NUR 414A Alzheimer's/Dementia

what are important questions to ask when a pt who has dementia has been admitted

-A/O -their routine, if they know or family knows -their support group

communication interventions

-adapt to the level of the pt and pay attention to non-verbal cues -use a firm volume and low pitched voice to communicate while standing directly in front of pt and maintaining eye contact -give time for pt to respond, provide alternative communication means if needed

altered sleep pattern interventions

-allow pt to wander in safe place until they become tired -prevent shadows by using indirect light -avoid use of hypnotics b/c they cause confusion and aggravate the sundowning effect

agitation interventions

-assess the precipitant of the agitation and reassure the pt -remove items that can be hazardous when pt is agitated -approach pt slowly and calmly from the front and speak, gesture, and move slowly -remove pt to less stressful environment

altered thought processes interventions

-call pt by name and orient frequently, use familiar objects in room -place calendar and clock in room, maintain familiar routines, allow pt to reminisce -make tasks simple, allow time for pt to complete task

what are good strategies for a pt who has sundown syndrome

-characterized by pronounced increase in s/s and problem behaviors in the evening -allow pt to wander in place until they become tired, prevent shadows by using indirect light -avoid use of hypnotics b/c they increase confusion and aggravate sundowning effect

interventions for BOTH alzheimer's and dementia

-identify and reinforce retained skills, monitor ADLs, remind pt how to perform self-care -provide continuity of care, orient pt to environment -acknowledge pt feelings and encourage family members to express feelings -assist pt and family members to manage memory deficits and behavior changes -provide pt with support and identify resources and support groups -provide pt with exercise (walking escort) -avoid taxing activities on memory -step-by-step approach -activities that distract or occupy time - listening to music, coloring, watching TV

what strategies keep a pt with dementia safe in the hospital

-orient pt to environment and furnish with familiar possessions -consistent routines, allow time to complete tasks -exercise, safe ambulation with mobility aids -closed with secure doors -ID bracelets and electronic surveillance -remove hazardous items when pt it agitated -avoid hypnotics

what are communication practices you could use with pts who have dementia

-predictable routine, consistent caregiver, simple instructions, eye contact, sensory aids -promote rest, sleep, fluid intake, nutrition, elimination, pain control, comfort -engage family in goal setting

what are good strategies for a pt who wanders

-priority: provide pt with safe environment, free from clutter and hazards -provide safe ambulation, well-fitting shoes and mobility aids -close and frequent supervision -close and secure doors -use ID bracelets and electronic surveillance -provide regular supervised exercise or walking program

strategies to keep pt with dementia safe at home

-remove throw rugs, toxic substances, dangerous electrical appliances -reduce hot water heater temperature -prevent shadows with indirect light -secure doors

The nurse is performing an assessment on a client with dementia. Which piece of data gathered during the assessment indicates a manifestation associated with dementia? 1.Use of confabulation 2.Improvement in sleeping 3.Absence of sundown syndrome 4.Presence of personal hygienic care

1

What are the 4 A's of Alzheimer's?

1. agnosia - failure to recognize or identify familiar objects despite intact sensory fxn 2. amnesia - loss of memory caused by brain degeneration 3. aphasia - language disturbance in understanding and expressing spoken words 4. apraxia - inability to perform motor activities, despite intact motor fxn

The nurse is caring for a client diagnosed with Alzheimer's disease. The nurse should anticipate that the client has changes in which component of the nervous system? 1.Glia 2.Peripheral nerves 3.Neuronal dendrites 4.Monoamine oxidase

3

The nurse is caring for a client diagnosed with Alzheimer's disease who is demonstrating characteristics of agnosia. Which client behavior supports the presence of this cognitive deficiency? 1.The client has difficulty with balance when rising from the chair. 2.The client has lost the cognitive ability to fold his own clothes. 3.The client recognizes his children but has difficulty calling them by name. 4.When asked to pick up the cup, the client consistently fails to identify the cup.

4

when is validation therapy appropriate

all the time. never make a pt feel embarrassed or like they are being dismissed

when is reality orientation appropriate

all the time; should have calendar in room with time, weather, time of next meal, etc.

what is the most common type of dementia

alzheimer's disease

what important teaching is needed about cholinesterase inhibitors and memantine

cholinesterase inhibitors -- slightly delays loss of brain fxn but doesnt fix the issue, s/s of cholinesterase toxicity memantine -- can cause severe headache, seizure, unusual changes in behavior

what is validation therapy

communicating with pt who has dementia in a way that acknowledges their words and actions with respect and empathy, rather than embarrassment, anger or dismissiveness

stage 4 of alzheimer's disease

end stage

what are the 1st symptoms of alzheimer's disease

forgetfulness forgets names misplaces household items

what is reality orientation

method of reducing confusion, disorientation, memory loss, and behavioral problems by giving the pt different environmental cues so they can master time, person, place, situation

stage 1 of alzheimers disease

mild - forgetfulness -independent in ADLs, denies s/s, forgets names, misplaces household items -short term memory loss -subtle changes in personality and behavior -mild impaired cognition -unable to travel alone to new destinations

stage 2 of alzheimer's disease

moderate - confusion -impairment of all cognitive functions -disoriented to time, place, and event -increasingly dependent in ADLs -visuospatial deficits (driving and gets lost) -speech and language deficits

stage 3 of alzheimer's disease

moderate to severe - ambulatory dementia -completely incapacitated -bedridden -totally dependent in ADLs -loss of mobility and verbal skills -agnosia

interventions with wandering

priority: provide pt with safe environment, free from clutter and hazards -provide safe ambulation, well-fitting shoes and mobility aids -provide close and frequent supervision -close and secure doors -use ID bracelets and electronic surveillance -rest periods in afternoon -regular supervised exercise or walking programs

impaired judgment interventions

remove throw rugs toxic substances dangerous electrical appliances reduce hot water heater temperature

why is routine important for alzheimer's disease pts

routines help pt to know what to expect and help the pt to continue to do things on their own; makes pt feel better and less agitated

what is dementia

syndrome with progressive deterioration in intellectual functioning secondary to structural or functional changes