, which should be treasured but not considered evidence that the patient is exaggerating or feigning his or her disease to obtain attention. Family members who provide care must be aware that they, too, have emotional needs and can become angry, frustrated, and impatient and that they need help to learn to forgive themselves as well as the loved one they are caring for. Finally, such caregivers must learn how to accept help and should not fear to admit that they cannot carry the burden of care by themselves.

AIDS-dementia complex

See: AIDS-dementia complex

alcoholic dementia

A form of toxic dementia in which there is loss of memory and problem-solving ability after many years of alcohol abuse.

dementia of the Alzheimer type

Abbreviation: DAT
See: Alzheimer disease

apoplectic dementia

Sudden loss of cognitive or intellectual function as a result of a large or bloody stroke or a brain tumor.

Binswanger dementia

Binswanger disease.

dialysis dementia

A neurological disturbance in patients who have been on dialysis for several years. There are speech difficulties, myoclonus, dementia, seizures, and, eventually, death. The causative agent is presumed to be aluminum in the dialysate.

epileptic dementia

An infrequent complication of epilepsy, presumed to result from injury to neurons during uncontrolled seizures.

frontotemporal dementia

A general term for any of four types of dementia: 1. frontotemporal lobar degeneration; 2. Pick’s disease; 3. primary progressive aphasia; or 4. semantic dementia. Symptoms include personality changes, apathy, compulsive or repetitive behavior, lack of social inhibition, and deterioration in language use.

Heller dementia

Regressive autism.

HIV-associated dementia

See: AIDS-dementia complex

dementia with Lewy bodies

A common neurodegenerative disease characterized by gradual and progressive loss of intellectual abilities combined with a movement disorder that resembles Parkinson disease. Those affected often have marked fluctuations in their ability to stay alert and awake and also visual hallucinations. The disease is characterized pathologically by deposits of Lewy bodies. The dementia is treated symptomatically.

mixed dementia

Dementia in which elements of both Alzheimer disease and vascular dementia are found.

multi-infarct dementia

Dementia resulting from multiple small strokes. After Alzheimer disease, it is the most common form of dementia in the U.S. It has a distinctive natural history. Unlike Alzheimer disease, which develops insidiously, the cognitive deficits of multi-infarct dementia appear suddenly, in stepwise fashion. The disease is rare before middle age and is most common in patients with hypertension, diabetes mellitus, or other risk factors for generalized atherosclerosis. Brain imaging in patients with this form of dementia shows multiple lacunar infarctions. Synonym: vascular dementia

paralytic dementia

An obsolete term for tertiary syphilis.

dementia paralytica

An obsolete term for tertiary syphilis.

postfebrile dementia

Dementia following a severe febrile illness.

presenile dementia

Dementia beginning in middle age, usually resulting from cerebral arteriosclerosis or Alzheimer disease. The symptoms are apathy, loss of memory, and disturbances of speech and gait.

primary dementia

Dementia associated with Alzheimer disease.

dementia pugilistica

Traumatic dementia, i.e., encephalopathy or an organic brain syndrome caused by closed head injury. It is sometimes referred to colloquially as “boxer's brain.”

semantic dementia

Any of a group of brain disorders marked by nearly complete losses in the understanding of word meanings, spelling, and the identification or recognition of facts, faces, or objects. The disease is marked pathologically by local atrophy in the neocortex of the temporal lobe of the brain.

senile dementia of the Alzheimer type

Abbreviation: SDAT
Alzheimer disease.

subcortical vascular dementia

Binswanger disease.

syphilitic dementia

Dementia caused by tertiary syphilis.

toxic dementia

Dementia caused by exposure to neurotoxins such as lead, mercury, arsenic, alcohol, or cocaine.

vascular dementia

Abbreviation: VaD
Multi-infarct dementia.

Age	Prevalence
< 60	0.1%
60–64	~1%
> 65	3 — 11%
> 85	25 — 47%

device

(di-vis') [Fr. devis, contrivance] An apparatus, tool, or machine made for a specific function.

ABDUCTION DEVICE

abduction device

A trapezoidal pillow, wedge, or splint placed between the arm and torso to prevent adduction. It is commonly used postoperatively for patients having total joint replacement or open reduction or internal fixation of the hip or shoulder. See: illustration

adaptive device

Assistive technology.

adaptive seating device

Abbreviation: ASD
A device that provides a proper sitting position for those with limited motor control. Such devices include seating inserts, wheelchairs, and postural support systems designed to prevent deformities and enhance function. Synonym: seating system

assistive technology device

Assistive technology.

augmentative device

A device that helps people with limited or no speech to communicate. Examples include communication boards, pictographs, or ideographs (symbols representing ideas, not sounds).

BAG MASK DEVICE

bag mask device

A manually operated resuscitator used to ventilate a nonbreathing patient or assist the ventilation of a patient who is not breathing at an effective rate or tidal volume. The device consists of a bag, an oxygen reservoir system, a one-way flow valve, and a clear face mask. It is designed to be attached to an oxygen source by tubing to deliver concentrations approaching 100%. See: illustration

belay device

A device using friction to brake or slow the movement of a rope, or to protect a patient, basket, climber, or other rescuer.

biventricular assist device

Abbreviation: BiVAD
A device that helps both ventricles of the heart contract more effectively. It is used to treat heart failure by propelling blood out of the chambers of the heart.

cardiac rhythm management device

Abbreviation: CRMD
An umbrella term for pacemakers and implantable cardioverter/defibrillators.

cervical immobilization device

Abbreviation: CID
A stiff neck brace or collar to prevent movement of the cervical spine in order to maintain spinal alignment and prevent injury or paralysis.

charge-coupled device

Abbreviation: CCD
A device used in video and digital imaging (such as in CT scanning) that creates electronic images from light.

clitoral vacuum device

A mechanical device used to engorge and stimulate the clitoris. It is used as a U.S. FDA–approved treatment for female sexual dysfunction.

electronic infusion device

Abbreviation: EID
A device for monitoring intravenous infusions. The device may have an alarm in case the flow is restricted because of an occlusion of the line. In that case, the alarm will sound when a preset pressure limit is sensed. The device can also signal that an infusion is close to completion. The pressure is regulated by the height at which the container is positioned above the level of the heart when the patient is lying flat. A height of 36 in (91 cm) provides a pressure of 1.3 lb/sq in (70 mm Hg). Most EIDs are equipped to stop the flow of the infused liquid if accidental free flow occurs. See: infusion pump

esophageal intubation detector device

A syringe attached to the endotracheal tube immediately after an intubation attempt.

Patient care

If aspiration is difficult or stomach contents are withdrawn, or both, the endotracheal (ET) tube may have been placed in the esophagus and needs to be removed and reinserted. If aspiration is easy and free of stomach contents, it is probable that the ET tube is located in the trachea; the rescuer should then confirm tube placement by other techniques, e.g., a combination of auscultation, x-ray, and pulse oximetry.

femoral compression device

A device used to apply pressure to the large artery or vein in the thigh after it has been cannulated in order to reduce bleeding from the punctured vessel. Femoral compression devices are used, e.g., after angiography.

flow-restricted oxygen-powered ventilation device

Abbreviation: FROPVD
A ventilation device that provides a peak flow rate of 100% oxygen at up to 40 L/min. See: oxygen-powered ventilation device

Flutter device

See: Flutter device

head immobilization device

A device that attaches to a long back board and holds the patient's head in neutral alignment. See: long back board

humanitarian use device

Humanitarian device exemption.

improvised explosive device

Abbreviation: IED
Military jargon for a homemade bomb or land mine used in unconventional warfare.

input device

In assistive technology, the device that activates an electronic device. This can be a manual switch, a remote control, or a joystick. See: switch

inspiratory impedance threshold device

Inspiratory impedance threshold valve.

intrauterine contraceptive device

Abbreviation: IUCD, IUD
See: intrauterine contraceptive device.

Kendrick extrication device

See: Kendrick extrication device

left ventricular assist device

Abbreviation: LVAD
A pump surgically implanted in patients with severe heart failure to move blood from the left ventricle to the ascending aorta. The LVAD usually augments the heart's function until it heals (following a severe myocardial infarction) or until a heart transplant becomes available, e.g., for patients with heart failure with a markedly diminished ejection fraction. The LVAD also may be used permanently for a patient who does not meet criteria for transplantation.

listening device

A speech amplifier that aids the hearing-impaired in direct person-to-person communication or telephone conversation. Such devices differ from conventional hearing aids in that they reduce interference from background noises.

medical device

Any health care product that is intended for the diagnosis, prevention, or treatment of disease and does not primarily work by effecting a chemical change in the body

mobility device

Any assistive technology that aids the movement of people with physical impairments. Examples include lift chairs, scooters, or wheelchairs.

needleless device

A device that has no exposed sharp surface, used to inject drugs and fluids. It is designed to decrease the risk of needle-stick injuries by health care professionals.

oxygen-conserving device

Abbreviation: OCR
Any device that reduces the loss of administered oxygen into the environment, e.g., one that releases oxygen to a patient only when the patient inhales.

oxygen-powered ventilation device

A multifunction ventilation devicehat uses high-flow oxygen. This device can often be triggered by negative pressure caused by an inhaling patient; it can also be operated by a button while the operator watches the patient's chest rise.

CAUTION!

During resuscitation, it is necessary to use the positive-pressure aspect of this device and manually trigger or compress the button because the patient cannot open the valve by inhaling. These devices should be fitted with an overinflation high-pressure alarm to avoid gastric distention and/or barotrauma.

personal flotation device

Abbreviation: PFD
A life vest to prevent drowning and near drowning. People engaged in water sports, such as boating or water skiing, or rescuers working on or near the water should wear PFDs at all times. The U.S. Coast Guard sets standards and establishes specifications for the manufacture and use of PFDs. Personal flotation devices may be used to provide added buoyancy for the patient during aquatic therapy.

personal assistive mobility device

Personal mobility device.

personal mobility device

Any assistive device that facilitates individual human transportation. Examples include powered wheelchairs, scooters, bicycles and unicycles. Although many such devices are used by people with activity or mobility restrictions, mobility aids can be employed generally, e.g., for urban transportation in place of automobiles. Synonym: personal assistive mobility device

pointing device

A type of input device for sending commands to a computer. Moving the device results in movement of a cursor on the monitor or computer screen. Pointing devices range from the conventional desktop mouse, trackball, and touch-sensitive screens to infrared and ultrasound pointers mounted on the head. See: light pointer; switch

position-indicating device

Abbreviation: PID
A device to guide the direction of the x-ray beam during the exposure of dental radiographs. This devices improves and standardizes dental radiographic imaging and reduces the patient's risk of radiation exposure.

positive beam limiting device

A collimator that automatically adjusts the size of the radiation field to match the size of the imaging device. Synonym: automatic collimator

powered mobility device

Abbreviation: PMD
Any assistive device (such as a powered wheelchair, a lift chair, or a scooter) that improves the movement of the functionally impaired.

pressure relief device

An appliance filled with air, water, gel, or foam, to reduce pressure points caused by the patient’s body weight when seated or bedridden. Examples include wheelchair cushions and air or water flotation mattresses.

prosthetic terminal device

A component of an upper extremity prosthesis that substitutes for the functions of the hand. There are many types of terminal devices, some of which are designed for use with specific tools and implements. These devices have two primary actions: voluntary opening and voluntary closing. Synonym: hook

protective device

An external support applied to vulnerable joints or other body parts to guard against injury. Protective devices include helmets, braces, tape or wrapping, and padding.

pubovaginal device

A device fitted for use in the vagina to help prevent urinary incontinence. See: pessary

sequential compression device

Abbreviation: SCD.
A device to reduce edema or prevent the formation of blod clots in an extremity. A chambered nylon sleeve is progressively inflated from its distal segment to the proximal segment, forcing venous and lymphatic return. Sequential compression devices are inflated with air (pneumatic compression) or, less commonly, chilled water (cryocompression). SCDs are used frequently in the perioperative period. See: intermittent compression

single-use device

A medical device used once for the care of a single patient and then immediately discarded.

spine arthroplasty device

A prosthesis to replace a damaged intervertebral disk.

superconductive quantum interference device

Abbreviation: SQUID
A biomagnetometer used to measure magnetic fields in the body or the presence of magnetically active elements or minerals, such as body stores of iron.

telecommunication device for the deaf

Abbreviation: TDD
A device that allows the hearing-impaired to use the telephone even if they cannot comprehend speech. A keyboard and display screen are used.

VENOUS ACCESS DEVICES: A. An over-the-needle catheter; B. An inside-the-needle catheter.

venous access device

A specially designed catheter for gaining and maintaining access to the venous system. This device provides access for patients who require intravenous fluids or medications for several days or more, e.g., those having a bone marrow transplant or who are receiving long-term total parenteral nutrition. See: venous port See: illustration

ventricular assist device

Abbreviation: VAD
A pump to treat heart failure. It helps the ventricles to contract and move blood to the lungs and/or the aorta. See: left ventricular assist device

ventricular assist device

Abbreviation: VAD
A pump to treat heart failure. It helps the ventricles to contract and move blood to the lungs and/or the aorta. See: left ventricular assist deviceSee also: device

VAD

VAD

Vad

VAD

Vad

VAD

VAD

VAD

dementia

Symptoms

Etiology

Treatment

Patient care

AIDS-dementia complex

alcoholic dementia

dementia of the Alzheimer type

apoplectic dementia

Binswanger dementia

dialysis dementia

epileptic dementia

frontotemporal dementia

Heller dementia

HIV-associated dementia

dementia with Lewy bodies

mixed dementia

multi-infarct dementia

paralytic dementia

dementia paralytica

postfebrile dementia

presenile dementia

primary dementia

dementia pugilistica

semantic dementia

senile dementia of the Alzheimer type

subcortical vascular dementia

syphilitic dementia

toxic dementia

vascular dementia

device

abduction device

adaptive device

adaptive seating device

assistive technology device

augmentative device

bag mask device

belay device

biventricular assist device

cardiac rhythm management device

cervical immobilization device

charge-coupled device

clitoral vacuum device

electronic infusion device

esophageal intubation detector device

Patient care

femoral compression device

flow-restricted oxygen-powered ventilation device

Flutter device

head immobilization device

humanitarian use device

improvised explosive device

input device

inspiratory impedance threshold device

intrauterine contraceptive device

Kendrick extrication device

left ventricular assist device

listening device

medical device

mobility device

needleless device

oxygen-conserving device

oxygen-powered ventilation device

CAUTION!

personal flotation device

personal assistive mobility device

personal mobility device

pointing device

position-indicating device

positive beam limiting device

powered mobility device

pressure relief device