Alzheimers Disease - Term Paper Example

Alzheimer’s disease of the Nursing of the Concerned 12 January, Alzheimer’s disease Introduction It is really startling to learn that one in eight aged Americans tend to suffer from Alzheimer’s (Alzheimer’s Association, 2012, p. 1). The statistics get really more disturbing when one accepts the fact that Alzheimer’s disease happens to be the sixth major cause leading to death in the United States of America (Alzheimer’s Association, 2012, p. 1). Not to mention that the consequences of managing and care provisions for Alzheimer are even more burdening. In the United States alone the cost of providing care for the Alzheimer patients in the year 2012 stood at dollar 200 billion (Alzheimer’s Association, 2012, p. 1). In fact, Alzheimer’s disease happens to be the most common form of dementia in this nation. Dementia in fact happens to be a large set covering a range of illnesses that involve deterioration of the nerve cells or a loss of their ability to work normally. Alzheimer’s disease is a serious condition that renders the patient incapable of performing the most basic of bodily activities like swallowing and walking. The irony is that Alzheimer’s disease in the long run eventually ends up being fatal. Disease process Though it is a still quiet difficult to explain as to how the Alzheimer’s disease process begins, it would be safe to say that the damage to the nerve cells in this disease begins a decade or more before the actual symptoms begin to appear (Newport & Hirsch, 2011). In the preclinical stage the patients in the Alzheimer’s disease tend to appear normal, however, the toxic alterations and changes in the brain do tend to start much earlier. The disease is characterized by abnormal deposits of proteins leading to the formation of tau tangles and amyloid plaques allover in the brain (Newport & Hirsch, 2011). Thereby the neurons which happened to be early healthier, begin to function in an abnormal manner. In the long run the neurons begin to lose the ability to work and communicate with each other, eventually leading to their death. Gradually the disease spreads to the hippocampus part of the brain, which is the repository of memories (Newport & Hirsch, 2011). With the gradual demise of neurons, the parts of brain proceed to shrink. In the long run the damage grows over to be widespread leading to a significant shrinking of the brain tissue (Newport & Hirsch, 2011). Alzheimer’s disease actually happens to be a progressive brain disease marked by symptoms like memory changes that disrupt normal life, confusions pertaining to time and place, difficulty in accomplishing even the most basic of tasks (Newport & Hirsch, 2011). Nursing assessment Early and accurate assessment can guide towards an early diagnosis and hence timely interventions. Nursing assessment for Alzheimer’s disease is most often clinical and comprises of cognitive assessment. Physical assessment is also mandatory as a part of the holistic management of these patients, given the disease is mostly prevalent in the geriatric population and patients in this age group have multiple comorbidities (Maslow, 2004). The purpose of cognitive assessment is to identify cognitive deficits in memory, language (aphasia), execution of motor activities (apraxia), inability to recognize objects (agnosia), concentration, personality and social changes (Bush, 2007; Boyd, 2004)). Also, assessment strives to differentiate dementia of Alzheimer’s disease with age related cognitive regression and dementia associated with organic disorders such as neurological conditions and vitamin deficiencies. Objective assessment is possible with standardized assessment scales such as Mini-Mental State Assessment Examination (MMSE). MMSE is widely used all over the world for measurement of cognitive function in dementia associated with Alzheimer’s disease as well as to prescribe medications for dementia (Bush, 2007). Its accuracy can be enhanced by combining it with other tests such as geriatric depression scale and clock drawing test (Bush, 2007)). Other than cognitive assessment, comprehensive clinical assessment includes a history of the disease process including the onset and progression of disease, an evaluation of the past and current medication history, a history of substance abuse and evaluation for coexisting medical conditions (Boyd, 2004)). Apart from cognitive, clinical and physical assessment, social and functional assessment is also important. Patient’s perspective and deterioration of his social interactions need to be assessed to plan for his level and venue of care. All these aspects of assessment need to be performed keeping in mind those patients are mostly forgetful and slow to understand and communicate. It is required that patients are approached in a calm, patient and friendly manner. Questions should be asked slowly and clearly and may need to be repeated often. Non verbal forms of communication such as hand gestures and eye contact can be very helpful as the patients may have coexisting hearing and visual impairment (Bush, 2007)). Nursing implications A diagnosis of dementia and Alzheimer’s disease in a patient implies nursing interventions and implications in multiple domains such as social, cognitive, functional, occupational and physical. Boyd (2004) has delineated these biopsychosocial interventions. These interventions are individualized according to the disease severity. The aim is to help the patients in retaining their functional independence and quality of life as much as possible with dementia. Biological implications in nursing care of Alzheimer’s disease are vast and spans areas of nutrition, hydration, sleep, bowel and bladder function, pain management and pharmacological management (Boyd, 2004)). Meals should be regular, easy to digest and well balanced in terms of nutrients, and patients should be assessed routinely for risk of aspiration. In some cases, patients may need to be fed with an orogastric or nasogastric tube. Self water intake may be decreased so patients need to be monitored for signs of dehydration and associated electrolyte imbalance especially hyponatremia which is the most common electrolyte disturbance in these patients. Bowel and bladder care entails avoiding and managing constipation and helping to retain continence by behavioral therapy. Diapering and hygiene maintenance are required in case of loss of bowel and bladder control. Sleep patterns are often irregular and insomnia can be very troublesome for the patients as well as the care givers. Naps are allowed to cope with restlessness associated with awakenings at night time (Boyd, 2004)). Pain management is done by pharmacological means as well as ensuring comfort of the patients. However, any pharmacological management in a dementia patient mandates vigilance and monitoring on the part of the care giver because of non compliance issues. Almost 70% adults with Alzheimer’s disease are cared for at homes. This creates additional strain on their relationship with their partners and other family members because of added responsibilities as caregivers as well as financial issues. Here in, nurses can play an important role by advising relatives on aspects of home care and nursing home care and offering counseling and support to the home caregivers. Patient’s communication with caregivers should be reinforced. Other social implications in nursing care are to maintain simple, uncomplicated routines for patients with minimal distractions. Psychological implications necessitate identification of triggers of anxiety and agitation in the patient and avoiding them. Patient should be detracted from hallucinations and delusions by environmental modification (Boyd, 2004)). Occupational rehabilitation, if possible, is best achieved by appropriate referral to an occupational therapist. Many nursing care models have been developed in accordance with evidence based medicine and can be utilized for optimal nursing care of these patients (Rentz, 2008). Conclusion There is no denying the fact that the stage specific treatment of Alzheimer’s disease does ameliorate the relative quality of life of the patients suffering from it. In that context, proper nursing care of the patients’ plays a significant role in the two basic strategies aimed at treating this disease that are administration of proper medication and the commensurate non drug strategies targeted at minimizing challenges and resolving obstacles in the life of the patients. References Alzheimer’s Association. (2012). 2012 Alzheimer’s Disease Facts and Figures. Retrieved from http://www.alz.org/downloads/facts_figures_2012.pdf Boyd, M.A. (2004). Psychiatric Nursing. New York: Lippincott Williams & Wilkins. Bush, T. (2007). Cognitive Assessment of Older Adults with Alzheimer’s Disease. Retrieved January 12, 2013, from Nursing Times website, www.nursingtimes.net Maslow, K. (2004). Dementia and Serious Coexisting Medical Conditions: A Double Whammy. Nursing Clinics of North America, 39, 561-579. Newport, M.T., & Hirsch, C. (2011). Alzheimer’s Disease. New York: Basic Health Publications. Rentz, C.A. (2008). Alzheimer’s Disease: An Elusive Thief. Nursing Management, 39(6), 33-37. Read More