Alzheimer’s disease (AD) is a progressive and irreversible, degenerative, fatal disease and is the most common form of dementia among older people. Dementia is a brain disorder that seriously affects a person’s ability to carry out daily activities. It usually begins after age 60, and the risk goes up as you get older. Risk is also higher if a family member has the disease.
Progression of the disease is done in phases until all cognitive function is destroyed. Pathologic consequences include the loss of neurons in multiple areas of the brain, atrophy with wide sulci and dilated brain ventricles, and plaques composed of neurites, astrocytes, and glial cells surrounding an amyloid center, and neurofibrillary tangles.
Symptoms of Alzheimer’s Disease result from the destruction of numerous neurons in the hippocampus and the cerebral cortex. The enzyme choline acetyltransferase has a decreased action with AD patients, which results in impaired conduction of impulses between the nerve cells caused by a lack of acetylcholine production.
Currently, no treatment can stop the progression of the disease. However, some drugs may help keep symptoms from getting worse for a limited time.
Nursing Care Plans
Nurses play a key role in recognizing dementia among hospitalized elderly by assessing for signs during the nursing admission assessment. Interventions for dementia are aimed at promoting patient function and independence for as long as possible. Other important goals include promoting the patient’s safety, independence in self-care activities, reducing anxiety and agitation, improving communication, providing socialization and intimacy, adequate nutrition, and supporting and educating the family caregivers.
- Impaired Memory
- Disturbed Thought Process
- Risk for Injury
- Chronic Confusion
- Impaired Verbal Communication
- Self-Care Deficit: Bathing
- Self-Care Deficit: Dressing
- Self-Care Deficit: Toileting
- Impaired Physical Mobility
- Disturbed Sleep Pattern
- Disturbed Sensory Perception*
- Social Isolation
- Compromised Family Coping
- Other Nursing Care Plans
- Impaired Memory
May be related to
- Alzheimer’s disease process
- Changes in cognitive abilities
- Chemical imbalance in the brain
- Neuronal destruction in the brain
May be evidenced by
- Disorientation to time, place, person, and circumstance
- Decreased ability to reason or conceptualize
- Inability to reason
- Inability to calculate
- Memory loss
- Decreased attention span
- Easy distractibility
- Inability to follow simple or complex commands
- Deterioration in personal care and appearance
- Inappropriate social behavior
- Inability to cooperate
- Disturbance in judgment and abstract thoughts
- Explosive behavior
- Illusions, delusions, hallucinations
- Deterioration of intellect
- Loss of sexual drive and desire reduced control of sexual behavior
- Inappropriate behavior
- Lack of inhibitions
- Hypervigilance or hypovigilance
- Alteration in sleep pattern
Desired goals and outcomes
- Patient will have appropriate maintenance of mental and psychological function as long as possible and reversal of behaviors when possible.
- Family members will exhibit an understanding of required care and demonstrate appropriate coping skills and utilize community resources.
- Patient will achieve functional ability at his optimum level with modifications and alterations within his environment to compensate for deficits.
Nursing Assessment and Rationales
1. Assess the patient’s overall cognitive function and memory.
Cognitive assessment tools such as the General Practitioner Assessment of Cognition (GPCOG) can be used to determine the patient’s cognitive function. Findings from the assessment are used for further evaluation and to guide treatment.
2. Assess the patient for sensory deprivation, concurrent use of CNS drugs, poor nutrition, dehydration, infection, or other concurrent disease processes.
May cause confusion and a change in mental status.
3. Perform regular, comprehensive person-centered assessments and timely interim assessments.
Assessments should be conducted at least every six months to identify issues that will help the person with dementia to live fully (Molony et al., 2018).
Nursing Interventions and Rationales
1. Orient the patient to the environment as needed if the patient’s short-term memory is intact. The use of calendars, radio, newspapers, television, and so forth are also appropriate.
Reality orientation techniques help improve patients’ awareness of self and environment only for patients with confusion related to delirium or depression. Depending on the stage of AD, it may be reassuring for patients in the very early states who are aware that they are losing their sense of reality. Still, it does not work when dementia becomes irreversible because the patient can no longer understand reality. Television and radio programs may be overstimulating, may increase agitation, and disorientating patients who cannot distinguish between reality and fantasy or what they may view on television.
2. Suggest the use of a calendar or making a list of reminders.
Written reminders can help remind the patient of certain actions.
3. Encourage the use of complementary and alternative therapies such as exercises, guided meditation, massage.
These activities can help reduce stress; stress can aggravate memory loss.
4. Assist the client in setting up a medication box.
A medication box can help remind them to take their medication at prescribed times and refill the box.
References & Sources
- Alzheimer’s Association. (2018). 2018 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 14(3), 367-429.
- Hyman, B. T., Phelps, C. H., Beach, T. G., Bigio, E. H., Cairns, N. J., Carrillo, M. C., … & Montine, T. J. (2012). National Institute on Aging–Alzheimer’s Association guidelines for the neuropathologic assessment of Alzheimer’s disease. Alzheimer’s & dementia, 8(1), 1-13.
- Lane, C. A., Hardy, J., & Schott, J. M. (2018). Alzheimer’s disease. European journal of neurology.
- Molony, S. L., Kolanowski, A., Van Haitsma, K., & Rooney, K. E. (2018). Person-centered assessment and care planning. The Gerontologist, 58(suppl_1), S32-S47.
- Montine, T. J., Phelps, C. H., Beach, T. G., Bigio, E. H., Cairns, N. J., Dickson, D. W., … & Hyman, B. T. (2012). National Institute on Aging–Alzheimer’s Association guidelines for the neuropathologic assessment of Alzheimer’s disease: a practical approach. Acta neuropathologica, 123(1), 1-11.
- Weller, J., & Budson, A. (2018). Current understanding of Alzheimer’s disease diagnosis and treatment. F1000Research, 7.
- Zimmerman, S., Sloane, P. D., & Reed, D. (2014). Dementia prevalence and care in assisted living. Health Affairs, 33(4), 658-666.
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Neurological Care Plans
Nursing care plans for related to nervous system disorders:
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- Guillain-Barre Syndrome | 6 Care Plans
- Meningitis | 7 Care Plans
- Multiple Sclerosis | 9 Care Plans
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- Spinal Cord Injury | 12 Care Plans