Nursing Care Plan (NCP) for Alzheimer’s Disease
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Outline
Lesson Objective for Alzheimer’s Disease Nursing Care:
- Understanding Alzheimer’s Disease:
- Develop a comprehensive understanding of Alzheimer’s disease, including its etiology, pathophysiology, and progression, to facilitate informed and individualized care.
- Symptom Recognition and Management:
- Recognize the common symptoms of Alzheimer’s disease, such as memory loss, cognitive decline, and behavioral changes, and implement effective management strategies to enhance the patient’s quality of life.
- Holistic Patient-Centered Care:
- Provide holistic, patient-centered care that addresses the physical, cognitive, emotional, and social needs of individuals with Alzheimer’s disease, fostering a supportive and compassionate environment.
- Communication and Engagement Techniques:
- Acquire communication and engagement techniques tailored to the unique needs of individuals with Alzheimer’s, promoting positive interactions, reducing frustration, and enhancing the overall caregiving experience.
- Collaboration with Caregivers and Multidisciplinary Team:
- Collaborate with caregivers, family members, and the multidisciplinary healthcare team to develop and implement a comprehensive care plan, ensuring continuity of care and support for both the patient and their caregivers.
Pathophysiology of Alzheimer’s Disease:
- Amyloid Beta (Aβ) Plaque Accumulation:
- Alzheimer’s disease is characterized by the accumulation of abnormal protein fragments called amyloid beta (Aβ) plaques. These plaques build up between nerve cells (neurons) and disrupt cell communication.
- Neurofibrillary Tangle Formation:
- Neurofibrillary tangles, composed of twisted tau protein fibers, develop inside neurons. These tangles impede the transportation of essential substances within the neurons, leading to cell dysfunction and death.
- Neuronal Cell Death and Atrophy:
- The accumulation of Aβ plaques and neurofibrillary tangles contributes to the death of neurons, particularly in brain regions crucial for memory and cognitive function. This neuronal loss results in overall brain atrophy.
- Disruption of Neurotransmitter Function:
- Alzheimer’s disease disrupts the balance of neurotransmitters, such as acetylcholine, which play a crucial role in facilitating communication between neurons. Reduced acetylcholine levels contribute to cognitive decline.
- Inflammatory Response and Glial Activation:
- The brain’s inflammatory response is activated in Alzheimer’s disease. Microglia, the brain’s immune cells, become overactivated, releasing inflammatory substances that further contribute to neuronal damage and cognitive impairment.
Etiology of Alzheimer’s Disease:
- Genetic Factors:
- Genetic factors play a significant role in the development of Alzheimer’s disease. Mutations in specific genes, such as the amyloid precursor protein (APP), presenilin 1 (PSEN1), and presenilin 2 (PSEN2), increase the risk of familial Alzheimer’s disease.
- Age as a Primary Risk Factor:
- Advanced age is a primary risk factor for Alzheimer’s disease. The prevalence of the condition increases with age, and the risk doubles approximately every five years after the age of 65.
- Amyloid Beta (Aβ) Imbalance:
- Imbalance in the production, clearance, and aggregation of amyloid beta (Aβ) peptides in the brain contributes to the formation of Aβ plaques, a hallmark feature of Alzheimer’s pathology.
- Tau Protein Abnormalities:
- Abnormalities in the tau protein, including hyperphosphorylation and the formation of neurofibrillary tangles, are associated with Alzheimer’s disease. Tau pathology disrupts the structural integrity of neurons.
- Environmental and Lifestyle Factors:
- Certain environmental and lifestyle factors, such as cardiovascular health, education, and traumatic brain injury, may influence the risk of developing Alzheimer’s disease. Addressing these factors can contribute to prevention or delay in onset.
Desired Outcome for Alzheimer’s Disease Nursing Care:
- Preservation of Cognitive Function:
- Aim to preserve and maximize cognitive function to the best extent possible, focusing on activities that promote mental stimulation, memory retention, and problem-solving skills.
- Enhanced Quality of Life:
- Improve the overall quality of life for individuals with Alzheimer’s disease by addressing their physical, emotional, and social needs. This includes promoting a sense of purpose, engagement in meaningful activities, and emotional well-being.
- Safe and Supportive Environment:
- Create a safe and supportive environment that minimizes the risk of accidents and injuries. Implement measures to prevent wandering, ensure proper nutrition, and address any medical concerns to enhance overall well-being.
- Effective Communication and Interaction:
- Foster effective communication and positive interactions between individuals with Alzheimer’s disease, caregivers, and healthcare professionals. Utilize communication techniques that reduce frustration and enhance understanding.
- Caregiver Education and Support:
- Provide education and support for caregivers, equipping them with the knowledge and skills needed to care for individuals with Alzheimer’s disease. Empower caregivers to manage challenges and seek assistance when needed.
Alzheimer’s Disease Nursing Care Plan
Subjective Data:
- Difficulty finding words during a conversation
- Difficulty remembering names
- Poor short-term memory
- Forgetting details of personal history (life events, phone number, etc.)
- Inability to recognize faces
Objective Data:
- Difficulty dressing or performing ADLs
- Loss of bladder and bowel control
- Personality changes
- Inappropriate behaviors (aggression, sexual gestures, etc.)
- Wandering or pacing
Nursing Assessment for Alzheimer’s Disease:
- Cognitive Function:
- Conduct a thorough assessment of cognitive function using standardized tools to evaluate memory, attention, language, and problem-solving skills. Monitor changes in cognitive abilities over time.
- Behavioral and Psychological Symptoms:
- Evaluate behavioral and psychological symptoms, including agitation, aggression, depression, and hallucinations. Assess triggers and patterns to develop targeted interventions.
- Functional Abilities:
- Assess the individual’s ability to perform activities of daily living (ADLs) independently. Identify any decline in functional abilities and implement supportive measures as needed.
- Physical Health Status:
- Evaluate the overall physical health of the individual, including any comorbid conditions, medication management, and nutritional status. Address any health concerns that may impact cognitive function.
- Safety and Environmental Factors:
- Assess the home environment for safety hazards and implement modifications to prevent accidents and injuries. Evaluate the need for assistive devices and adaptive technologies.
- Social and Support Systems:
- Explore the individual’s social support network, including family and friends. Assess the availability of caregiver support and involvement in the care plan.
- Communication Abilities:
- Evaluate the individual’s communication abilities, considering any challenges in verbal expression or understanding. Implement communication strategies that enhance understanding and minimize frustration.
- Caregiver Burnout and Stress:
- Assess the well-being of caregivers, evaluating signs of burnout and stress. Provide education and support to caregivers, emphasizing the importance of self-care and seeking assistance when needed.
Outcomes for Alzheimer’s Disease Nursing Care:
- Stabilized Cognitive Function:
- Aim to stabilize or slow the progression of cognitive decline, allowing individuals to maintain a level of independence in daily activities and decision-making for as long as possible.
- Improved Behavioral Management:
- Implement strategies that lead to improved management of behavioral and psychological symptoms, reducing agitation, aggression, and other challenging behaviors.
- Enhanced Functional Independence:
- Work towards enhancing or maintaining functional independence in activities of daily living (ADLs) by implementing supportive measures and adaptive strategies.
- Safe and Supportive Environment:
- Create an environment that promotes safety and support, minimizing the risk of accidents and ensuring a comfortable and familiar setting for individuals with Alzheimer’s disease.
- Quality of Life Enhancement:
- Strive to enhance the overall quality of life by addressing emotional, social, and physical well-being. Focus on activities that bring joy, meaning, and a sense of accomplishment.
Nursing Interventions and Rationales
- Perform complete nursing assessment
Get a baseline for interventions and monitor progression of disease
- Assess neurological status and level of confusion routinely, per facility protocols
Help determine necessary interventions and progression of disease.
- Assess for depression or reclusiveness
Clients in the earlier stages who are still able to understand that they are losing their sense of reality may become depressed and withdrawn.
- Routinely assess client for organic contributors to behavior:
- Dehydration
- Poor nutrition
- Infection (systemic, urinary)
Many organic factors may contribute to an increase in client’s confusion or changes in mental status. It is important not to ignore them, since it could be related to infection or dehydration, which is treatable.
- Communicate effectively
- Speak in a slow and low comforting voice
- Call client by name
- Speak face-to-face
Helps increase the possibility of the client understanding what is being communicated. Repeating the name helps the client maintain a sense of self-identity.
- Limit choices for independent decisions appropriate to stage of disease progression
Progressively reducing the client’s need for decision-making helps reduce frustration and stress.
- Avoid allowing client to watch television or violence on television
Clients often have difficulty distinguishing fiction from reality and may cause aggressive or violent behaviors or unwarranted fears.
- Monitor for non-verbal cues and anticipate client’s needs
- Grimacing
- Crying
- Pointing
As the disease progresses, clients have more difficulty communicating verbally. Anticipating needs helps reduce stress and prevent frustration and anxiety.
- Orient client to environment as often as needed
- Calendars
- Pictures
- Signs
Helps client feel safer and reassured of their surroundings. Promotes awareness of environment.
- Provide structured and guided activities that client can accomplish with minimal challenge
This helps to keep the mind active and incorporate a sense of accomplishment. Make sure the activity is not sp challenging so as to cause frustration or stress.
- Maintain schedule and routine
Helps the client maintain an awareness of time of day and offers a sense of security and reality.
- Assist with ADLs as needed
Advanced stages of the disease may diminish the client’s ability to perform simple tasks like dressing, bathing, combing hair, and feeding. Provide whatever assistance the client needs to maintain a sense of dignity.
- Provide an opportunity for clients to interact with others, but avoid forcing interaction
Helps prevent clients from feeling isolated or alone. Gives them an opportunity to share stories or memories and maintain or develop social relationships. Forced interaction may cause aggression or inappropriate behaviors.
- Monitor client’s wandering habits and determine specific reasons, if any, for wandering
Clients may wander because they are thirsty or hungry, or are looking for a bathroom. Assess needs and provide assistance or direction within a safe environment.
- Educate family about disease process and resources for coping
- Therapy or counseling for families
- Support groups for families or caregivers
- Respite care options
- Home modifications
Help families cope and be prepared for the changes in their loved one.
Help families adapt to the needs of the clients.
Help reduce stress and anxiety that may be transferred to the client.
- Administer medications appropriately and as needed
- Cholinesterase inhibitors (donepezil)
- NMDA receptor antagonist (memantine)
- Antipsychotics (olanzapine, quetiapine)
- Benzodiazepines (lorazepam, temazepam)
- SSRI antidepressants (citalopram, paroxetine)
Some medications may be given regularly for management of memory loss and delay progression of the disease.
Other medications may be given PRN to treat behaviors and symptoms such as depression, anxiety, or loss of appetite.
- Minimize environmental hazards and make pathways clear and illuminated
Promote safety and prevent injury.
Evaluation for Alzheimer’s Disease Nursing Care:
- Cognitive Function Assessment:
- Regularly assess cognitive function using standardized tools to monitor changes over time. Evaluate the effectiveness of cognitive stimulation activities in maintaining or improving cognitive abilities.
- Behavioral Symptom Monitoring:
- Continuously monitor behavioral symptoms and assess the impact of implemented strategies. Adjust interventions as needed to address changes in behavior and enhance overall well-being.
- Functional Independence Evaluation:
- Evaluate the individual’s functional independence in performing activities of daily living (ADLs). Measure progress or any decline in functional abilities and adjust support measures accordingly.
- Caregiver Support and Satisfaction:
- Assess caregiver well-being and satisfaction with the provided education and support. Evaluate the effectiveness of caregiver training in managing the challenges associated with caring for someone with Alzheimer’s disease.
- Quality of Life Assessment:
- Conduct assessments to measure the individual’s overall quality of life. Seek feedback from both the individual and caregivers to identify areas of improvement and ensure the care plan aligns with the individual’s preferences and needs.
References
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5619474/
- https://www.theravive.com/therapedia/major-or-mild-neurocognitive-disorder-due-to-alzheimers-disease-dsm–5-331.0-(g30.9)
- https://www.alzheimers.net/stages-of-alzheimers-disease/
- https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447
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Example Nursing Diagnosis For Nursing Care Plan (NCP) for Alzheimer’s Disease
- Impaired Memory: Alzheimer’s disease is characterized by memory loss. This diagnosis addresses the cognitive impairment related to memory.
- Risk for Falls: Alzheimer’s patients are at risk of falls due to impaired cognition and mobility. This diagnosis emphasizes fall prevention.
- Impaired Communication: Alzheimer’s may affect communication abilities. This diagnosis focuses on facilitating effective communication strategies.
Transcript
Hey guys, in this care plan, we will explore Alzheimer’s disease.
So, in this Alzheimer’s disease care plan, we’re going to cover the desired outcome, the subjective and objective data along with the nursing interventions and rationales.
So, our medical diagnosis is Alzheimer’s disease. Alzheimer’s disease is an irreversible neurological disorder where there’s decreased acetylcholine in the brain causing microscopic plaques and the destruction of neurons, the patient experiences a loss of memory and cognitive dysfunction. The exact cause is unknown, but it’s thought to be a combination of genetic, environmental and lifestyle factors along with aging.
So, our desired outcome is that the patient will remain at the optimal level of independence or assisted functioning, remain free from injury and have adequate resources and support. Now, let’s take a look at our care plan. So, the patient with Alzheimer’s disease is going to experience some poor short-term memory.
Um, this usually happens before long-term memory loss and causes things like forgetting what they ate for lunch, Um, and this is due to the changes in the brain. The patient will eventually experience poor long-term memory, where they can’t remember, for example, childhood memories. And again, that’s because of the changes in the brain. They will also start to experience increased confusion in the evenings, and at night. This is often called “sundowning” and it’s really hard on them. They get really confused and they might actually be fine during the day, and then all of a sudden at night, it’s like a switch is flipped and they completely change.
Now let’s look at the objective data. So, you’re going to start to notice personality changes and family will as well. Normally this might be a sweet, sweet, old lady and then now, she’s all of a sudden, very angry, frustrated and doesn’t know what’s going on. You know, it’s very hard. Um, you might notice some inappropriate behaviors that they usually don’t have such as being combative. You might notice difficulty with ADL’s, getting around, and this is all because of those changes in the brain structure. The patient eventually is going to have a really hard time with, um, trying to control their bladder and bowels, which is why often we can use depends to help with that.
Now let’s look at our nursing interventions and the rationales. So, you will perform a complete assessment of the patient, assess the baseline and monitor the disease progression. Regularly, assess their neurological status and their mental status, because this is not easy on them.
Something to think about is checking out their nutritional status. Just to make sure they’re eating because sometimes they forget. I mean, they’re very forgetful and, um, it can be hard for them to remember to eat or even just drink a glass of water.
You want to practice effective communication. This is so, so important. This is going to help you to increase that patient/ nurse understanding. Um, you know, it can be very frustrating, um, when they feel like they’re trying to tell you something, but they can’t get it across. You know, they can’t remember everything. Just try to listen. That’s the best thing I can say, listen to what they’re saying to you. Let them express their anger and frustrations. Even if it doesn’t seem important to you, you might then be able to redirect them to what you need them to do at that time. This can help them to feel as though you care about them and what they need next. You want to make sure that you assist with ADL’s and limit choices for independent decisions, according to disease progression to minimize hazards. So our number one goal is we want to keep them safe, right?
So try to reduce frustration. You don’t want them to get frustrated or angry. Reduce their stress. And also this is going to help incorporate a sense of accomplishment for the patient. They can feel like they’re actually able to do things for themselves next. You want to make sure you reorient your patient often. There’s a lot of times they’re going to just feel confused. They might say something silly like, oh, um, you know, I’ve got to go talk to my mom. They might think they’re back into childhood again. So just redirect them, just reorient them to what’s going on right now, help them feel safe, you know, help promote awareness in themselves and their environment. It’s really helpful. Also, when you enter the room, just say who you are and why you’re there. Next, you want to provide structured and guided activities while maintaining a schedule and routine to try to keep things normal.
This is going to help the patient maintain awareness and offer a sense of security. So, you’ll want to educate the patient’s family about the disease. This is going to help that family to cope. This is really hard on them you guys, really hard. Their family member is changing right in front of their eyes. So, you want to help them cope. You want to help prepare them for changes and adapt to the needs of the patient.
Lastly, you want to make sure you administer medications as ordered guys. We can’t reverse this disease at this point in time, we don’t have that ability with medications, but we can stop it from progressing as much as we can with medications, right? Um, so medications are going to help to manage that memory loss and hopefully delay the progression of the disease. There’s other meds as well that we might need to use to treat behavior such as agitation, combativeness, things like that and symptoms.
We love you guys! Now go out and be your best self today. And as always, happy nursing!
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