Question

M.E. is a 66 year old woman who has a 2-year history of progressive forgetfulness. After a neurological evaluation, M.E. was diagnosed as having Alzheimer Disease (AD). She is no longer able to care for herself, has become increasingly depressed and paranoid, and recently started a fire in the kitchen. Her husband and children have come to the Alzheimer unit at your extended care facility to seek information about AD and discuss the possibility of placement for M.E. You assure the family that you have experience dealing with the questions and concerns of most people in their situation.

1. How would you explain AD to the family?

2. M.E.’s husband asks, “How did she get Alzheimer’s? We don’t know anyone else who has it.” How would you respond?

3. After asking the family to describe M.E.’s behavior, you determine that she is in stage 2 of the disease. Describe the common signs and symptoms for each of the three stages of the disease and the length of time each stage generally lasts.

4. M.E.’s daughter expresses some frustration at the number of tests M.E. had to undergo and the length of time it took for someone to diagnose M.E.’s problem. What tests are likely to be performed, and how is AD diagnosed?

M.E.’s husband states, “How are you going to take care of her? She wanders aroung all night long. She cannot find her way to the bathroom in a house that she lived in for 43 years. She cannot be trusted to be alone anymore. She almost burned the house down. We’re all exhausted; there are three of us, and we can’t keep up with her.” You acknowledge how exhausted they must be from trying to keep her safe. You tell the family he Alheimer units have been created to provide a structured, safe environment.

5. Describe specific nursing interventions to place in M.E.’s plan of care that are aimed at minimizing her risk of falling.

6. M.E.’s son wants to know why the unit is only accessible through a keypad locked door. He is worried that there are violent patients on the unit. How will you respond?

7. Describe the Alzheimer-related nursing interventions related to each of the following problems: chronic confusion, inability to perform self-hygiene, disturbed sleep pattern, impaired verbal communication, and agitation.

8. M.E.’s son asks whether medications can help her AD. How would you respond?

9. What other medications might be prescribed for AD and why?

10. Who can you collaborate with and for what problems?

Answer 1

1.How would you explain AD to the family?  

ME's family will be told about the alzheimers disease as a degenerative brain disorder result in progressive memmory loss,impaired thinking,disorientation and changes in personality or mood.

2.M.E.’s husband asks, “How did she get Alzheimer’s? We don’t know anyone else who has it.” How would you respond?

ME's spouse will be told as the reason for the Alzhemier's disease is unknown in most cases,in few cases family history or some brain injuries would contribute.

3.After asking the family to describe M.E.’s behavior, you determine that she is in stage 2 of the disease. Describe the common signs and symptoms for each of the three stages of the disease and the length of time each stage generally lasts.

Progress of disease can be categorized in three stages based on the severity of symptoms:

Stage1-Mild Alzhemier's disease or Early stage,symptoms include;

• Person may function independently but may feel some memory lapses such as forgetting words,places etc.
• Forgetting own names on introducing to others.
• Forgetting valuable items.
• Forgetting commitments related to social or work place.

Stage2-Moderate Alzhemier's disease or Middle stage,symptoms include;(longest stage ,will last for years)

• Dementia will become more severe .
• people will face severe memmory problems in performing works,still able to remeber significant details in the life.
• Mood changes will be exhibited.
• changes in sleep pattern is noticed.
• Unable to control bladder and bowel pattern.
• high risk of wandering and getting lost from home.
• behaviour changes ,personality changes ,delusion or repetitive behavior

Stage3-Severe Alzhemier's disease or late stage,symptoms include;( stage will last till the end of life)

• Dementia will be severe and unable to perform daily activities and personal care.
• unable to do physical activities like walk,sit and eventually to swallow.
• problems with communication.
• High risk for infection due to aspiration pneumonia and pressure injury.

4.M.E.’s daughter expresses some frustration at the number of tests M.E. had to undergo and the length of time it took for someone to diagnose M.E.’s problem. What tests are likely to be performed, and how is AD diagnosed?

M.E's daughter will be told about the different test for Alzhemiers disease as follows;

• Physical and mental Assesment.
• Laboratory tests.
• Radiological test which include CT scan ,MRI scan ,PET Scan and SPECT
• csf examination

5. Describe specific nursing interventions to place in M.E.’s plan of care that are aimed at minimizing her risk of falling.

Family will be clearly told about the fall prevention measures setting for the Alzhemiers patient unit.

categorizing the patient as a high risk patient as per morse fall risk assesment and implementing the measures accordingly;

• Beds are equipped with side rails.
• patients are closely monitored by nurses.
• Clutter free floors and environment.
• non slippery floors for preventing falls.
• Bed will be kept at the low postition always.
• Adequate room lightings.

6. M.E.’s son wants to know why the unit is only accessible through a keypad locked door. He is worried that there are violent patients on the unit. How will you respond?

He will be reassured as the locked door will only allow the health care personal or authorized personal to enter the room.Also it will prevent ME to remain in the room.

7. Describe the Alzheimer-related nursing interventions related to each of the following problems: chronic confusion, inability to perform self-hygiene, disturbed sleep pattern, impaired verbal communication, and agitation.

chronic confusion:

Asses the patient for reversible or irreversible dementia,orientation and behaviour.

perform consistent regular check to meet the patient needs and address it early.

Do not over stumilate or induce anxiety provoking behaviours.

Assist with establishing cues and reminders for recollection of patient thoughts.

Disturbed sleep pattern;

Assess patient’s sleep patterns and frequency, duration of activity, number and time of awakenings during night, and patient’s complaints of tierdness .

Asses patients complaints of dysuria,pain,dysponea which makes sleep disturbances.

provide a calm and quiet environment to promote sleep.

provide relaxation methods for sleep like music therapy.

8. M.E.’s son asks whether medications can help her AD. How would you respond?

• Medication management include:
• Anticholinisterase inhibitors-egs:Donepezil,Rivastigmine.
• NMDA receptor antagonist-egs:Memantine.

9. What other medications might be prescribed for AD and why?

Some other medicaitons also need to be prescribed based on the patients behaviour and mental health assesment

• Antipsycotics- for Delusive or paranoid behaviours
• Anxiolytics-Mood changes or agitation.
• Antidepressents- for Mood changes or apathy.
• Antibiotics to treat infections from aspiration pneumonia.

10. Who can you collaborate with and for what problems?

MDT team involvment is needed for AD managemen it involves:

Neurologist- neurologist for treating muscle twitching ,spasams,convulsion etc.

psychatrist-For assesing and treating different cognitive problems.

psychologist-For different therapy like behavioural therapy.

physiotherapist - For Mobilizaition and rehabilitation programme

Geriatritian-In identifying and treating the age related problems.