Alzheimer’s Nursing Diagnosis and Nursing Care Plan

Alzheimer’s Nursing Care Plans Diagnosis and Interventions

Alzheimer’s NCLEX Review and Nursing Care Plans

Alzheimer’s Disease (AD) is an age-related progressive neurodegenerative disorder commonly associated with memory loss and cognitive decline.

This condition is characterized by the loss of neurons and the presence of intracellular neurofibrillary tangles and extracellular amyloid plaques in the brain leading to decline in memory, thinking, behavioral and social skills.

Alzheimer’s disease is the most common cause of dementia in elderly people.

It is estimated that about 24 million people worldwide have Alzheimer’s disease.

Although it is commonly seen in people aged 65 years and above, Alzheimer’s disease can still occur in those younger than 65 years.

Signs and Symptoms of Alzheimer’s Disease

The signs and symptoms of Alzheimer’s disease may be subtly present years before its diagnosis.

Also, the signs and symptoms are more commonly recognized by relatives and friends rather than the patient himself/herself.

Suspicion may arise when the individual start getting short term memory loss.

  1. Memory
    • Repeat statements and questions over and over again
    • Forget special and important events such as appointments and birthdays
    • Often misplaces possessions or stores stuff in odd places
    • Gets lost in what used to be familiar places
    • Forgets names of things or of family members
    • Difficulty finding the words to say or to express self
  2. Thinking and Reasoning
  3. Changes in the ability to concentrate
  4. Reduced ability to work with numbers – this may have an effect in the person’s ability to manage finances, bank affairs, and anything related.
  5. Making judgments and decisions – Symptoms relating to judgments and decision making may become apparent. Examples are the inability to dress depending on what the weather is like or inability to recognize when to turn the stove off when cooking.
  6. Planning and performing familiar tasks – Decline in ability to do activities of daily living will be apparent. The person may lose the ability to shop, to eat, to shower to name a few.
  7. Changes in personality – The person with Alzheimer’s disease may exhibit changes in personality such as being confused at times, having mood swings, delusions, apathy, loss of trust in others, and social withdrawal.

Causes of Alzheimer’s Disease

The exact etiology of Alzheimer’s disease is still unknown.

In early onset Alzheimer’s disease, a genetic mutation has been found to have caused the condition.

However, this mutation may not be present in Alzheimer’s disease in older people.

Research and studies are focused on the hallmark pathological feature of the disease – the plaques and tangles.

  • Intracellular amyloid plaques – These are clumps of fragments of beta-amyloid proteins and other cellular debris. These plaques are believed to have a toxic effect on neurons, and they disrupt cellular communication.
  • Neurofibrillary tangles – neurofibrillary tangles are distorted Tau proteins that is present in people with Alzheimer’s disease. Tau proteins play a role in the transport system of neurons.  

Risk factors that can predispose a person to Alzheimer’s disease include:

  • Age – Alzheimer’s disease is common in people aged 65 years and above
  • Family History and Genetics
  • Down Syndrome
  • Sex – Alzheimer’s disease is recorded to have a slightly higher prevalence in women than in men
  • Mild Cognitive Impairment
  • Head Trauma
  • Air Pollution
  • Excessive alcohol consumption
  • Poor sleep pattern

Complications of Alzheimer’s Disease

  1. Wandering. Wandering is a common complication of Alzheimer’s disease. Due to the changes in their sleep pattern, people with AD may become confuse and restless making them wander around or outside their home. If not monitored properly, people with AD may not find their way back.
  2. Malnutrition and dehydration. AD can affect the ability to maintain proper nutrition and hydration. Complications related to malnutrition and dehydration are quite common with the disease.
  3. Infections. Cognitive decline in patients with AD can also make them susceptible to infections which may range from being mild to severe which may need hospital treatment.
  4. Falls. Changes in learnt skills is common in AD. The loss of sense of direction and inability to recognize walking aids make people with AD at an extremely high risk of falling.
  5. Depression. This is a quite common complication as well in people with AD.

Diagnosis of Alzheimer’s Disease

The signs and symptoms in Alzheimer’s disease are often recognized by friends and family members first.

The following are the common diagnostic procedures to help diagnose Alzheimer’s disease:

  • Physical and Neurologic Exams – A thorough physical and neurologic exam will be completed, focusing on the following:
    • Reflexes
    • Muscle tone and strength
    • Ability to get up and walk
    • Sense of sight and hearing
    • Coordination
    • Balance
  • Blood tests – blood tests may be requested as part of the diagnostic procedure. They are used to rule out other possible causes of the signs and symptoms.
  • Mental status and neuropsychological tests – tests to assess memory and mental status are commonly performed to identify changes and decline in function.
  • Imaging – imaging of the brain is often done in the diagnostic process. Tests may include an MRI or CT scan of the brain. These simple imaging techniques are often used to help rule out other possible causes of the disease. They can also give the doctor a picture of the brain function. In detail, other imaging studies may be performed such as the following:
    • Fluorodeoxyglucose (FDG) PET – which can show the pattern of brain degeneration. It can help distinguish Alzheimer’s disease from other forms of dementia.
    • Amyloid PET – this scan can measure the amyloid deposits in the person’s brain.
    • Tau PET – This type of imaging measures the neurofibrillary tangles in the brain.

Treatment of Alzheimer’s Disease

Treatment options for Alzheimer’s disease are mostly supportive. Although medications are available, they only help manage the progression of the disease.

  1. Medication therapy. The following are the common medications given to patients with AD:
  2. Cholinesterase inhibitors – these drugs are given to people with Alzheimer’s disease as it boosts the communication ability between brain cells.
  3. NMDA Receptor agonist – a certain drug under this drug classification can also be prescribed to manage the progression of Alzheimer’s disease. It is often used in combination with cholinesterase inhibitors in moderate to severe cases of AD.
  4. Supportive management. Modification of the environment will greatly help assist a person with dementia to maintain safety. It may also assist them to remember certain things in the environment. Simplifying tasks by building of a structure and routine is found helpful in people with AD.

Nursing Diagnosis for Alzheimer’s

Nursing Care Plan for Alzheimer’s 1

Nursing Diagnosis: Disturbed Thought Process related to cognitive impairment secondary to Alzheimer’s disease as evidenced by problems with coordination and motor functions, difficulty handling complex tasks, confusion and disorientation, inability to do activities of daily living (ADLs) as normal

Desired Outcome: The patient will be able to maintain appropriate mental and physical functioning as long as possible.

Nursing Interventions for Alzheimer’s DiseaseRationales
Assess the patient’s level of confusion.To monitor effectiveness of treatment and therapy.
Assist the patient performing activities of daily living. Consider one-to-one nursing.To maintain a good quality of life and promote dignity by allowing the patient to perform their ADLs while maintaining safety.
Simplify tasks for the patients by using simple words and instructions. Label the drawers with simple words and big letters and use written notes when necessary.Alzheimer’s disease patients may have difficulty handling complex tasks.  
Provide opportunities for the patient to have meaningful social interaction, but never force any interaction.To prevent feelings of isolation. However, forced interaction can make the patient agitated or hostile due to confusion.
Allow the patient to wander and hoard within acceptable limits and while maintaining patient safety.To prevent agitation and increase the sense of security while allowing the patient to perform activities that are difficult to stop for him/her.    

Nursing Care Plan for Alzheimer’s 2

Nursing Diagnosis: Impaired Physical Mobility related to disease process of AD as evidenced by problems with coordination and motor functions, difficulty handling complex tasks, confusion and disorientation, inability to do activities of daily living (ADLs) as normal

Desired Outcome: The patient will be able to perform activities of daily living within the limits of the disease.

Nursing Interventions for Alzheimer’s DiseaseRationales
Assess the patient’s level of functional mobility and ability to perform ADLs.To assist in creating an accurate diagnosis and monitor effectiveness of treatment and therapy.
Assist the patient during exercises and when performing activities of daily living. Consider one-to-one nursing.To encourage the patient to perform muscle-strengthening exercises and promote dignity by allowing the patient to perform their ADLs while maintaining safety.
Simplify tasks for the patients by using simple words and instructions.Alzheimer’s disease patients may have difficulty handling complex tasks.  
Ensure the safety of the environment. Check that the call bell is within reach, the bed rails are up when the patient is on the bed, the bed is in the lowest level, the room is well-lit, the floor is not slippery, and that important things like phone and eyeglasses are easy to reach.To maintain patient safety and reduce the risk of falls.      
Encourage the patient to perform range of motion (ROM) exercises in all extremities.To improve venous return, muscle strength, and stamina while preventing stiffness and contracture deformation.
Refer to the physiotherapy and occupational therapy team.To provide a specialized care for the patient to gain physical and mental support in performing ADLs and mobilizing.

Nursing Care Plan for Alzheimer’s 3

Nursing Diagnosis: Fatigue related to disease process of AD as evidenced by generalized weakness, tremors, and verbalization of overwhelming tiredness

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

Nursing Interventions for Alzheimer’s DiseaseRationales
Assess the patient’s degree of fatigability by asking to rate his/her fatigue level (mild, moderate, or severe). Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance.
Encourage activity through self-care and exercise as tolerated Alternate periods of physical activity with rest and sleep.    Encourage enough rest and sleep, and provide comfort measures.To help the patient balance his/her physical activity and rest periods.   To reserve energy levels and provide optimal comfort and relaxation.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in balancing daily physical activity and rest periods.

Nursing Care Plan for Alzheimer’s 4

Chronic Confusion

Nursing Diagnosis: Chronic Confusion related to the disease process secondary to Alzheimer’s disease as evidenced by the decreased ability to interpret one’s environment, memory impairment, disorientation, and behavioral changes.

Desired Outcomes:

  • The patient will maintain a stable and safe environment with routine scheduling of activities that will help decrease anxiety and confusion.
  • The patient will be able to show tolerance to stimuli when introduced slowly in a non-threatening manner, with one item at a time.
  • The patient will be able to use techniques to help avoid the stress that may cause him or her aggressive and intimidating behaviors.
  • The family of the patient will be able to utilize the information that will help the family in making decisions for the long-term plans for the patient.
InterventionRationale
1. Provide a consistent schedule for the patient’s daily living activities.Providing a clear and patterned schedule prevents agitation and erratic behaviors that will also help the patient achieve independence and will help the patient maintain dignity and self-worth.
2. Avoid exposing the patient to a situation and topics that are emotionally draining for him or her.Failure of the patient to do tasks and inappropriate conversation and situations may trigger emotional flare-ups in a patient with confusion. It is important to respond to the patient calmly to ensure validation of the patient’s feelings which will help reduce unnecessary stress.
3. Avoid unnecessary sensory distractions and speak in a calm and low voice as much as possible.A patient with Alzheimer’s disease may have an altered ability to respond to stimuli, limiting distractions may prevent mitigating factors that increase the risk of anxiety episodes.  Avoidance of sensory distractions will help decrease the patient’s stress level and will promote a sense of security.
4. Recognize family members and support systems available for the patient.This will help the nurse determine the appropriate person that can assist when caring for the patient. Care from someone familiar will help the patient deal with his or her confusion.
5. Assess the family’s ability to provide care for the patient, especially during confusion episodes.This will help the nurse identify the needs of the family for assistance.
6. Educate the family about the available community services and long-term healthcare facilities that may help in caring for the patient.Caring for a patient with Alzheimer’s disease may require ongoing skilled nursing care that the patient’s family is unable or unwilling to provide.
7. Teach the family about the distraction techniques that may help the patient such as soothing music, walking, and showing the patient album pictures especially if the patient is experiencing delusions.Soothing music, walking, and looking at picture albums may calm the patient is stressful situations occur.
8. Advise the patient’s family to avoid arguing with the patient.The family should be advised to avoid arguing with the patient because the patient may experience altered thought patterns and he or she may be prone to an emotional outburst.

Nursing Care Plan for Alzheimer’s 5

Disturbed Sensory Perception

Nursing Diagnosis: Disturbed Sensory Perception related to the inability to communicate, understand, speak and respond secondary to Alzheimer’s disease as evidenced by disorientation to time, place, person, events, and altered patterns of communication.

Desired Outcomes:

  • The patient will show preservation of perceptual function and controlled effects of deficit within the limits of the disease process.
  • The patient will be able to minimize deficits through the use of assistive devices.
  • The patient’s family will be compliant in making adjustments to the patient’s environment that will help prevent accidents and injuries.
InterventionRationale
1. Evaluate the patient’s confusion state, disorientation, changes in behavior, and emotional response.Behavioral changes may happen as a result of sensory deficits and deprivation due to physiologic, psychological, or environmental factors.
2. Assess for the patient’s sensory problems especially visual and auditory difficulties or loss.Sensory problems and deficits should be assessed to help the nurse formulate interventions that will help the patient. Sensory information includes what the patient sees, hears, smells, tastes, and touches. A sensory deficit happens because of the condition in which the brain has trouble receiving information from the patient’s senses.
3. Provide the patient time to respond and be patient when talking and interacting with the patient. Use different words and rephrase a message especially when the patient is confused, or puzzled, or if the patient gives an inappropriate response to a conversation.The patient might experience difficulty understanding the conversation, providing the patient ample time to respond may help him or her to communicate and express his or her thoughts easily.
4. Help the patient when ambulating or performing activities of daily living as appropriate.Assisting the patient when doing activities of daily living reduces the risk of falls or injury.
5. Advise and encourage the patient to participate in physical and social interactions as tolerated.Participation in activities may prevent isolation and sensory deficit.
6. Advise the patient’s family about the environmental modifications that will help in enhancing vision, hearing, taste, smell, and touch as appropriate.The environmental modification will provide patient safety and will prevent injury in the presence of impairment.
7. Provide emotional support and establish effective communication with the patient and the family.Providing emotional support and effective communication will help the patient and the family to adjust to the patient’s altered cognitive activities.
8. Advise the patient to use assistive devices such as a hearing aid, corrective glasses, or contact lenses as needed.Using assistive devices will help the patient with Alzheimer’s disease and will help in correcting the deficit.
9. Advise the patient’s family about the importance of maintaining the patient’s safety and advise the family to stay with the patient at all times.Patients with Alzheimer’s disease who are experiencing disturbed sensory perception are at high risk for falls and injury. For the safety of the patient, he or she will need someone to assist him or her all the time in doing his or her activities of daily living including bathing and mobilizing.

Nursing Care Plan for Alzheimer’s 6

Impaired Verbal Communication

Nursing Diagnosis: Impaired Verbal Communication related to decreased circulation from the brain and age-related factors secondary to Alzheimer’s Disease as evidenced by confusion, anxiety, restlessness, disorientation to person, place, time, and inability to speak properly.

Desired Outcomes:

  • The patient will be able to show effective speech and understanding of the communication.
  • ●       The patient will be able to use another method of communication that will make his or her needs known.
InterventionRationale
1. Evaluate the patient’s ability to speak, language deficits, cognitive or sensory impairment, and presence of aphasia, dysarthria, aphonia, dyslalia, or apraxia.Evaluating the patient’s ability to speak will help in identifying problems and speech patterns that will help in establishing a plan of care.
2. Assess the effects of communication deficit on the patient.Patients with Alzheimer’s disease may experience impaired communication because the left-side cerebral functions are decreased. It is important to assess the communication deficit to formulate appropriate interventions that may help the patient, because patients with Alzheimer’s disease may have difficulty speaking, reading, and writing.
2. Assess the patient’s nonverbal communication including facial grimace, smiling, pointing, and crying.Nonverbal communication may help the nurse in assessing the patient’s feelings and needs. Nonverbal cues such as excessive mumbling, striking out, or nonverbal cues is a way of expressing a patient’s discomfort, especially to patients at the later stage of Alzheimer’s disease.
3. Maintain eye contact, speak slowly, and enunciate clearly when talking and communicating with the patient.The nurse should maintain clarity, and brevity and provide time for the patient’s response that will help the patient’s successful speech. Give the patient ample time to receive and process the information and avoid rushing the patient.
4. Provide and maintain a calm environment and remove competing stimuli.This will help the nurse in promoting clear communication with the patient. Reducing the noise and distractions allows the patient more time to understand and interpret the message.
5. Use a simple, direct question that requires a one-word answer when talking to the patient and repeat and reword the questions if the patient experiences difficulty understanding the question.The nurse should use clear and simple sentences to help the patient understand the message better because the patient often forgets the meaning of words or the patient may have difficulty organizing and expressing thoughts.
6. Anticipate the patient’s needs at all times.Patients with Alzheimer’s disease should be provided with meaningful responses to prevent frustrations and anxiety.
7. Instruct the patient to breathe before speaking, pause between words and advise him or her to use tongue, lips, and jaws when speaking.This intervention will help the patient in promoting coordinated speech breathing.
8. Instruct the patient to perform facial muscle exercises including smiling, frowning, sticking the tongue out, moving the tongue from side to side and up and down.Performing facial muscle exercises may be used by the patient to communicate and will help in increasing muscle coordination and tone.
9. Encourage and advise to seek consultation with a speech therapist as needed.Consultation with speech specialists will help in facilitating the patient’s speech ability and will help in providing potential alternatives for the patient’s communication needs.

Other possible Alzheimer’s Nursing Diagnosis

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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