Dementia is a progressive neurocognitive disorder characterized by declining cognitive function, behavioral changes, and impairments in daily living activities. This nursing diagnosis focuses on identifying symptoms, managing behavioral changes, preventing complications, and supporting both patients and caregivers throughout the disease’s progression.
Causes (Related to)
Dementia affects patients through various mechanisms and contributing factors:
- Primary neurodegenerative processes such as:
- Alzheimer’s disease
- Vascular dementia
- Lewy body dementia
- Frontotemporal dementia
- Risk factors including:
- Advanced age
- Family history
- Cardiovascular disease
- Traumatic brain injury
- Diabetes
- Depression
- Environmental factors such as:
- Social isolation
- Lack of cognitive stimulation
- Poor nutrition
- Inadequate support systems
Signs and Symptoms (As evidenced by)
Dementia presents with various signs and symptoms that nurses must recognize for proper assessment and care planning.
Subjective: (Patient/Caregiver reports)
- Memory loss affecting daily activities
- Difficulty finding words
- Problems with planning and organization
- Confusion about time and place
- Changes in mood and personality
- Difficulty completing familiar tasks
- Poor judgment
- Social withdrawal
Objective: (Nurse assesses)
- Impaired cognitive function
- Disorientation
- Behavioral changes
- Decreased self-care ability
- Impaired communication
- Altered sleep-wake patterns
- Changes in appetite
- Safety risks
Expected Outcomes
The following outcomes indicate successful management of dementia:
- The patient will maintain optimal cognitive function
- The patient will demonstrate safe behaviors
- The patient will maintain adequate nutrition and hydration
- The patient will experience minimal behavioral disturbances
- The patient/caregiver will demonstrate effective coping strategies
- The patient will maintain maximum independence in ADLs
- The patient will remain free from injury
Nursing Assessment
Cognitive Status Assessment
- Conduct mental status examinations
- Monitor orientation levels
- Assess memory function
- Evaluate decision-making capacity
- Document behavioral changes
Safety Assessment
- Evaluate fall risk
- Assess home environment
- Check for wandering risk
- Monitor medication management
- Document safety incidents
Functional Status
- Assess ADL performance
- Evaluate mobility
- Check nutritional status
- Monitor continence
- Document activity tolerance
Psychosocial Assessment
- Evaluate mood
- Assess social support
- Monitor caregiver stress
- Check for depression
- Document behavioral symptoms
Physical Assessment
- Monitor vital signs
- Assess pain levels
- Check skin integrity
- Monitor weight
- Document physical symptoms
Nursing Care Plans
Nursing Care Plan 1: Impaired Memory
Nursing Diagnosis Statement:
Impaired Memory related to neurodegenerative changes as evidenced by inability to recall recent events, disorientation, and difficulty learning new information.
Related Factors:
- Progressive cognitive decline
- Neurological changes
- Altered thought processes
- Environmental changes
Nursing Interventions and Rationales:
- Establish consistent daily routines
Rationale: Promotes familiarity and reduces confusion - Use memory aids and environmental cues
Rationale: Supports orientation and independence - Implement reality orientation techniques
Rationale: Helps maintain awareness of surroundings
Desired Outcomes:
- The patient will maintain the current level of cognitive function
- The patient will use memory aids effectively
- The patient will demonstrate improved orientation to the environment
Nursing Care Plan 2: Risk for Falls
Nursing Diagnosis Statement:
Risk for Falls related to impaired judgment and altered mobility as evidenced by unsteady gait and history of falls.
Related Factors:
- Cognitive impairment
- Decreased muscle strength
- Environmental hazards
- Medication side effects
Nursing Interventions and Rationales:
- Implement fall prevention protocol
Rationale: Reduces risk of injury - Modify the environment for safety
Rationale: Creates safer living space - Monitor gait and balance
Rationale: Identifies changes in fall risk
Desired Outcomes:
- The patient will remain free from falls
- The patient will demonstrate safe mobility
- Caregiver will implement safety measures effectively
Nursing Care Plan 3: Self-Care Deficit
Nursing Diagnosis Statement:
Self-care deficit related to cognitive impairment as evidenced by the inability to complete ADLs independently.
Related Factors:
- Decreased cognitive function
- Impaired mobility
- Fatigue
- Confusion
Nursing Interventions and Rationales:
- Assist with ADLs while promoting independence
Rationale: Maintains dignity and functional abilities - Establish simple routines
Rationale: Supports consistent self-care - Provide adaptive equipment
Rationale: Facilitates independent function
Desired Outcomes:
- The patient will maintain a maximum level of independence
- The patient will participate in self-care activities
- The patient will use adaptive equipment appropriately
Nursing Care Plan 4: Disturbed Thought Processes
Nursing Diagnosis Statement:
Disturbed Thought Processes related to neurocognitive changes as evidenced by impaired judgment and altered interpretation of the environment.
Related Factors:
- Progressive brain changes
- Altered perceptions
- Environmental stressors
- Sleep disturbances
Nursing Interventions and Rationales:
- Use clear, simple communication
Rationale: Enhances understanding and cooperation - Maintain consistent caregivers
Rationale: Reduces confusion and anxiety - Create a structured environment
Rationale: Promotes stability and orientation
Desired Outcomes:
- The patient will demonstrate improved decision-making
- The patient will experience reduced confusion
- The patient will maintain safe behaviors
Nursing Care Plan 5: Caregiver Role Strain
Nursing Diagnosis Statement:
Caregiver Role Strain related to the progressive nature of dementia as evidenced by expressed feelings of stress and fatigue.
Related Factors:
- Complex care requirements
- Limited support systems
- Emotional demands
- Financial strain
Nursing Interventions and Rationales:
- Provide caregiver education
Rationale: Enhances caregiving skills and confidence - Connect with support resources
Rationale: Reduces isolation and burden - Teach stress management techniques
Rationale: Promotes caregiver well-being
Desired Outcomes:
- Caregiver will demonstrate effective coping strategies.
- Caregiver will utilize available support systems
- Caregiver will report reduced stress levels
References
- Aarsland D. Epidemiology and Pathophysiology of Dementia-Related Psychosis. J Clin Psychiatry. 2020 Sep 15;81(5):AD19038BR1C. doi: 10.4088/JCP.AD19038BR1C. PMID: 32936544.
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Gale SA, Acar D, Daffner KR. Dementia. Am J Med. 2018 Oct;131(10):1161-1169. doi: 10.1016/j.amjmed.2018.01.022. Epub 2018 Feb 6. PMID: 29425707.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Tisher A, Salardini A. A Comprehensive Update on Treatment of Dementia. Semin Neurol. 2019 Apr;39(2):167-178. doi: 10.1055/s-0039-1683408. Epub 2019 Mar 29. PMID: 30925610.
