Dementia Brain and Self Care Activities free essay sample

Alzheimers disease is a progressive disease that destroys memory and other important mental functions. In Alzheimers disease, the connections between brain cells and the brain cells themselves degenerate and die, causing a steady decline in memory and mental function. The disease was first described by Dr. Alois Alzheimer, a German physician, in 1906. Its the most common cause of dementia — a group of brain disorders that results in the loss of intellectual and social skills. These changes are severe enough to interfere with day-to-day life. Definition Alzheimers disease is a progressive, degenerative disorder that attacks the brains nerve cells, or neurons, resulting in loss of memory, thinking and language skills, and behavioral changes. Epidemiology An estimated 5% of people older than age 65 have a severe form of this disease, and 12% suffer from mild to moderate dementia. Because this is a primary progressive dementia, the prognosis for a patient with this disease is poor. Causes †¢Unknown †¢Neurochemical factors, such as deficiencies of the neurotransmitters, acetylcholine, somatostatin, norepinephrine. †¢Viral factors such as CNS factors. †¢Genetic immunological factors †¢Trauma †¢Environmental factors, such as aluminium and manganese Risk factors Age Increasing age is the greatest known risk factor for Alzheimers. Alzheimers is not a part of normal aging, but the risk increases greatly after the person reach age 65. Nearly half of those older than age 85 have Alzheimers. Family history and genetics The risk of developing Alzheimers appears to be somewhat higher if a first-degree relative — if the person’s parent or sibling — has the disease. If there is changes (mutations) in three genes that virtually guarantee a person who inherits them will develop Alzheimers. But these mutations account for less than 5 percent of Alzheimers disease. Sex Women may be more likely than are men to develop Alzheimers disease, in part because they live longer. Mild cognitive impairment People with mild cognitive impairment (MCI) have memory problems or other symptoms of cognitive decline that are worse than might be expected for their age, but not severe enough to be diagnosed as dementia. Those with MCI have an increased risk — but not a certainty — of later developing dementia. Past head trauma People whove had a severe head trauma or repeated head trauma appear to have a greater risk of Alzheimers disease. Lifestyle and heart health Lack of physical activity, cognitive stimulation, social engagement and a healthy diet. Others Lack of exercise Smoking High blood pressure High blood cholesterol Poorly controlled diabetes A diet lacking in fruits and vegetables Lack of social engagement Stages and Symptoms Alzheimer’s disease progresses in three stages: a)Mild or Early Stage Functions Symptoms Language Anomia, empty speech Memory Defective Visuospatial skills Impaired Calculation Impaired Personality Indifferent, occasionally irritable, sad or depressed Motor system Normal EEG Normal CT/MRI scan Normal b)Moderate or Middle Stage Functions Symptoms Language Fluent aphasia Memory Severely impaired Visuospatial skills Severely impaired Personality Indifferent, irritable, suspicious and angry Motor system Restless, pacing EEG Slowing of background rhythms CT scan/ MRI Atrophy c)Severe or Late Stage Functions Symptoms Intellectual function Severely impaired Language Palilalia, echolalia or mutism Motor system Limb rigidity Sphincter control Incontinence EEG Diffuse slowing CT scan/ MRI Diffuse atrophy Tests and Diagnosis †¢History taking of the patient with his/her near family members, relatives and friends. †¢Physical and neurological exam Reflexes Muscle tone and strength Ability to get up from a chair and walk across t the room Sense of sight and hearing Coordination Balance †¢Lab tests Blood tests may help to rule out other potential causes of memory loss and confusion, such as thyroid disorders or vitamin deficiencies. †¢Mental status testing A brief mental status test is done to assess the memory and other thinking skills. Short forms of mental status testing is done which takes about 10 minutes. †¢Neuropsychological testing consists of a battery of tests designed to assess cognitive ability and reasoning. These tests can help differentiate Alzheimer’s disease from other types of dementia. †¢Cerebrospinal Fluid Analysis may help determine if the patient’s signs and symptoms stem from a chronic neurologic infection. Cerebral blood flow studies may detect abnormalities in blood flow to the brain. †¢EEG Allows evaluation of the brain’s electrical activity and may show slowing of the brain waves in the late stages of the disease. This diagnostic test also helps identify tumors, abscesses, and other intracranial lesions that might cause the patient’s symptoms. †¢Brain imaging Images of the brain are now used chiefly to pinpoint visible abnormalities related to conditions other than Alzheimers disease — such as strokes, trauma or tumors — that may cause cognitive change. Brain-imaging technologies include: Computerized tomography (CT) In some patients shows progressive brain atrophy in excess of that which occurs in normal aging. -Magnetic resonance imaging (MRI) Magnetic resonance imaging may permit evaluation of the condition of the brain and rule out intracranial lesions as the source of dementia. -Positron emission tomography (PET) Measures the metabolic activity of the cerebral cortex and may help confirm early diagnosis. Treatments and drugs †¢No cure or definitive treatment exists for Alzheimer’s Disease. Treatment focuses on attempting to slow disease progression, managing behavioral problems, implementing modifications of the home environment, and eliciting family support. †¢However some medications have proven helpful. Cholinesterase inhibitors ?These drugs work by boosting levels of a cell-to-cell communication chemical depleted in the brain by Alzheimers disease. Less than half of those taking these drugs can expect to have any improvement in their memory function. ?Commonly prescribed cholinesterase inhibitors include donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon). The main side effects of these drugs include diarrhea, nausea and sleep disturbances. Memantine (Namenda) ?This drug works in another brain cell communication network and slows the progression of symptoms with moderate to severe Alzheimers disease. Its sometimes used in combination with a cholinesterase inhibitor. Prevention †¢Many of the same factors that increase the risk of heart disease can also increase the risk of Alzheimers disease and vascular dementia. Important factors that may be involved include high blood pressure, high blood cholesterol, excess weight and diabetes. Therefore considerations should be made for reducing the risks related to the disease. †¢Physical activity, cognitive stimulation, social engagement and a healthy diet may be helpful. These activities also help in memory compensation strategies that help optimize daily function even if brain changes progress. †¢Keeping active — physically, mentally and socially — may make life more enjoyable and may also help reduce the risk of Alzheimers disease. †¢Regular exercise has known benefits for heart health and may also help prevent cognitive decline. Exercise may also help improve mood. †¢A diet low in fat and rich in fruits and vegetables is another heart-healthy choice that also may help protect cognitive health. †¢Omega-3 fatty acids found in fish are good for the heart and can boost on cognitive health. †¢Social engagement and intellectual stimulation may make life more satisfying and help preserve mental function. Nursing Management Assessment History Taking Mental Status Examination Physical Examination Reviewing Symptoms Nursing Diagnosis ? Impaired thought process related to declining cognitive function ? Risk for injury related to decline in cognitive function ? Anxiety related to confused thought processes ? Imbalanced nutrition less than body requiremente related to cognitive decline ? Activity intolerance related to imbalance in activity/rest pattern ? Deficient self care, bathing/hygiene, feeding, toileting related to cognitive decline ? Impaired social interaction related to cognitive decline ? Deficient knowledge of family/caregiver related to care for patient as cognitive function declines Planning and Goal Supporting cognitive function Promoting physical safety Reducing anxiety Maintaining adequate nutrition Improving activity tolerance Promoting independent in self care activities Meeting socialization needs Improve education for caring the patient at home Nursing Intervention ?Supporting cognitive function Provide a calm, predictable environment to minimize confusion and disorientation. Help patient feel a sense of security with a quiet, pleasant manner, clear, simple explanation and use of memory aids and cues. ?Promoting physical safety Provide a safe environment to allow patient to move about as freely as possible and relieve family’s worry about safety. Prevent falls and other accidents by removing obvious hazards and providing adequate lighting. Monitor intake of medication and food. Supervise all activities outside the home to protect patient. Avoid restraints, because they may increase agitation. ?Reducing anxiety and agitation Give emotional support to support a positive self image. When skill losses occur, adjust goals to fit patient’s declining ability and structure activities to help prevent agitation. Keep the environment simple, familiar, and noise free; limit changes. Remain calm and unhurried. Use easy to understand sentence to convey messages. ?Promoting adequate nutrition Keep mealtimes simple and calm. Cut food into small pieces to prevent choking and convert liquids to gelatin to ease swallowing. Offer one dish at a time. Prevent burns by serving typically hot food and beverages warm. ?Balancing activity and rest Help patient to relax to sleep with music, warm milk or a back rub. To enhance night time sleep, provide sufficient opportunities for day time exercise. Discourage long periods of day time sleeping. ?Promoting independence in self care activities Simplify daily activities into short achievable steps so that the patient feels sense of accomplishments. Maintain patient’s personal dignity and autonomy. Encourage patient to make choices when appropriate and to participate self care activities as much as possible. ?Meeting socialization needs Encourage visits, letters and phone calls. (visits should be brief and nonstressful; with one or two visitors at a time). ?Family Teaching Advise family member to provide patients with exercise. Suggest physical activities, such as walking or light house work, that occupy and satisfy the patient. Tell them about the importance of diet. The patient becomes forgetful especially of recent events. Aware of his function, he may compensate by relinquishing tasks that might reveal his forgetfulness.