Among many other cases, the nurses are trying daily to people who are affected by Alzheimer’s, conducting a series of care and functions that will facilitate the acceptance and treatment of disease. Since nursing is involved in various pathologies and diseases existing today I will focus on “the forgotten disease.”
Alzheimer’s disease is a progressive brain disorder characterized by degenerative changes in cortical nerve cells and brain nerve endings. This process produces an irreversible deterioration of memory and destruction of intellectual functions. The causes are unknown, the most common causes are shuffled autoimmune disease, a virus, genetic disease and neurotransmitter deficiency. The main risk factor is age, the onset is insidious, it can affect individuals of up to 40 years, the disease will progress to total disability.
Rating:
The occurrence and severity of symptoms varies among individuals, is characterized by memory loss, intellectual deterioration and personality change. is classified into three stages: Beginner, intermediate and final phase. The initial indicators are mild, but the main sign is the loss of short-term memory, the diagnosis may take years or even diagnosed in the next stage of the disease. In the half-stage patients have trouble recognizing objects and things, to perform activities or to launch or skills she used to communicate. In the final stage are absent memory and intellectual capacidd. In the final stage the patient is in a vegetative state.
Memory:
Initially the loss is mild, usually consisting of an inability to retain newly acquired information. The individual may forget dates and losing things, how to use common tools and objects, while maintaining coordination to implement them. The individual may be lost in the home or family environments, and gradually losing the ability to recognize or name objects or remember the names of their relatives.
Objectives of Nursing: Helping the caregiver / aa monitor the patient’s behavior caused by mental deterioration, and to take measures to compensate for dementia.
Nursing interventions:
1 .- To provide the patient a consistent environment and routine, to help work with their limited capacities.
2 .- Avoid redirect the patient more than once in every encounter with him, to avoid the frustration that can lead to being unable to remember.
3 .- Allow patient behaviors, such as the objects and vagrancy acaparación always taking place in a safe environment.
4 .- To evaluate the patient for signs and symptoms of depression.
5 .- To avoid the turmoil and unrest of the patient must maintain the structured environment, consistent and easy to follow a routine for the patient can make an album of pictures to remember the past, promoting physical activity and art therapy .
6 .- Place labels with the names of objects and rooms, to help remember your name and function.
7 .- To provide clues to the identity of objects and tasks.
8 .- Put a clock and a calendar in his room and place an “X” days gone by, to help you remember the correct date.
9 .- Make a list of daily activities.
* Deterioration of verbal communication relcionado with cognitive deterioration in the state:
Nursing Goals: Establish a verbal and nonverbal communication as efficient as possible and understand their needs as his dementia increases and deterioration of verbal skills.
Posts:
1 .- Go to the patient in an open, friendly and relaxed.
2 .- Discuss with the patient tone of voice low and clear.
3 .- Identify and always look directly at the patient.
4 .- To provide a relaxed and heartening, to avoid noise and distractions.
5 .- Rate nonverbal behavior, facial expression, body language, posture, gestures, etc …
6 .- Explain this activity using short sentences. When giving instructions to ensure splitting the tasks into small units and understandable. Use simple gestures, point to objects or use the show if possible.
7 .- Be sure to have your attention.
8 .- Listen to the patient and included in the conversation.
9 .- Identify behaviors agendas, namely the realization of a certain behavior to ask for something, write to better understand its significance for the patient.
10 º .- Encourage the patient to describe past situations or stories.
* High risk of injury related to lack of awareness of environmental hazards secondary to cognitive deficits:
Nursing Goal: To ensure patient safety as it loses its ability to control potential hazardous environmental factors.
Nursing interventions:
1 .- Guiding the patient on the surrounding environment.
2 .- Place the bed rails.
3 .- Keep him unhindered environment, ensure that there is enough light to prevent falls in the dark.
4 .- Avoid using space heaters, stoves, etc …
5 .- Use of shoes with nonslip soles.
6 .- Watch for signs of pain issued by the patient.
7 .- Maintain a calm and without major changes.
* Faecal incontinence associated with memory loss:
Nursing Goal: Reduce the number of episodes of fecal incontinence and continence aumertar of sphincters.
Nursing interventions:
1 .- Showing the location of the toilet, if it is necessary to identify the door with a drawing of a toilet to help you find it.
2 .- Assess bowel habits, take him to the bathroom at the same time every day often defecate.
3 .- To assess the non-verbal indicators of the patient before the need to defecate.
4 .- After removal help clean the perianal area.
* Disruption of patterns of urinary elimination related to memory loss:
Nursing objectives: To evaluate the existence of the acute symptoms of incontinence and, if necessary, a scheme of bladder retraining.
Nursing interventions:
1 .- To evaluate the patient for causes of acute incontinence, infection, retention, or delirium.
2 .- Make sure the patient knows the toilet situation, if necessary put in the closet door with a drawing to help locate the patient.
3 .- To evaluate the presence of non-verbal codes that indicate the need to urinate.
4 .- To evaluate the model of patient evacuation and use the information to plan an evacuation plan.
5 .- Limiting fluid intake at night.
6 .- After verifying that urination is dry the perianal area to help maintain skin integrity.
7 .- To evaluate the type of incontinence and infection ruled out and see if it is treatable.
8 .- Starting bladder retraining.
* Disruption of sleep pattern associated with anxiety and confusion secondary to cognitive deficits:
Nursing Goals: To reduce the sleep disorder.
Nursing interventions:
1 .- Space activities throughout the day interspersed rest periods.
2 .- Avoid that patients fall asleep during the day, using short trips, planned activities.
3 .- The patients who sleep during the day should endeavor to do so sitting in the chairs instead of the bed to remind them that there should not be sleeping.
4 .- Avoid the use of restraints because they often increase the fiscal turmoil.
5 .- Provide a quiet, no noise and no lights at night.
6 .- Admin when anxiolytics and sedatives may be prescribed.
7 .- Establish a bedtime routine, and ensuring compliance.
8 .- To teach the patient how to perform relaxation techniques.
* Lack of self in the elimination, grooming, hygiene, clothing and evacuation-related weakness, impairment of motor control and memory loss.
Purpose of Nursing: Helping the patient to perform the tasks themselves.
Nursing interventions:
1 .- To evaluate the failure of dressing, feeding, bathing, etc …
2 .- To evaluate the physical and cognitive patient.
3 .- Teach the family and the caregiver to provide care.
4 .- To provide care to the patient totally dependent on aid and not be totally dependent.
5 .- Provide step by step instructions for the patient to make the maximum number of tasks on its own.
6 .- In the bath use a stool in the shower, to promote self-care.
7 .- To dress and undress the patient is recommended shoes without laces, or loose clothing presndas closures with pressure, with Velcro closures and elastic waistband, avoid buttons and belts.
8 .- To assist the patient to dress, putting the clothes in the order they should wear.
9 .- To assist the patient at mealtimes, allowing her to eat alone, providing straws, special cups, cutlery with large handles adequate.
10 .- An outline plan of escape to avoid urinary incontiencia.
* Alteration of processes due to family crisis caused by the chronic illness of a family, disruption of family life and changing roles within the family:
Nursing Goal: Reduce family conflict and increase the capacity of the caregiver
Nursing interventions:
1 .- Encourage the carer and family to express their feelings, frustrations and problems.
2 .- Provide support, understanding and safety to their families.
3 .- To assist the caregiver to learn the responsibilities that just assume.
4 .- To refer to the family to social services to help with home care.
5 .- Encourage the carer to use the services of home help.
6 .- Advise relatives or friends to interpret their behavior as a reflection of the disease process.
7 .- Advise caregivers to continue to keep his friends and attending social events.
8 .- Advise family participation in a self-help group local or national.
* Social isolation (patient and family) related to the anxiety felt by the disability and loss of memory and the impossibility of leaving alone:
Nursing Goal: Avoid social isolation of the patient and family.
Nursing interventions:
1 .- To evaluate the patient’s ability to communicate and the level of social isolation of the family.
2 .- Discuss with the patient’s family the opportunity to have friends that offer support and help.
3 .- Identify alternative systems of support for the family so the caregiver can maintain a social life.
* Anxiety-related changes or real or perceived threats:
Nursing Goal: The patient will decrease their anxiety.
Nursing interventions:
1 .- Give the patient time to express their fears, escuchalo with respect.
2 .- To help reduce anxiety by establishing a fluid communication, avoid changing room and provide an environment with few changes.
3 .- During hospitalization ask relatives to bring familiar objects.
4 .- Help to find lost objects.
5 .- avoid forcing too many tasks to perform.
6 .- Avoid limited visiting hours for relatives.
* High risk of violence associated with irritability, frustration and confusion secondary to degeneration of cognitive thought:
Nursing Goal: Patient will demonstrate control of their behavior in the absence of violence.
Nursing interventions:
1 .- Ask the caregiver to explain how to behave and that is usually done to calm down.
2 .- Monitor the patient for signs of increased anxiety.
3 .- Reduce environmental stimuli such as noise and light.
4 .- To document the signs, symptoms, precipitating factor, time, etc …
