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Outline
Pathophysiology
Alzheimer’s disease, sometimes called Alzheimer’s Dementia, is a progressive and irreversible neurological disorder that causes loss of memory and cognitive function. Symptoms begin gradually, with signs that are easily attributed to other factors such as misplacing items, forgetting appointments or getting lost in a familiar area. The disease may actually begin occurring in the fifties and sixties, but symptoms may not present until the client is in their eighties or nineties. Studies have shown that clients who reside in smaller living spaces, avoid social interaction or rarely leave their homes are twice as likely to have Alzheimer’s disease. Since Alzheimer’s is an irreversible disease, treatment is geared toward management of symptoms and promoting support and the best quality of life possible.
Etiology
Diagnostic Criteria:
Diagnosis of Alzheimer’s disease should not be applied when symptoms began following a stroke, traumatic brain injury (TBI), there is another known neurological disorder or when client is being treated with medications for other neurological disorders that would produce similar symptoms. The following characteristics must be met for diagnosis:
- Gradual onset (may take months or years)
- Clear observation of cognitive decline
- Decline in memory or learning and one other cognitive area (based on history of testing)
- Speech
- Visual-spatial (recognition of objects or faces)
- Reasoning or judgement
- Steady cognitive decline without periods of stability
Desired Outcome
Client will maintain optimal level of independent or assisted functioning. Client will remain free from injury. Client will have minimal wandering behaviors. Client’s family will have adequate resources and support for coping with client’s disease.
Alzheimer’s Disease Nursing Care Plan
Subjective Data:
- Difficulty finding words during a conversation
- Difficulty remembering names
- Poor short-term memory
- Forgetting details of personal history (life events, phone number, etc.)
- Inability to recognize faces
Objective Data:
- Difficulty dressing or performing ADLs
- Loss of bladder and bowel control
- Personality changes
- Inappropriate behaviors (aggression, sexual gestures, etc.)
- Wandering or pacing
Nursing Interventions and Rationales
- Perform complete nursing assessment
Get a baseline for interventions and monitor progression of disease
- Assess neurological status and level of confusion routinely, per facility protocols
Help determine necessary interventions and progression of disease.
- Assess for depression or reclusiveness
Clients in the earlier stages who are still able to understand that they are losing their sense of reality may become depressed and withdrawn.
- Routinely assess client for organic contributors to behavior:
- Dehydration
- Poor nutrition
- Infection (systemic, urinary)
Many organic factors may contribute to an increase in client’s confusion or changes in mental status. It is important not to ignore them, since it could be related to infection or dehydration, which is treatable.
- Communicate effectively
- Speak in a slow and low, comforting voice
- Call client by name
- Speak face-to-face
Helps increase the possibility of the client understanding what is being communicated. Repeating the name helps the client maintain a sense of self-identity.
- Limit choices for independent decisions appropriate to stage of disease progression
Progressively reducing the client’s need for decision making helps reduce frustration and stress.
- Avoid allowing client to watch television or violence on television
Clients often have difficulty distinguishing fiction from reality and may cause aggressive or violent behaviors or unwarranted fears.
- Monitor for non-verbal cues and anticipate client’s needs
- Grimacing
- Crying
- Pointing
As the disease progresses, clients have more difficulty communicating verbally. Anticipating needs helps reduce stress and prevent frustration and anxiety.
- Orient client to environment as often as needed
- Calendars
- Pictures
- Signs
Helps client feel safer and reassured of their surroundings. Promotes awareness of environment.
- Provide structured and guided activities that client can accomplish with minimal challenge
This helps to keep the mind active, and incorporate a sense of accomplishment. Make sure the activity is not sp challenging so as to cause frustration or stress.
- Maintain schedule and routine
Helps the client maintain an awareness of time of day and offers a sense of security and reality.
- Assist with ADLs as needed
Advanced stages of the disease may diminish the client’s ability to perform simple tasks like dressing, bathing, combing hair and feeding. Provide whatever assistance the client needs to maintain a sense of dignity.
- Provide an opportunity for clients to interact with others, but avoid forcing interaction
Helps prevent clients from feeling isolated or alone. Gives them an opportunity to share stories or memories and maintain or develop social relationships. Forced interaction may cause aggression or inappropriate behaviors.
- Monitor client’s wandering habits and determine specific reasons, if any, for wandering
Clients may wander because they are thirsty or hungry, or are looking for a bathroom. Assess needs and provide assistance or direction within a safe environment.
- Educate family about disease process and resources for coping
- Therapy or counseling for families
- Support groups for families or caregivers
- Respite care options
- Home modifications
Help families cope and be prepared for the changes in their loved one.
Help families adapt to the needs of the clients.
Help reduce stress and anxiety that may be transferred to the client.
- Administer medications appropriately and as needed
- Cholinesterase inhibitors (donepezil)
- NMDA receptor antagonist (memantine)
- Antipsychotics (olanzapine, quetiapine)
- Benzodiazepines (lorazepam, temazepam)
- SSRI antidepressants (citalopram, paroxetine)
Some medications may be given regularly for management of memory loss and delay progression of the disease.
Other medications may be given PRN to treat behaviors and symptoms such as depression, anxiety or loss of appetite.
- Minimize environmental hazards and make pathways clear and illuminated
Promote safety and prevent injury.
References
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5619474/
- https://www.theravive.com/therapedia/major-or-mild-neurocognitive-disorder-due-to-alzheimers-disease-dsm–5-331.0-(g30.9)
- https://www.alzheimers.net/stages-of-alzheimers-disease/
- https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447
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