Alzhiemer's disease and nursing care

ALZHEIMER’S DISEASE.

                   ALZHIEMER’S DISEASE IS THE MOST COMMON TYPE OF DEMENTIA AMONG OLDER ADULTS. THE TERM DEMENTIA REFERS TO THE LOSS OF MEMORY, REASONING, JUDGEMENT AND LANGUAGE TO SUCH AN EXTENT THAT IT INTERFERES WITH EVERYDAY LIFE.

                   COGNITION REFERS TO THE ACT OF OR PROCESS OF THINKING, PERCIEVING AND LEARNING. DEMENTIA IS THE DISORDER OF COGNITION. IN DEMENTIA COGNITIVE ACTIVITIES LIKE DECISION MAKING, JUDGEMENT, MEMORY, SPATIAL ORIENTATION, THINKING, REASONING AND VERBAL COMMUNICATION GETS IMPAIRED. THE PERSON ALSO EXPERIENCES BEHAVIOURAL CHANGES AND PERSONALITY CHANGES DEPENDING ON THE AREAS OF THE BRAIN AFFECTED.

ETIOLOGY AND RISK FACTORS:

·         THE EXACT CAUSE IS UNKNOWN.

          THE RISK FACTORS MAY BE,

·         INCREASING AGE.

·         GENETIC FACTORS.

·         INFLAMMATION.

·         STROKE.

·         OXIDATIVE DAMAGE.

PATHOPHYSIOLOGY:

        IN ALZHEIMER’S DISEASE THE CHANGES SEEN THE BRAIN ARE DEVELOPMENT OF BETA AMYLOID PLAQUES AROUND THE NERVE FIBRES AND NEURUFIBRILLARY TANGLES.

BETA AMYLOID IS A PROTIEN SUBSTANCE. IT IS A PRODUCT OF DEGENERATING NERVE FIBRES. IN ALZHEIMER’S DISEASE THE NERVE FIBRES UNDERGO DEGENERATIVE CHANGES LEADING TO FORMATION AND ACCUMULATION OF THEIS PROTIEN AROUND THE NERVE FIBRES AND ALSO CAUSING NERVE FIBRE TANGLES.

PATIENTS SUFFERING FROM ALZHIEMER’S ALSO SHOW THE DECREAS IN THE NEUROTRANSMITTER ACETYLCHOLINE.

THE DEVELOPMENT OF PLAQUES IS FIRST SEEN ON THE HIPPOCAMPUS, THE AREA OF THE BRAIN WHICH STORES MEMORY. THUS THE INITIAL SYMPTOMS OF ALZHEIMER’S DISEASE IS MEMORY IMPAIRMENT.

CLINICAL MANIFESTATIONS:

·         MEMORY DISTURBANCE

·         POOR JUDGEMENT AND PROBLEM SOLVING SKILLS

·         CONFUSION EVEN IN DAILY ACTIVITIES AND PATIEMT USUALLY FORGETS WHERE HE IS AND WHAT HE IS DOING.

·         THE PATIENT BECOMES IRRITABLE, SUSPICIOUS OR INDIFFERENT.

·         AGITATION.

·         LANGUAGE DISTURBANCE.

·         PARAPHASIAS (WORDS USED IN WRONG CONTEXT)

·         PALILALIA – REPEATING WORDS OR PHRASES JUST SPOKEN BY HIMSELF.

·         ECHOLALIA-REPEATING WORDS OR PHRASES SPOKEN BY OTHERS.

·         APRAXIA

·         HYPERORALITY- DESIRE TO TAKE EVERYTHING INTO MOUTH TO CHEW OR TASTE.

·         DIFFICULTY IN SWALLOWING.

·         DEPRESSION.

·         PERSON FEARS PERSONAL HARM, THEFT OF PROPERTY OR INFEDILITY OF THE SPOUSE.

·         DELUSIONS

·         WANDERING AT NIGHT.

·         FAILURE TO RECOGNIZE FAMILY AND FRIENDS AND TOTAL CESSATION OF COMMUNICATION.

·         MINIMAL VOLUNTARY MOVEMENT AND RIGIDITY OF LIMBS.

·         URINARY AND FECAL INCONTINENCE.

·         ASPIRATION.

DIAGNOSTIC EVALUATION:

·         THERE IS NO DEFINITIVE TEST FOR ALZHEIMER’S DISEASE. THE DIAGNOSIS IS MADE BY OBSERVATION OF SIGNS AND SYMPTOMS AND AN EXAMINATION OF THE COGNITIVE FUNCTION.

·         COMPUTED TOMOGRAPHY

·         MRI.

·         POSITRON EMISSION TOMOGRAPHY.

MEDICAL MANAGEMENT:

SEVERAL MEDICATIONS ARE AVAILABLE TO CONTROL THE SYMPTOMS OF ALZHEIMER’S DISEASE ALTHOUGH THERE IS NO CURE FOR IT.

DONEPEZIL, TACRINE TO RETAIN ACETYLCHOLINE.

VITAMIN E IS PROVED TO BE EFFECTIVE IN DELAYING THE DEVELOPMENT OF ALZHEIMER’S DISEASE.

NURSING MANAGEMENT:

1.      IMPAIRED VERBAL COMMUNICATION RELATED TO NEURONAL DEGENERATION.

·         DECREASE THE ENVIRONMENTAL STIMULI.

·         APPROACH THE CLIENT CALMLY AND WITH ASSURANCE.

·         DO NOT PLACE ANY DEMANDS IN FRONT OF THE PATIENT.

·         GENTLY DISTRACT THE PATIENT FROM THE TOPIC IF HE STARTS GETTING AGITATED OR DEPRESSED.

·         USE MULTIPLE SENSORY MODALITIES.

2.      DISTURBED THOUGHT PROCESS RELATED TO NEURONAL DEGENERATION.

·         APPLY INTERVENTIONS TO ENHANCE MEMORY.

·         REORIENT THE CLIENT AS PER NECESSITY.

·         REPETATION IS USEFUL FOR RETAINING THE MEMORY.

3.      RISK FOR INJURY RELATED TO FORGETFULNESS, IMPAIRED JUDGEMENT AND MOTOR IMPAIRMENTS.

·         ENSURE THE CLIENTS CANNOT LEAVE THE PREMISES WITHOUT BEING NOTICED.

·         THE CLIENT SHOULD AN IDENTIFICATION BADGE.

·         CLIENT SHOULD NOT BE ALLOWED TO DO DANGEROUS ACTIVITIES LIKE COOKING, DRIVING WITHOUT SUPERVISION.

4.      SELF CARE DEFICIT RELATED TO LOSS OF MEMORY.

·         AS FAR AS POSSIBLE PROMOTR INDEPENDENCE FOR CLIENT’S SELF CARE ACTIVITIES AS IT WILL PROMOTE HIS CONFIDENCE.

·         GIVE THE CLIENT ENOUGH TIME TO COMPLETE THE TASK.

·         CONSTANTLY REMINDING AND ENCOURAGING IS ALSO REQUIRED.

·         CLIENT MAY REQUIRE SOME ASSISTANCE WHICH SHOULD BE GIVEN TO THE CLIENT.

5.      URINARY INCONTINENCE RELATED TO NEURONAL DEGENERATION.

·         SCHEDULED VOIDING AND DEFECATION TIME.

·         FLUID INTAKE AFTER DINNER CAN BE RESTRICTED.

·         THE CLIENT MAY FORGET WHERE THE TOILET OR BATHROOM IS. HE MAY REQUIRE ASSISTANCE.