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Nursing Considerations r/t treatments
Sierra Bartlett
Because their memory and judgment are altered. They are at an increased risk of falls and getting lost. Patients with Alzheimer are at an increased risk of agitation and anxiousness because of memory loss. Increased risk of loss of bladder/bowel control which can lead to an increased risk of skin breakdown.Increased risk of malnutrition and dehydration related to not remembering to eat or drink fluids.
Care of the Pateint with Alzheimers
Treatments &
Interventions
Sierra Bartlett
○There is no cure for Alzheimers. There is only symptom management. Some drugs include: cholinesterase inhibitors and partial N-methyl D-aspartate (NMDA) antagonists.
■ Do not use Galantamine if the client has renal or hepatic impairment.
○ Partial N-Methyl D-Aspartate (NMDA) ( Memantine)
■ blocks NMDA receptors and slows intracellular calcium accumulation
■ It can be taken in combination with cholinesterase inhibitors
■ Used to treat memory loss.
Potential side effects or complications
Sierra Bartlett
Most common side effects of cholinesterase inhibitors are gastrointestinal-like nausea, vomiting, and diarrhea. For memantine: Dizziness, body aches, headache, and constipation are common side effects. Sleep disturbances are more common with donepezil. Due to increased vagal tone, bradycardia, cardiac conduction defects, and syncope can occur, and these medications are contraindicated in patients with severe cardiac conduction abnormalities.
Patho
Julie Cosby
Alzheimer’s disease is a chronic, progressive, and irreversible neurogenerative brain disease. Changes in the brain structure and function with AD include (1) amyloid plaques, (2) neurofibrillary tangles, (3) loss of connections between neurons, and (4) neuron death. **Age is the primary risk factor with most people being diagnosed at 65 years or older, but family history, genetics, cardiovascular health and head trauma are also relevant risk factors. The majority of Alzheimer’s patients are women because they live longer, and about twice as many women as men die from Alzheimer’s annually. (Table 64.2) (1576-1578)
Symptoms
Julie Cosby
• Memory loss, challenges with abstract thinking, difficulty completing familiar tasks, confusion with time or place, issues with depth perception, may forget familiar words for items they know, misplacing things, changes in mood and personality, social isolation/loss of initiative
Evaluate
Jackie Mickle and Julie Cosby:
Jackie Mickle:
Safety (risk for injury):
o The patient will remain safe, without injury, from environmental hazards and cognition impairment.
o patient will have few, if any, falls.
•Mobility (impaired functional mobility):
o Patient has increased functional mobility or maintains functional mobility as long as possible during the disease process.
o Patient will maintain ROM through ROM exercises.
o Patient will have few if any, complications related to decreasing of functional mobility due to disease.
•Nutrition (nutrition deficit):
o Patient will maintain adequate nutrition, with help of family members or caregivers, and/or a set routine.
o Patient will maintain weight without any major weight loss or excessive gain.
Julie Cosby
•Does the patient function at their highest level of cognitive ability?
•Can they perform basic ADLs independently or with assistance
•Can the patient remain free from injury?
•Does the patient have adequate caregiver support?
•Are the patient’s medications remaining effective?
•Is the patient’s nutrition continuing to be adequate?
Nurses role:
Jackie Mickle and Julie Cosby:
Jackie Mickle
• Create and follow a care plan for the patient.
• Establish daily routines with the patient.
• Aid patients with ADLs such as: hygiene, eating, and toileting; especially those who have significant cognitive impairment.
• Assess patient safety and complete tasks/take precautions that lower the risk for injury.
• Manage behavior problems, anxiety, and anger from patients.
• Encourage and provide time for patient socialization with friends, family, and/or other members of their healthcare team (especially if hospitalized).
Julie Cosby
Caring for the Patient with AD (Table 64.14)
Assess which stage of AD the patient is in currently (mild, moderate, and severe) according to the Reisberg Functional Assessment Staging Test (FAST)
Assess patients on an ongoing basis, assess support system, provide for patient needs, provide a safe environment, provide caregiver support, delegate tasks to LPN and patient care tech and supervise assistive personnel, collaborate with a dietician, occupational therapist, and social worker.
Promote communication by being conscious of the do’s and do not’s (Table 64.15) such as treating the patient with respect as an adult, being patient and kind, simplifying tasks, being flexible, using distractions, using praise and reassurance, but do not criticize, argue, or correct, rush or force the patient, patronize or be condescending, overreact, or try to rationalize.
Maintain safety by being mindful of the risk of falls
Manage pain.
Adapt according to eating/swallowing difficulties to maintain nutrition.
Practice infection precautions
Monitor skincare.
Be mindful of elimination problems.
Ensure caregiver support.
Diagnostic tests
Abraham Garcia
According to the National Alzheimer's Association, there is currently no single diagnostic test that can detect if a person has Alzheimer's disease (AD). However, new diagnostic tools and criteria make it possible for a physician to make a positive clinical diagnosis of AD with an accuracy of 85-90%.
There is no one or combination of diagnostic tests that will conclusively result in a diagnosis of AD. The tests will, however, help rule out other possible causes of the dementia-like symptoms. Once testing is completed, the diagnosing physician will review the results of the examinations, laboratory tests, and other consultations to arrive at a diagnosis. If all test results appear to be consistent with Alzheimer's disease, the clinical diagnosis is generally "probable Alzheimer's disease," or "dementia of the Alzheimer type." If the symptoms are not typical, but no other cause is found, the diagnosis may be "possible Alzheimer's disease." A definitive diagnosis of AD can only be obtained upon autopsy of the brain at death.
Prep for diagnostic test
Abraham Garcia
Start discussions early with your family members, Put important papers in one place and make sure a trusted person knows where.Update documents as situations change, Make copies of health care directives to be placed in all medical files.As symptoms progress, long-term care may be needed. People diagnosed with Alzheimer's or a related dementia and their family members should begin planning for the possibility of long-term care as soon as possible. Geriatric care managers, often nurses or social workers, can work with you to create a long-term care plan.
Educate
Jackie Mickle and Julie Cosby:
Jackie Mickle:
Education will be given to patient and family/caregivers, as a cognition impairment will most likely be present.
Educate on these points for safety:
-Keep typical items of patients within their reach.
-Utilize fall alert devices.
-Keep the environment uncluttered and walkways clear.
-Be aware of the possible visual acuity of the patient when considering environmental hazards.
-Offer help to patients when completing tasks.
-Educate on these points for mobility:
-Educate on the risk of falls.
-Aid patients in completing tasks.
-Educate on ROM exercises.
-Educate on these points for nutrition:
-Maintain a schedule and routine of nutrition (and other ADLs).
-Offer simple choices to the patient.
-Signage can be used around the environment.
Julie Cosby
•Mild stage
o Do not let patient drive – risk to self and others
o Encourage physical and social activities
o Maintain a structured routine and keep things in a sensible and consistent place
o Do not correct patient
o Register with MedicAlert + Alzheimer’s Association Safe Return as patient’s wander
o Get end of life care in order (Advance directives, care options, finances, and personal preferences)
•Moderate Stage
o Install door locks
o Provide protective wear
o Install safety measures to reduce falls (good lights, handrails in bathrooms and stairways, and remove area rugs)
o Label drawers and faucets (hot and cold) for safety
o Develop distraction and diversion to cope with behavioral issues and identify triggers for disruptive behaviors (reduce stress and maintain a comfortable temperature in the home)
o Provide memory triggers such as pictures of loved ones
•Severe Stage
o Maintain regular schedules for toileting to reduce incontinence and prevent skin breakdown
o Perform oral and skin care
o Ensure adequate nutrition
o Continue therapeutic communication through talk and touch
o Consider placement in a long-term care facility when total care is too much
Assessment
Jackie Mickle and Julie Cosby
Jackie Mickle
• Obtain a good history of the patient (can ask family members or caregivers, as the patient might have trouble with memory), as well as a physical examination.
• Assess functional abilities.
• Complete a mental status examination, assessing:
• Concentration
• Attention
• Recent/remote memory
• Language/speech
• Visuospatial and executive functioning
• Praxis
• A detailed neurological assessment may be necessary.
• Assess risk for falls.
• Collected Data
• Subjective Data
• Objective Data
Julie Cosby
Gather subjective data (health history, medications, health perception, nutritional-metabolic, elimination, activity/exercise, cognitive-perceptual) and objective data (general appearance and agitation, neurological state, possible diagnostic findings from tests, labs, and scans). Ask questions like, “When did you first notice the memory loss?” and “How has the memory loss progressed since then?” Cognitive tests to help diagnose Alzheimer’s include the Mini-Cog (64.9) and the Mini-Mental State Examination (MMSE) (64.10), and clock drawing.
Labs to evaluate pre and post
Abraham Garcia
a variety of laboratory tests may be ordered to rule out other disorders that may be causing dementia. Blood and urine tests are used to check for anemia, infections, diabetes, kidney and liver disorders, nutritional deficiencies, and abnormally high or low levels of thyroid hormone. Brain imaging techniques, such as a CT scan or MRI, may be ordered to rule out the presence of tumors, stroke, blood clots, or other factors that may be causing memory and thinking problems. In some circumstances, a doctor may use brain imaging tools to find out if the individual has high levels of beta-amyloid, a hallmark of Alzheimer’s; normal levels would suggest Alzheimer’s is not the cause of dementia.Researchers are studying other brain imaging techniques so they can better diagnose and track the progress of Alzheimer’s.Your provider may give you a brief mental status test to assess memory and other thinking skills. Longer forms of this type of test may provide more details about mental function that can be compared with people of a similar age and education level. These tests can help establish a diagnosis and serve as a starting point to track symptoms in the future.