In: Nursing
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)
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.