Question

In: Nursing

You are a nurse educator who is preparing a community seminar for caregivers of individuals diagnosed...

You are a nurse educator who is preparing a community seminar for caregivers of individuals diagnosed with dementia and Alzheimer’s disease. There is a wealth of information that you will need to make sure is covered in your seminar and you are having a difficult time deciding which information to include.

1. What are the most important points you wish to focus upon because your time is limited?

2. What nursing diagnoses would be most important to address the caregivers’ needs? Pick 2 and provide reasoning. (10pts)

Solutions

Expert Solution

Alzheimer's disease - A progressive disease that destroys memory and other important mental functions. Brain cell connections and the cells themselves degenerate and die, eventually destroying memory and other important mental functions.
There are two types of Alzheimer's—early-onset and late-onset. Both types have a genetic component.
Requires a medical diagnosis
Memory loss and confusion are the main symptoms.
People may experience:
Cognitive: mental decline, difficulty thinking and understanding, confusion in the evening hours, delusion, disorientation, forgetfulness, making things up, mental confusion, difficulty concentrating, inability to create new memories, inability to do simple maths, or inability to recognise common things
Behavioural: aggression, agitation, difficulty with self care, irritability, meaningless repetition of own words, personality changes, restlessness, lack of restraint, or wandering and getting lost
Mood: anger, apathy, general discontent, loneliness, or mood swings
Psychological: depression, hallucination, or paranoia
Also common: inability to combine muscle movements, jumbled speech, or loss of appetite.
Laboratory and imaging tests can rule out other potential causes or help the doctor better characterize the disease causing dementia symptoms.

The entire set of diagnostic tools is designed to detect dementia and determine with relatively high accuracy whether Alzheimer's disease or another condition is the cause. Alzheimer's disease can be diagnosed with complete certainty after death, when microscopic examination of the brain reveals the characteristic plaques and tangles.

Tests
A diagnostic work-up would likely include the following tests:Physical and neurological assessment.
Your doctor will perform a physical assessmernt and likely assess overall neurological health by testing the following:

Reflexes:-
Muscle tone and strength
Ability to get up from a chair and walk across the room
Sense of sight and hearing
Coordination
Balance
Lab tests
Blood tests may help your doctor rule out other potential causes of memory loss and confusion, such as a thyroid disorder or vitamin deficiencies.

Mental status and neuropsychological testing
Your doctor may conduct a brief mental status test or a more extensive set of tests to assess memory and other thinking skills. Longer forms of neuropsychological testing may provide additional details about mental function compared with people of a similar age and education level. These tests are also important for establishing a starting point to track the progression of symptoms in the future.

Brain imaging
Images of the brain are now used chiefly to pinpoint visible abnormalities related to conditions other than Alzheimer's disease — such as strokes, trauma or tumors — that may cause cognitive change. New imaging applications — currently used primarily in major medical centers or in clinical trials — may enable doctors to detect specific brain changes caused by Alzheimer's. Imaging of brain structures include the following: Magnetic resonance imaging (MRI). MRI uses radio waves and a strong magnetic field to produce detailed images of the brain. MRI scans are used primarily to rule out other conditions. While they may show brain shrinkage, the information doesn't currently add significant value to making a diagnosis.
Computerized tomography (CT). A CT scan, a specialized X-ray technology, produces cross-sectional images (slices) of your brain. It's currently used chiefly to rule out tumors, strokes and head injuries.
Imaging of disease processes can be performed with positron emission tomography (PET). During a PET scan, a low-level radioactive tracer is injected into the blood to reveal a particular feature in the brain. PET imaging may include the following: Fluorodeoxyglucose (FDG) PET scans show areas of the brain in which nutrients are poorly metabolized. Identifying patterns of degeneration — areas of low metabolism — can help distinguish between Alzheimer's disease and other types of dementia.
Amyloid PET imaging can measure the burden of amyloid deposits in the brain. This imaging is primarily used in research but may be used if a person has unusual or very early onset of dementia symptoms.
Tau Pet imaging, which measures the burden of neurofibrillary tangles in the brain, is only used in research.
In special circumstances, such as rapidly progressive dementia or very early onset dementia, other tests may be used to measure abnormal beta-amyloid or tau in the cerebrospinal fluid.

Future diagnostic tests
Researchers are working on tests that can measure the biological evidence of disease processes in the brain. These tests may improve the accuracy of diagnoses and enable earlier diagnosis before the onset of symptoms. Genetic testing generally isn't recommended for a routine Alzheimer's disease evaluation. The exception is people who have a family history of early-onset Alzheimer's disease. Meeting with a genetic counselor to discuss the risks and benefits of genetic testing is recommended before undergoing any tests.

2) DEMENTIA :-
Nursing diagnoses that you can use for developing nursing care plans for patients with dementia include:
1. Risk for trauma related to disorientation or confusion. Risk for self directed or other directed violence related to delusional thinking.
2. Risk for self directed or other directed violencerelated to delusional thinking.
3. Chronic confusion related to alteration in structure/function of brain tissue.
4. Self care deficit related to cognitive impairment.
5. Risk for falls related to cognitive impairment.
ALZHEIMER'S DISEASE :-
Primary Nursing Diagnosis
Risk for Injury related to: Unable to recognize / identify hazards in the environment.
1. Disorientation, confusion, impaired decision making. Weakness, the muscles are not coordinated, the presence of seizure activity.
2. Urinary and Bowel Elimination
related to:
neurological function loss / muscle tone,inability to determine where the bathroom / identify needs.
2. Disturbed Sleep Pattern
related to: sensory changes.
3. Impaired physical mobility
related to: neuromuscular damage,
decreased muscle tone or strength.
4. Self-care deficit
related to: cognitive decline,
physical limitations.
5. Disturbed Sensory Perception
related to: changes in the reception, transmission, and / or integration.
6. Altered thought processes
related to: irreversible neuronal degeneration.
7. Ineffective individual coping
related to: inability to resolve the issues, intellectual changes.
8. Impaired verbal communication
related to: intellectual changes (dementia, disorientation, decreased ability to cope with the problem).
9. Impaired social interaction
related to: emotional changes (irritability, lack of confidence).
10. Imbalanced Nutrition, Less Than Body Requirements
related to: sensory changes, it is easy to forget
11. Risk for Injury
related to: weaknesses, the inability to recognize / identify hazards in the environment.


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