Alzheimer’s Nursing Diagnosis and Nursing Care Plan

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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.

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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