Nursing Care Plan (NCP) for Dementia
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Outline
Nursing Care Plan (NCP) for Dementia
Lesson Objective for Dementia Nursing Care Plan:
Upon completion of this nursing care plan for dementia, nursing students will be able to:
- Recognize Signs and Stages of Dementia:
- Identify the signs and stages of dementia, distinguish between different types of dementia, and understand the progression of cognitive and functional decline.
- Implement Person-Centered Care:
- Demonstrate the ability to provide person-centered care for individuals with dementia, emphasizing empathy, effective communication, and a tailored approach to meet the unique needs of each patient.
- Manage Behavioral Symptoms:
- Acquire skills in managing behavioral symptoms associated with dementia, such as agitation, aggression, wandering, and sundowning, through non-pharmacological interventions and behavioral strategies.
- Foster a Safe and Supportive Environment:
- Create and maintain a safe and supportive environment for individuals with dementia, considering physical safety measures, sensory stimulation, and activities that promote engagement and well-being.
- Collaborate with Interdisciplinary Team:
- Collaborate effectively with the interdisciplinary healthcare team, including physicians, occupational therapists, and social workers, to develop and implement a comprehensive care plan addressing the medical, psychological, and social aspects of dementia care.
Pathophysiology of Dementia
- Neuronal Damage and Death:
- Dementia is characterized by progressive neuronal damage and death, particularly in areas of the brain responsible for memory, cognition, and executive function. This damage disrupts neural communication and leads to cognitive decline.
- Amyloid Plaque Accumulation:
- In Alzheimer’s disease, the most common cause of dementia, abnormal accumulation of beta-amyloid plaques occurs in the brain. These plaques disrupt neuronal function and contribute to neurodegeneration.
- Neurofibrillary Tangle Formation:
- Alzheimer’s disease is also associated with the formation of neurofibrillary tangles inside neurons, primarily consisting of tau protein. These tangles further impair neuronal structure and function.
- Loss of Neurotransmitters:
- Dementia is often linked to a reduction in neurotransmitters, such as acetylcholine, which play a crucial role in neuronal communication. The loss of these neurotransmitters contributes to cognitive and behavioral symptoms.
- Vascular Changes:
- Vascular dementia, another common form of dementia, is associated with changes in blood vessels that supply the brain. Vascular damage, often due to strokes or small vessel disease, can lead to cognitive impairment.
Etiology of Dementia
- Alzheimer’s Disease:
- Alzheimer’s disease is the most common cause of dementia, accounting for a significant majority of cases. It is characterized by the accumulation of beta-amyloid plaques and neurofibrillary tangles in the brain.
- Vascular Factors:
- Vascular dementia is often linked to vascular factors, such as stroke or small vessel disease, which lead to impaired blood flow to the brain. Vascular changes contribute to cognitive decline.
- Lewy Body Dementia:
- Lewy body dementia is characterized by the presence of abnormal protein deposits (Lewy bodies) in the brain. This form of dementia often presents with a combination of cognitive and motor symptoms.
- Frontotemporal Dementia (FTD):
- Frontotemporal dementia is associated with degeneration of the frontal and temporal lobes of the brain. It manifests in changes in behavior, personality, and language skills.
- Mixed Dementia:
- Some individuals may experience a combination of different types of dementia, referred to as mixed dementia. This can involve a mix of Alzheimer’s disease, vascular dementia, and other contributing factors.
Desired Outcome
- Ensure patient safety
- Determine the patient’s risk for falls or injury due to symptoms related to dementia. Implement appropriate strategies to reduce these risks and keep the patient safe from harm.
- Maintain Quality of Life:
- Ensure the individual with dementia maintains a satisfactory quality of life by focusing on interventions that address physical, emotional, and social well-being.
- Preserve Functional Independence:
- Aim to preserve and support the individual’s functional independence for as long as possible. Implement strategies to assist with activities of daily living and maintain a sense of autonomy.
- Manage Behavioral Symptoms:
- Effectively manage and reduce behavioral symptoms associated with dementia, such as agitation and aggression, to enhance the individual’s comfort and minimize distress.
- Facilitate Meaningful Engagement:
- Promote engagement in meaningful activities and social interactions to provide cognitive stimulation and emotional connection, contributing to an improved sense of purpose and fulfillment.
- Provide Support for Caregivers:
- Offer support and education to caregivers, including family members and healthcare professionals, to enhance their ability to provide compassionate care, manage challenges, and maintain their well-being.
Subjective Data for Dementia Assessment:
- Memory Complaints
- Cognitive Challenges
- Communication Issues
- Mood and Emotions
- Daily Functioning
- Sleep Disturbances
- Social Withdrawal
- Safety Concerns
- Impact on Daily Life
Objective Data for Dementia Assessment:
- Cognitive Screening Tests
- Neurological Examination
- Functional Abilities
- Speech and Language Evaluation
- Mood and Behavior Observation
- Gait and Mobility Assessment
- Physical Health Monitoring
- Laboratory and Imaging Tests
Nursing Assessment for Dementia:
- Comprehensive Health History:
- Obtain a detailed health history, including past medical conditions, medications, surgeries, and family history of cognitive disorders.
- Cognitive Functioning:
- Perform cognitive assessments using standardized tools to evaluate memory, orientation, attention, language, and executive function.
- Neurological Examination:
- Conduct a neurological assessment, including examination of reflexes, sensory perception, and coordination, to identify any signs of neurological impairment.
- Functional Abilities:
- Assess the individual’s ability to perform activities of daily living (ADLs), including personal hygiene, dressing, eating, and mobility.
- Speech and Language Evaluation:
- Evaluate speech and language skills, noting any changes in articulation, comprehension, or expression.
- Mood and Behavior Assessment:
- Observe and document mood fluctuations, behavioral changes, and signs of emotional distress, such as depression, anxiety, or agitation.
- Social Functioning:
- Explore the individual’s social interactions, relationships, and participation in social activities to gauge changes in social functioning.
- Safety Evaluation:
- Assess the home environment for safety risks, including potential hazards, wandering tendencies, and the need for modifications to support independence.
- Sleep Patterns:
- Document sleep patterns, including duration, quality, and any disruptions, to address sleep-related concerns.
- Medication Review:
- Review the individual’s current medications, dosages, and potential interactions, considering their impact on cognitive function.
- Collaboration with the Healthcare Team:
- Work collaboratively with other healthcare professionals, such as neurologists, psychiatrists, and occupational therapists, to gather additional insights and coordinate care.
- Family and Caregiver Input:
- Seek input from family members or caregivers regarding changes in behavior, daily functioning, and safety concerns.
- Laboratory and Imaging Tests:
- Order and review relevant laboratory tests and imaging studies to rule out or identify underlying medical conditions contributing to cognitive impairment.
Nursing Interventions for Dementia:
- Cognitive Stimulation Activities:
- Engage the individual in activities that stimulate cognitive function, such as puzzles, memory games, or reminiscence therapy, to maintain mental agility.
- Structured Routine:
- Establish a consistent daily routine, including regular meal times, activities, and rest periods, providing a sense of predictability and reducing confusion.
- Visual and Auditory Aids:
- Use visual cues, labels, and auditory prompts to assist with orientation, navigation, and communication in the environment.
- Memory Aids:
- Implement memory aids, such as calendars, notes, or electronic reminders, to support memory recall for daily tasks and appointments.
- Communication Strategies:
- Use clear and simple language, maintain eye contact, and provide ample time for the individual to process information during communication interactions.
- Environmental Modifications:
- Ensure a safe and clutter-free environment, modifying the living space as needed to prevent falls, enhance navigation, and reduce sensory overstimulation.
- Behavioral Management Techniques:
- Employ behavioral interventions, including redirection, positive reinforcement, and validation therapy, to manage challenging behaviors and enhance emotional well-being.
- Medication Management:
- Collaborate with healthcare providers to manage medications effectively, ensuring the individual’s safety and addressing any behavioral or psychiatric symptoms.
- Nutritional Support:
- Monitor and encourage a balanced diet, addressing any nutritional deficits, and adapting food textures or preferences to promote adequate intake.
- Family and Caregiver Education:
- Provide education and support to family members and caregivers, offering strategies for effective communication, managing behavioral changes, and ensuring the safety of the individual.
- Physical Exercise:
- Encourage regular physical exercise tailored to the individual’s abilities, promoting overall health and well-being.
- Social Engagement:
- Facilitate social interactions and activities, such as group outings, support groups, or participation in community events, to combat social isolation.
- Promotion of Sleep Hygiene:
- Establish a consistent sleep routine, address factors contributing to sleep disturbances, and promote a calming environment to enhance sleep quality.
- Regular Reassessment:
- Continuously reassess the individual’s needs, adjusting interventions as necessary, and collaborating with the healthcare team to optimize care.
Nursing interventions for dementia focus on enhancing the individual’s quality of life, maintaining independence, and providing a supportive environment that addresses their unique needs and challenges.
Evaluation of Dementia Care:
- Cognitive Function Assessment:
- Regularly assess cognitive function using standardized tools to evaluate changes in memory, attention, and problem-solving abilities. Track any progression of cognitive decline.
- Behavioral Symptom Monitoring:
- Monitor and document behavioral symptoms, such as agitation, aggression, or wandering, to assess the effectiveness of interventions and identify patterns or triggers.
- Functional Independence:
- Assess the individual’s ability to perform activities of daily living (ADLs) independently. Evaluate any changes in functional independence and adapt care plans accordingly.
- Engagement in Activities:
- Evaluate the individual’s engagement in meaningful activities and social interactions. Assess the impact of these activities on mood, behavior, and overall well-being.
- Medication Management:
- Review and assess the impact of prescribed medications on symptom management. Monitor for any adverse effects and collaborate with healthcare providers to adjust medications as needed.
- Caregiver Well-Being:
- Assess the well-being of caregivers, including family members and healthcare professionals. Provide support, education, and resources to address caregiver stress and burnout.
- Safety Measures:
- Regularly evaluate the safety measures implemented in the environment to prevent accidents and injuries. Modify safety plans as necessary to ensure the individual’s well-being.
- Interdisciplinary Collaboration:
- Collaborate with the interdisciplinary healthcare team, including physicians, psychologists, occupational therapists, and social workers, to review the overall effectiveness of the care plan and make adjustments based on their expertise.
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Transcript
This is the nursing care plan for dementia. So dementia is the chronic progressive loss of brain function. Dementia primarily affects the ability to learn new information. The most common form of dementia is Alzheimer’s disease. And the second most common is vascular dementia, and that is associated with stroke. The exact cause of Alzheimer’s disease is unknown age, gender, female more than male, and familial history are some of the contributing factors. So some nursing considerations that we want to think of when we’re taking care of these patients, we want to make sure that these patients are safe. So we want to make sure that we initiate any safety precautions. We want to do frequent rounding. If these patients are admitted to the hospital and we also want to make sure that we give the caregiver some education on home safety and care, we also want to provide resources for the caregiver regarding any assistance that they may need for the desired outcome for this patient. And that this patient is going to remain free from injury. And this patient will also maintain adequate nutrition and maintain skin integrity.
So when this patient comes in and presents to us, this patient with dementia, they are going to, more than likely, be accompanied by a caregiver. The caregiver is going to tell us a few things about themselves. The subjective data that we’re going to get from this patient is the first thing we’re going to see is they’re going to have trouble sleeping. This patient tends to want to stay up at night just because their day/night rhythm tends to be off. This patient is forgetful. They may be irritable. They may have poor appetite or no appetite. And when they do eat, they may cough when eating, and this may indicate maybe some type of aspiration.
So when we assess the patient, there are going to be quite a few things that we’re going to be able to see. We’re going to be able to gather some good data just from assessing the patient and spending a little time with them. These things are, the patient may aphasic. And if you don’t know what that is, that’s just a loss of, of the sensory. They’re not going to be able to tell you or communicate, I have some discomfort. I have pain. I’m cold, I’m hot. They may be impulsive. You may notice that these patients are going to have some memory loss. They’re going to be agitated. So there’s going to be some agitation.
And then also they may have a short term memory deficit. There’s going to be some dysphagia or trouble swallowing. And finally, the term as we call sundowning. So sundowning is when the patient gets worse. At night, when the sun goes down, they tend to be more agitated, more impulsive. And we’re going to talk about that in the next couple of slides, we want to perform a good physical assessment. So this is our first nursing intervention to perform an assessment. A full physical and psychosocial assessment should be performed. This is to give us a baseline. We want a baseline. Where is this patient at? At this point, we want to take this time as well to assess the skin for breakdown and to see how advanced the dementia is. We also would like to do a swallow evaluation. These patients are at high risk for aspiration, so increased risk for aspiration. And because they are at increased risk for aspiration, they need a swallow evaluation. The liquids that they drink mainly to be thinking on their food may need to be chopped. So let’s say thin, thicken liquids, or chop food.
This is all to prevent aspiration. The next thing we want to do is assess for evidence of sundowning. Remember, patients with dementia can have an increased confusion at night. It’s important to have extra safety precautions at night, the bed alarm should be placed in non-slip socks. The bed should be placed at its lowest position. And we should also do frequent rounding. It’s very important to round on these patients more often than you would round on your other patients. Because again, these patients are quick, they’re impulsive and they can hurt themselves if not properly monitored. The next thing we want to do is with these patients, we want to assess for changes and self-management so pretty much what this means is we want to look at the patient because as the disease progresses, this patient tends to lose interest. In many things, a personal appearance, eating emulating this patient may become less mobile and develop a risk for skin breakdown, poor nutritional intake. This person is just not interested in food. So poor nutrition for feeding and decreased interest.
Finally, we want to support that caregiver. It is very difficult to take care of a patient with dementia, and at times it could be frustrating. So we need to make sure that we support caregivers. Most caregivers are families, maybe a spouse or a child. It’s very important to make sure that we collaborate with the social worker to provide resources regarding respite care. We want to make sure that we give these caregivers enough information and enough support. Maybe they can do a respite stay, where they have a substitute caregiver come in just for a few hours so they can get away and do something for themselves. We wanted to do support groups where other pertinent information needs to be provided to these caregivers. Let’s take a look at the key points. So the patho behind dementia is that it’s a chronic progressive loss of brain function.
The subjective data that we’re going to gather is we are going to hear that this patient is forgetful. This patient is very forgetful, irritable, and has trouble sleeping. They have a lot of trouble sleeping, some things that we’re going to see when we assess this patient is we’re going to see some aphasia. They may have some memory loss, some agitation, some sundowning, they’re going to be impulsive. What we need to do in the hospital to keep this patient safe; we want to implement some extra safety measures. We want to make sure that this patient, because they’re impulsive, that they are put on a fall risk. We want to do frequent rounding because they tend to sundown at night. We want to also make sure that we are supporting these caregivers. Their caregiver is taking on a huge, huge task. It’s very difficult. So we want to make sure that we provide those resources. We want to make sure we give them information for support groups, and we want to make sure that they have an outlet such as some type of respite care, where they can have a substitute caregiver come in.
We love you guys; go out and be your best self today. And, as always, happy nursing.
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