Psych: Alzheimer's

There are several types of dementia. Name some.

Dementia is associated with AD, frontotemporal lobar degeneration, Lewy bodies, vascular issues, traumatic brain injury, substances, HIV infection, Prion disease, Parkinson's disease, and Huntington's disease

Describe the AD symptom: aphasia

This involves the loss of language ability. Initially the person has difficulty finding the correct word, then is reduced to a few words, and finally is reduced to babbling or mutism.

Inability to read or write

agraphia

Based on current research, which of the following patients is most likely to develop dementia? Karen, who works as an office manager in a high-stress environment Milo, who is a former boxer and is now a trainer Lilly, who works in a factory where asbestos is found Justin, who is a bartender in a dark underground club/bar

Brain injury and trauma are associated with a greater risk of developing Alzheimer's disease and other dementias. People who suffer repeated head trauma, such as boxers and football players, may be at greater risk. The other options do not specifically represent known risk.

How to interpret dementia behaviors

Interpreting behavior not as a biological sign of an illness but rather as a sign of unmet needs can improve well-being for people with dementia.

A susceptibility gene has been identified for late-onset AD as well. What does the protein made from this gene do?

It helps carry cholesterol. It is also implicated in cardiovascular disease.

When planning care for a person with dementia, see if the the person or family needs the following:

Transportation services •Supervision and care when primary caregiver is out of the home •Referrals to day care centers •Information on support groups within the community •Meals on Wheels •Information on respite and residential services •Telephone numbers for help lines •Home health services

Why do Alzheimer's patients wander?

Wandering may result from changes in the physical environment, fear caused by hallucinations or delusions, or lack of exercise.

Which event would a client with early stage 4 Alzheimer's disease have greatest difficulty remembering? His or her high school graduation The births of his or her children The story of a teenage escapade What he or she ate for breakfast

What he or she ate for breakfast. Initially, recent memory is impaired, and remote memory remains intact.

The nurse is expected to perform an assessment of a client suspected to be in the earliest stage of Alzheimer's disease. What finding would be out of character if the client truly has stage 2 Alzheimer's disease? (Select all that apply) Willingness to respond directly to questions posed by nurse Charming behavior designed to hide memory deficit Confabulation to compensate for forgotten information Avoidance of questions by subject changing

Willingness to respond directly to questions posed by nurse. During stage 1 Alzheimer's disease the client is aware of memory impairment and may attempt to disguise it or cover it by being evasive or using confabulation.

The family members of a client with stage 1 Alzheimer's disease have jobs and cannot provide adequate supervision for the client. A reasonable alternative for the nurse to explore with them would be day care. acute care hospitalization. long-term institutionalization. group home residency.

day care. Day care is a good option for clients with early-stage Alzheimer's disease. It provides supervision, a protected environment, and supportive interactions.

Dementia

Dementia is the general term used to describe a variety of progressive conditions that develop when brain cells die or no longer function.

A wide range of problems may be mistaken for dementia or AD.

Depression in the older adult

What technologies have diagnostic capabilities for Alzheimer's?

Brain imaging with CT, positron emission tomography (PET), and other developing scanning technologies. They reveal brain atrophy and rule out other conditions such as neoplasms.

Compare delirium, dementia, and depression: prognosis

Delirium: Reversible with proper and timely treatment Dementia: Not reversible; progressive Depression: Reversible with proper and timely treatment

Compare delirium, dementia, and depression: level of consciousness (measure of arousal other than normal)

Delirium: altered Dementia: not altered Depression: not altered

In the early stages of Alzheimer's, people may be able to compensate for loss of memory. As time goes on, symptoms became more obvious, and other defense mechanisms become evident, including: (4)

(1) denial, (2) confabulation (making fantastic fabrications), (3) perseveration (repetition of phrases or behavior), and (4) avoidance of questions.

Some of the troubling behaviors exhibited by people with dementia, with which their caregivers must cope, are: (4)

(1) psychotic symptoms (hallucinations, paranoia), (2) severe mood swings (depression is very common), (3) anxiety (agitation), and (4) verbal or physical aggression (combativeness).

Symptoms observed in Alzheimer's disease include the following:

1. Memory impairment 2. Disturbances in executive functioning 3. Aphasia 4. Apraxia 5. Agnosia

Recently, the Alzheimer's Association and the National Institute on Aging (Alzheimer's Association, 2012) have proposed new staging of the illness. The recommendations are that AD be identified in three stages:

1. preclinical AD 2. mild cognitive impairment (MCI) due to AD, and 3. dementia due to AD.

Risk factors in Alzheimer's disease

Age Cardiovascular disease Inactivity High cholesterol Diabetes Obesity Brain injury Trauma--particularly repeated head trauma (boxers, football players) some evidence: mentally and socially inactive, lack of healthy diet Presence of genes mentioned above

The physician mentions to the nurse that a client who is about to be admitted has "sundowning." The nurse can expect to assess nightly agitation. lethargy. depression. mania.

Agitation. Sundowning involves increased disorientation and agitation occurring at night.

Rosa, a 78-year-old patient with Alzheimer's disease, picks up her glasses from the bedside table but does not recognize what they are or their purpose. She is experiencing: apraxia. agnosia. aphasia. agraphia.

Agnosia is the loss of sensory ability to recognize objects. Apraxia is the loss of purposeful movement in the absence of motor or sensory impairment. Aphasia is the loss of language ability. Agraphia is the loss of the ability to read or write.

When preparing educational materials for the family of a client diagnosed with progressive dementia, the nurse will include information related to local: (select all that apply): day care centers legal professionals home health services family support groups professional counseling

All but legal professionals. Most importantly, families need to know where to get help. Help includes professional counseling and education regarding the process and progression of the disease. Families especially need to know about and be referred to community-based groups that can help shoulder this tremendous burden (e.g., day care centers, senior citizen groups, organizations providing home visits and respite care, and family support groups). While legal professionals may be of interest to the family, client and family education does not include such services.

Which problem is NOT considered a causative agent in delirium? Elevated blood urea nitrogen levels Infection Anticholinergic drugs Antibiotic therapy

Antibiotic therapy. Although delirium may be a result of an infection, antibiotic therapy is not known to cause cognitive disorders.

As AD progress the person needs repeated instructions and directions to perform the simplest tasks. What is this called?

Apraxia

Confabulation

Confabulation is the creation of stories or answers in place of actual memories to maintain self-esteem. NOT the same as lying. It is UNCONCIOUS. For example, the nurse addresses a patient who has remained in a hospital bed all weekend: Nurse: Good morning, Ms. Jones. How was your weekend? Patient: Wonderful. I discussed politics with the president, and he took me out to dinner. or Patient: I spent the weekend with my daughter and her family.

Characteristics of delirium from key points

Delirium is marked by acute onset, disturbance in consciousness, and symptoms of disorientation and confusion that fluctuate by the minute, hour, or time of day. • Delirium is always secondary to an underlying condition; therefore, it is temporary, transient, and may last from hours to days once the underlying cause is treated. If the cause is not treated, permanent damage to neurons can result.

Compare delirium, dementia, and depression: activity level

Delirium: Can be increased or reduced; restlessness, behaviors may worsen in evening (sundowning); sleep/wake cycle may be reversed Dementia: Can be increased or reduced; restlessness, behaviors may worsen in evening (sundowning); sleep/wake cycle may be reversed Depression: Usually decreased; lethargy, fatigue, lack of motivation; may sleep poorly and awaken in early morning

Compare delirium, dementia, and depression: cognition

Delirium: Patient will have impaired memory, judgment, calculations, attention span. The cognition will fluctuate throughout the day. Dementia: Patient will have impaired memory, judgment, calculations, attention span, abstract thinking, and agnosia. Depression: Patient has difficulty concentrating, with forgetfulness and inattention.

Compare delirium, dementia, and depression: emotional state

Delirium: Rapid swings; can be fearful, anxious, suspicious, aggressive, have hallucinations and/or delusions Dementia: Flat; agitation Depression: Extreme sadness, apathy, irritability, anxiety, paranoid ideation

Compare delirium, dementia, and depression: speech and language

Delirium: Rapid, inappropriate, incoherent, rambling Dementia: Incoherent, slow (sometimes due to effort to find the right word), inappropriate, rambling, repetitious Depression: Slow, flat, low

The __________ Dementia Scale (Figure 23-1) can be used by nurses and families to plan strategies for addressing immediate needs and to track progression of the dementia.

Functional

What is recommended for those who may carry the early-onset gene?

Genetic counseling, available through the Alzheimer's Disease Research Center, is recommended. Commercial testing is available for one of the three genes that can confirm the disease or predict its onset, but this testing raises significant ethical concerns.

Trudy is a 72-year-old patient hospitalized with pneumonia and experiencing delirium. She points to her IV pole and screams, "Get him out of here! He's going to hurt me!" You recognize that what Trudy is experiencing is a(n): hallucination. delusion. illusion. confabulation.

Illusions are errors in perception of sensory stimuli. The stimulus is a real object in the environment; however, it is misinterpreted and often becomes the object of the patient's projected fear. Hallucinations are false sensory stimuli. For example, individuals experiencing delirium may become terrified when they "see" giant spiders crawling over the bedclothes or "feel" bugs crawling on or under their bodies. A delusion is described as thinking or believing something that is not true and is seen more often in schizophrenia. For example, a patient may firmly believe that government agencies can read and are monitoring his or her thoughts or that neighbors can see him or her through walls. Confabulation is the creation of stories or answers in place of actual memories to maintain self-esteem.

Perseveration

Perseveration is the repetition of phrases or behavior. It is eventually seen and is often intensified under stress.

Dementia is classified as either a ___ or a ___ neurocognitive disorder.

minor or major

A client is brought to the hospital by her daughter, who visited this morning and found her mother to be confused and disoriented. When the client is admitted, the daughter states, "I'll take her glasses and hearing aid home, so they don't get lost." The best reply for the nurse would be "That will be fine. I'll have you sign our hospital release form." "Because we do not have a copy of durable power of attorney, we cannot release them to you." "Don't worry. You can leave them at her bedside. We are insured for losses of this sort." "I would like to have your mother wear them. It will help her to be less confused."

"I would like to have your mother wear them. It will help her to be less confused." Clients with cognitive disorders usually profit from being able to see and hear clearly. Confusion is reduced through the use of glasses and hearing aids.

Describe the two processes that lead to brain cell death

1. Accumulation of protein outside neurons that interferes with synapses 2. Accumulation of protein inside the neurons, which forms tangles that block the flow of nutrients

ASSESSMENT GUIDELINES: Dementia

1. Evaluate the person's current level of cognitive and daily functioning. 2. Identify any threats to the person's safety and security and arrange their reduction. 3. Evaluate the safety of the person's home environment (e.g., with regard to wandering, eating inedible objects, falling, engaging in provocative behaviors toward others). 4. Review the medications (including herbs, complementary agents) the patient is currently taking. 5. Interview family to gain a complete picture of the person's background and personality. 6. Explore how well the family is prepared for and informed about the progress of the person's dementia, depending on cause (if known). 7. Discuss with the family members how they are coping with the patient and their main issues at this time. 8. Review the resources available to the family. Ask family members to describe the help they receive from other family members, friends, and community resources. Determine if caregivers are aware of community support groups and resources. 9. Identify the needs of the family for teaching and guidance (e.g., how to manage catastrophic reactions, lability of mood, aggressive behaviors, and nocturnal delirium and increased confusion and agitation at night [sundowning]).

Alzheimer's disease is classified according to the stage of the degenerative process. The number of stages defined ranges from three to seven, depending on the source. Outline the 7 stages identified by the Alzheimer's Association.

1: Preclinical 2-4 Mild 5-7 Major Stage 2: Very mild cognitive decline (may be due to age or dementia); not detected by medical exam/friends/family/coworkers Stage 3: mild cognitive decline. Others begin to notice. Stage 4: Moderate cognitive decline. Moody, withdrawn, difficulty performing complex tasks like paying bills, managing finances Stage 5: moderate or midstage Alzheimer's. Begin to need help with day to day activities. Confusion about where they are and what day it is. Still remember significant details about selves/families. No assistive with eating or using toilet yet. Stage 6: Severe cognitive decline. Personality may change. Extensive help with daily activities. Remember name but not personal history. Trouble remembering spouse/caregiver name. Major sleep pattern change. Help toileting. Wander and get lost. Suspicious, delusions, repetitive behavior. Stage 7: Very severe cognitive decline. Lose ability to respond to environment, carry on conversation, and eventually to control movement. May still say words/phrases. Need help with all care. Lose ability to smile, sit without support, hold head up. Abnormal reflexes Swallowing impaired. Muscles rigid.

There is currently no cure for Alzheimer's disease; however, there are ___ AD drugs approved by the U.S. Food and Drug Administration (FDA) that are considered to be "disease modifying" and may slow the progression of the illness

5

When assessing for Alzheimer's disease, in addition to performing a complete physical and neurological examination, it is important to obtain:

A complete medical and psychiatric history, description of recent symptoms, review of medications used, and nutritional evaluation. The observations and history provided by family members are invaluable to the assessment process.

Who gets Alzheimer's disease?

AD, the most common type of dementia, attacks indiscriminately, striking men and women, people of various ethnicities, rich and poor, and individuals with varying degrees of intelligence. Although the disease can occur at a younger age (early onset), most of those with the disease are 65 years of age or older (late onset). It is estimated that 5.4 million Americans have AD.

Etiology of Alzheimer's disease

Although the cause of AD is unknown, most experts agree that, like other chronic and progressive conditions, it is a result of multiple factors that include genetics, lifestyle, and environmental. While many causes are hypothesized, the greatest risk factor is advanced age.

PATIENT AND FAMILY TEACHING: GUIDELINES FOR SELF-CARE IN DEMENTIA

Always have the person perform all tasks within his or her present capacity. Always have the person wear own clothes, even if in the hospital. Use clothing with elastic and substitute fastening tape (Velcro) for buttons and zippers. Label clothing items with the person's name and name of item. Give step-by-step instructions whenever necessary (e.g., "Take this blouse. Put in one arm .... now the other arm. Pull it together in front. Now ....") Make sure that water in faucets is not too hot. If the person is resistant to performing self-care, come back later and ask again. Monitor food and fluid intake. Offer finger food that the person can take away from the dinner table. Weigh the person regularly (once a week). During periods of hyperorality, watch that the person does not eat nonfood items (e.g., ceramic fruit or food-shaped soaps). Begin bowel and bladder program early; start with bladder control. Evaluate use of disposable diapers. Label bathroom door, as well as doors to other rooms. Avoid use of restraints

GUIDELINES FOR COMMUNICATION WITH PEOPLE WITH DEMENTIA

Always identify yourself and call the person by name at each meeting. Speak slowly. Use short, simple words and phrases. Maintain face-to-face eye contact. Be near the person when talking, one or two arm-lengths away. Focus on one piece of information at a time. Talk with the person about familiar and meaningful things. Encourage reminiscing about happy times in life. When the person is delusional, acknowledge the person's feelings and reinforce reality. Do not argue or refute delusions.If the person gets into an argument with another person, stop the argument and temporarily separate those involved. After a short while (5 minutes), explain to each person matter-of-factly why you had to intervene. When the person becomes verbally aggressive, acknowledge the person's feelings and shift the topic to more familiar ground (e.g., "I know this is upsetting for you because you always cared for others. Tell me about your children.") Have the person wear prescription eyeglasses or hearing aid. Keep the person's room well lit. Have clocks, calendars, and personal items (e.g., family pictures or Bible) in clear view of the person while he or she is in bed. Reinforce the person's pictures, nonverbal gestures, Xs on calendars, and other methods used to anchor the person in reality.

__________ is the most common type of dementia, accounting for 60-80% of all dementias.

Alzheimer's disease

Ethical stance with dementia

Called person-centered care (PCC) (Kitwood, 1997), this model is based on an ethical stance that personhood in dementia remains and should be honored. It is especially relevant to nursing care because it is based on an appreciation that people exist in a social, relational world.

BASIC MEDICAL WORKUP FOR DEMENTIA

Chest and skull radiographic studies • Electroencephalography • Electrocardiography • Urinalysis • Sequential multiple analyzer 12-test serum profile • Thyroid function tests • Folate level • Venereal Disease Research Laboratories (VDRL), human immunodeficiency virus tests • Serum creatinine assay • Electrolyte assessment • Vitamin B12 level • Liver function tests • Vision and hearing evaluation • Neuroimaging (when diagnostic issues are not clear)

Compare delirium, dementia, and depression: cause and contributing factors

Delirium: sudden, over hours or days. Patient may be hypoglycemic, have a fever, hypotension, infection, adverse drug reaction, head injury, pain, emotional stress. Dementia: slowly, over months! Cause may be Alzheimer's disease, vascular disease, HIV infection, neurological disease, chronic alcoholism, or head trauma. Depression: may have been gradual, with exacerbation during crisis or stress. Caused by having a lifelong history of depression, loss, loneliness, crisis, declining health, and medical conditions.

Elaine is a 62-year-old patient who is recovering from a urinary tract infection during which she was hospitalized with delirium. She is following up with her primary care provider 4 weeks after being discharged. Based on research regarding possible postdelirium complications, what are important areas for the provider to assess at this time? Sleeping habits Sexual functioning Symptoms of posttraumatic stress Depression and level of cognition

Depression and level of cognition . Although delirium is usually a short-term condition, it may have long-term consequences. In patients with preexisting cognitive impairment, there is an acceleration of cognitive decline. Although there are reports of long-term cognitive impairment (in the absence of preexisting cognitive impairment) and functional decline following delirium, results of studies have been inconsistent. An association also exists with depression after delirium. Although a holistic examination would assess sleep, this is not the area that research has found to be problematic. A holistic examination would include sexual functioning, but it is not the priority at this time. Posttraumatic stress symptoms have been seen in younger patients who experienced delirium while hospitalized.

When might a person have Alzheimer's and depression?

Depression may occur early in the disease but usually lessens as the disease progresses.

There are three known genetic mutations that guarantee that a person will develop AD, although these account for less than 1% of all cases. These mutations lead to which type of Alzheimer's?

Early-onset form of AD, which occurs before the age of 65 and as young as 30 years

A client with delirium strikes out at a staff member. The nurse can most correctly hypothesize that this behavior is related to anger. fear. an unmet physical need. the need for social interaction.

Fear. Clients with delirium often misinterpret reality, perceiving threat where none actually exists. Delirious clients who are fearful may strike out at others, seemingly without provocation.

PATIENT AND FAMILY TEACHING: GUIDELINES FOR CARE AT HOME

Gradually restrict use of the car remove throw rugs and other objects in person's path minimize sensor stimulation if verbally upset, listen briefly, given support, then change the topic label all rooms and drawers. label often used itmes install safety bars in bathroom supervise when smoking educate family how to deal with seizures if person wanders in the night, put mattress on the floor have them wear medical alert bracelet that cannot be removed provide police department with recent pictures alert local police and neighbors about wanderer put complex locks on door encourage physical activity provide picture magazines and children's books when reading ability diminishes singing, walking, dancing

Stress is common when working with persons with cognitive impairments. How can nurses be proactive in minimizing its effects?

Having a realistic understanding of the disease so that expectations for the person are realistic. •Establishing realistic outcomes for the person and recognizing when they are achieved. These outcomes may be as minor as patient feeds self with spoon, yet remember that even the smallest achievement can be a significant accomplishment for the impaired individual.• Maintaining good self-care. As nurses, we need to protect ourselves from the negative effects of stress by obtaining adequate sleep and rest, eating a nutritious diet, exercising, engaging in relaxing activities, and addressing our own emotional and spiritual needs.

Describe the brains of people with Alzheimer's disease

In the brains of people with AD there are signs of neuronal degeneration that begins in the hippocampus, the part of the brain responsible for recent memory, and then spreads into the cerebral cortex, the part of the brain responsible for problem solving and higher-order cognitive functioning.

Describe the AD symptom: memory impairment

Initially the person has difficulty remembering recent events. Gradually, deterioration progresses to include both recent and remote memory.

Age and Alzheimer's

It is estimated that one in eight people aged ≥ 65 years has AD and that 45% of the people ≥ 85 years has AD. Of the people with AD:•4% are younger than 65 years old.•6% are between 65 and 74 years old.•44% are between 75 and 84 years old.•46% are 85 years old or older.

Claire is a student nurse working with Carl, an 82-year-old patient with dementia. She finds herself frustrated at times by not knowing how best to care for or communicate with Carl. Which of the following statements she could make to Carl illustrates best care practice? Lighthearted banter: "Carl, you look great today in your new sweater, you handsome devil!" Limit setting: "Carl, you cannot yell out in your room. You are upsetting other patients." Firm direction: "You will take a shower this morning; there is no debating about it so don't try to argue." Positive regard: "Carl, I am glad to be here caring for you today. Let's talk about your plans for the day."

Positive regard implies respect. It is the ability to view another person as being worthy of caring about and as someone who has strengths. The attitude of unconditional positive regard is the nurse's single most effective tool in caring for people with dementia. It induces people to cooperate with care and increases family members' satisfaction with care. Although the patient may not be able to verbalize plans for his day, this response conveys belief that the patient has something to offer and treats him with respect. It also shows that the nurse wants to care for the patient and conveys commitment to the relationship. Limit-setting may be necessary at times; however it is not the most effective care tool. The other responses are nontherapeutic.

Nursing diagnoses for a person with Alzheimer's disease

Risk for injury Impaired verbal communication Impaired environmental interpretation syndrome Impaired memory Confusion Caregiver role strain Anticipatory grieving

___________ __________ is a common phenomenon of the aging process (age-associated memory loss) but not memory loss that interferes with one's activities of daily living.

Slight forgetfulness

Name a mental status questionnaire that may be used to identify deterioration in mental status and brain damage

The Mini-Mental State Examination

Describe the AD symptom: disturbances in executive functioning (planning, organizing, abstract thinking)

The degeneration of neurons in the brain results in the wasting away of the brain's working components. These cells contain memories, receive sights and sounds, cause hormones to secrete, produce emotions, and command muscles into motion.

Describe the AD symptom: apraxia

This involves the loss of purposeful movement in the absence of motor or sensory impairment. The person is unable to perform once-familiar and purposeful tasks. For example, in apraxia of dressing, the person is unable to put clothes on properly (may put arms in trousers or put a jacket on upside down).

Describe the AD symptom: agnosia

This involves the loss of sensory ability to recognize objects. For example, a person may lose the ability to recognize familiar sounds (auditory agnosia), such as the ring of the telephone. Loss of this ability extends to the inability to recognize familiar objects (visual or tactile agnosia), such as a glass, magazine, pencil, or toothbrush.

Since a deficiency of _________ has been linked to AD, medications aimed at preventing its breakdown have been developed.

acetylcholine

The nurse caring for a client with Alzheimer's disease can anticipate that the family will need information about therapy with antihypertensives. benzodiazepines. immunosuppressants. acetylcholinesterase inhibitors.

acetylcholinesterase inhibitors. Memory deficit is thought to be related to a lack of acetylcholine at the synaptic level. Acetylcholinesterase inhibitor drugs prevent the chemical that destroys acetylcholine from acting, thus leaving more available acetylcholine.

As AD progresses the person is often unable to identify familiar objects or people, even a spouse. What is this called?

agnosia

The family of a client diagnosed with Alzheimer's disease mentions to the nurse that seeing his loss of function has been very difficult. A nursing diagnosis that might be considered for such a family would be ineffective denial. anticipatory grieving. disabled family coping. ineffective family therapeutic regimen management.

anticipatory grieving. It involves working through potential loss.

A person's declining intellect often leads to emotional changes such as: (3)

anxiety, mood lability (mood swings), and depression

When symptoms of dementia are present, a ____________ assessment must be completed in order to rule out conditions that mimic dementia but are treatable.

comprehensive

In June 2008, the FDA warned that the use of antipsychotics, both conventional and atypical, is no longer indicated for dementia-related psychosis because they are associated with increased risk of ______

death

A family member reports that the client had been oriented and able to carry on a logical conversation last evening, but this morning she is confused and disoriented. The nurse can suspect that the client is displaying symptoms associated with delirium. dementia. amnesic disorder. selective inattention.

delirium. Delirium is characterized by a disturbance of consciousness, a change in cognition (such as impaired attention span), and a fluctuating level of consciousness that develop over a short period of time.

Dementia in an older adult is often a misdiagnosis for depression. cerebral emboli. normal effects of aging. poor nutritional status.

depression. Depression in an older adult is frequently confused with dementia.

A person's declining intellect often leads to neurological changes that produce: (2)

hallucinations and delusions.

Touching everything in sight

hypermetamorphosis

The need to taste, chew, and put everything in one's mouth

hyperorality

The rationale for the introduction of a mild category for dementia is that:

identifying early-presenting symptoms may aid in earlier interventions at a stage when some disease-modifying therapies may be most neuroprotective

An initial intervention the nurse might suggest to the family members of a client diagnosed with Alzheimer's disease who has begun incontinence would be to label the bathroom door with a picture. provide toileting on an as-needed basis. apply disposable diapers. encourage hourly toileting.

label the bathroom door with a picture. Labeling doors and various items with pictures can be helpful for a client who has forgotten where things are and what certain items are.

PROBLEMS THAT MAY AFFECT PEOPLE WITH DEMENTIA AND THEIR FAMILIES

memory impairment (forget things) disorientation (loses way) need for physical help (dressing, toileting, toileting) risks in the home (falls, fire, blooding, wandering) Risks outside the home (driving, getting lost) apathy (little convo, lack of interest, poor self care) poor communication (dysphasia) receptiveness uncontrolled emotion (distress, anger or aggression) uncontrolled behavior (undressing, restlessness, shoplifting, sexual disinhibition) incontinence emotional reactions (anxiety, frustration, embarrassment) suspiciousness hallucinations think parents still alive indecisive easily influenced refuses help burden on family--disruption of social life, distress, guilt, rejection, family discord

Severe memory loss is ____ a normal part of growing older.

not

Although dementia often begins with a worsening of ability to remember new information, it is marked by:

progressive deterioration in cognitive functioning and the ability to solve problems and learn new skills and by a decline in the ability to perform activities of daily living.

Outcomes for Alzheimer's patients

remains safe in hospital or at home sleep pattern is regular, balances rest and activity self-care needs are met with optimal participation by the patient anxiety is reduced to a mild-moderate level, acknowledges the reality of an object or sound after it is pointed out reports feeling safe, responds well to orientation interventions communicates needs, connects with other patients, visitors, and staff at an optimal level with a variety of verbal and nonverbal methods Expresses feelings, demonstrates a decreased preoccupation with loss

A client diagnosed with Alzheimer's disease has become more forgetful and has difficulty performing familiar tasks like bathing and dressing. The nurse would assess the client as being in the stage of Alzheimer's disease labeled stage 1, mild. stage 2, moderate. stage 3, moderate-severe. stage 4, end.

stage 3, moderate-severe. Moderate-severe Alzheimer's disease requires a high level of supervision because of the severe memory loss the client is experiencing. Wandering and inability to meet self-care needs become problematic.

Major neurocognitive disorders are characterized by:

substantial cognitive decline that results in curtailed independence and functioning among affected individuals.

Minor neurocognitive disorders are characterized by:

symptoms that place individuals in a zone between normal cognition and noticeably significant cognitive deterioration.

Name cholinesterase inhibitor medications approved for alzheimer's treatment

tacrine (no longer used), donepezil (drug of choice-once a day), rivastigmine once daily patch), memantine

Planning care for a person with dementia is geared toward:

the person's immediate needs.

The attitude of ___________ is the nurse's single most effective tool in caring for people with dementia.

unconditional positive regard

Loss of ability to recognize familiar objects

visual agnosia

Can dementia and delirium coexist?

yes

Can dementia and depression coexist?

yes

INTERVENTIONS FOR DEMENTIA MANAGEMENT

•Include family members in planning, providing, and evaluating care, to the extent desired. •Determine and monitor cognitive deficit(s), using standardized assessment tool. •Identify usual patterns of behavior for such activities as sleep, medication use, elimination, food intake, and self-care. •Provide rest periods to prevent fatigue and reduce stress. •Monitor nutrition and weight. •Place identification bracelet on patient. •Address patient by name when initiating interaction, and speak slowly. •Give one simple direction at a time in a respectful tone of voice. •Avoid frustrating patient by quizzing with orientation questions that cannot be answered. •Use distraction, rather than confrontation, to manage behavior. •Provide consistent caregivers, physical environment, and daily routine. •Provide a low-stimulation environment with adequate lighting. •Identify and remove potential dangers in environment for patient. •Provide cues—such as current events, seasons, location, and names—to assist orientation. •Seat patient at small table in groups of three to five for meals, as appropriate. •Provide finger foods to maintain nutrition for patient who will not sit and eat. •Select television or radio programs based on cognitive processing abilities and interests. •Select one-to-one and group activities geared to patient's cognitive abilities and interests. •Limit number of choices patient has to make so as not to cause anxiety. •Place patient's name in large block letters in room and on clothing, as needed. •Use symbols, rather than written signs, to assist patient in locating room, bathroom, or other area.