Nursing Care Plan for Alzheimer’s Disease

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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

Transcript

Hey guys, in this care plan, we will explore Alzheimer’s disease. 

 

So, in this Alzheimer’s disease care plan, we’re going to cover the desired outcome, the subjective and objective data along with the nursing interventions and rationales. 

 

So, our medical diagnosis is Alzheimer’s disease. Alzheimer’s disease is an irreversible neurological disorder where there’s decreased acetylcholine in the brain causing microscopic plaques and the destruction of neurons, the patient experiences a loss of memory and cognitive dysfunction. The exact cause is unknown, but it’s thought to be a combination of genetic, environmental and lifestyle factors along with aging. 

 

So, our desired outcome is that the patient will remain at the optimal level of independence or assisted functioning, remain free from injury and have adequate resources and support. Now, let’s take a look at our care plan. So, the patient with Alzheimer’s disease is going to experience some poor short-term memory. 

 

Um, this usually happens before long-term memory loss and causes things like forgetting what they ate for lunch, Um, and this is due to the changes in the brain. The patient will eventually experience poor long-term memory, where they can’t remember, for example, childhood memories. And again, that’s because of the changes in the brain. They will also start to experience increased confusion in the evenings, and at night. This is often called “sundowning” and it’s really hard on them. They get really confused and they might actually be fine during the day, and then all of a sudden at night, it’s like a switch is flipped and they completely change.

 

Now let’s look at the objective data. So, you’re going to start to notice personality changes and family will as well. Normally this might be a sweet, sweet, old lady and then now, she’s all of a sudden, very angry, frustrated and doesn’t know what’s going on. You know, it’s very hard. Um, you might notice some inappropriate behaviors that they usually don’t have such as being combative. You might notice difficulty with ADL’s, getting around, and this is all because of those changes in the brain structure. The patient eventually is going to have a really hard time with, um, trying to control their bladder and bowels, which is why often we can use depends to help with that. 

 

Now let’s look at our nursing interventions and the rationales. So, you will perform a complete assessment of the patient, assess the baseline and monitor the disease progression. Regularly, assess their neurological status and their mental status, because this is not easy on them.

 

Something to think about is checking out their nutritional status. Just to make sure they’re eating because sometimes they forget. I mean, they’re very forgetful and, um, it can be hard for them to remember to eat or even just drink a glass of water.

 

You want to practice effective communication. This is so, so important. This is going to help you to increase that patient/ nurse understanding. Um, you know, it can be very frustrating, um, when they feel like they’re trying to tell you something, but they can’t get it across. You know, they can’t remember everything. Just try to listen. That’s the best thing I can say, listen to what they’re saying to you. Let them express their anger and frustrations. Even if it doesn’t seem important to you, you might then be able to redirect them to what you need them to do at that time. This can help them to feel as though you care about them and what they need next. You want to make sure that you assist with ADL’s and limit choices for independent decisions, according to disease progression to minimize hazards. So our number one goal is we want to keep them safe, right?

 

So try to reduce frustration. You don’t want them to get frustrated or angry. Reduce their stress. And also this is going to help incorporate a sense of accomplishment for the patient. They can feel like they’re actually able to do things for themselves next. You want to make sure you reorient your patient often. There’s a lot of times they’re going to just feel confused. They might say something silly like, oh, um, you know, I’ve got to go talk to my mom. They might think they’re back into childhood again. So just redirect them, just reorient them to what’s going on right now, help them feel safe, you know, help promote awareness in themselves and their environment. It’s really helpful. Also, when you enter the room, just say who you are and why you’re there. Next, you want to provide structured and guided activities while maintaining a schedule and routine to try to keep things normal.

 

This is going to help the patient maintain awareness and offer a sense of security. So, you’ll want to educate the patient’s family about the disease. This is going to help that family to cope. This is really hard on them you guys, really hard. Their family member is changing right in front of their eyes. So, you want to help them cope. You want to help prepare them for changes and adapt to the needs of the patient. 

 

Lastly, you want to make sure you administer medications as ordered guys. We can’t reverse this disease at this point in time, we don’t have that ability with medications, but we can stop it from progressing as much as we can with medications, right? Um, so medications are going to help to manage that memory loss and hopefully delay the progression of the disease. There’s other meds as well that we might need to use to treat behavior such as agitation, combativeness, things like that and symptoms. 

 

We love you guys! Now go out and be your best self today. And as always, happy nursing!