Cognitive Impairment, Adult
Lazaro, R. Louis: Elsevier. Ongoing medical management to maximize health and well-being for persons living with dementia. The Gerontologist. Cognitive training for people with mild to moderate dementia. Cochrane Database of Systematic Reviews. Differential effects of cognitive training modules in healthy aging and mild cognitive impairment: A comprehensive meta-analysis of randomized controlled trials. Psychology and Aging. Information and communication technology-based assistive technology to compensate for impaired cognition in everyday life: A systematic review.
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Philadelphia: Elsevier Health Sciences. Memory-focused interventions for people with cognitive disorders: A systematic review and meta-analysis of randomized controlled studies. Tai Chi is effective in delaying cognitive decline in older adults with mild cognitive impairment: Evidence from a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine.
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The beneficial effects of mind-body exercises for people with mild cognitive impairment: A systematic review with meta-analysis. Care should always be individualized by adding patient specific information to the Plan of Care.
Alzheimer’s Disease Nursing Care Plan & Management
Also, note if there are problems in articulation. Assessment of the level of orientation and any trigger to confusion and alteration helps in planning for interventions. Orient the patient to his current environment, time, place, and person.
If needed, provide the patient with aids to help him stay oriented, such as television, clocks, and calendars. NOTE: Some facilities may also allow the patient to use mobile phones since these devices can also display time and date. Orientation of the patient to his immediate environment and reality can help ease his confusion and prevent delirium or depression.
Establish a routine for the patient to follow. Include activities such as bathing, grooming, eating, rest, and other cognitive activities as part of the routine. Having a structured and predictable list of activities that the patient can follow helps the patient have fewer episodes of confusion and thought process impairment. It also sets a routine for him to follow while helping him maintain a degree of autonomy in his activities of daily living.
Allow the patient to engage in other activities such as walking, drawing, and reading books and magazines. These activities can help the patient focus more on a sense of reality and normality and the other things that he can do and control.
Allow the patient to wander around or collect other items within acceptable limits. Allowing them to spend their energy on wandering or tinkering with other items within safe and acceptable limits reduces their agitation and stress and increases their feelings of security. Provide the patient positive reinforcement when he behaves within acceptable limits. This helps encourage acceptable behaviors and increases the confidence level of the patient. Provide the patient two options when deciding on something food, activities, colors, and others.
Ensure that he can decide on what he thinks is best and that you are there to support him. Limiting the choices from which he can choose helps reduce confusion. Allowing him to decide for himself increases his sense of security and confidence in his ability to make independent choices. Involve the family in the care plan, letting them know the level of guidance and assistance the patient needs daily, ensuring that independence and optimal levels of functioning are maintained.
Having the family know the care protocols for the patient, its rationale and how it affects overall patient wellbeing. This creates baseline information for patient condition and helps plan for effective care. Assist the family in exploring the possible causes of ineffective coping and what coping techniques they have employed. Giving the family the importance of identifying their own problem helps establish rapport and facilitates better nurse-patient relationships.
Help the family in ascertaining the manifestations of ineffective coping seen among them. Provide guide questions to determine the degree to which these symptoms affect their family dynamics. This allows the family to determine the potential long-term effects of these manifestations upon them. Providing them a guide on gauging its impact on their family dynamics helps stress the importance of addressing these problems immediately.
Allow members of the family to express their thoughts and feelings freely. Provide a safe environment for them to do so, conveying acceptance and willingness of the nurse to listen. When family members can verbalize their thoughts and feelings, the action helps reduce stress and anxiety. Also, allowing them to verbalize may help the nurse find more information that can be useful in planning for interventions.
Proving accurate information and health education about the condition of their loved one allows the other family members to prepare themselves for what is to come. This can also help them to anticipate their responses and actions when discussed symptoms appear. Remind members of the family of the need to maintain their health and social contacts.
This helps relieve feelings of stress, fatigue, and burden from caring for an ailing family member. Meeting with friends or colleagues also helps divert from their usual responsibility in caring for their loved ones.
Refer the family to support groups when needed. Support groups are composed of people who have faced or are facing situations similar to what the family is going through.
By being part of a community with the same situations, family members would feel that they are not alone and may gain insight into ways to handle their loved ones. However, if there are conditions present that help supports the diagnosis, they may be added to the statement.
Nursing Action Rationale Assess the level of impairment the patient is currently suffering, including confusion, speech and cognition problems as well as motor movements This creates baseline information for patient condition and helps plan for effective care. A patient with advanced-stage AD would not assess environmental risks and hazards, which increases their risk for injury.
Involving the family in this step helps the nurse to ensure sustained care of the patient. Provide the patient with a non-stimulating environment, removing causes of excessive noise and other stimuli which can aggravate confusion and agitation. Limiting stimuli that the patient needs to help ease his anxiety, reduce agitation, limit wandering behavior and decrease the risk for injury. Provide relaxing and calming activities when there are indications of starting agitation, restlessness, or anxiety.
Ensure that the patient in the late stages of the disease is monitored regularly and not left unattended. Impairment in judgment and thought processes at the later stages of the disease can cause the patient to wander outside their homes, get lost, or suffer from extreme environmental elements. Having someone to ensure that the patient is in a safe environment promotes safety. Remind the family members to secure potentially harmful items such as knives and sharp objects, corrosive cleaning materials, insecticides, poisonous substances, and even medications under lock and key.
The patient may inadvertently use these items to cause himself harm due to problems in cognition and decision making.
Writing SMART memory goals for a reluctant patient
Vascular Dementia. This type of dementia is caused by significant cerebrovascular disease. The client suffers the equivalent of small strokes caused by arterial hypertension or cerebral emboli or thrombi, which destroy many areas of the brain. The onset of symptoms is more abrupt than in AD and runs a highly variable course, progressing in steps rather than a gradual deterioration.
Dementia due to HIV disease. The immune dysfunction associated with human immunodeficiency virus HIV can lead to brain infections by other organisms. HIV also appears to cause dementia directly. Dementia due to head trauma. The syndrome of symptoms associated with dementia can be brought on by a traumatic head injury.
Dementia due to Lewy Body Disease. Clinically, Lewy Body disease is fairly similar to AD,; however, it tends to progress more rapidly, and there is an earlier appearance of visual hallucinations and parkinsonian features Rabins et al, This disorder is distinctive by the presence of Lewy bodies-eosinophilic inclusion bodies- seen in the cerebral cortex and brainstem Andreasen and Black, This disease is transmitted as a Mendelian dominant gene, and damage occurs in the areas of the basal ganglia and the cerebral cortex.
Pathology occurs from atrophy in the frontal and temporal lobes of the brain. Dementia due to Creutzfeldt-Jakob disease. The clinical presentation is typical of the syndrome of dementia and the course is extremely rapid, with progressive deterioration and death within one year after onset. Dementia due to other general medical conditions. A number of other general medical conditions can cause dementia. Some of these include endocrine conditions, pulmonary disease, hepatic or renal failure, cardiopulmonary insufficiency, fluid and electrolyte imbalancesnutritional deficiencies, frontal or temporal lobe lesions, uncontrolled epilepsycentral nervous system or systemic infections, and other neurological conditions.
Substance-induced Persisting Dementia. This type of dementia is related to the persisting effects of substances such as alcohol, inhalants, sedatives, hypnoticsanxiolytics, other medications, and environmental toxins.
Clinical Manifestations The following symptoms have been identified with the syndrome of dementia: Memory impairment. Impaired ability to learn new information or to recall previously learned information.
Impairment in abstract thinking, judgment, and impulse control. Impairment in language ability, such as difficulty naming objects. In some instances, the individual may not speak at all aphasia. Personality changes are common. Impaired ability to perform motor activities despite intact motor abilities apraxia.
What are the Goals of Alzheimer’s Treatment?
Patient may feel disoriented regarding current place, time, o names of persons they are close with. Because of disorientation, patient with dementia may often wander from one place to another. Delusions are common particularly delusions of persecution. Tools and techniques range from simple colored floor squares to virtual reality treadmills that can present real-world navigation scenarios and incorporate cognitive challenges.
Episodes of care can last up to eight weeks, with one to two hour-long therapy sessions per week. Episodes recur as determined by patient follow-up.
Nurses can make a difference: caring for those living with dementia
Mary S. People with dementia can learn these things. Advertising Policy In an effort to make a clearer connection between exercise and cognitive health, Cleveland Clinic investigator Stephen M. Memantine tends to be prescribed to people with more severe dementia and may be used in combination with the Acetylcholinesterase inhibitors. Memantine also appears to have an effect on agitation, aggression and psychotic symptoms and may have the potential to reduce the need for antipsychotic medication.
As with all medications side effects can occur when taking any of these drugs. Acetycholinesterase Inhibitors can in a minority of cases cause nausea and other side effects including diarrhoea. Fewer side effects are associated with Memantine. All medications come in tablet form and rivastigmine also comes in a slow release patch that can be placed on the skin. All of these medications are expensive.
Accordingly, if prescribed by your GP or specialist, it is advisable to apply for a medical card to offset their cost. In some instances, if refused a medical carc, it might be possible to apply to have your circumstances considered for the long term illness scheme card.
Applications for the long term illness scheme are available from GPs and from local health centres. During CST, The person with dementia is invited to participate in therapeutic sessions with a trained practitioner, skilled in interpersonal communication and dementia care. Each session consists of themed activities designed to engage and stimulate. The initial sessions are generally held twice weekly, beginning with 14 sessions and followed by 24 maintenance sessions.
CST is underpinned by key principles of person centeredness, respect, involvement, inclusion, choice, fun, the use of reminiscence, and of maximising potential and strengthening relationships. Spector et al, It is considered amongst the most popular of all non-pharmacological interventions and can be enjoyed by both people with dementia, their relatives and health service professionals.