Question

George Palo is a 90-year-old male who has been diagnosed with early stage dementia. George's wife Anna died two years ago and he moved into a small one-bedroom apartment in a retirement community, independent living setting. George has five children, but only his oldest daughter Maggie lives nearby. George has been relatively healthy over his long life with the exception of high blood pressure which is controlled with medication. He is very independent and loves to be outdoors, walking his golden retriever, Max. Maggie and her siblings are trying to support their dad's independence as long as possible, but are cognizant of his age and concerned about his overall safety.

1. Discuss the clinical manifestations evidenced during your assessment. How would you explain these manifestations?

2. Explain the nursing management considerations for this patient. Discuss the knowledge guiding your thinking.

Answer 1

1.CLINICAL MANIFESTATIONS OF DEMENTIA;

*Warning signs of Alzheimer's dementia-

*Memory loss

*Difficulty performing familiar task.

*Problems with language

*Disorientation to time and place

*Poor or decreased judgment

*Problems with abstract thinking

*Misplacing thinks

*Changes in mood or behaviour

*Changes in personality

*Loss of initiative

CLINICAL FEATURES:

*Personality changes;lack of interest in day to day activities,easy mental fatigability,self centered ,withdrawn ,decreased self care.

*Memory impairment;Recent memory is prominently affected.

*Cognitive impairment;disorientation,poor judgements,difficulty in abstraction,decreased attention span.

*Effective impairment ;labile mood,irritabilness depression.

*Behavioural impairments;Stereotyped behaviour,alteration in sexual drives and activities,neurotic /psychotic behaviour.

*Neurological impairment;Aphasia,apraxia,agnosia,seizures,headache.

*Catastrophic reaction;agitation ,attempt to compensate for defects by using strategies to avoid demonstrating failures in intellectual performance.

*Sundowner syndrome;its is characterized by drowsiness,confusion,ataxia,accidental falls may occur at night when external stimuli such as light and interpersonal orienting cues or diminished.

NURSING ASSESMENT_Assesment data for the patient with dementia should include a past health and medication history.

2.NURSING MANAGEMENT OF PATIENT ;

Nursing care for patient of Alzheimer 's disease is most important.Whether at home,in an acute hospital environment, a day care center or in a long term stay instituition.Care givers must be trained to promote the patient's remaining intellectual abilities;help them maintain their independence in attending to their usual funcyioning and avoid injuries;and provide for a good quality of life.

Nursing assesment-Assesment data for the patient with dementia should include a past health and medication history.

NURSING INTERVENTIONS-

*Daily routine-Maintaing a daily routine includes drawing up a fixed timetable for patient for waking up in the morning,toilet ,excersise and meals.This gives the patient a sense of security.Patient often detoriate after dark(sun dowing).Additional care during evening and night.Use calendar with large writing and seperate page for each day.Provide newspapers which stimulates the interesting curent events.Orient the patient to reality in order to decrease confusion.

*Nutrtion body weight- patient should be provided a well balanced diet.Rich in protein and high in fibre with adequate amount of calories.Allow plenty of time for meals.Food served should neither to be too hot not too cold.

_Advice the patient to take salt free diet .(due to hypertension)

_semisolid diet is the safest while liquides are most dangerous these can be easily aspirated to the lungs.

*Personal hygiene-particular care should be taken about the pateint personal hygiene,including brushing teeth ,bathing keeping the skin clean and dry.People with dementia may have problem with the lock on the bathroom door.It is advicable to remove the lock.

*Toilet habits and incontinence;Toilet habits should be established as soon as possible and maintain a rigid routine.condition behaviour-going for bowel movement immediately after a cup of tea.

_patient should be urinate at fixed interval.

_patient have postrate trouble ,doctor should be checked.

_COnstipation can be avoided by fiber supplement in the diet daily.

*Accident-Patient should be made to wear soft slip on shoes with strapes which fittes securely.Any floor covering must be firmly secured.

*Fluid management;- sufficient fluid should be given during the day and only the minimal essential amount of fluid after 6pm.After 5 pm, no bevereages given.

_Proper fluid management will reduce bed wetting.

*Moods and emotions-it is controlled by keeping a calm environment with fixed daily routine.

*Wandering -Patients often lose their geographic orientation and can get lost even in familiar surrondings.The doors should be securly locked.The patient should always be accompanied while going for walk or for simple choes outside the house.

*Disturbed sleep-If the patient is restless at night or wanders and talk at night ,the entire family is disturbed.Sleep pattern must be maintained.

_Napping during the day should be avoided.

_Sleeping pills are avoided .

*Interpersonal relationship-Verbal communication should be clear and unhurried.YES or no answers are best.

#FOLLOWUP ,HOMECARE AND REHABILITATION_-

*Early diagnosis and early intervention are beneficial.

*family remains the main piller of support for the patient.

*HOMe care available home care agencies,public health agencies etc.