W14: Alzheimer's Disease Care of the Older Adult PDF

W14: ALZHEIMER’S DISEASE CARE OF THE OLDER ADULT NCMB 314, BSN-3-Y1-17| PROF. EDWIN B. MALIC| SEM 1 ALZHEIMER’S DISEASE ALZHEIMER’S FACTS (CDC.GOV) 5th leadin...

W14: ALZHEIMER’S DISEASE CARE OF THE OLDER ADULT NCMB 314, BSN-3-Y1-17| PROF. EDWIN B. MALIC| SEM 1 ALZHEIMER’S DISEASE ALZHEIMER’S FACTS (CDC.GOV) 5th leading cause of death among adults 65 and older Chronic Brain disease that is type of dementia 6.2 Americans have Alzheimer’s disease (2021) This is the most common type of dementia expect to rise by 14 million by 2060 Neurons lose the ability to communicate with each Women are more likely to develop other and eventually dies Hispanics, African Americans have higher risk of ○ dies → hindi nagr-regenerate ang neurons that’s disease why Alzheimer is a progressive disorder affecting Over 60 years old when sign and symptoms often the neurons; it is a chronic brain disease because begin to appear (or sooner) it happens for several years Risk factor Neurons can’t communicate, why? ○ family history – pwede ma-inherit or maipasa sa succeeding generation Beta-amyloid plaques ○ age – 65 yrs old usually lumalabas s and sx plus ○ normally kasi inaabsorb siya with the help of the with the aging process, there is or you expect the amyloid precursor protein but w/ the beta-amyloid changes neurologically which will put u at risk ng plaque formation, the beta-amyloid instead of deterioration for beta-amyloid formation and neuro going up to the amyloid precursor protein what fibrillary tangles happens is → the beta-amyloid will go outside ○ gender, your neuron and they will bind with each other ○ diabetes, and it will form plaques ○ heart disease, ○ so imagine that there are neurons and then ○ smoking (unhealthy lifestyle/alcoholism), etc. lagyan mo ng plaques which is what you call the - can cause injury to the brain and later on, it beta-amyloid that will cause the neurons & the will cause problems with the neurons to be other neurons to have problems in terms of specific your beta-amyloid plaque formation communication and then it will result into the and your neuro fibrillary tangles neurons/for the neurons to die bc of that reasons ○ main purpose of neurons: to receive and send Question: Does there a sx happen earlier than 60? Or does messages (w/ the beta-amyloid plaque formation, the sx appear earlier than 60? nagkakaroon ng interfere yung pag-send and - YES. Because Alzheimer’s remember is a type of pag-receive ng communication) dementia and dementia, it involves the injury to the Neuro fibrillary tangles brain. At any age, pwede naman tayo magkaroon ng ○ so if u are going to cut your neurons there is what injury with the brain but with Alzheimer– again it u call microtubules → will release tau protein → happen for the several years or it will develop for what happens? they bind to each other until it will several years. form tangles & those w/ cause the neurons to die - There are some statistics that Alzheimer’s or there is ○ Diagnostic procedure: what you call early Alzheimer’s wherein the sx appear - cognitive assessment and mental evaluation instead of 65 above → it appears as early as 30 years - imaging = might reveal the beta-amyloid old, 35 up to 40 years old. plaque formation - biomarkers = might reveal that there is a Different stages of Alzheimer’s disease increase in the level of tau protein Exact course not fully understood This will result to progressive loss w/c will result to No cure ○ lose memory ○ learning problems ○ judgment PATHOPHYSIOLOGY ○ communication ○ behavior changes Neurons = are responsible for sending and receiving ○ self-care neurotransmitters—chemicals that carry information - and also since this is a progressive, degenerative between brain cells or chronic disease, your pt will go into the state that he/she cannot take care of themselves ADORIAS, ARMADA, DABUET, DORIA, GALVEZ, GRANADO, HERNANDEZ, LUMIARES, MIRANDA, RAQUINTAN, STA. CRUZ, SULIT 1 W14: ALZHEIMER’S DISEASE CARE OF THE OLDER ADULT NCMB 314, BSN-3-Y1-17| PROF. EDWIN B. MALIC| SEM 1 Dendrite = carry the signal to the cell body; it has a In Alzheimer's, the enzyme that is healthy (beta nucleus that’s going to process the message that has amyloid peptide) isn’t working right, this will been received congregate together in between these neurons then creates plaques overtime. Axon terminal Neurotransmitters (4 major) NEURO FIBRILLARY TANGLES ○ Acetylcholine Inside of the neurons made up of tau protein w/c ○ Glutamate provide structure to microtubule ○ GABA the microtubule play a lot of role in delivering nutrients ○ Dopamine throughout the neuron ○ Serotonin In Alzheimer's, abnormal chemical changes cause tau The axon carries AWAY the signal from the cell body to detach from microtubules and stick to other tau These signals can be sent to other neurons, muscles, molecules, forming threads that eventually join to form glands or whatever they are targeting with tangles inside neurons. neurotransmitters. ○ kanina the beta-amyloid is outside the Microglia cells = cells that reside within the neuron and this time, eto yung tinatawag parenchyma of the nervous system, that share many natin na tangles inside the neurons if not all the properties of macrophages in other tissues BETA AMYLOID PLAQUES made of beta amyloid found outside neuron and congregate together impede communications among neurons makes an inflammation until the neurons die PART OF THE BRAIN AMYLOID PRECURSOR PROTEIN Cell membrane in the nerve cell HIPPOCAMPUS it will breakdown into small pieces of peptides and will first part of the brain na naaapektuhan with be metabolized outside the neurons Alzheimer’s and it involves learning new things and ADORIAS, ARMADA, DABUET, DORIA, GALVEZ, GRANADO, HERNANDEZ, LUMIARES, MIRANDA, RAQUINTAN, STA. CRUZ, SULIT 2 W14: ALZHEIMER’S DISEASE CARE OF THE OLDER ADULT NCMB 314, BSN-3-Y1-17| PROF. EDWIN B. MALIC| SEM 1 - Intervention: it is important that you always memory, navigating around or finding object remind, orient and reorient your client to somewhere remain calm ENTORHINAL CORTEX - With Alzheimer’s disease, the medication and understand time, memory, sense of direction interventions are tend not to quit or cure the AMYGDALA Alzheimer’s but to delay the progression of the basic emotion, how do you respond to environment disease. You will start memory changes in the patient Start suddenly and gradually progress and gets worse STAGES OF ALZHEIMER’S As the disease progresses and more plaques and tangles on neurons and it going to spread and affect PRE-CLINICAL the cerebral cortex (outer layer of gray matter of cerebrum) Changes occurring in the brain, but no symptoms noted As Alzheimer's progresses and affects each lobe, the patient Can happen over years will have s/s that correlate with the function of each lobe. also during this pre-clinical stage, there is a MILD COGNITIVE IMPAIRMENT ○ Memory changes that are subtle, but it does NOT affect their activities or how they function ○ Forgetful about recent things (commitments, new people they met, conversation they had recently) ○ May feel that they can’t think clearly (start to get confused on places sometimes) ○ Can last for several years MILD ALZHEIMER’S (EARLY STAGE) Typically, when it’s diagnosed The s & sx of Alzheimer’s depends on what part of the brain Mild forgetfulness that is noticed by others is affected. Sample: Forgetfulness started to affect functioning short term problem with thinking, speaking, memory and memory problem, frequently movement so affected na si parietal lobe Lose objects, can’t remember new materials they just problem with the hearing, learning and feelings learn, having trouble at the job. affected na si temporal lobe Learning new things, start repeating themselves and asking the same question over and over again Language problem, forget a word, mental instability SIGNS AND SYMPTOMS (confusion, depression, (?), difficulty sleeping → affects sleeping pattern) Apraxia – unable to perform certain motor Still can function and be independent but should movements (brushing of teeth, unable to pick up the consider end of life care toothbrush) ○ remember – there is no cure, this is a chronic Aphasia – unable to understand speech or create it disorder so meaning upon ma-diagnose ang (showing image of what to do)(sometimes words Alzheimer’s dapat cinoconsider na natin ang cannot be interpreted by your patient but they can end of life care because eventually the pt will understand if you show them images) go into a vegetative state Agnosia – unable to recognize object, people, ○ ma-prepare si relative emotionally, mentally senses (incontinence, they don’t recognize the food) and physically Amnesia – memory loss (they don’t know who they Last a couple of years are, address, etc.) Anomia – recall of objects (apple in front of them, they don’t remember/recognize) ADORIAS, ARMADA, DABUET, DORIA, GALVEZ, GRANADO, HERNANDEZ, LUMIARES, MIRANDA, RAQUINTAN, STA. CRUZ, SULIT 3 W14: ALZHEIMER’S DISEASE CARE OF THE OLDER ADULT NCMB 314, BSN-3-Y1-17| PROF. EDWIN B. MALIC| SEM 1 MODERATE ALZHEIMER’S DISEASE (MIDDLE STAGE) 7M’s Confusion now set in which affects how the patient can function Memory – reorient, remind, remain patient, keep Needs held and supervision simple (task), do not scold Safety (one of the priority) and supervision is a major Movement – independent as allowed, routines, concern exercises, can also include fun games Patient can wander, and judgement is lapsed Mental Health – calm, distract, do not hurry, hallucinations (well lit, remove reflective objects) Mental instability; anger, anxiety, hallucinations Able to move around and engage in activity but must Sundowner’s triggers: exhaustion, sickness, new medication, be monitored low exposure to sunlight [why need to provide a well lighted room] Sundowners syndrome may be present ○ during the afternoon, the pt/client might feel Decreasing sundowner’s: low noise, relaxing calm depressed during this time kapag bumababa environment, no caffeine at night, routine are important, yung araw or when the sun is down exercise and rest, avoid long naps so that your client will sleep ○ Intervention: provide a well lighted room, during the night and not at the daytime avoid long naps during the day so that the pt will sleep at night, no coffee at night, avoid too Maintain safety – beware of driving, hide keys, much fluids before bedtime. supervise cooking, beware of wandering Intense time for caregivers Longest stage Wandering/s: get lost or forget places, taking longer than normal to return to a place, having trouble finding a room in the SEVERE ALZHEIMER’S DISEASE house, talking about going somewhere or visiting someone. Severe symptoms Wandering triggers: Crowded stressful places, a need to be Language/communication minimal, along with motor met, following a normal routine activities swallowing and eating issues Needs constant care INTERVENTION FOR WANDERING At risk for lung infections like pneumonia due to aspirations W Wear bracelet Interacting with the patient is still very important ○ it is important that you stimulate the brain → A Avoid crowded unfamiliar places important part: interact with your client Use nonverbal and touch as needed N Needs met (foods, water, bathroom) D Display signs providing cues TESTING FOR ALZHEIMER’S DISEASE E Exercise is important Cognitive assessment R Remove access to doors and windows Mental Evaluation Diagnostic imaging (MRI, CT Scan, Amyloid pet scan [beta amyloid]) Maximize communication Biomarkers (CSF, Blood test) which might reveal - Patient communication will progress worsen increased in tau protein in time - it is important to tailor communication to patient’s ability NURSES ROLE IN ALZHEIMER’S DISEASES - Communication is still extremely important Helping patient identify the sign and symptoms Medication Educating how the disease progresses Educating the caregivers & helping them take breaks ADORIAS, ARMADA, DABUET, DORIA, GALVEZ, GRANADO, HERNANDEZ, LUMIARES, MIRANDA, RAQUINTAN, STA. CRUZ, SULIT 4 W14: ALZHEIMER’S DISEASE CARE OF THE OLDER ADULT NCMB 314, BSN-3-Y1-17| PROF. EDWIN B. MALIC| SEM 1 HOW DO WE COMMUNICATE? Bradycardia (risk for fall) P Pick one question/instruction at a time (repeat) 2. NMDA (N-Methyl D-aspartate) antagonist - Memantine (mod to severe Alzheimer’s) take A Avoid correcting or arguing (watch down glutamate (excitatory work with increase tone/expression) calcium in neuron) become damage and die - WOF: headache, dizziness, constipation T Take time for patient to speak or respond I Identify yourself from front not side/back 3. Aducanumab - IV infusion around every 4 weeks, decrease or E Eye contact from eye level not from above to reduce the beta-amyloid plaques (or totally - there are some paranoia idea during this in remove bc again, there is no cure and you are taking care of patients trying to delay the progression of the disease) - Amyloid tap or Pet scan = to confirm presence N Non-verbal communication is helpful (act, paint, of beta amyloid plaque image) - they cannot process words but they can understand what you are trying to show them Memantine and Donepezil acts on the neurotransmitter like which are some images acetylcholine and the one that increases calcium & neurons. T Talk in slow, normal, clear tone and eliminate noise Medical need - Hygiene (bathing, grooming, mouth care, incontinence, dressing) - Hydration (thirst, access to refreshment, measure), variety - Nourishment (do not eat, loss of taste, dysphagia) INTERVENTIONS FOR EATING FOOD: Do not overwhelm with options Offer healthy food patient’s like to eat Use finger foods that are soft easy to swallow Have patient focus on meal, eat with me ○ eat with them, why? → bc there are times na mas mahaba yung time nila for wandering rather than eating so it is your responsibility to remind them to consume their food MEDICATION 1. Cholinesterase inhibitors: Donepezil, Rivastigmine, Galantamine - Helps breakdown acetylcholine - Donepezil = important that this is taken w/ food SIDE EFFECTS: GI upset Nausea and vomiting Diarrhea Muscle spasm ADORIAS, ARMADA, DABUET, DORIA, GALVEZ, GRANADO, HERNANDEZ, LUMIARES, MIRANDA, RAQUINTAN, STA. CRUZ, SULIT 5