Thursday, May 7, 2009

Nursing outcomes, interventions and Patient teaching for Alzheimer's disease

Alzheimer's disease (AD) is a slowly progressive disease of the brain that is characterized by impairment of memory and eventually by disturbances in reasoning, planning, language, and perception. Many scientists believe that Alzheimer's disease results from an increase in the production or accumulation of a specific protein (beta-amyloid protein) in the brain that leads to nerve cell death.
Patient will:
  • Perform bathing and hygiene needs.
  • Maintain a regular bowel elimination pattern.
  • Use support systems and develop adequate coping behaviors.
  • Oriented to time, person, place, and situation to the fullest extent possible.
  • Perform dressing and grooming needs within the confines of the disease process.
  • Consume daily calorie requirements.
  • Show no signs of malnutrition.
  • Effectively communicate needs verbally or through the use of alternative means of communication.
  • Use support systems and develop adequate coping behaviors.
  • Free from signs and symptoms of infection.
  • Perform toileting needs within the confines of the disease process.

Nursing interventions for patient Alzheimer's disease
  • Establish an effective communication system with the patient and his family to help them adjust to the patient's altered cognitive abilities.
  • Provide emotional support to the patient and his family. Encourage them to talk about their concerns. Listen carefully to them, and answer their questions honestly and completely.
  • Because the patient may misperceive his environment, use a soft tone and a slow, calm manner when speaking to him.
  • Allow the patient sufficient time to answer your questions because his thought processes are slow, impairing his ability to communicate verbally.
  • Administer ordered medications to the patient and note their effects.
  • If the patient has trouble swallowing, check with a pharmacist to see if tablets can be crushed or capsules can be opened and mixed with a semi-soft food.
  • Protect the patient from injury by providing a safe, structured environment. Provide rest periods between activities because these patients tire easily.
  • Encourage the patient to exercise, as ordered, to help maintain mobility.
  • Encourage patient independence, and allow ample time for the patient to perform tasks.
  • Encourage sufficient fluid intake and adequate nutrition. Provide assistance with menu selection, and allow the patient to feed himself as much as he can. Provide a well-balanced diet with adequate fiber. Avoid stimulants, such as coffee, tea, cola, and chocolate. Give the patient semisolid foods if he has dysphagia. Insert and care for a nasogastric tube or a gastrostomy tube for feeding as ordered.
  • Because the patient may be disoriented or neuromuscular functioning may be impaired, take the patient to the bathroom at least every 2 hours, and make sure he knows the location of the bathroom.
  • Assist the patient with hygiene and dressing as necessary. Many patients with Alzheimer's disease are incapable of performing these tasks.

Family And Patient Teaching For Patient Alzheimer's Disease
  • Teach the patient's family about the disease. Explain that the cause of the disease is unknown. Review the signs and symptoms of the disease with them. Be sure to explain that the disease progresses but at an unpredictable rate and that patients eventually suffer complete memory loss and total physical deterioration. (See Teaching patients about Alzheimer's disease.)
  • Review the diagnostic tests that are to be performed and treatment the patient requires.
  • Advise family members to provide the patient with exercise. Suggest physical activities, such as walking or light housework, that occupy and satisfy the patient.
  • Stress the importance of diet. Instruct family members to limit the number of foods on the patient's plate so he doesn't have to make decisions. If the patient has coordination problems, tell family members to cut his food and to provide finger foods, such as fruit and sandwiches. Suggest using plates with rim guards, easy-grip utensils, and cups with lids and spouts.
  • Encourage family members to allow the patient as much independence as possible while ensuring his and others' safety. Tell them to create a routine for all the patient's activities, which helps them avoid confusion. If the patient becomes belligerent, advise family members to remain calm and try to distract him.
  • Refer family members to support groups such as the Alzheimer's Association. Set up an appointment with the social service department to help family members assess their needs.
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