4 nursing care plans for dementia plus diagnosis and interventions with examples 1

Nursing Care Plans for Dementia Plus Diagnosis and Interventions with Examples

Introduction

Dementia is a broad term that describes a loss of thinking ability, memory, attention, logical reasoning, and other mental abilities. These changes are severe enough to interfere with social or occupational functioning.

It occurs when the part of the brain used for learning, memory, decision making, and language are damaged or diseased.

Dementia is not a disease; instead, it is a group of symptoms that cause by other conditions. Alzheimer’s disease is the most common cause of dementia.

This blog post discusses nursing care plans for dementia together with the diagnosis, causes, symptoms and interventions with elaborate examples .As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Types of Dementia

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These forms of dementia are partially manageable but are not reversible. They include:

  1. Alzheimer’s disease
  2. Vascular Dementia
  3. Dementia from Parkinson’s disease and similar disorders.
  4. Dementia with Lewy bodies
  5. Frontotemporal Dementia
  6. Creutzfeldt-Jakob disease.

Dementia can be grouped into two based on the affected part of the brain. These groups are:

Cortical dementias happen because of problems in the cerebral cortex, the brain’s outer layer. They play a critical role in memory and language. People with these types of dementia usually have severe memory loss and can’t remember words or understand language. Alzheimer’s and Creutzfeldt-Jakob disease are two forms of cortical dementia.

Subcortical dementias happen because of problems in the parts of the brain beneath the cortex. People with subcortical dementias tend to show changes in their thinking speed and ability to start activities. Usually, people with subcortical dementia don’t have forgetfulness and language problems. Parkinson’s disease, Huntington’s disease, and HIV can cause these types of dementia.

Some types of dementia affect both parts of the brain. For example, Lewy Body dementia is both cortical and subcortical.

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Dementia Versus Other Types of Memory Loss

Dementia is not temporary confusion or forgetfulness that might result from an infection that heals without treatment. It can also come from an underlying illness or side effects of medications. Dementia typically gets worse over time.

Causes of Dementia

The most common causes of dementia include:

Degenerative neurological diseases.

These include:

  • Alzheimer’s disease
  • Parkinson’s disease
  • Huntington’s disease
  • Some types of multiple sclerosis.

These diseases get worse over time.

Vascular disorders.

These conditions affect the blood circulation in your brain.

  • Traumatic brain injuries caused by car accidents, falls, concussions, etc.
  • Infections of the central nervous system. These include meningitis, HIV, and Creutzfeldt-Jakob disease.
  • Long-time alcohol or drug use
  • Certain types of hydrocephalus, a buildup of fluid in the brain

Some reversible causes of dementia include:

  • Alcohol or substance use disorder
  • Tumors
  • Subdural hematomas, blood clots beneath the outer covering of the brain
  • Normal-pressure hydrocephalus, a buildup of fluid in the brain
  • Metabolic disorders such as a vitamin B12 deficiency
  • Low levels of thyroid hormones, called hypothyroidism
  • Low blood sugar, called hypoglycemia
  • HIV-associated neurocognitive disorders (HAND)

Risk Factors for Dementia

Certain physical and lifestyle factors can raise your chances of dementia, including:

  1. Age
  2. Dementia in your family
  3. Illnesses including diabetes, Down syndrome, multiple sclerosis, heart disease, and sleep apnea
  4. Depression
  5. Smoking, heavy alcohol use, poor diet, and lack of exercise
  6. Brain injury
  7. Strokes
  8. Infection of the brain (for example, meningitis and syphilis)

Symptoms of Dementia

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  1. People with dementia have problems with thinking and remembering that affect their ability to manage their daily life.
  2. These are some signs to watch for:
  3. Short-term memory problems, like forgetting where you put something or asking the same question over and over
  4. Communication problems like not being able to come up with a word
  5. Getting lost
  6. Trouble with complex but familiar tasks, like fixing a meal or paying bills
  7. Personality changes, like depression, agitation, paranoia, and mood swings

Stages of Dementia

Usually, dementia goes through these stages. But it may vary depending on the area of the brain that’s affected.

1. No impairment. Someone at this stage will show no symptoms, but tests may reveal a problem.

2. Very mild decline. You may notice slight changes in behavior, but your loved one will still be independent.

3. Mild decline. You’ll notice more changes in their thinking and reasoning. They may have trouble making plans and repeat themselves a lot. They may also have a hard time remembering recent events.

4. Moderate decline. They’ll have more problems with making plans and remembering recent events. They may have a hard time with traveling and handling money.

5. Moderately severe decline. They may not remember their phone number or their grandchildren’s names. They may be confused about the time of day or day of the week. At this point, they’ll need assistance with some basic day-to-day functions, such as picking out clothes to wear.

6. Severe decline. They’ll begin to forget the name of their spouse. They’ll need help going to the restroom and eating. You may also see changes in their personality and emotions.

7. Very severe decline. They can no longer speak their thoughts. They can’t walk and will spend most of their time in bed.

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Dementia Diagnosis

The doctor will review the patient’s history and perform a physical exam and cognitive testing. Further testing might happen depending on the history and physical.

This testing might include:

  1. Blood and urine tests
  2. Chest X-ray
  3. Brain scanning (MRI or CT scanning)
  4. Electroencephalogram (EEG)
  5. Spinal fluid analysis

They use certain criteria to diagnose dementia. These include:

  1. impairment of attention
  2. Orientation
  3. Memory
  4. Judgment
  5. Language, motor, and spatial skills and function. (By definition, dementia is not due to major depression or schizophrenia.)

Dementia Treatments

To treat dementia, doctors will treat whatever is causing it. About 20% of the causes of dementia are reversible. If the cause of a person’s dementia is not reversible, treatment will focus on managing symptoms, particularly agitation and other emotional concerns.

Aducanumab-avwa (Aduhelm) is the first drug approved by the FDA to treat Alzheimer’s disease in decades. If your loved one is in the early stages of Alzheimer’s disease, the most common form of dementia, their doctor may prescribe this monthly infusion. It’s a monoclonal antibody that lessens the buildup of things called amyloid plaques in your brain. These plaques are part of what leads to the memory loss associated with Alzheimer’s disease.

Medicines such as acetylcholinesterase inhibitors (for example, donepezil and galantamine) can sometimes help to slow the progression of cognitive changes, but quite often, the effects of medicines are only modest and cannot prevent eventual worsening of the underlying condition.

4 Nursing Diagnosis for Dementia.

  1. Self-care deficit
  2. Impaired thought process
  3. Ineffective family coping
  4. Risk of injury

Nursing Care Plans for Dementia Based on Diagnosis

Nursing Care Plan 1: Diagnosis – Self-Care Deficit

Self-care deficit related to impairment in cognitive and motor functions secondary to degenerative changes due to a diagnosis of Alzheimer’s Disease as evidenced by (include assessment findings specific to which particular type of deficit the patient is manifesting such as:

  • Inability to bathe oneself (you may describe the difficulties the patient manifests, such as recognizing objects used for bathing)
  • Feed oneself (describe difficulties in feeding)
  • Toileting

Desired Outcomes

After nursing interventions, the patient is expected to:

  1. Have self-care needs met
  2. Participate in self-care activities
  3. Perform self-care requisites within the level of ability
Nursing ActionRationale
Assess the patient’s current level of self-care and identify areas of challenges and difficulty in performing such tasks.  This creates baseline information for patient condition and helps plan for effective care.
Ask the patient (if possible) or significant others the patient’s level of independence in the performance of self-care tasks.Ascertaining level of independence can help the nurse decide which activities the patient can perform independently and which ones he would need attention to.
Arrange for all items required for self-care activities are present when the patient needs them (i.e., bathing implements, toileting materials, eating utensils, grooming materials).   NOTE:  For patients needing assistance with bathing, ensure adequate water temperature to prevent accidental burns or hypothermia.Having all necessary items available and within reach of the patient allows him to perform the task easier and prevents him from looking for them.
Encourage the patient to perform self-care tasks independently, guiding or assisting him only when needed.Allowing the patient to perform his self-care tasks independently helps maintain his optimal function and promotes self-care for as long as possible. Note that once patients with AD lose the capacity to perform self-care independently, it will be irreversible.
Guide the patient while doing the activity, providing him with detailed instructions for each step. When needed, demonstrate the action for him to follow.Telling the patient the succeeding steps in the performance of a task helps reduce confusion and successful accomplishment on the part of the patient. When the nurse provides instructions in a calm and unhurried fashion, the act lessens frustrations on the part of the patient and contributes to increased self-esteem.
Involve the family in the care plan, letting them know the level of guidance and assistance the patient needs daily, ensuring that independence and optimal levels of functioning are maintained.Having the family know the care protocols for the patient, its rationale, and how it affects overall patient wellbeing.

Nursing Care Plan 2: Diagnosis – Impaired Thought Processes

Impaired thought processes related to changes in cognitive abilities (or others such as chemical imbalances in the brain, neuronal brain destruction evidenced by (include assessment findings indicating the identified nursing problem the patient is manifesting such as:

  • Disorientation (i.e., to time, place, person, and events)
  • Difficulty in thinking abstract thoughts
  • Forgetfulness or memory losses
  • Problems with attention span (shortened; difficulty focusing)
  • Easily distracted
  • Inability to speak coherently
  • Mumbling, saying unintelligible thoughts

Desired Outcomes

  • After nursing interventions, the patient/family is expected to:
  • Achieve functional ability at the highest possible level
  • Manifest improved thought processes
  • Access community resources to help them manage patient’s long term care
Nursing ActionRationale
Assess the patient’s ability to think and speak coherently, noting for indications of disorientation, memory lapses, shifting from one topic to another, and even using words. Also, note if there are problems in articulation.  This helps the nurse determine any changes in the patient’s mental status, indicating possible improvement or deterioration of the condition.
Identify the patient’s level of orientation to time, place, persons, and events, noting when the forgetfulness or impairment in thought processes becomes more pronounced.Assessment of the level of orientation and any trigger to confusion and alteration helps plan interventions.
Orient the patient to his current environment, time, place, and person. If needed, provide the patient with aids to help him stay oriented, such as television, clocks, and calendars.   NOTE:  Some facilities may also allow the patient to use mobile phones since these devices can also display time and date.Orientation of the patient to his immediate environment and reality can help ease his confusion and prevent delirium or depression. However, note that television and radio should be monitored so that the programs/stations that the patient is allowed to tune in to do not cause him confusion or disorientation.
Establish a routine for the patient to follow. Include activities such as bathing, grooming, eating, rest, and other cognitive activities as part of the routine.Having a structured and predictable list of activities that the patient can follow helps the patient have fewer episodes of confusion and thought process impairment. It also sets a routine for him to follow while helping him maintain a degree of autonomy in his activities of daily living.
Allow the patient to engage in other activities such as walking, drawing, and reading books and magazines.These activities can help the patient focus more on reality and normality and the other things he can do and control.
Allow the patient to wander around or collect other items within acceptable limits.Allowing them to spend their energy on wandering or tinkering with other items (within safe and acceptable limits) reduces their agitation and stress and increases their feelings of security.
Provide the patient with positive reinforcement when he behaves within acceptable limits.This helps encourage acceptable behaviors and increases the confidence level of the patient.
Provide the patient two options when deciding on something (food, activities, colors, and others). Ensure that he can decide on what he thinks is best and that you are there to support him.Limiting the choices from which he can choose helps reduce confusion. Allowing him to decide for himself increases his sense of security and confidence in his ability to make independent choices.
Involve the family in the care plan, letting them know the level of guidance and assistance the patient needs daily, ensuring that independence and optimal levels of functioning are maintained.Having the family know the care protocols for the patient, its rationale, and how it affects overall patient wellbeing.

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Nursing Care Plan 3: Diagnosis – Ineffective Family Coping           

Ineffective family coping related to the presence of chronic disease on a family member that exhausts the family as a unit as evidenced by (include assessment findings specific to which particular type of deficit the patient is manifesting such as:

  • Family verbalization of anxiety
  • Fatigue and stress
  • Expression of the financial burden of the disease on the family
  • Ignoring the patient and his needs (indicate signs of ignoring)
  • Poor patient prognosis

Desired Outcomes

  • After nursing interventions, the patient/family is expected to:
  • Identify behaviors that promote ineffective family coping
  • Work on interventions that would foster adjustment to their current situation
Nursing ActionRationale
Assess the family’s understanding of the disease process, how it affects the patient, and the care required to be provided in each stage of the disease.This creates baseline information for patient condition and helps plan for effective care.
Assist the family in exploring the possible causes of ineffective coping and what coping techniques they have employed.Giving the family the importance of identifying their problem helps establish rapport and facilitates better nurse-patient relationships.
Help the family in ascertaining the manifestations of ineffective coping seen among them. Provide guide questions to determine the degree to which these symptoms affect their family dynamics.This allows the family to determine the potential long-term effects of these manifestations upon them. Providing them a guide on gauging its impact on their family dynamics helps stress the importance of addressing these problems immediately.
Allow members of the family to express their thoughts and feelings freely. Provide a safe environment for them to do so, conveying acceptance and willingness of the nurse to listen.When family members can verbalize their thoughts and feelings, it helps reduce stress and anxiety. Also, allowing them to verbalize may help the nurse find more information useful in planning for interventions.
Orient the family on the disease progression and the various needs of patients with Alzheimer’s disease across all phases/stages and how these affect the patient’s functioning.Proving accurate information and health education about the condition of their loved one allows the other family members to prepare themselves for what is to come. This can also help them anticipate their responses and actions when discussed symptoms appear.
Involve the family in the care plan, letting them know the level of guidance and assistance the patient needs daily, ensuring that independence and optimal levels of functioning are maintained.Having the family know the care protocols for the patient, its rationale, and how it affects overall patient wellbeing.
Remind members of the family of the need to maintain their health and social contacts.This helps relieve stress, fatigue, and burden from caring for an ailing family member. Meeting with friends or colleagues also helps divert from their usual responsibility in caring for their loved ones.
Refer the family to support groups when needed.Support groups are composed of people who have faced or are facing situations similar to what the family is going through. By being part of a community with the same situations, family members would feel that they are not alone and may gain insight into handling their loved ones.

Nursing Care Plan 4: Diagnosis – Risk for Injury

Risk for injury (specify which type of injury) related to the inability of the patient to identify and recognize environmental hazards, disorientation, and confusion secondary to a diagnosis of Alzheimer’s ‘Disease.

Desired Outcomes

  • After nursing interventions, the patient/family is expected to:
  • Remain free from injury
  • The family will be able to secure the patient’s immediate environment and eliminate hazards.
Nursing ActionRationale
Assess the level of impairment the patient is currently suffering, including confusion, speech, and cognition problems, as well as motor movements  This creates baseline information for patient condition and helps plan for effective care.
Involve the family in assessing the patient’s immediate surroundings for potential hazards and take actions to remove them accordingly.A patient with advanced-stage AD would not assess environmental risks and hazards, which increases their risk for injury. Involving the family helps the nurse ensure the patient’s sustained care.
Provide the patient with a non-stimulating environment, removing causes of excessive noise and other stimuli which can aggravate confusion and agitation.Limiting stimuli that the patient needs to help ease his anxiety, reduce agitation, limit wandering behavior and decrease the risk for injury.
Provide relaxing and calming activities when there are indications of starting agitation, restlessness, or anxiety.Activities such as meditation, breathing, reading a book, or walking can help reduce the patient’s anxiety and risk of injury.
Ensure that the patient in the late stages of the disease is monitored regularly and not left unattended.Impairment in judgment and thought processes at the later stages of the disease can cause the patient to wander outside their homes, get lost, or suffer from extreme environmental elements. Having someone to ensure that the patient is in a safe environment promotes safety.
Remind the family members to secure potentially harmful items such as knives and sharp objects, corrosive cleaning materials, insecticides, poisonous substances, and even medications under lock and key.The patient may inadvertently use these items to cause himself harm due to problems in cognition and decision making. Keeping things that can harm the patient helps ensure safetSaSampleAAlzheimer’ss Nursing Care Plan.

References

  • ncbi.gov
  • scholar.google.com