Alzheimers Coupled with Depression - Term Paper Example

Alzheimer’s Coupled with Depression Name Institution Alzheimer’s Coupled with Depression Introduction Alzheimer’s disease is a brain illness in elderly people aged above 65 years that leads to impaired memory, poor reasoning and judgment skills, social withdrawal, isolation, and mood and behaviors changes (Wilson et al., 2010). It is caused by the protein tangles and plaques which build up around and in the nerve cells in brain that eventually cause the cells death. Depression is the common most psychiatric symptom of Alzheimer’s disease since an elderly person suffering from depression has double the risk of developing Alzheimer’s disease[Len11]. Other causes of this condition include the thyroid disease, infections and drug interactions. This paper will discuss into the details the assessment, nursing care, treatment, management of a male client 82 years recently admitted with a diagnosis of Alzheimer’s coupled with depression. Assessment The aim of the assessment is to find out what the client needs, the circumstances he is in and the support that he needs to improve the quality of his life. The assessment will fully involve the client and the caregiver or a family member so that he or she can help in evaluating the client’s condition and also his or her well-being. There will be also a combination of tests to be computed with an aim to understand the actual effectiveness of the treatment that can be quickly be administered by a clinician. There will simultaneously numerous assessments that will include the client’s history of the present disease, a review of the client medical history, a physical examination, laboratory tests and a cognitive screening test (Conn & Thorpe, 2007). To assess the client’s history of the present condition, the doctor will ask some questions to the client and the primary caregiver. The client will answer the question about the memory problems and other signs and symptoms that are related to the Alzheimer’s. The doctor will also ask some questions that may help to screen for depression and any other psychiatric issue. The caregiver will be asked questions such as; What are some of the symptoms he or she has noticed? When did the symptoms start? How regularly do the symptoms happen? And How worse do they get? A review of client medical history will consist of the past illnesses and medications. The doctor will ask about some of the key medical condition affecting the other client family members and relatives. The doctor will also ask the client if they may have had the current client’s conditions. The doctor will in addition review and ask some questions related to the current medications the client may be taking, ask about client’s health habits, nutrition and diet, exercise, and social status (Gallagher et al., 2008). The laboratory tests and the physical examination of the client will help to identify the health issues which caused the symptoms of the current conditions and his overall health. Physical examination will include checking his blood pressure, weight, temperature, listening to the lungs and heart pulse and a visual inspection (Conn & Thorpe, 2007). The doctor will perform various laboratory tests that may help to determine the underlying problems that lead to the current client’s condition. This will include the complete blood and glucose count, liver tests, urine tests, and other tests. Finally, the doctor will conduct a cognitive screening test that will include the Mini-Mental State Examination (MMSE), Blessed Information-Memory-Concentration Test (BIMC) and Alzheimer’s disease Assessment Scale, cognitive subsection (ADAS-cog) (Wilson et al., 2010). Nursing Care The nursing care will be conducted by a nurse with an aim of promoting the client’s health, preventing other diseases, and also to help the client cope up with current illness. The following is the nursing care work that the nurse will perform; The nurse will assess, observe and record the symptoms progress and reactions He or she will assist the physicians during examination and treatment of the client The nurse will manage and develop the nursing care plans, instruct the client and his family for a proper nursing care The nurse will be responsible for providing periodic services to the client as prescribed by the physician and assisting in developing of the treatment plans that will aid in providing a comprehensive care to the client in order to improve the quality of his life (Grober et al., 2008). The nurse will also provide supportive counseling during the treatment phase of the client which will help the client and his family understand better the current client’s condition (Feil, MacLean, & Sultzer, 2007). The nurse will may also help the client to tackle his everyday tasks such as grooming, dressing and the management of the client medications. Treatment In treatment of the client current conditions, the physician will consider the treatment of behavioral and cognitive symptoms separately. These treatments will help in slowing down the progression of the depressed Alzheimer’s disease in few months or even years. Treatment will boost the performance of client’s brain chemicals which are involved in carrying of brain cells information from one to another (Budnitz et al., 2007; Lenze, 2011). This will prevent and decline the death of the brain cells which in turn delay Alzheimer’s progression, improve the symptoms associated to memory loss, reasoning and thinking. The physician will also administer the antidepressants such as fluoxetine (Prozoa), citalopram (celexa), sertraline (zoloft) and the paroxetine (paxil) that have less anticholinergic side effects to treat the depression mood (Arrighi et al., 2010). The treatment can be conducted in 3 to 4 months therapy that will involve the administration of the cholinesterase inhibitors such as Exelon (rivastigmine), Razadyne (galantamine), Aricept (donezepil HCL), Namenda (memantine) and Tacrine (cognex) which will increase the acetylcholine level in the brain to boost the client’s memory, thinking, speaking skills and reasoning (Gallagher et al., 2008). The behavioral symptoms such as the suspicion and agitation will be treated using the anti-anxiety and anti-psychotic medications such as Anxiolytics, Neuroleptics, Antiepileptic drugs, Beta-blockers and the Anti-parkinsonian agents (Herrmann & Lanctot, 2007). The dosage of the drugs will vary starting with a low dosage at the beginning of the treatment and later the dosage will be increased in order to maximize the effectiveness of the drugs the client is taking. For example, Aricept (donezepil HCL) 5 mg tablets can be taken once a day when the treatment starts which will be increased to 10 mg a day may after one month. For Razadyne (galantamine), the client should take 8 mg per day for the first four weeks, 16 mg per day for the next four following weeks and then it should be maintained at 16 – 24 mg per day for the remaining treatment process of the current client’s conditions (Schubert et al., 2008; Lenze, 2011). Starting the dosage at low levels will greatly reduce the chances of the client being affected by the side effects of the drugs during and after the treatment process. The client should also take these drugs together with food since this practice also minimizes the side effects of the drugs especially in Exelon (rivastigmine), Razadyne (galantamine), Aricept (donezepil HCL) and Namenda (memantine) cholinesterase inhibitors[Len11]. Since depressed Alzheimer’s disease is progressive, the client care and treatment plan and symptoms will change now and then as it may be sometime difficult for the doctor if the depressed Alzheimer’s drugs are helping the client[Alz13]. This is because the effects of these drugs are usually modest. However, it is also hard to know and tell the severe of the symptoms without the client medication and hence the doctor will be very keen during the treatment process considering that the client is 82 years old. The doctor will also use non-drug treatments that will involve analyzing of the client’s behavior and being able to identify what might have triggered the behavior. He or she should create a calm environment for the client since excessive noise to the client will increase his agitation. In addition, this old man should be reacted in a calm, reduced tension and controlled manner. The drugs administered to the client may have some few side effects such as nausea, diarrhea and even vomiting but will significantly improve the life of the client after the treatment process (Femia et al., 2007). Management The client will have special needs due to his current conditions and it will be important to have a caregiver for him in order to help him maintain the quality of life and offer the support and love needed for the client to meet the challenges that comes with depressed Alzheimer’s (Gallagher-Thompson & Coon, 2007). The caregiver will also be intended to maximize the client’s functional abilities while providing a compassionate, competent care which respects and acknowledges the clients and his family. The caregiver should be able to overcome the challenges faced by the client by communicating effectively, assisting the client with the ADLs (Activities of Daily Living), planning activities which will help to maintain the well-being of the client while preventing the boredom, and being capable of managing his behavioral problems like the agitation, sleep disturbance and wandering (Grober et al., 2008). The caregiver will have great sensitivity, good judgment, tact, patience, stamina, communication skills and flexibility. For a fundamental care management, the caregiver should: Changes should be made slowly to prepare the client in case of any change in nutrition, medication, location, personnel or therapy. The caregiver should keep the client active as much as possible. He or she should help him to have daily activities that will maintain his emotional and physical function. These activities will be meant to make the client more comfortable (Grossberg et al., 2010; Budson & Solomomn, 2012). The caregiver should make up a routine for the client since he will feel more secure when following an established routine. The communication of the caregiver should be simple and short. He or she should monitor the nutrition and hygiene of the client and his environment in order to reduce the infections risks. The caregiver should maintain the client’s self-esteem by complimenting and praising him for his achievement and by allowing and encouraging him in self-participation in daily activities. The caregiver will also assist the client in attending the basic lie activities such as drinking, bathing, eating and dressing. The caregiver should closely identify the emerging symptoms and reporting them to the doctor before they can become unmanageable. He or she should commend the client’s family efforts and support. The caregiver should reduce the background distractions and noise since these may increase the agitation of the client. The caregiver should prepare the bathroom with correct water temperatures in advance because the client might be frightened by the showers. Conclusion Depressed Alzheimer’s is a progressive chronic disease that leads to impaired memory, poor reasoning and judgment skills, social withdrawal, isolation, and mood changes and behaviors. There should be a thorough assessment of the condition in order to find out the client’s needs, the circumstances he is in and the support that he needs to improve the quality of his life. There should be simultaneously numerous assessments that will include the client’s history of the present disease, a review of the client medical history, a physical examination, laboratory tests and a cognitive screening test. The nursing care is critical since it will promote the client’s health, prevent other diseases infections and also help the client to cope up with the current illness. The treatment of the client will prevent and decline the death of the brain cells which in turn delay Alzheimer’s progression, improve the symptoms associated to memory loss, reasoning and thinking. The physician will also administer the antidepressants such as fluoxetine (Prozoa), citalopram (celexa), sertraline (zoloft) and the paroxetine (paxil) that have less anticholinergic side effects to treat the depression mood. The client will have special needs due to his current conditions and it will be important to a caregiver for him in order to help him maintain the quality of life and offer the support and love needed for the client to meet the challenges that comes with depressed Alzheimer’s. This will maximize the client’s functional abilities and quality of life while providing a compassionate, competent care which respects and acknowledges the clients and his family. References Len11: , (Lenze, 2011), Alz13: , (Alzheimer's Association, 2013), Read More