Comprehensive Assessment of Dementia - Essay Example

Comprehensive Assessment of Dementia Very few types of dementia are treatable, which means that the disease can only be managed by controlling its cognitive and behavioural symptoms. This case study describes a comprehensive assessment of a patient, discusses an intervention plan, and gives an overview of other factors that a registered nurse, who is a team leader, should consider. Dementia requires interventions that target its symptoms since the disease cannot be cured; these interventions reduce the patients’ suffering, improve the quality of life, and slow down the rate of development of the disease (Boustani et al., 2003). In order to develop an effective care plan for the patient, the following must be determined about the patient: Presenting Problem The nurse would collect information on the patient’s dementia, including signs and symptoms of the disease. Moreover, the nurse should identify the aspects of the patient’s life that have been affected by dementia (Smith and Buckwalter, 2005). History Information about the events prior to the dementia, and any records that may lead to a clear picture of underlying factors should be collected. For instance, these records would help to point out if the cause of the dementia is a factor that can be controlled or if the situation cannot be reversed (Nhs.uk, 2010). Medical Status This would indicate if the patient has had any prior treatment for the condition, and if the condition has been improving, deteriorating, or has not been affected by the treatment. This would enable the nurse to decide if the patient needs alternative medication or needs to first complete the current regimen. Routine tests like haematology, thyroid function tests, biochemistry tests and serology should be used as indicators of physiological causes and results of the condition. Specific tests like memory assessment should point out the exact condition of the patient based on tests that indicate current body function; these tests include AMTS, MMSC, 3MS, and CASI (Teng and Chui, 2007). Day-to-Day Functioning This analysis helps to determine if the patient needs further supportive care in addition to medication, or medication is enough to get the patient to live independently and productively. For instance, the patient should be assessed for inconsistencies in cognitive function including poor judgment, memory lapses and loss of reasoning capacity (Gleason, 2003). Support A patient needs support from family and friends, religious and community groups, and from social care service institutions. The nurse has to determine if these stakeholders support the patient as is necessary to aid in the dementia control efforts (Shub and Kunik, 2009). The nurse can then incorporate participation of family and friends in order to accelerate and improve the efficiency and effectiveness of intervention measures. Evidence of Abuse or Neglect The patient should be assessed for any evidence of mistreatment, including identification of the nature of the mistreatment, if possible (Karlawish and Clark, 2003). This is important in that the patient is taken to an environment that does not expose them to abuse or neglect, which may worsen the condition. Detailed Care Plan to Guide Jack’s Care Interventions for patients with dementia are focused on three main pathologies of the condition; they include interventions for cognitive disorders, intervention for non-cognitive disorders, and interventions for emotional disorders. One or a combination of these interventions should be used depending on the condition of the patient. Interventions for Cognitive Symptoms These are divided into pharmacological and non-pharmacological interventions; depending on the condition of the patient and underlying functions, the latter are the more recommended of these interventions. Non-pharmacological interventions involve giving the patient a chance to participate in activities to stimulate their cognitive functions regardless of whether there are other interventions; however, it is only suitable for mild-to-moderate dementia cases (Mcgilton et al., 2004). Pharmacological interventions depend on the underlying cause of the dementia; for instance, dementia that results as an Alzheimer’s complication is treated using donepezil, galantamine, rivastigmine and memantine. Acetylcholinesterase inhibitors are the most commonly used pharmacological agents for dementia that is not caused by Alzheimer's disease (Fadil et al., 2009). Interventions for Non-cognitive Symptoms Non-cognitive symptoms include behavioural changes in the patient resulting in sexual dis-inhibition, aggression, wandering, agitation, apathy and shouting. Depending on the level at which this behaviour affects the patients and others around them, the nurse may need to adopt pharmacological, non-pharmacological or combined approaches. Non-pharmacological intervention includes checking the patient for undetected pain, analysis for depression or poor physical health as well as social and environmental factors; these are accompanied by corrective measures to ensure that the environment is suitable for positive development of patient condition. Antipsychotics and acetylcholinesterase inhibitors are used for non-cognitive symptoms if the symptoms can be traced back to cognitive causes (Cullen et al., 2007). Interventions for Comorbid Emotional Disorders The patient should be analyzed for dementia-related anxiety and/or depression, and psychosocial and pharmacological corrective measures taken by the nurse in charge of the patient. Psychosocial interventions include cognitive behavioural therapy practices like animal-assisted therapy, exercise, multisensory stimulation and reminiscence therapy (Calleo and Stanley, 2008). Before using pharmacological agents on patients, the risks of using the drugs should be weighed against the benefits, and if the latter outweigh the former, the nurse should administer antidepressants as necessary. Since cognition may suffer adversely from anticholinergic drugs, these drugs should be avoided at all times, unless other drugs do not show improvement in the patient’s condition. The nurse should ensure that the patient adheres to the provisions of the treatment regimen, as the effects of the drugs may be hampered by an inconsistence schedule of administration. Side effects of the drugs, including during and after administration should be explained and action taken to minimize chances of patient suffering. Other Issues to be considered Causes and Types of Dementia The treatment and management of each dementia case depends on the cause of the condition as they affect the body in different ways. For instance, the nurse should work with team members to differentiate between dementia resulting from Alzheimer's, vascular dementia, dementia with Lewy bodies, and frontal-temporal dementia (Webmd.com, 2012). The most common form of dementia is Alzheimer's dementia, and is one of the true dementias; meaning that once the condition commences, it cannot be reversed and patient condition deteriorates progressively. One common cause of dementia is nutritional deficiencies; if these deficiencies can be supplemented, the patient condition may improve with time. Diseases like Huntington’s, Parkinson’s, and Alzheimer's result in death of brain neurons, which results in deterioration of the patient’s cognitive function and eventually dementia. Stroke and other conditions that reduce the efficiency of blood vessels cause dementia if the shortage of nutrients and oxygen affects the brain. Hydrocephalus, head injury and diseases of other organs may also result in dementia. Therefore, the head nurse should know which dementia the patient is suffering from in order to decide the most effective intervention for the patient. Motivation of Group Members Dementia patients are the hardest to deal with, especially since they are most of the times adamant despite their loss of cognitive function. Moreover, their disinhibition in their thoughts and actions may cause physical and psychological injury to nurses (Gelder, Mayou and Geddes, 2005). Therefore, the head nurse must ensure that group members remain motivated for the sake of the parents; nurses who have suffered physical or psychological trauma should be taken for treatment and counselling respectively. Another approach would be to engage group members in social activities to strengthen the bonds among them and promote teamwork, which is the only way to reduce the work of dealing with the most difficult of patients. Patient Discomfort Dementia is commonly accompanied by severe pain, and side effects of drugs among other pathologies, most of which can result in discomfort of the patient that is already sick. Moreover, as the disease progresses, patients lose the ability to express their needs, wants, and feelings (Fleisher et al., 2007). This means that some conditions like hunger, thirst and pain may go unnoticed and the patient suffers in silence. It is pertinent that nurses possess the skills, talents and knowledge necessary to derive information from the patients by use of non-verbal signals like flinching and others. Requirements for Nurses According to Bear, Connors and Paradiso (2007), the nurses dealing with patients of dementia must possess some characteristics that enable them to work with patients who cannot explain what they want, are rude or outright obnoxious due to the conditions of their brains. Firstly, these nurses must be tolerant, such that they can ensure that a patient is well taken care of despite a negative attitude and actions from the patient. Secondly, nurses should be compassionate, such that they can feel when a patient is suffering and take the necessary measures to reverse the situation. Thirdly, nurses should understand that dementia patients may be irrational sometimes, and thus should not take their words and actions personally. Finally, nurses should have the knowledge and experience to deal with patients of dementia; this is necessary when one has to make decisions on incidences that were not included in the intervention plan. Therefore, the head nurse should evaluate team members to ensure that they have what it takes to work in a department dealing with patients of dementia. Conclusion In the assessment of dementia, a nurse should assess the condition as it is in the present, its history of development, effects of condition on day-to-day functioning, support from significant others, and evidence of abuse and neglect. Interventions include pharmacological and non-pharmacological agents for cognitive, non-cognitive and emotional disorders. 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