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Alzheimer's disease is a progressive degenerative disorder of the cerebral cortex that accounts

for more than half of all cases of dementia. An estimated 5% of people older than age 65 have a
severe form of this disease, and 12% suffer from mild to moderate dementia. Alzheimer's
disease 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.

Causes For Alzheimer's Disease


The cause of Alzheimer's disease is unknown, The amyloid cascade hypothesis is the most
widely discussed and researched hypothesis about the cause of Alzheimer's disease. The
strongest data supporting the amyloid cascade hypothesis comes from the study of early-onset
inherited (genetic) Alzheimer's disease. Mutations associated with Alzheimer's disease have
been found in about half of the patients with early-onset disease. In all of these patients, the
mutation leads to excess production in the brain of a specific form of a small protein fragment
called ABeta (Aβ).
The cause of Alzheimer's disease is unknown, risk factors for alzheimer's disease:

• Neurochemical risk factors for Alzheimer’s disease, such as deficiencies of the


neurotransmitters acetylcholine, somatostatin, substance P, and norepinephrine
• Environmental risk factors for Alzheimer’s disease, such as aluminum and manganese;
trauma;
• Genetic immunologic factors, autosomal dominant form of Alzheimer's disease
associated with early onset and early death; this form accounts for about 100,000 deaths
per year. A family history of Alzheimer's disease and the presence of Down syndrome are
two established
• Viral risk factors for Alzheimer’s disease such as slow-growing central nervous system
viruses.

Complications For Alzheimer's Disease


• Complications of Alzheimer's disease include injury from own violent behavior or
wandering or unsupervised activity;
• Pneumonia and other infections
• Some time patient with Alzheimer's Disease refuses or forgets to eat; malnutrition and
dehydration
• Aspiration.

Nursing Assessment Nursing Care Plans for Alzheimer's Disease


The onset of this disorder is insidious the initial changes are almost imperceptible but gradually
progress:

• Patient history shows very small changes, such as forgetfulness and subtle memory loss
without loss of social skills and behavior patterns.
• Over time the patient began experiencing recent memory loss and had difficulty learning
and remembering..
• General deterioration in personal hygiene and appearance and an inability to concentrate.
• Difficulty with abstract thinking and activities that require judgment;
• Progressive difficulty in communicating; and a severe deterioration of memory, language,
and motor function that in the more severe cases finally results in coordination loss and
an inability to speak or write.
• Repetitive actions and experience restlessness;
• Negative personality changes e.g. Irritability, depression, paranoia, hostility, and
combativeness, nocturnal awakening, disorientation.
• Suspicious and fearful of imaginary people and situations
• Misperceives his environment
• Misidentifies objects and people
• Difficulty using correct words, possibly even substituting meaningless words. He may
report that conversations with the patient drift off into nonsensical phrases. The patient's
• Labile Emotions

Neurologic examination

• Impaired sense of smell


• Impaired stereo gnosis
• Gait disorders,
• Tremors
• Loss of recent memory.
• Positive snout reflex.

10 classic signs of Alzheimer's disease:

1. Memory loss
2. Disorientation to time and place
3. Difficulty performing familiar tasks
4. Problems with language
5. Poor or decreased judgment,
6. Problems with abstract thinking
7. Misplacing things
8. Changes in mood or behavior
9. Changes in personality
10. Loss of initiative.

Alzheimer's disease test Diagnostic

• Position emission tomography


• Computed tomography scanning
• EEG
• Cerebrospinal fluid analysis
• Cerebral blood flow studies may detect abnormalities in blood flow to the brain.
• Neuropsychologic

Alzheimer’s disease therapy and Treatment


No definitive cure or treatment for Alzheimer's disease. Only focuses on attempting to slow
progression of the Alzheimer’s disease, managing behavioral problems, implementing
modifications of the home environment, and family support.

Nursing diagnoses Nursing Care Plans for Alzheimer's Disease

• Bathing or hygiene self-care deficit


• Constipation
• Disturbed thought processes
• Dressing or grooming self-care deficit
• Feeding self-care deficit
• Imbalanced nutrition: Less than body requirements
• Impaired verbal communication
• Ineffective coping
• Risk for infection
• Toileting self-care deficit
• Disabled family coping
• Interrupted family processes
• Risk for injury

Suggested NOC Labels

• Cognitive Ability
• Distorted Thought Control
• Safety Behavior: Personal
• Mood Equilibrium

NIC Interventions (Nursing Interventions Classification)

Suggested NIC Labels

• Delusion Management
• Dementia Management
• Presence
• Behavior Management

NANDA Definition: Disruption in cognitive operations and activities

Cognitive processes include those mental processes by which knowledge is acquired. These
mental processes include reality orientation, comprehension, awareness, and judgment. A
disruption in these mental processes may lead to inaccurate interpretations of the environment
and may result in an inability to evaluate reality accurately. Alterations in thought processes are
not limited to any one age group, gender, or clinical problem. The nurse may encounter the
patient with a thought disorder in the hospital or community, but patients with significant
thought disorders are likely to be hospitalized or housed in extended care facilities until their
symptoms can be reduced sufficiently for them to be safe in a community setting. Wherever the
patient is encountered, the nurse is responsible for effecting a treatment plan that responds to the
specific needs of the patient for structure and safety, as well as effective treatment for the
presenting symptoms. This care plan discusses management in the acute phase of the disorder for
the hospitalized patient.

Defining Characteristics:

• Disorientation to one or more of the following: time, person, place, situation


• Altered behavioral patterns (e.g., regression, poor impulse control)
• Altered mood states (e.g., lability, hostility, irritability, inappropriate affect)
• Impaired ability to perform self-maintenance activities (e.g., grooming, hygiene, food and
fluid intake)
• Altered sleep patterns
• Altered perceptions of surrounding stimuli caused by impairment in the following
cognitive processes:
o Memory
o Judgment
o Comprehension
o Concentration
• Ability to reason, problem solve, calculate, and conceptualize
• Altered perceptions of surrounding stimuli caused by hallucinations, delusions,
confabulation, and ideas of reference
Related Factors:

• Organic mental disorders (non-substance-induced):


o Dementia
o Primary degenerative (e.g., Alzheimer’s disease, Pick’s disease)
o Multi-infarct (e.g. cerebral arteriosclerosis)
• Organic mental disorders associated with other physical disorders:
o Huntington’s chorea
o Multiple sclerosis
o Parkinson’s disease
o Cerebral hypoxia
o Hypertension
o Hepatic disease
o Epilepsy
o Adrenal, thyroid, or parathyroid disorders
o Head trauma
o Central nervous system (CNS) infections (e.g., encephalitis, syphilis, meningitis)
o Intracranial lesions (benign or malignant)
o Sleep deprivation
• Organic mental disorders (substance-induced):
o Organic mental disorders attributed to the ingestion of alcohol (e.g., alcohol
withdrawal; dementia associated with alcoholism)
o Organic mental disorders attributed to the ingestion of drugs or mood-altering
substances
• Schizophrenic disorders
• Personality disorders in which there is evidence of altered thought processes
• Affective disorders in which there is evidence of altered thought processes

Expected Outcomes

• Patient experiences reduced disorientation to time, place, person, and situation.


• Patient interacts with others appropriately.
• Patient is assisted in assuming self-care responsibilities to the limits of his or her ability.

Ongoing Assessment

• Assess degree of disorientation to time, place, person, and situation regularly and
frequently. This will determine the amount of reorientation and intervention the patient
will need to evaluate reality accurately.

Therapeutic Interventions

• Orient to surroundings and reality as needed:


o Use patient’s name when speaking to him or her. This decreases chances for
misinterpretation.
o Speak slowly and clearly. Present information in a matter-of-fact manner.
o Refer to the time of day, date, and recent events in your interactions with the
patient. Encourage patient to check calendar and clock often to get oriented to
time.
o Encourage patient to have familiar personal belongings in his or her environment.
These decrease the sense of alienation patient may feel in an environment that is
strange. Familiar personal possessions increase the patient’s comfort level.
o Be matter-of-fact and respectful when correcting patient’s misperceptions of
reality.

Orientation to one’s environment increases one’s ability to trust others. Increased


orientation ensures a greater degree of safety for the patient.

• Use the words "you" and "I," instead of "we." This increases orientation and
encourages patient to maintain his or her sense of separateness and personal boundary.

Nursing Diagnosis: Disturbed Thought Processes - Disorientation


Confusion; Disorientation; Inappropriate Social Behavior; Altered Mood States;
Delusions; Impaired Cognitive Processes
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Cognitive Ability
* Distorted Thought Control
* Safety Behavior: Personal
* Mood Equilibrium

NIC Interventions (Nursing Interventions Classification)


Suggested NIC Labels

* Delusion Management
* Dementia Management
* Presence
* Behavior Management

NANDA Definition: Disruption in cognitive operations and activities

Cognitive processes include those mental processes by which knowledge is


acquired. These mental processes include reality orientation, comprehension,
awareness, and judgment. A disruption in these mental processes may lead to
inaccurate interpretations of the environment and may result in an inability to
evaluate reality accurately. Alterations in thought processes are not limited to any
one age group, gender, or clinical problem. The nurse may encounter the patient
with a thought disorder in the hospital or community, but patients with significant
thought disorders are likely to be hospitalized or housed in extended care facilities
until their symptoms can be reduced sufficiently for them to be safe in a community
setting. Wherever the patient is encountered, the nurse is responsible for effecting
a treatment plan that responds to the specific needs of the patient for structure and
safety, as well as effective treatment for the presenting symptoms. This care plan
discusses management in the acute phase of the disorder for the hospitalized
patient.

* Defining Characteristics: Disorientation to one or more of the following: time,


person, place, situation
* Altered behavioral patterns (e.g., regression, poor impulse control)
* Altered mood states (e.g., lability, hostility, irritability, inappropriate affect)
* Impaired ability to perform self-maintenance activities (e.g., grooming, hygiene,
food and fluid intake)
* Altered sleep patterns
* Altered perceptions of surrounding stimuli caused by impairment in the following
cognitive processes:
o Memory
o Judgment
o Comprehension
o Concentration
* Ability to reason, problem solve, calculate, and conceptualize
* Altered perceptions of surrounding stimuli caused by hallucinations, delusions,
confabulation, and ideas of reference

* Related Factors: Organic mental disorders (non-substance-induced):


o Dementia
o Primary degenerative (e.g., Alzheimer’s disease, Pick’s disease)
o Multi-infarct (e.g. cerebral arteriosclerosis)
* Organic mental disorders associated with other physical disorders:
o Huntington’s chorea
o Multiple sclerosis
o Parkinson’s disease
o Cerebral hypoxia
o Hypertension
o Hepatic disease
o Epilepsy
o Adrenal, thyroid, or parathyroid disorders
o Head trauma
o Central nervous system (CNS) infections (e.g., encephalitis, syphilis, meningitis)
o Intracranial lesions (benign or malignant)
o Sleep deprivation
* Organic mental disorders (substance-induced):
o Organic mental disorders attributed to the ingestion of alcohol (e.g., alcohol
withdrawal; dementia associated with alcoholism)
o Organic mental disorders attributed to the ingestion of drugs or mood-altering
substances
* Schizophrenic disorders
* Personality disorders in which there is evidence of altered thought processes
* Affective disorders in which there is evidence of altered thought processes

* Expected Outcomes Patient experiences reduced disorientation to time, place,


person, and situation.
* Patient interacts with others appropriately.
* Patient is assisted in assuming self-care responsibilities to the limits of his or her
ability.

Ongoing Assessment

* Assess degree of disorientation to time, place, person, and situation regularly and
frequently. This will determine the amount of reorientation and intervention the
patient will need to evaluate reality accurately.

Therapeutic Interventions

* Orient to surroundings and reality as needed:


o Use patient’s name when speaking to him or her. This decreases chances for
misinterpretation.
o Speak slowly and clearly. Present information in a matter-of-fact manner.
o Refer to the time of day, date, and recent events in your interactions with the
patient. Encourage patient to check calendar and clock often to get oriented to
time.
o Encourage patient to have familiar personal belongings in his or her environment.
These decrease the sense of alienation patient may feel in an environment that is
strange. Familiar personal possessions increase the patient’s comfort level.
o Be matter-of-fact and respectful when correcting patient’s misperceptions of
reality.
Orientation to one’s environment increases one’s ability to trust others. Increased
orientation ensures a greater degree of safety for the patient.
* Use the words "you" and "I," instead of "we." This increases orientation and
encourages patient to maintain his or her sense of separateness and personal
boundary.