Dementia

Dementia Nursing Care Plans Diagnosis and Interventions

Dementia NCLEX Review Care Plans

Nursing Study Guide on Dementia

Dementia is a complex neurocognitive condition affecting one’s memory, thought process, and social skills.

The decline in these functions may affect the person’s ability to complete activities of daily living.

Dementia can also change feelings and behavior. It is often related to memory loss; however, memory loss alone does not signify the presence of the disease.

Dementia is most common in people aged 65 years and above.

This is referred to as late-onset dementia. On the other hand, early onset dementia occurs in people below the age of 65 years.

The majority of cases are late-onsets which accounts to about 97% of recorded incidents.

Dementia is an umbrella term referring to the decline in neurocognitive function.

Signs and Symptoms of Dementia

  1. Cognitive symptoms include the following:
  2. Short-term memory loss
  3. Aphasia or difficulty in using words
  4. Reduced visual and spatial abilities
  5. Problem reasoning or problem solving
  6. Difficulty handling complex tasks
  7. Problem planning and organizing
  8. Problems with coordination and motor functions
  9. Confusion and disorientation
  10. Psychological symptoms include the following:
  11. Changes in personality
  12. Depression
  13. Anxiety
  14. Inappropriate behavior
  15. Paranoia
  16. Agitation
  17. hallucination

Causes and Types of Dementia

In general, dementia is caused by damage to brain cells which interferes with the normal function of the brain to communicate normally with each other. The following are the types of dementia and their etiology.

  • Alzheimer’s Dementia. Alzheimer’s dementia or Alzheimer’s disease is the most common of all dementia types with prevalence of about 50-70% of reported cases. Alzheimer’s disease is a progressive degenerative brain disorder caused by complex brain changes due to cell damage. Symptoms usually start to appear years before diagnosis, but they may be too subtle to be noted.
  • Vascular Dementia. Vascular dementia refers to the decline in neurocognitive functions due to conditions resulting to reduced blood flow to various parts of the brain.
  • Creutzfeldt-Jakob Disease. This type of dementia is a form of prion disease. Prion disease refers to the abnormal change in shapes of prion proteins which are found throughout the human body. The shape changes also occur in the prion proteins in the brain causing dementia.
  • Lewy Body Dementia (LBD). LBD is a type of dementia that occurs due to abnormal deposits of Lewy bodies containing alpha-synuclein protein in brain cells. These Lewy bodies are also found in other types of dementia and Dementia.
  • Frontotemporal Dementia. As the name suggests, frontotemporal dementia refers to neurocognitive decline due to nerve cell loss in the frontal or temporal lobe of the brain.
  • Huntington’s Disease (HD). This type of dementia is caused by a defective mutation on a gene, resulting to changes in the central brain area affecting movement, mood, and thinking skills.
  • Mixed Dementia. Mixed dementia refers to the presence of two or more forms of dementia occurring simultaneously.
  • Normal Pressure Hydrocephalus. This form of dementia occurs as a result of the accumulation of cerebrospinal fluid in the brain’s ventricles. This accumulation causes damage to the nearby brain cells.
  • Posterior Cortical Atrophy (PCA). PCA is a type of dementia that refers to the gradual and progressive degeneration of the brain cortex.
  • Parkinson’s Dementia. Parkinson’s dementia is a type of dementia that occurs as a result of Dementia.
  • Korsakoff Syndrome. Korsakoff syndrome refers to memory disorder which occurs due to severe deficiency in Vitamin B1 or thiamine.

Complications of Dementia

Dementia affects the person’s ability to function. It may lead to serious medical conditions and other related complications.

  • Malnutrition. Nutrition is a concern in people with dementia. The disease can make the individual stop eating or have reduced food intake. Dementia can also affect their ability to chew and swallow food.
  • Pneumonia. The effects dementia has on swallowing predisposes individuals to choke on food and cause pneumonia.
  • Inability to perform self-care activities. Depending on the type, progress of the disease, and symptoms present, individuals with dementia may require care assistance as the disease may affect their ability to perform self-care.
  • Issues with personal safety. The safety of people with dementia may become a challenge as the disease progresses. Short-term memory loss, confusion, and the other symptoms of the disease can all pose danger to the person with the disease.
  • Death. Death may occur as a result of infection from dementia. The disease itself predisposes individuals to secondary infections and medical conditions.

Diagnosis of Dementia

Diagnosing dementia may be tricky. Its symptoms often coincide or is mask by an overlying medical condition. The following are often performed to diagnose dementia:

  • Detailed medical history. History taking is performed to ascertain the presence of symptoms in patients. If short-term memory loss is present, history may be taken from family members or carers.
  • Physical examination. A thorough physical examination is performed to provide baseline information. It is also a chance to check for the presence of another medical condition and to rule out other neurocognitive problems.
  • Cognitive and neuropsychological tests. These include memory tests and other tests that will measure the person’s reasoning, judgment, and language skills.
  • Neurological evaluation. This assessment checks for the person’s neurological skills such as memory, balance, and reflexes.
  •  Imaging of the brain. Brain imaging through CT scans and MRI may be performed to check for evidence of brain damage and possible causes such as stroke. A PET scan can also help doctors to assess brain activity patterns and the presence of amyloid protein that may suggest Alzheimer’s disease.
  • Laboratory tests. Lab tests may include testing of the cerebrospinal fluid and the level of thiamine.

Treatment of Dementia

Most types of dementia are irreversible. However, treatment methods are available to help manage the symptoms.

  1. Medications. Certain drugs can be used to temporarily alleviate symptoms of dementia.
    • Cholinesterase inhibitors. These drugs work by improving the levels of a neurotransmitter called acetylcholine. Acetylcholine is a neurotransmitter related to memory and judgement.
    • NMDA receptor antagonists. NMDA receptor antagonists are often given with a cholinesterase inhibitor. These drugs work by regulating the activities of glutamate – a chemical messenger involved in memory and learning.
    • Other drugs. Other medications can also be used to treat specific symptoms.
  2. Therapies. Several behavioral therapies are also used to improve the symptoms of dementia.
    • Occupational therapy. This kind of therapy is focused on enhancing the patient’s independence with essential day to day activities. It allows the patient to arrange a safe environment and to prepare for the possible progression of their disease.
    • Modifying the environment. Major changes with function will occur as the disease progresses. 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. Building of a structure and routine is found helpful in people with dementia.

Nursing Care Plans for Dementia

Nursing Care Plan 1

Nursing Diagnosis: Disturbed Thought Process related to cognitive impairment secondary to dementia 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.

InterventionsRationales
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.Dementia 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 2

Nursing Diagnosis: Impaired Physical Mobility related to disease process of dementia 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.

InterventionsRationales
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.Dementia 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 3

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

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

InterventionsRationales
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 nursing diagnoses:

  • Self-care Deficit
  • Wandering
  • Risk for Injury
  • Chronic Confusion

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. (2017). 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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