ASSIG

ALZHEIMER’S DISEASE Thelma Walker

Rasmussen University

NUR2755 Section BMPD1A0E Instructor: Eymie Fitzgerald

April 10, 2022

Pathophysiology • Alzheimer’s disease (AD) is a progressive and chronic progressive disease

of the brain. • Its development is related to changes in the brain anatomy and physiology. • There is increased plaque formation consisting of neurons, beta-amyloid

proteins, and microglia, which produce neurotoxic astrocytes. • Plaques mostly form in the frontal lobe and later advance to the cerebral

cortex. • Alteration of the Tau proteins resulting in neurofibrillary tangles and

neuron death can also cause AD. • This leads to structural brain damage leading to brain atrophy, causing

impairment in memory, language, and behavior (Lewis et al., 2019).

Etiology

• The exact etiology remains unclear, but age, sex, and genetics play a vital role in AD development (Ignatavicius et al., 2017).

• Less common predisposing factors are immunologic changes, African Americans and Hispanic ethnicities, metal toxins, and viruses.

Incidence

• There is increased incidence after the age of 65.

• Below 40 years, females are at a greater risk.

Health Promotion & Maintenance • Maintaining a healthy lifestyle is vital to preventing and managing

comorbidities such as diabetes and hypertension.

• Eating a balanced diet with soy and light exercises such as walking and swimming is essential.

• Enough quantities of folate & vitamins such as B12, C, and E significantly decrease cognitive decline.

• Risky behaviors such as smoking and alcohol intake should be avoided as they worsen cardiovascular health (Ignatavicius et al., 2017).

History and Risk Factors • Patients over 65 years should be assessed for changes in memory and personality

and impaired language and communication skills.

• Females below 40 years are at greater risk than males.

• Family history of AD or Down syndrome.

• Occupational history predisposes one to repeated head injuries such as veterans and athletes and exposure to metal toxins (Ignatavicius et al., 2017).

• Check for the medical history of brain injury and viral illness such as herpes zoster.

Physical Signs and Symptoms

• Early stage: denial, forgetting a name, misplacing items, decreased attention span, avolition, and behavior changes.

• Middle stage: total cognitive impairment, visuospatial deficits, incontinence, speech and language deficits, episodes of wandering, and disorientation.

• Late stage: loss of mobility, making the patient bedridden, loss of verbal skills, and agnosia (Ignatavicius et al., 2017).

• Changes in cognition: short-term memory impairment, communication dysfunction, poor judgment, short attention span, and poor concentration.

• Changes in behavior and personality: aggressiveness, delusions, wandering, hallucinations, hoarding items, rapid mood swings, and ransacking another’s belongings.

• Changes in self-management skills: bowel and bladder incontinence, poor appetite, selection of inappropriate dress code regarding whether or event, and decreased interest in personal appearance (Ignatavicius et al., 2017).

Laboratory and Imaging Assessment

• Genetic testing.

• CT scan shows enlarged ventricles. The cerebral cortex has widened sulci and shrunken gyri (Ignatavicius et al., 2017).

• MRI scan to detect mild cognitive impairment to predict patients at risk.

• Histopathology of the brain tissue at autopsy produces a definitive diagnosis.

Planning and Implementation

• The client should perform normal mental processes in the early stages of the disease.

• As AD worsens, the goal should be to conserve memory and cognitive function, maintain safety, and promote the quality of daily living (Ignatavicius et al., 2017).

• Individualized plan of care should be followed consistently.

Interprofessional Collaborative Care

• Training in communication helps interact with better effect and compassion with the patients.

• Cognitive stimulation and memory training such as interactive pet therapy should promote cognitive function and memory.

• The environment should be structured and a daily routine established

• Use reminiscence therapy while performing a treatment or assessment.

• Clocks and single-date calendars help the patient maintain orientation

• Take the patient to the toilet or provide bedpans every 2 hours to maintain continence (Ignatavicius et al., 2017).

Psychosocial Integrity

• Provide adequate support systems since AD diagnosis may cause depression and denial.

• Avoid using restraints to prevent physical injury, maintain patient dignity and reduce the length of hospital stay (Ignatavicius et al., 2017).

• Provide family-centered and patient-oriented counseling.

• Link the family with appropriate professionals for more support.

Medication

• Cholinesterase inhibitors such as donepezil, galantamine, and rivastigmine mitigate AD symptoms.

• N-methyl-D-aspartate receptor antagonist such as memantine is used in advanced AD.

• Antidepressants such as serotonin reuptake inhibitors may be used for patients with depression. (Ignatavicius et al., 2017).

• Psychotropic drugs may be prescribed to help control mental/behavioral symptoms such as hallucinations and delusions.

Safety Considerations

• Falls can be prevented by frequent surveillance and two hourly toileting. • Use a patient identification badge or bracelet if the patient tends to

wander. • The patient should not be exposed to staircases to minimize falls. • The patient’s room should remain permanent with familiar objects

to prevent confusion. • Avoid excessive stimuli such as loud noise or intense light. • Physical and chemical restraints should be avoided to promote a

better quality of life (Ignatavicius et al., 2017).

References

•Ignatavicius, D., Workman, M., Rebar, C., & Heimgartner, N. (2017). Medical-surgical nursing (9th ed.). Saunders

•Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Harding, M. (2019). Medical-surgical nursing (11th ed.). Mosby.