Alzheimer's Disease (AD) Nursing Interventions

• Alzheimer's disease causes a progressive decline in neurologic function.
• Families should be taught what to expect in areas of decline, care and support, and stress management for the progressive nature.
• The major goal of care is to help clients achieve an optimal level of functioning in light of chronic neurologic deficit.

Common Nursing Diagnoses

• Altered thought process
• Memory deficit
• Visual-perceptual alteration
• Impaired physical mobility
• Incontinence
• Self-care deficit
• Impaired individual and family coping

Definition of Terms

• Dementia refers to losing memory, reasoning, judgement, and language that interferes with daily life.
• Cognition is the act or process of thinking, perceiving, and learning.

Cognitive Activities Affected

• Decision-making
• Judgement
• Memory
• Thinking
• Spatial orientation
• Reasoning
• Calculation
• Behavior
• Personality
• Verbal communication

Alzheimer's Etiology

• The cause of Alzheimer's is idiopathic.
• The disease results in progressive mental deterioration because of generalized degeneration of the brain
• Early onset is due to the mutation of beta amyloid protein.
• Sporadic cases are more common in people over 65.
• Genetics and environmental factors affect the condition.

Risk Factors

• Genetics can be a risk.
• Elevated homocysteine levels are a risk.
• Inflammation and stroke
• Oxidative damage from free radicals

Gross Brain Changes

• Structural changes occur in the brain.
• Neurotransmitter changes are affected, especially decreased Ach.

Clinical Manifestations: Preclinical

• Alzheimer's begins in the hippocampus.
• It leads to memory loss over 10-20 years.

Clinical Manifestations: Mild

• Family members notice memory disturbance before the client does.
• The patient has poor judgement and problem-solving skills.
• They are confused about location and get lost easily.
• Routine and daily tasks take longer.
• The person becomes careless in work.

Clinical Manifestations: Moderate

• Language disturbance and circumlocution can present.
• Repetitiveness
• Palilalia (repeating words spoken by themselves) appears
• Echolalia (repeating words spoken by others) appears
• Paraphasias (using words in the wrong context) occurs.
• Loss of ability to perform activities (apraxia)
• Hyperorality (desire to take everything into the mouth) develops
• Delusions and psychosis
• Wandering at night is common.

Clinical Manifestations: Severe

• Clients cannot recognize family and friends.
• The patient does not communicate.
• Frequent urinary and fecal incontinence develop.
• Aspiration pneumonia becomes frequent.
• Limbs become rigid with flexor posturing (decortication).

Diagnostic Findings

• Diagnosis is confirmed with dementia involving 2 or more areas of cognition.
• Impairment of Thinking
• Impairment of Perceiving
• Impairment of learning
• Insidious onset and steady progression occurs.
• Loss of normal alertness happens
• PET Scans use radioactive tracers to highlight amyloid protein plaques in the brain.
• Amyloid plaques are a hallmark of Alzheimer's disease.

Medical Management

• Acetylcholinesterase inhibitors temporarily improve thinking abilities.
• They reduce advanced Alzheimer's demonstrations such as wandering, agitation, and inappropriate behavior.
• Tacrine, donepezil, Galanthamine, and Rivastigmine act as Acetylcholinesterase inhibitors.
• Alpha-tocopherol (vit. E) can be administered.
• Selegiline (MAO B inhibitor) delays the development of later stages of AD by combating the effects of oxygen free radicals.
• Ginkgo biloba has terpenes to treat cerebral and peripheral vascular disease.
• Anxiolytics treat anxiety and agitation.
• Neuroleptics treat unusual or troubled behavior.
• Antidepressants treat mood disorders.
• There aren't specific drugs or dosages to address the range of problems for clients.

Nursing Diagnosis

• Impaired memory can relate to losses of short term memory, inability to execute complex mental processes, or concentrate on specific task.
• Reorient clients with a calendar or clock in obvious places.
• Use repetition to ensure maximal retention of information.
• Allow clients to reminisce because long term memory is retained longer than short term memory.
• Risk for injury is related to impaired judgement, forgetfulness, or motor impairments.

Interventions

• Inpatient settings need to ensure clients cannot leave without being noticed by securing doors and windows, and making sure clients wear ID.
• Home settings need to eliminate safety hazards and toxic substances, maintain adequate lighting, and keep dangerous objects out of reach.
• Cooking and driving should be supervised.
• Caregiver role strain comes from grieving the loss of providing care for a family member.

Support Interventions

• Allow them to discuss concerns.
• Explain resources such as the AD and Related Disorders Association.
• Determine if they have someone to call for caregiving support.
• Use chore service workers
• Use adult day care
• Respite care involves facility admission for some time to allow caregiver time to recover from 24-hour commitment demands.
• Nursing home care may be need for caregiver burnout.

Questions cover appropriate nursing interventions for clients with memory loss and Alzheimer's Disease. Includes caregiver education, home safety, cognitive deficits, and community resources for support with AD.