Nursing Care Plan (NCP) for Dementia

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Outline

Pathophysiology

Dementia is the chronic, progressive loss of brain function. Dementia primarily affects the ability to learn new information. The most common form is Alzheimer’s Disease. The second common is vascular dementia that is associated with  a stroke.

Etiology

The exact cause of Alzheimer’s Disease is unknown. Age, gender (female more than male) and familial history are some of the predispositioning factors.

Desired Outcome

The patient will remain free from injury; Patient will maintain adequate nutrition; Maintain skin integrity

Subjective Data

  • Trouble sleeping
  • Forgetful
  • Irritability
  • Poor Appetite
  • Cough when eating

Objective Data

  • Aphasia
  • Agnosia
  • Impulsive
  • Memory Loss
  • Agitation
  • Short Term memory deficit
  • Dysphagia
  • Sundowning
  • Wandering

Nursing Interventions

Intervention

Rationale

Perform physical assessment

Full physical and psychosocial assessment should be performed. This is to get a baseline for the patient. This is the time to assess skin for breakdown and to see how advanced their dementia is.

Swallow evaluation

As Dementia advances, patients often experience dysphagia. It is important to perform swallow evaluation to assess for aspiration risk. Liquids  may need to be thickened or food may need to be chopped.

Assess for evidence of sundowning

Patients with Dementia can have increased confusion at night. Important to have extra safety precautions at night. Bed alarm should be placed. Non-slip socks, bed at lowest position. Frequent rounding.

Assess for changes in self-management

As the disease progresses, patients lose interest in many things such as personal appearance, eating, ambulating. May become less mobile and develop risk of skin breakdown and poor nutritional intake.

Provide caregiver with  support resources

It’s very important to support the caregiver as caring for patients with dementia can be challenging and oftentimes leads to caregiver strain. Collaborate with a social worker to provide resources regarding respite, support groups and other pertinent information.

Lesson Details

Writing a Nursing Care Plan (NCP) for Dementia

A Nursing Care Plan (NCP) for Dementia starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.

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Transcript

This is the nursing care plan for dementia. So dementia is the chronic progressive loss of brain function. Dementia primarily affects the ability to learn new information. The most common form of dementia is Alzheimer’s disease. And the second most common is vascular dementia, and that is associated with stroke. The exact cause of Alzheimer’s disease is unknown age, gender, female more than male, and familial history are some of the contributing factors. So some nursing considerations that we want to think of when we’re taking care of these patients, we want to make sure that these patients are safe. So we want to make sure that we initiate any safety precautions. We want to do frequent rounding. If these patients are admitted to the hospital and we also want to make sure that we give the caregiver some education on home safety and care, we also want to provide resources for the caregiver regarding any assistance that they may need for the desired outcome for this patient. And that this patient is going to remain free from injury. And this patient will also maintain adequate nutrition and maintain skin integrity. 

So when this patient comes in and presents to us, this patient with dementia, they are going to, more than likely, be accompanied by a caregiver. The caregiver is going to tell us a few things about themselves. The subjective data that we’re going to get from this patient is the first thing we’re going to see is they’re going to have trouble sleeping. This patient tends to want to stay up at night just because their day/night rhythm tends to be off. This patient is forgetful. They may be irritable. They may have poor appetite or no appetite. And when they do eat, they may cough when eating, and this may indicate maybe some type of aspiration. 

So when we assess the patient, there are going to be quite a few things that we’re going to be able to see. We’re going to be able to gather some good data just from assessing the patient and spending a little time with them. These things are, the patient may aphasic. And if you don’t know what that is, that’s just a loss of, of the sensory. They’re not going to be able to tell you or communicate, I have some discomfort. I have pain. I’m cold, I’m hot. They may be impulsive. You may notice that these patients are going to have some memory loss. They’re going to be agitated. So there’s going to be some agitation. 

And then also they may have a short term memory deficit. There’s going to be some dysphagia or trouble swallowing. And finally, the term as we call sundowning. So sundowning is when the patient gets worse. At night, when the sun goes down, they tend to be more agitated, more impulsive. And we’re going to talk about that in the next couple of slides, we want to perform a good physical assessment. So this is our first nursing intervention to perform an assessment. A full physical and psychosocial assessment should be performed. This is to give us a baseline. We want a baseline. Where is this patient at? At this point, we want to take this time as well to assess the skin for breakdown and to see how advanced the dementia is. We also would like to do a swallow evaluation. These patients are at high risk for aspiration, so increased risk for aspiration. And because they are at increased risk for aspiration, they need a swallow evaluation. The liquids that they drink mainly to be thinking on their food may need to be chopped. So let’s say thin, thicken liquids, or chop food. 

This is all to prevent aspiration. The next thing we want to do is assess for evidence of sundowning. Remember, patients with dementia can have an increased confusion at night. It’s important to have extra safety precautions at night, the bed alarm should be placed in non-slip socks. The bed should be placed at its lowest position. And we should also do frequent rounding. It’s very important to round on these patients more often than you would round on your other patients. Because again, these patients are quick, they’re impulsive and they can hurt themselves if not properly monitored. The next thing we want to do is with these patients, we want to assess for changes and self-management so pretty much what this means is we want to look at the patient because as the disease progresses, this patient tends to lose interest. In many things, a personal appearance, eating emulating this patient may become less mobile and develop a risk for skin breakdown, poor nutritional intake. This person is just not interested in food. So poor nutrition for feeding and decreased interest. 

Finally, we want to support that caregiver. It is very difficult to take care of a patient with dementia, and at times it could be frustrating. So we need to make sure that we support caregivers. Most caregivers are families, maybe a spouse or a child. It’s very important to make sure that we collaborate with the social worker to provide resources regarding respite care. We want to make sure that we give these caregivers enough information and enough support. Maybe they can do a respite stay, where they have a substitute caregiver come in just for a few hours so they can get away and do something for themselves. We wanted to do support groups where other pertinent information needs to be provided to these caregivers. Let’s take a look at the key points. So the patho behind dementia is that it’s a chronic progressive loss of brain function. 

The subjective data that we’re going to gather is we are going to hear that this patient is forgetful. This patient is very forgetful, irritable, and has trouble sleeping. They have a lot of trouble sleeping, some things that we’re going to see when we assess this patient is we’re going to see some aphasia. They may have some memory loss, some agitation, some sundowning, they’re going to be impulsive. What we need to do in the hospital to keep this patient safe; we want to implement some extra safety measures. We want to make sure that this patient, because they’re impulsive, that they are put on a fall risk. We want to do frequent rounding because they tend to sundown at night. We want to also make sure that we are supporting these caregivers. Their caregiver is taking on a huge, huge task. It’s very difficult. So we want to make sure that we provide those resources. We want to make sure we give them information for support groups, and we want to make sure that they have an outlet such as some type of respite care, where they can have a substitute caregiver come in. 

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

 

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