Deliver effective care to patients with Alzheimer’s disease this nursing care plan and management guide. Gain insights into nursing assessment, interventions, goals, and diagnosis customized for their specific needs. Enhance your ability to provide specialized care for Alzheimer’s disease.
Table of Contents
- What is Alzheimer’s Disease?
- Nursing Care Plans and Management
- Nursing Problem Priorities
- Nursing Assessment
- Nursing Diagnosis
- Nursing Goals
- Nursing Interventions and Actions
- 1. Improving Cognitive Function
- 2. Promoting Safety and Preventing Injury
- 3. Managing Confusion
- 4. Reducing Anxiety
- 5. Improving Communication
- 6. Promoting Independent Self-Care Activities
- 7. Promoting Physical Mobility
- 8. Enhancing Sleep Pattern
- 9. Providing Socialization
- 10. Enhancing Family Coping
- 11. Managing Wandering
- 12. Initiating Patient Education and Health Teachings
- 13. Administer Medications and Provide Pharmacologic Support
- 14. Monitoring Results of Diagnostic and Laboratory Procedures
- 15. Assessing and Monitoring for Potential Complications
- Recommended Resources
- See also
- References & Sources
What is Alzheimer’s Disease?
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 and Management
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.
Nursing Problem Priorities
The following are the nursing priorities for patients with Alzheimer’s disease (AD):
- Assess and support individuals with Alzheimer’s disease and dementia.
- Promote cognitive function and safety.
- Assist with daily activities and provide a safe environment.
- Offer emotional support to individuals and families.
- Educate families on communication and behavior management.
- Monitor and manage cognitive changes and behaviors.
- Provide resources and referrals for support services.
- Respect individual dignity and autonomy.
Assess for the following subjective and objective data:
- See nursing assessment cues under Nursing Interventions and Actions.
Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with Alzheimer’s disease (AD) based on the nurse’s clinical judgment and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.
Goals and expected outcomes may include:
- 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.
- Patient will remain safe from environmental hazards resulting from cognitive impairment.
- Family will ensure safety precautions are instituted and followed.
- Patient will remain in a safe environment with no complications or injuries obtained.
- Family will be able to identify and eliminate hazards in the patient’s environment.
- Patient will have minimal confusion, cognitive impairment, and other dementia manifestations.
- Patient will have stable, safe environment with routine scheduling of activities to decrease anxiety and confusion.
- Patient will exhibit minimal or reduced confusion, memory loss, and cognitive disturbances, depending upon stage of AD.
- Patient will have preservation of sensory/perceptual function and controlled effects of deficits within limits of disease process.
- Patient will be able to identify sounds and objects correctly.
- Patient will be able to use assistive devices to minimize deficits.
- Family will be compliant with making adjustments n the patient’s environment for prevention
- Patient will be able to tolerate stimuli when introduced slowly in a nonthreatening manner, with one item at a time.
- Patient will be able to be distracted or use other techniques to avoid stressful situations that may cause aggressive, hostile behaviors or frustration.
- Family will be able to utilize information effectively in dealing with patients with confusion regarding limitations of stimulation and validation of the patient’s thoughts.
- Family will be able to utilize information to begin making decisions for long-term plans for patient.
- Patient will demonstrate and report decreased anxiety.
- Patient will display decreased muscle tension and diminished restlessness.
- Patient will be able to have effective speech and understanding of communication, or will be able to use another method of communication and make needs known.
- Patient will have self-care needs met and have few, if any complications.
- Patient’s family will be able to carry out self-care program on a daily basis.
- Patient will maintain an acceptable appearance.
- Patient will be able to perform a portion of self-care within the limitations of the disease.
- Patient will accept assistance with self-care when needed.
- Patient and family will use assistive devices to perform self-care for the patient.
- Family will be able to provide bathing and hygiene care for the patient competently.
- Patient will be appropriately groomed and dressed independently with or with minimal assistance.
- Patient will have self-care needs met without any complications
- Patient’s family will be able to carry out toileting program.
- Patient will maintain functional mobility as long as possible within limitations of disease process.
- Patient will have a few, if any, complications related to immobility as disease condition progresses.
- Patient will achieve and maintain restorative restful sleep.
- Patient will exhibit no behavioral symptoms, such as restlessness, irritability, or lethargy.
- Patient will be able to maintain effective social interaction with others within limitations of disease process.
- Family will maintain their own optimal health.
- Family will be able to access support groups, counseling, for assistance as needed.
- Family will increase their knowledge about the disease and the care of the patient to enable them to feel more in control of their situation
- Family will have reduced anxiety and be able to cope and use problem-solving techniques.
- Family will be able to adjust role reversal status and resolve conflicts regarding the care of the patient.
- Family members will achieve increased coping ability concerning the patient’s dementia and care needs.
- Patient will have minimized wandering behavior.
- Patient will be able to ambulate safely, and will not have unplanned outings.
- Patient will be able to participate in activities.
- Patient will have minimal wandering behaviors, and will experience no injuries.
Nursing Interventions and Actions
Therapeutic interventions and nursing actions for patients with Alzheimer’s disease (AD) may include:
1. Improving Cognitive Function
Improving cognitive function in patients with Alzheimer’s disease (AD) is a significant challenge as this progressive neurological disorder leads to the deterioration of memory, thinking skills, and overall cognitive abilities. However, various approaches and interventions have been explored to help alleviate symptoms and enhance cognitive function in individuals with AD. Early detection, proper medical care, and a holistic approach involving various interventions can significantly contribute to managing the symptoms and supporting cognitive function in patients with AD.
Assess the patient’s ability for thought processing every shift.
Observe the patient for cognitive functioning, memory changes, disorientation, difficulty with communication, or changes in thinking patterns. Changes in cognitive status may indicate progression of deterioration or improvement in condition.
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.
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.
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).
Assess the level of confusion and disorientation.
Confusion may range from slight disorientation to agitation and may develop over a short period or slowly over several months. May indicate the effectiveness of treatment or decline in condition.
Assess the patient’s ability to cope with events, interests in surroundings and activity, motivation, and changes in memory pattern.
The elderly may have a decrease in memory for more recent events, more active memory for past events, and more active memory for past events and reminisce about the pleasant ones. The client may exhibit assertiveness or aggressiveness to compensate for feelings of insecurity or develop more narrowed interests and have difficulty accepting lifestyle changes.
Assess visual acuity, visual difficulties or loss, and its effect from these changes; the presence of cataract, glaucoma, and status of remaining vision.
Presbyopia is common among the elderly. Other visual changes caused by physiologic changes require correction by surgery or with eyeglasses. Visual deficits create mobility and socialization changes.
Assess auditory acuity, cerumen in ears, responses to noises and effects on hearing, ability to communicate, amount of loss and effect, and difficulty locating and identifying sounds.
Presbycusis is common in the elderly. Conductive hearing loss results in false interpretation of words and creates poor communication, isolation, and depression.
Assess olfactory or gustatory loss, changes in appetite and eating patterns, and amount of loss and effect on nutritional status.
Deterioration results from physiologic changes of aging and create a loss of interest and pleasure in eating.
Assess tactile changes tingling or numbness in extremities, loss of sensation, pain, or pressure.
Tactile perception is reduced in the aged, and different discriminating sensations decrease and risk injury.
Assess kinesthetic perception, expression, or behavior, indicating awareness, extent, and direction of movement.
Cognitive deficits or aging neurologic changes may prevent awareness, control of muscles, muscles movements and create risk of falls.
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.
Suggest the use of a calendar or making a list of reminders.
Written reminders can help remind the patient of certain actions.
Administer softening agent to ear and rinse with a bulb syringe.
Soften and emulsifies cerumen for easier removal to facilitate hearing.
Promote the use of assistive devices: hearing aid, corrective glasses, or contact lenses.
Provides for correction of deficit.
Provide reading materials with larger print, recorded material, phone numbers with large font, and posters with contrasting colors.
Provides visual aids that allow for more control and independence.
Provide magnifying glass, reading stand with a magnifier attached, or brighter lights
Promotes visual acuity.
Suggest sunglasses or use a visor.
Reduces glare that is a common complaint among the elderly.
Arrange articles familiarly and maintain the same location. Follow through with food on the table, personal hygiene articles, furniture, including clothing.
Provides alteration in the environment that facilitates independence with limited vision and promotes safety.
Suggest using colors that are bright and contrasting; avoid hues of blues and greens.
Minimizes the problem of distinguishing items from one another as colors tend to blend.
Provide adequate lighting at night; avoid abrupt movement from bright to dim light.
Prevents confusion and accidents as the ability to adjust to differences in lighting is decreased.
Provide telephone amplifier on receiver and bell tone, flashing light on the phone, a loudspeaker for TV, radio, etc.
Promotes auditory perception and acuity.
Determine the type of hearing loss. If the head turns to hear, asks for a repeat of conversations frequently, or cannot follow a verbal conversation.
The patient with conductive loss experiences hearing loss of all frequencies and will hear any loudly spoken words. Sensorineural loss experiences loss of hearing even when speech is loud enough to be heard.
Eliminate background noise.
Excessive noise can interfere with hearing.
Face the patient, use eye contact and speak loud enough to be heard, speak slowly and clearly with proper pitch, use short, clear sentences and gestures, maintain position even with the patient to allow the view of lips, and use touch to hold attention.
Enhances communication if the hearing is impaired and promotes a feeling of warmth and caring.
Allow time for answers and be patient. Rephrase a message using different words if the patient is confused, puzzled, or gives an inappropriate response.
May need time to sort out and identify sounds or may not understand certain frequency sounds.
Use a hand-held device if appropriate.
Hearing horns and speaking tubes enhance communication.
Offer sweet and salt substitutes.
Helps satisfy the desire for these tastes as taste buds decrease with aging without compromising diet.
Allow for interaction during mealtime.
Promotes interest in eating.
Provide alarm and flashing light type smoke detectors and safety alarms for stoves and heating units.
Reduces the risk of injury if olfactory perception is reduced.
Prevent any exposure to extreme temperatures and pressure on the skin.
Reduces the risk of burns or injury if tactile perception is impaired.
23. Instruct patient or family in the application of hearing aids, removal of them two times per week, and cleaning ear and device. Instruct about troubleshooting device according to manufacturer’s recommendation.
Prevents cerumen buildup and enhances hearing.
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.
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.
Maintain a regular daily routine to prevent problems resulting from thirst, hunger, lack of sleep, or inadequate exercise.
If the needs of a patient with AD are not met, it may cause the patient to become agitated and anxious. Predictable behavior is less threatening to the patient and does not tax limited ability to function with ADLs.
Allow the patient the freedom to sit in a chair near the window, utilize books and magazines as desired.
Validates the patient’s sense of reality and assists the patient in differentiating between day and night. Respect for the patient’s personal space allows the patient to exert some control.
Label drawers, use written reminders notes, pictures, or color-coding articles to assist patients.
Assists the patient’s memory by using reminders of what to do and the location of articles.
Allow hoarding and wandering in a controlled environment, as appropriate or within acceptable limitations.
Increases patient’s security and decreases hostility and agitation by permitting difficult behaviors to be allowed within the confines of a safe, supervised environment.
Provide positive reinforcement and feedback for positive behaviors.
Promotes patient confidence and reinforces progress.
Limit decisions that the patient makes. Be supportive and convey warmth and concern when communicating with the patient.
The patient may be unable to make even the simplest choice decisions, resulting in frustration and distraction. By avoiding this, the patient has an increased feeling of security. Patients frequently have feelings of loneliness, isolation, and depression, and they respond positively to a smile, friendly voice, and gentle touch.
Inform the patient of care to be done, with one instruction at a time.
Patients with AD require extended time for processing information. Removal of decision-making may facilitate improved compliance and feelings of security.
Instruct family in methods to communicate with the patient: listen carefully, listen to stories even if they’ve heard them many times previously, and avoid asking questions that the patient may not be able to answer.
Comments from the patients may involve reminiscing experiences from previous years and maybe appropriate within that context. In the early stages of AD, questions may cause embarrassment and frustration when the patient is presented with another reminder that abilities are decreasing.
Instruct family members about the disease process, what can be expected, and assist with providing a list of community resources for support.
Once the diagnosis of AD is made, the family should be prepared to make long-term plans to discuss problems before they arise—choices for resuscitation, legal competency, and guardianship, including financial responsibility needed to be addressed. The care of a person with AD is expensive and time-consuming and energy-draining, and emotionally devastating for the family. Community resources can help delay the need for placement in a long-term care facility and may help defray some costs.
2. Promoting Safety and Preventing Injury
Promoting safety and preventing injury in patients with Alzheimer’s disease (AD) is of paramount importance due to the cognitive and functional impairments associated with the disease. AD can result in memory loss, confusion, disorientation, and difficulties with judgment, which increase the risk of accidents and injuries. Implementing certain strategies and modifications can help create a safer environment for individuals with AD.
Assess the degree of impaired ability of competence, the emergence of impulsive behavior, and a decrease in visual perception.
Impairment of visual perception increases the risk of falling. Identify potential risks in the environment and heighten awareness so that caregivers are more aware of the danger.
Assess the patient’s surroundings for hazards and remove them.
Persons with AD have decreased awareness of potential dangers. All potential and obvious hazards should be removed to allow the patient to move about as freely as possible. Install handrails when necessary. Promote a hazard-free environment to relieve the family of constant worry about the patient’s safety.
Eliminate or minimize sources of hazards in the environment.
Maintain security by avoiding a confrontation that could improve the behavior or increase the risk for injury. An environment that is free of hazards allows maximum patient independence and a sense of autonomy.
Instruct family regarding the removal or locking up knives and sharp objects away from the patient. These include cleaning supplies, insecticides, other household chemicals, medications, aerosol sprays, weapons, power tools, small appliances, smoking materials, and breakable items.
Prevents physical injury from ingestion, burns, overdoses, or accidents.
Instruct family to apply protective guard over electrical outlets, thermostats, and stove knobs.
Prevents accident injury and electrocution.
Instruct family to keep pathways clear, move furniture against the wall, remove small rugs, remove wheels on beds and chairs or lock them in place.
Prevents the risk of falls.
Instruct family to double lock doors and windows, swimming pool areas, and install pressure-sensitive buzzers on doors.
Helps reduce the risk of injury to patients who wander.
Instruct the family to ensure that the patient has hearing aids, glasses, and others if they have a sensory deficit.
Reduces the risk for patients who need supplemental assistance with sensory status.
Instruct the family to provide non-slip shoes and shoes without laces when possible.
Helps to prevent tripping and falls.
Have the patient wear some form of identification when doing activities outside
Identification can help in case of separation from the caregiver. All activities done outside the home must be supervised to protect the patient. Because of impaired verbal communication, the patient may not be able to state pertinent information about themselves to facilitate a safe return if lost.
Maintain adequate lighting and clear pathways.
Adequate lighting in halls, stairways, bathrooms is necessary to prevent injury. This will also allow the patient to see and find their way around the room without danger of tripping or falling. Installing nightlights is helpful, especially for patients who have sundowning or increased confusion at night.
Divert attention to a client when agitated or dangerous behaviors like getting out of bed by climbing the fence bed.
The patient may have a short attention span and be forgetful. Repeat instructions as necessary to promote safety and prevent injury.
During the middle and later stages of AD, the patient must not be left unattended.
Patients with AD have impaired thinking and cannot rationalize cause and effect. This can result in wandering outside without clothes on, exposure to extreme cold or heat, and may cause
3. Managing Confusion
Managing confusion in patients with Alzheimer’s disease (AD) is a crucial aspect of their care, as confusion is a common symptom associated with the progression of the disease. Cognitive decline in AD can lead to difficulties with memory, attention, problem-solving, and overall cognitive processing, resulting in increased confusion and disorientation.
Assess the patient for reversible or irreversible dementia, causes, ability to interpret the environment, intellectual thought processes, memory loss, disturbances with orientation, behavior, and socialization.
Determines the type and extent of dementia to establish a plan of care to enhance cognition and emotional functioning at optimal levels.
Utilize cognitive function testing.
Determines the extent of dementia.
Maintain consistent scheduling with allowances for patients’ specific needs, and avoid frustrating situations and overstimulation.
Prevents patient agitation, erratic behaviors, and combative reactions. Scheduling may need revision to show respect for the patient’s sense of worth and facilitate completing tasks.
Avoid or terminate emotionally charged situations or conversations. Avoid anger and expectation of the patient to remember or follow instructions. Do not expect more than the patient is capable of doing.
Catastrophic emotional responses are prompted by task failure when the patient feels expected to perform beyond ability and becomes frustrated and angry. Responding calmly to the patient validates feelings and causes less stress.
Provide time for reminiscing if the patient so desires.
Allows for remembering past pleasant events. The patient may be reliving events in the past, and the caregiver should identify this behavior and respect it.
Limit sensory stimuli by decreasing noise, keeping stimuli to a minimum, speaking in a calm, low voice, and take an unhurried approach.
Decreases frustration and distractions from the environment. Decreasing the stress of making a choice helps to promote security.
Assist with establishing cues and reminders for patient’s assistance.
Assists patients with early AD to remember the location of articles and facilitates some orientation.
Identify family members and support systems for the patient.
Helps to determine the appropriate person to notify for changes, assist with care, and someone familiar to the patient to help deal with his confusion.
Ask family members about their ability to provide care for the patient.
Identifies family’s need for assistance.
Instruct the family and provide them with information regarding community services and long-term health care facilities.
The patient may require ongoing skilled nursing care that the patient’s family is unable or unwilling to provide.
Instruct the family to avoid arguing with the patient on what they think, see, or hear.
Persons with AD may have delusions and hallucinations that are real to the patient, and no amount of persuasion will convince them otherwise. The patient may become agitated or violent if contradicted.
Instruct the family to avoid having the patient watch violent TV shows.
The patient may not be able to distinguish reality from fiction, and witnessing violent acts on the screen may be frightening to the patient.
Instruct family to utilize distraction techniques, such as soothing music, walking, or looking at picture albums if the patient has delusions.
Distraction may be effective in calming the patient if stressful situations occur.
4. Reducing Anxiety
AD can lead to increased feelings of confusion, disorientation, and a loss of control, which can contribute to heightened anxiety levels. Addressing anxiety in individuals with AD requires a holistic approach that encompasses various strategies to promote a sense of calm and security.
Monitor for early signs and symptoms of fatigue and agitation.
Early identification of problems results in prompt intervention to promote rest or remove the person from the situation causing anxiety.
Remove the patient from situations that are causing anxiety.
Activities involving large groups or noise that can stimulate the patient negatively can increase anxious feelings and agitation. The use of music therapy can help decrease agitation.
Watch out for signs of catastrophic reaction.
Overreaction to excessive stimulation may put the patient in a combative or agitated state. Excitement and confusion can be upsetting. The patient may respond by screaming, crying, or becoming abusive, which is their only way of expressing their inability to cope with the environment. If this occurs, moving the patient to a familiar environment or removing distractions may quiet the patient.
Keep the daily routine as consistent as possible.
Diversion from the usual routine can cause stress and anxiety. Providing a structured day enhances feelings of familiarity. Help the patient familiarize themselves with the environment. Keep it noise-free and avoid overstimulation.
Provide rest periods or quiet times throughout the day.
Fatigue contributes to anxiety and lowers the ability to tolerate stress. Activities such as listening to music, reading books, and meditation should be encouraged during quiet periods.
Establish a calm and structured environment
Creating a peaceful and organized living environment is crucial for managing anxiety. Minimize noise, excessive stimuli, and chaotic surroundings. Maintain a predictable routine and provide a sense of stability and familiarity, as this can help alleviate anxiety by reducing uncertainty.
Maintain consistent caregivers.
Individuals with AD may find comfort and reassurance in familiar faces and consistent caregivers. Continuity in caregiving personnel can help build trust and a sense of security, reducing anxiety associated with encountering unfamiliar individuals.
Use clear and simple language when communicating.
Use clear and simple language when communicating with individuals with AD.
Speak calmly and softly, using a gentle tone of voice. Avoid using complex or confusing language. Provide simple explanations and instructions, allowing ample time for processing and response.
Validate patient’s feelings and reassure comfort.
Validating and acknowledging the feelings and concerns of individuals with AD can help alleviate anxiety. Offer reassurance, comfort, and empathy, even if their worries or fears seem irrational. Avoid dismissing their emotions or arguing with their perception of reality, as this can heighten anxiety.
Introduce relaxation techniques.
Introducing relaxation techniques can be beneficial in reducing anxiety in AD patients. Techniques such as deep breathing exercises, guided imagery, gentle massage, or playing soothing music can promote relaxation and a sense of calm. However, it’s important to tailor these techniques to the individual’s preferences and capabilities.
Allow patient to engage in meaningful activities.
Engaging individuals with AD in meaningful and enjoyable activities can help redirect their focus and reduce anxiety. Activities such as listening to familiar music, looking through photo albums, engaging in simple crafts, or spending time in nature can provide a sense of joy and relaxation.
5. Improving Communication
Alzheimer’s disease gradually diminishes the person’s ability to communicate. This nursing care plan is to help promote communication. Verbal communication involves the use of words, whether spoken, written, or signed, as a means of conveying information. It distinguishes humans from other species, as we possess language systems that allow for organized and meaningful communication. Clarity is essential in verbal communication, not only in transmitting information but also in ensuring comprehension, expanding ideas, and addressing any points of confusion. Challenges may arise due to impaired communication, and it is the nurse’s responsibility to recognize ineffective communication and employ strategies to enhance information transmission and understanding, whether in a hospital or community setting.
Assess the patient’s ability to speak, language deficits, cognitive or sensory impairment, presence of aphasia, dysarthria, aphonia, dyslalia, or apraxia. Assess for the presence of psychosis or other neurologic disorders affecting speech.
Identifies problem areas and speech patterns to help establish a plan of care.
Evaluate the effects of communication deficit.
Communication becomes progressively impaired as AD advances. The left side cerebral functions consisting of language reasoning and calculation are decreased. Receptive and expressive aphasia are major symptoms of AD and affect speaking, reading, writing, and math. The mechanics of speech production is usually intact until the last stages of AD. Still, the patient has difficulty concentrating on what has been said, understanding and processing what was said, and preparing a response. In the first stage of AD, vocabulary skill decreases and the patient has trouble finding the correct word to use, resulting in word substitution. The patient can usually understand most messages but forgets them because of memory deficits. As the disease evolves, the ability to comprehend written and spoken language is decreased. False details about past events may be invented to camouflage the inability to remember (confabulation). Ultimately the patient will become mute.
Monitor the patient for nonverbal communication, such as facial grimacing, smiling, pointing, crying, and so forth; encourage the use of speech when possible.
This indicates that feelings or needs are being expressed when speech is impaired. Excessive mumbling, striking out, or nonverbal cues may be the only method to express discomfort, especially for patients in later stages of AD.
Assess the patient for hearing deficits and use appropriate adaptive devices if needed. Minimize glare in the room, speak normally but distinctly, and use short phrases with speech attempts.
If the patient is deaf or requires hearing aids, ensure the battery is working, and the aid is correctly placed to enhance hearing ability. Shouting usually increases the pitch of the voice and does not help with hearing. Glare makes it more difficult for the patient to read the care provider’s lips.
Ascertain circumstances or situations that may limit the patient’s ability to use or comprehend language, such as the following:
Several clinical conditions may change the person’s ability to communicate effectively.
- Alternative airway (e.g., tracheostomy, oral nasal intubation)
Sounds are not produced when air does not pass over the vocal cords.
- Orofacial/maxillary problems (e.g., wired jaws)
Words are articulated by coordinated movements of mouth and tongue; when movement impinges, communication may be ineffective.
Evaluate mental status, and note the presence of psychotic conditions (e.g., manic-depressive, schizoid/affective behavior). Assess psychological response to communication impairment, and willingness to find alternate means of communication.
Evaluating the mental status of the patient is vital to determine contributing factors.
Assess the following:
- The patient’s preferred language for verbal and written communication
Patients may speak a language properly without being able to read it effectively. Discharge self-care and follow-up information must be communicated and strengthened with written information that the patient can use. In recognition of the wide array of cultures and physical challenges that patients face, it is the nurse’s responsibility to communicate effectively.
- The patient’s primary and preferred means of communication (e.g., verbal, written, gestures)
Patients may have skills with many forms of communication, yet they will favor one method for important communication.
- Ability to get spoken word
It is necessary for the health care team to learn that the construct of gestured language has a completely different structure from verbal and written English.
- Ability to understand written words, pictures, and gestures
A way to be certain that communication has been productive is to provide for a certified interpreter to confirm information from both sides of the discussion.
Assess environmental factors (e.g., room noise level).
The surrounding may affect the ability to communicate.
Evaluate the patient’s energy level.
Fatigue/shortness of breath can make communication difficult or impossible.
Observe for the presence and history of dyspnea.
Patients who are experiencing breathing problems may reduce or cease verbal communication which may complicate their respiratory efforts.
Assess for the presence of expressive dysphasia (inability to convey information verbally) and receptive dysphasia (word meaning may be scrambled during the processing of information by the patient’s brain).
The patient with expressive dysphasia has nonfluent speech; however, his or her verbal comprehension is intact. The ability to read and write may be impaired with this type of dysphasia. The patient with receptive dysphasia has fluent speech, but the content of his or her communication is often meaningless.
Face the patient, maintain eye contact, speak slowly, and enunciate clearly when communicating with the patient.
Clarity, brevity, and time provided for responses promote the opportunity for a successful speech by allowing the patient time to receive and process the information.
Remove competing stimuli and provide a calm, unhurried atmosphere for communication.
To promote clear communication with the patient, the nurse should remain unhurried during the interaction. Reduction of noises and distractions allows the patient more time to interpret the conveyed message.
Avoid rushing the patient when struggling to express feelings and thoughts.
Impaired verbal communication results in the patient’s feeling of isolation, despair, depression, and frustration. Compassion helps to foster a therapeutic relationship and sense of trust and is important for continuing communication.
Use simple, direct questions requiring one-word answers. Repeat and reword questions if misunderstandings occur.
Using clear and simple sentences can help the patient understand the message better because they often forget the meaning of words or have difficulty organizing and expressing thoughts.
Utilize pencil and paper to write messages.
Provides an alternative method of communication if the fine motor function is not impaired. Using a magic slate is also suitable. The use of lists and simple written instructions for reminders are helpful in the earlier stages of AD.
Be persistent in deciphering the patient’s message.
Do not interrupt the patient when they are communicating. Allow extra time to understand the patient’s message and do not pretend to understand when the message is unclear.
Attempt to anticipate the patient’s needs.
Be engaged and provide meaningful responses to the patient’s concerns to help prevent frustrations and anxiety.
Encourage the patient to breathe before speaking, pause between words, and use tongue, lips, and jaw to speak.
Promotes coordinated speech breathing.
Encourage the patient to control the length and rate of phrases, over articulate words, and separate syllables, emphasizing consonants.
Helps to promote speech in the presence of dysarthria.
Perform facial muscle exercises, such as smiling, frowning, sticking tongue out, moving the tongue from side to side, and up and down.
Promotes facial expressions used to communicate by increasing muscle coordination and tone.
Use therapeutic touch and tactile stimuli as appropriate.
Tactile stimuli (hugs, touch, hand holding) have a calming effect on the patient who may be frightened due to communication difficulties and can be interpreted as signs of affection, concern, and security.
Encourage the patient to take part in social activities.
It helps reduce feelings of isolation, resulting in further depression and unwillingness to communicate, even if the patient is physically able to.
Instruct the patient and significant other (SO) regarding the need to use glasses, hearing aids, dentures
Helps promote communication with sensory or other deficits.
Provide consultation with speech therapists, as appropriate.
It helps facilitate speech ability and provides potential alternatives for communication needs.
Learn patient needs and pay attention to nonverbal cues.
The nurse should set aside enough time to attend to all of the details of patient care. Care measures may take longer to complete in the presence of a communication deficit.
Place important objects within reach.
To maximize the patient’s sense of independence.
Provide an alternative means of communication for times when interpreters are not available (e.g., a phone contact who can interpret the patient’s needs).
An alternative means of communication (e.g., flashcards, symbol boards, electronic messaging) can help the patient express ideas and communicate needs.
Never talk in front of a patient as though he or she comprehends nothing.
This increases the patient’s sense of frustration and feelings of helplessness.
Clarify your understanding of the patient’s communication with the patient or an interpreter.
Feedback promotes effective communication.
Keep distractions such as television and radio at a minimum when talking to patients.
To keep patient-focused, decrease stimuli going to the brain for interpretation, and enhance the nurse’s ability to listen.
Avoid talking with others in front of the patient as though he or she comprehends nothing.
Excluding the patient from an interaction increases the patient’s sense of frustration and feeling of helplessness.
Do not speak loudly unless the patient is hearing-impaired.
Loud talking does not improve the patient’s ability to understand if the barriers are primary language, aphasia, or a sensory deficit.
Maintain eye contact with the patient when speaking. Stand close, within the patient’s line of vision (generally midline).
Patients may have defects in the field of vision or they may need to see the nurses’ faces or lips to enhance their understanding of what is being communicated.
Individualize techniques using breathing for relaxation of the vocal cords, rote tasks (such as counting), and singing or melodic intonation.
To assist aphasic clients in relearning speech.
Give the patient ample time to respond.
It may be difficult for patients to respond under pressure; they may need extra time to organize responses, find the correct word, or make necessary language translations.
Maintain a calm, unhurried manner. Provide sufficient time for the patient to respond.
Individuals with expressive aphasia may talk more easily when they are rested and relaxed and when they are talking to one person at a time.
Praise the patient’s accomplishments. Acknowledge his or her frustrations.
The inability to communicate enhances a patient’s sense of isolation and may promote a sense of helplessness.
Provide environmental stimuli as needed.
To maintain contact with reality, or reduce stimuli to lessen the anxiety that may worsen the problem.
Use confrontation skills, when appropriate, within an established nurse-patient relationship.
To clarify discrepancies between verbal and nonverbal cues.
Try to phrase questions requiring “yes” and “no” answers.
Patients can be frustrated when they cannot communicate in a simple manner.
Use short sentences, and ask only one question at a time.
This method allows the patient to stay focused on one thought.
Encourage the patient to speak slowly.
This approach provides the patient with more channels through which information can be communicated.
Provide concrete directions that the patient is physically capable of doing (e.g., “point to the pain,” “open your mouth,” “turn your head”).
Simple, one-action directions enhance comprehension for the patient with language impairment.
Provide practice sessions within the day.
Practice will increase the patient’s communication.
Not correcting errors reinforces undesirable performance and makes correction more difficult later.
Create a list of words that the patient can say; add new words to it as needed. Share this with family members, significant others, and other care providers.
Sharing information with others broadens the group of people with whom the patient can communicate.
Provide word-and-phrase cards, a writing pad, and pencil, or a picture board. Use eye blinks or finger movements for “yes” or “no” responses.
Supplemental communication devices are especially helpful for intubated and tracheal patients or those whose jaws are wired.
Use and assist patients or significant others to learn therapeutic communication skills of acknowledgment, active listening, and Imessages.
Improves general communication skills.
Involve family and significant others in the plan of care as much as possible.
Enhances participation and commitment to the plan.
Carry on a one-way conversation with a totally dysphasic patient.
It may not be possible to determine what information is understood by the patient, but it should not be assumed that the patient understands nothing about his or her environment.
Consider the use of an electronic speech generator in post-laryngectomy patients.
Adaptive devices can aid communication with patients who cannot produce vocal speech.
Assist the patient in seeking an evaluation of his or her home and work settings.
This evaluation will help the patient make decisions about the need for assistive devices such as talking computers, telephone typing devices, and interpreters.
Allow significant others the opportunity to ask questions about the patient’s communication problem.
It is vital for the family to know that there are many ways to send information to someone and that time may be needed to understand the special needs of the patient.
Refer to appropriate resources (e.g., speech therapist, group therapy, individual/family and/or psychiatric counseling).
Specialized services may be required to meet needs.
6. Promoting Independent Self-Care Activities
Promoting independent self-care activities in patients with Alzheimer’s disease (AD) is important for maintaining their dignity, autonomy, and overall well-being. AD can gradually affect an individual’s ability to perform daily tasks and self-care activities. However, with appropriate support and modifications, individuals with AD can continue to engage in self-care to the best of their abilities.
Assess the patient’s appearance, body odors, ability to recognize and use articles for washing and grooming, and any other self-care deficits.
Identifies specific needs and the amount of assistance that the patient will require to establish a care plan.
Assess and identify the patient’s previous history of grooming and bathing, and attempt to maintain similar care.
Promotes familiarity with routine bathing time and type of bath or shower and lessens further confusion and agitation.
Ensure all needed items are present in the bathroom before the patient’s arrival. Ensure that the water temperature in the tub is appropriate.
Prevents the need to leave the patient unattended, which may result in injury. Test and adjust the water temperature appropriately to prevent scalding.
Allow the patient to perform as much of the task as possible.
Repetition of tasks will help the patient in the long term as it fosters independence and promotes self-care.
Promote autonomy and independence and maintain personal dignity.
Persons with AD should be encouraged to make appropriate choices and participate in self-care activities as much as possible.
Assist with as much activity as needed. Give the patient a washcloth or hand towel to hold and use.
Promotes independence and self-esteem when the patient is allowed to control the situation. Patients with AD frequently will grasp the nurse’s hand during a bath, and the use of a washcloth helps them have something to hold and use.
Inspect the patient’s skin during and after bath.
Provides the opportunity to observe for the presence of rashes, lesions, pressure areas, ulcers, bruises, growths, or contaminated skin areas, which may require more assistance with hygiene to prevent further skin deterioration.
Instruct the patient in activity with a short step-by-step method. Do not rush the patient.
Promotes self-esteem, dignity, and feelings of accomplishment; rushing the patient causes frustration.
Instruct family members in bathing techniques and what to observe during bath.
Provides knowledge on what to do and observe.
Assess the patient’s functional and cognitive ability to provide self-care.
Identifies functional level and helps establish a plan of care to meet a patient’s needs.
Provide assistive devices as needed.
Facilitates independence on some tasks.
Allow the patient to perform as much care as possible, giving simple instructions, step-by-step.
Patients can dress independently if they are provided selective choice and simple verbal instructions when dressing in comfortable, familiar, and safe areas (Prizer & Zimmerman, 2014).
Promote autonomy and independence and maintain personal dignity.
Persons with AD should be encouraged to make appropriate choices and participate in self-care activities as much as possible.
Assist the patient with dressing and grooming as needed.
Patients with AD have difficulty with dressing because of the need to have fine and gross motor skills, balance, sequencing ability, and the ability to tell right from left and top from bottom. Dressing up is less difficult if the patient’s clothes are large enough and soft, slick, and stretchy material.
Provide oral care after meals and at bedtime. Use adaptive devices as required.
The patient requires oral care to remove any leftover food particles, prevent decay, and promote dental hygiene. Patients may be unable to understand directions for spitting out toothpaste or rinsing with water and may be unable to open their mouths during flossing. Adaptive devices may be used to facilitate proper dental hygiene.
Instruct family regarding removal of clothing out of season or no longer fits; layout clothes in the order they are to be put on; use larger sized clothing with fasteners or Velcro that are easier to handle.
Assists AD patients with self-care while still doing part of care and assists the caregivers when they assume this duty.
Instruct family in the use of electric razors for men and depilatory cream products for women.
Helps facilitate an easier grooming process.
Instruct the family that the patient will require oral care at least twice daily and use artificial saliva.
Daily oral care will help lower significantly the risks of needing extensive dental care later on. Oral care may be difficult in the later stages of AD because the patient may not spit out toothpaste or rinse with water. Artificial saliva may be required for patients who suffer from dry mouth caused by medications or lack of fluid intake.
Instruct the family regarding the possibility of cutting the patient’s hair and keeping it in a short and simple style.
Helps keep the appearance of the patient tidy. Longer hair requires more brushing and intensive care; it may also cause aggressive behavior and frustration in the AD patient.
Allow the patient to perform a toileting routine, as able, and provide sufficient time to avoid rushing the patient.
Facilitates the patient’s independence as much as the condition will allow. Rushing induces excessive stress and leads to failure.
Establish a scheduled toileting and habit training program.
Take the patient to the bathroom every 2 hours, run the water, place the patient’s hands in warm water, or pour warm water over the genitalia.
Assist the patient with toileting as necessary.
Allows the patient to perform independently for as long as possible.
Establish a urinary and bowel care program if the patient is unable to complete toileting.
Monitoring the success or failure of the plan of care helps to identify and resolve areas of failure.
Monitor the patient for sudden changes in urinary status.
Incontinence is usually not occurring until the later stages of AD, so sudden urinary incontinence may indicate the presence of infection, prostatic hyperplasia, urethral sphincter failure, bladder irritation, or certain medication effects.
Observe the patient and monitor for wandering, rubbing the genital area, or irritability.
May indicate that their bladder is full.
Encourage fluid intake of at least 2-3 L per day unless contraindicated; ensure that the patient drinks the fluid.
Provides hydration and enhances renal function.
Administer stool softeners, laxatives, or suppositories and take the patient to the bathroom at the same time each day to promote stool evacuation.
Helps establish toileting routines.
Instruct family regarding toileting programs, times to take the patient to the bathroom, and maintaining a consistent schedule.
Promotes knowledge and facilitates continuity of care to promote toileting routines.
Teach the family the procedure for administering suppositories or enemas and the potential for manually removing impacted stool.
Provides knowledge and helps to instill confidence in family members who provide care. This may also induce family members to decide if they can provide personal care for the patient or need a long-term care facility for the patient.
7. Promoting Physical Mobility
AD can lead to a decline in physical abilities, coordination, and balance, which may result in decreased mobility and increased risk of falls. However, with appropriate strategies and interventions, individuals with AD can engage in physical activity and maintain their mobility to the best of their abilities.
Assess the patient’s functional ability for mobility and note changes.
Identifies problems and helps to establish a plan of care. Mobility deteriorates as AD progresses, but most patients are ambulatory until the latter stages.
Assess the patient’s degree of cognitive impairment and ability to follow commands, and adapt interventions as needed.
Helps to determine the presence of deficits.
Provide patients with enough time to perform mobility-related tasks. Use simple instructions.
The patient may need repetitive instruction and comprehensive assistance to perform the task.
Perform range of motion exercises every shift. Encourage an active range of motion exercises.
Helps to prevent joint contractures and muscle atrophy.
Reposition every 2 hours and prn.
Turning at regular intervals prevents skin breakdown from pressure injury.
Apply trochanter rolls or pillows to maintain joint alignment.
Prevents musculoskeletal deformities.
Assist with walking if at all possible, utilizing sufficient help. A one or two-person pivot transfer utilizing a transfer belt can be used if the patient has weight-bearing ability.
Preserves the patient’s muscle tone and helps prevent complications of immobility.
Use mechanical lift for patients who cannot bear weight, and help them out of bed at least daily.
Provides change of scenery, movement and encourages participation in activities.
Avoid restraints as possible.
Inactivity created by the use of restraints may increase muscle weakness and poor balance.
Avoid the use of walkers and canes.
Most AD patients cannot use them properly because of their cognitive impairment, increasing the potential for injury.
Instruct family regarding ROM exercises, transferring patients from bed to wheelchair, and turning at routine intervals.
Prevents complications of immobility, and knowledge assists family members in being better prepared for home care.
8. Enhancing Sleep Pattern
Enhancing sleep patterns in patients with Alzheimer’s disease (AD) is crucial for their overall well-being and cognitive functioning. AD can disrupt sleep patterns, causing sleep disturbances, insomnia, and excessive daytime sleepiness. Improving sleep hygiene and implementing strategies to promote better sleep can significantly benefit individuals with AD.
Assess the patient’s sleep patterns and changes, naps, and frequency, amount of activity, inactive status, number and time of awakenings during the night, and patient’s complaints of fatigue, apathy, lethargy, and impotence.
Provide information on which to establish a plan of care for correction of sleep deprivation. If the patient sleeps during the day, Sundowning syndrome may be the problem, with the patient’s day and night mixed up. By keeping the patient up during the day, sleeping at night may return.
Assess the patient for complaints or signs of pain, dyspnea, nocturia, or cramps.
May be causes of frequent awakenings and interruptions of the sleep cycle.
Monitor patient’s medications, use of alcohol (if any), and caffeine.
These drugs can alter REM sleep, which may cause irritability and lethargy. Drug action, absorption, and excretion may be delayed in the elderly patient, and toxicity may place the patient at risk.
Ensure the patient’s sleeping environment is quiet, relaxing, and comfortable.
External stimuli can interfere with going to sleep with frequent awakenings.
Provide ritualistic procedures of warm drink, extra covers, clean linens, or warm baths before bedtime.
Prevents disruption of established patterns and promotes comfort and relaxation before sleep.
Provide backrubs, music, and other relaxation techniques.
Helps in relaxation before sleep and reduces anxiety and tension. AD patients respond well to therapeutic touch.
Provide sleep apnea apparatus if required.
Provides for completion of all stages of sleep, resulting in restorative rest.
If all efforts fail, allow the patient to remain awake in a recliner by the nurse’s station.
Provides for surveillance of the patient, and the patient may willingly return to bed later.
Instruct family regarding Sundowning syndrome, coping methods, and the possibility of changing their sleeping cycle to match that of the patient’s once discharged.
The patient may not be able to revert to a “normal” day-night cycle, and either the caregiver will have to change their sleeping pattern, hire a sitter during night time, or placement in a long-term facility.
Instruct the family to avoid putting out the patient’s clothes for the next day if the patient exhibits a sleep disorder.
The patient may assume they are supposed to get dressed and go somewhere.
Provide rest and sleep; avoid situations that cause frustration, agitation, or sensory overload.
Permits coping with stimuli and prevents erratic reactions.
Instruct the patient and family regarding plans for periods of rest and activities during the day.
Promotes social interaction and activity.
Instruct the family regarding establishing a consistent bedtime routine.
Promotes sleep and helps to avoid frustration and confusion from sleep deprivation.
9. Providing Socialization
Providing socialization opportunities for patients with Alzheimer’s disease (AD) is essential for their emotional well-being, cognitive stimulation, and overall quality of life. AD can often lead to social isolation and a sense of disconnection, but engaging individuals with AD in meaningful social interactions can have numerous benefits.
Assess the patient’s feelings about their behavioral problems.
Interview the patient about their negative feelings about self, their ability to communicate, anxiety, depression, and powerlessness. This will help determine the extent of loneliness and isolation and the reasons for it.
Encourage socialization with families and friends.
Patients with AD can find socialization to be comforting. Encourage families and friends to visit, call, or write letters.
Provide recreational activities as appropriate for functional ability.
People with AD are encouraged to participate in simple activities to promote optimal psychosocial functioning. Hobbies or simple activities like gardening, walking, exercising, and socialization can help improve the quality of life. Care of pets can be an outlet for energy that can provide stimulation, comfort, and contentment.
Provide information about pet therapy.
Small pets provide sensory stimulation, encourage movement, as well as facilitating social interaction and nonverbal communication.
Instruct family regarding horticulture activities and their healing and therapeutic properties.
Plants grow and provide patients with the prospect of caring and nurturing, and sensory stimulation when working in the garden.
Identify possible support systems and the ability to participate in social activities.
Community resources are available for clients and families dealing with stages of AD that provide information and assistance.
Provide an opportunity for social interaction, but do not force interaction.
Helps prevent isolation. Forcing interaction usually results in confusion, agitation, and hostility.
10. Enhancing Family Coping
Enhancing family coping in patients with Alzheimer’s disease (AD) is crucial for supporting both the individuals with AD and their family members who provide care and support. AD can present numerous challenges, including changes in behavior, communication difficulties, and the progressive nature of the disease. However, with appropriate strategies and support, families can better cope with the demands of caregiving and maintain their own well-being.
Assess the family’s knowledge of the patient’s disease, erratic behaviors, and possibly violent reactions.
Knowledge will enhance the family’s understanding of dementia associated with the disease and develop coping skills and strategies. This can also allow the nurse to understand the family’s perspectives and correct myths and assumptions about AD.
Assess the level of family’s fatigue, reduced social exposure of family, feelings about role reversal in caring for the patient, and increasing patient demands.
The emotional burden of the diagnosis can overwhelm the family of the patient. The patient’s long-term needs may affect the physical and psychosocial health of the caregiver, their economic status and hinder the family in achieving their own goals in life.
Provide an opportunity for the family to express concerns and lack of control of the situation.
Promotes venting of feelings, helps identify problems and reduces anxiety.
Assist in defining problems and use of techniques to cope and solve problems.
Provides support for problem solving and management of family’s fatigue and chronic stress.
Assist family to identify patient’s reactions and behaviors and reasons for them.
May indicate the onset of agitation and allow for interventions to prevent or reduce frustration.
Instruct family and demonstrate time-saving, energy-conserving techniques to be used to assist patients.
Assists family to prevent injury or accident to patient or themselves.
Instruct the family regarding the need to maintain their health and social contacts.
Fatigue, isolation, and anxiety will affect the physical health and care capabilities of the caregiver.
Instruct the family regarding community resources available for AD, their families, as well as utilization of respite care.
Provides information and support from those people that understand and empathize with these families. Respite care may help facilitate the caregiver’s sense of well-being. Some families may feel that asking for help from others indicates a lack of caring for the patient.
Consult with social workers as appropriate.
May help assist with financial help and respite services and identifying the need for long-term care facilities.
11. Managing Wandering
Assess the patient for the presence of wandering behavior, noting time, place, and people whom they ambulate with.
Helps to identify the gravity of the problem and to establish a plan of care. Purposeful wandering occurs when the patient intends for their movements, such as escaping boredom or exercises. Aimless wandering is usually purposeless and involves disoriented patients who may enter other patients’ rooms and take their belongings. The patient who wandered usually has a destination in mind and can leave the premises undetected even though closely supervised.
Assess specific reasons for wandering if the patient can verbalize motivation.
Helps identify possible causes for wandering and the needs that this behavior may be meeting.
Inquire how the family handles the patient’s wandering behavior.
Helps to identify potential appropriate methods of management of patient’s behavior by using consistent methods.
Maintain a safe environment and structured routine.
Allow the patient to wander within boundaries in a safe environment. Structure in the patient’s routine may decrease wandering tendencies. Wandering behavior may be worse in a hospital setting due to unfamiliar surroundings. Place the patient close to the nursing station.
Encourage the patient to participate in activities if able to do so.
Exercise helps to decrease restlessness and may decrease potential wandering.
Install bed alarms or pressure-sensitive doormats.
Alerts the nurses of movement and helps prevent injury to the patient.
Instruct family regarding installing deadbolt locks, fences, locks on gates, and locks on doors and windows.
Helps to prevent unsafe exits from home and for the protection of the patient.
Avoid using restraints if at all possible.
Restraints can lead to injury, increase agitation, anxiety, and cause complications of immobility, feelings of powerlessness, and tendency for wandering.
Assess the patient for thirst, hunger, pain, or discomfort and need for toileting.
May wander about looking for these needs to be fulfilled.
Instruct family to notify neighbors or local police regarding the patient’s condition and penchant for wandering.
Provides awareness of others to prevent the patients from becoming lost or injured.
Instruct family to be prepared for possible escape attempts and keep up-to-date pictures of the patient and other information available.
Provides for information that may be used by police or other authorities to find a lost person.
12. Initiating Patient Education and Health Teachings
Initiating patient education and health teachings in patients with Alzheimer’s disease (AD) is crucial for promoting their understanding of the disease, empowering them to actively participate in their care, and optimizing their overall well-being. Although AD poses challenges to learning and memory, tailored educational approaches can still be effective in enhancing knowledge and facilitating disease management.
1. Assess individual learning needs.
Conduct an assessment to determine the individual’s baseline knowledge, learning abilities, and preferred learning style. This assessment helps tailor the education and teaching strategies to meet the individual’s specific needs.
2. Simplify and repeat information.
Present information in a clear and concise manner, using simple language and avoiding jargon. Break down complex concepts into smaller, easily understandable parts. Repeat key information multiple times, reinforcing learning through repetition and review.
3. Utilize visual aids and written materials.
Enhance comprehension by using visual aids, such as diagrams, pictures, or videos, to support verbal explanations. Provide written materials, such as pamphlets or handouts, that summarize the information covered during the education session. Visual and written materials can serve as helpful references for the individual and their caregivers.
4. Engage in hands-on demonstrations.
Incorporate hands-on demonstrations to facilitate understanding and practical application of skills. For example, if teaching medication management, provide opportunities for the individual to practice using pill organizers or demonstrate proper techniques for administering medications.
5. Involve caregivers and support systems.
Engage caregivers and family members in the education process. Provide them with information, resources, and guidance to support the individual’s learning and reinforce education at home. Encourage open communication and involve caregivers in decision-making to ensure a collaborative approach to care
13. Administer Medications and Provide Pharmacologic Support
Administering medications and providing pharmacologic support in patients with Alzheimer’s disease (AD) requires a careful and individualized approach. AD is a progressive neurodegenerative disorder that affects memory, cognition, and behavior. Medications prescribed for AD aim to manage symptoms, slow disease progression, and improve quality of life.
1. Cholinesterase Inhibitors
- Donepezil (Aricept). Improves cognitive function, such as memory and thinking skills, by increasing the levels of acetylcholine in the brain.
- Rivastigmine (Exelon). Enhances cognitive function and helps manage symptoms of mild to moderate AD by inhibiting the breakdown of acetylcholine.
2. NMDA Receptor Antagonist
- Memantine (Namenda). Regulates the activity of glutamate, a neurotransmitter involved in learning and memory processes, to help manage symptoms of moderate to severe AD.
14. Monitoring Results of Diagnostic and Laboratory Procedures
Monitoring the results of diagnostic and laboratory procedures in patients with Alzheimer’s disease (AD) is an essential aspect of managing the disease and evaluating its progression. These monitoring processes help healthcare professionals assess the effectiveness of interventions, track changes in cognitive function, and provide valuable information for disease management.
1. Cognitive Assessment
A comprehensive evaluation of cognitive function is crucial for diagnosing AD. Healthcare professionals may use standardized cognitive assessment tools, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA), to assess memory, attention, language, and other cognitive domains.
2. Medical History and Physical Examination
Gathering a detailed medical history and conducting a thorough physical examination helps rule out other possible causes of cognitive impairment. It allows healthcare professionals to assess overall health, identify potential risk factors, and evaluate the presence of comorbid conditions.
3. Brain Imaging
- Magnetic Resonance Imaging (MRI). MRI scans provide detailed images of the brain, helping to detect structural changes and rule out other causes of cognitive impairment.
- Positron Emission Tomography (PET) Scan. PET scans can help assess brain metabolism and identify abnormal accumulation of beta-amyloid plaques, a hallmark of AD.
- Single Photon Emission Computed Tomography (SPECT). SPECT scans can evaluate regional cerebral blood flow, aiding in the diagnosis and differentiation of different types of dementia.
4. Laboratory Tests
- Blood Tests. Blood tests can help rule out other potential causes of cognitive impairment, such as vitamin deficiencies, thyroid dysfunction, or infections.
- Genetic Testing. In some cases, genetic testing may be considered to identify specific gene mutations associated with familial forms of AD or to determine the presence of the APOE-e4 allele, a risk factor for late-onset AD.
5. Cerebrospinal Fluid (CSF) Analysis
Analysis of CSF obtained through a lumbar puncture can help assess biomarkers associated with AD, such as levels of beta-amyloid and tau proteins. CSF analysis is typically used in research settings or specialized clinics.
15. Assessing and Monitoring for Potential Complications
1. Monitor vital signs regularly.
Vital signs provide valuable information about the patient’s overall health status and can help identify potential complications. Monitoring blood pressure, heart rate, respiratory rate, and temperature allows for early detection of any abnormalities or signs of distress.
2. Assess patient’s skin integrity.
Patients with AD may have decreased mobility, altered sensory perception, or difficulty expressing discomfort, making them more prone to skin breakdown and pressure ulcers. Regular assessment of the skin helps identify areas of redness, irritation, or signs of pressure sores, allowing for timely interventions and prevention measures.
3. Assess patient’s neurological status.
Rationale: AD affects cognitive function and can lead to changes in neurological status. Regular assessment of neurological signs, such as level of consciousness, orientation, motor function, and pupillary response, helps detect any neurological complications or deterioration.
4. Monitor patient’s hydration and nutritional status.
Rationale: Patients with AD may have difficulty with eating, drinking, or remembering to stay hydrated, which can lead to dehydration and malnutrition. Regular monitoring of fluid intake, nutritional status, and signs of dehydration (e.g., dry mucous membranes, decreased urine output) is crucial for early identification and intervention.
5. Assess patient’s fall risks.
Patients with AD are at an increased risk of falls due to impaired judgment, gait disturbances, and balance issues. Regular assessment of fall risk factors, such as gait stability, muscle strength, and environmental hazards, allows for the implementation of fall prevention strategies, including the use of assistive devices, removing obstacles, and ensuring a safe environment.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans related to neurological disorders:
- Alzheimer’s Disease | 15 Care Plans
- Brain Tumor | 3 Care Plans
- Cerebral Palsy | 7 Care Plans
- Cerebrovascular Accident | 12 Care Plans
- Guillain-Barre Syndrome | 6 Care Plans
- Meningitis | 7 Care Plans
- Multiple Sclerosis | 9 Care Plans
- Parkinson’s Disease | 9 Care Plans
- Seizure Disorder | 4 Care Plans
- Spinal Cord Injury | 12 Care Plans
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.