Topic: Nursing care of the patient with Alzheimers disease

Audience:

3rd year Bscn. Student nurses, NCU and UTECH

Date:

March 22nd, 2012

Time:

10:30 Am

Duration:

45 Minutes

Venue:

In-Service Unit

Methodology: Lecture Discussion

Number of participants: 30
Learning Theories:

Ausubel: Emphasized the use of advance organizers which he said was

different from overviews and summaries. His use of an advance organizer acted to bridge the
chasm between learning material and existing related ideas. The advanced organizer used; sought
to bridge new knowledge with what was known (sometimes what is known is uncertain and not
concrete). Though he specified that his theory applied only to reception learning in schools, it
was utilized because it introduced the topic and aided the sequence of the information to be
imparted. (Ormrod & Rice, 2003).
Rogers: Dealt with the adult learner, he posited that learning is student centered and
personalized and the educators role is that of a facilitator. Affective and cognitive needs are
central and the goal is to develop self-actualized persons in a cooperative, supportive
environment. This theory was used because all the participants were adult learners, thus they

were responsible for their learning experience and the teacher sought to guide them through this
experience. (Quinn, 2006).
Bruner: Believed that learners were not blank slates but bought past experiences to a new
situation, he also stated that new information was linked to prior knowledge, thus mental
representations are subjective. Bruners Discovery learning is an inquiry-based, constructivist
learning theory that takes place in problem solving situations where the learner draws on his or
her own past experience and existing knowledge to discover facts and relationships and new
truths to be learned. (Quinn, 2006). Students interact with the world by exploring and
manipulating objects, wrestling with questions and controversies, or performing experiments. As
a result, students may be more likely to remember concepts and knowledge discovered on their
own (in contrast to a transmissionist model). (Quinn, 2006). Models that are based upon
discovery learning model include: guided discovery, problem-based learning, simulation-based
learning, case-based learning, incidental learning, among others. The advantages of this theory
are: it encourages active engagement, promotes motivation, a tailored learning experience, and
promotes autonomy, responsibility, independence, the development of creativity and problem
solving skills. (Quinn, 2006) Bruners theory was used because it encouraged active engagement,
promotes motivation, a tailored learning experience, and promotes autonomy, responsibility,
independence and the development of creativity and problem solving skills for this presentation.
Vygotsky: Posited that individuals learn from each other through social interaction and the
teacher and the learner collaborate in a reciprocal relationship where each learns from each other
through the same process of social interaction (Quinn, 2006). This theory was chosen since it
lays the overall foundation for human behaviours that of interaction, it coincides with the topic
and the overall mode of delivery of the topic.

Dewey: Posited that the teachers role is not to stand off and look, but to participate and share in
the learning activity (Democracy and Education, 1924).This theory was used because the teacher
participated actively in the process .
Bandura: Posited that people learn from each other through observation, imitation and modeling.
It is often called a bridge between behaviourists and cognitive learning theories since it
encompasses memory, attention and motivation. (Ormrod & Rice, 2003). Bandura was used
because this topic called for the use of cognitive skills attention, imitation and modeling, the
theory matches the mode of presentation for this topic
Aim of activity:

To educate student on the nursing management of the patients with

Alzheimers disease

Scientific Principle: Equilibrium: Any unchanging condition or state of a bodys

system resulting from the balancing out of processes to which it is subjected.
(Dictionary.Com). This scientific principle was used because it covers the
intent of the topic, which is to return the body to it balancing processes or to
equilibrium
Resources:

Registered nurse, Lap top computer, multimedia, white

board and markers.

Objectives:

At the end of the 45mins interactive session students should be able to:

1. Define the term Alzheimers according to The Free Dictionary

2. Identify the major signs and symptoms for Alzheimers Disease

3. State the causes of Alzheimers Disease

4. Describe the nursing management for Alzheimers Disease
Evaluation: Formative and Summative. Questions will be asked before and after each objective
as well as a demonstration/return demonstration
followed by a quiz at the end

References:
Ackley, B & Gulanick, M. (2011). Nursing diagnosis handbook: Nursing care plans
Amsterdam: Elsevier
Alzheimers Disease Education & Referral Center (2011, July) National Institute on Aging
National Institutes of Health. U.S. Department of Health and Human Services
Anderson, H. Alzheimers Disease Retrieved on March 22nd, 2012 from

http://emedicine.medscape.com/article/1134817-overview#aw2aab6b2b6

Crystal. H.(2012). Alzheimer's Disease Causes, Stages, and Symptom

http://www.medicinenet.com/alzheimers_disease_causes_stages_and_symptoms/page
htm#tock
Doenges, M., Moorhouse, M & Murr, A. (2008). Nursing diagnosis manual, planning,
individualizing and documenting patient care. Philadelphia: F.A. Davis
Dudek, Susan G. (2007). Nutrition essentials for nursing practice. Hagerstown, Maryland:

Lippincott Williams & Wilkins.

Dunne, T., Neargarder, S., Cipolloni, P & Cronin-Golomb. (2004) A. Visual contrast enhances

food and liquid intake in advanced Alzheimer's disease. Clinical Nutrition. 23(4):533

538.

Frisch, N, C & Frisch, Lawrence E. (2006). Psychiatric mental health nursing

Colorado Springs, Colorado: Thomson Delmar Learning.
Gitlin, L., Hauck,W., Dennis, M & Winter L. (2005) Maintenance of effects of the home

environmental skill-building program for family caregivers and individuals with Alzheimer's

disease and related disorders. J. Gerontol. A Biol. Sci. Med. Sci.. 60(3):36874

Ormrod, J & Rice, F. (2003). Lifespan development and learning. Boston MA: Pearson
Publishing.
Quinn, F. (2006). The principles and practice of nurse education. London: Stanley Thornes

OBJECTIVES

CONTENT

TEACHERS
OBJECTIVES

LEARN
OBJECT

Ice breaker
A child and his grandparents were at their house.
Grandpa saw that his grandchild was eating ice cream.
Grandpa: Honey!
Grandma: What, sweetheart?
Grandpa: Get me some ice cream. Don't forget, ice
cream, ice cream, ice-cream! You have Alzheimers
disease (can easily forget), so don't forget, ICE-CREAM!
Grandma: What are you talking about?? Your
Alzheimers disease is even worse than mine! Okay, I'm
going to get your I- SCREAM!
Afterwards, Grandma came back.
Grandma: Here they are the hotdogs you asked me to get.
Grandpa: Ha ha ha.... I told you so... you really have
Alzheimer's disease.............you forgot the ketchup.
Define the term

Teacher will ask

Students will

three students to

term Alzheim

define the term

disease in the

Alzheimer's disease is a degenerative brain disorder

Alzheimers
marked by a continual loss of neurons (nerve cells) and
disease
their connections with other neurons (synapses) that are
Alzheimers disease words.

in their own words.

crucial to memory and other mental functions and a

Students will
decrease in neuro chemical especially Acetylcholine
Teacher will define

attentively an

Alzheimers

on screen as t

disease according

definition of

to the content with

Alzheimers d

the aid of

presented.

which carries complex messages back and forth.(The

Free Dictionary)

PowerPoint
presentation

Teacher will ask

Two students

two individuals

the back of th

seated at the back

will define th

of the class to

Alzheimers u

define Alzheimers

least two key

according to the

such as a deg

content

brain disorde

by a continua

neurons (nerv

and their con

with other ne

(synapses) th

crucial to me

other mental

Identify the signs

Teacher will ask

Seven studen

seven students to

identify one

The signs and symptoms of Alzheimers disease are:

and major
symptoms of

1. Trouble remembering things: At first, only short-term

identify

sign/symptom

Alzheimers

memory may be affected. The individual may forget an

sign/symptom each

after reading

disease

appointment or the name of a new acquaintance. She may for subsequent to

also forget where she left things, or she may leave things

reading a slip of

in odd places (for example, putting her shoes in the

paper posted under

microwave). Eventually, long-term memory also is

desk by teacher.

paper remove
under desk.

impaired, and the individual may not recognize family

members.
2. Mood or personality changes: The person may
suddenly become angry or sad for no apparent reason. Or
someone who was social and outgoing may become
withdrawn. The person may also become stubborn or

Teacher will

Students will

identify the

and follow at

signs/symptoms for

on PowerPoin

Alzheimers using

sign/symptom

PowerPoint

Alzheimers a

presentation

identified.

Teacher will ask

Three studen

distrustful. Depression also often accompanies

Alzheimer's disease, bringing such symptoms as loss of

three students on

right and four

the right and four

left will state

on the left to state

sign/symptom

one sign/symptom

Alzheimers a

3. Trouble completing ordinary tasks: Simple tasks that

factor each for

to the content

once caused no difficulty may become much more

Alzheimers

challenging. For example, the individual may forget how

according to the

to use the oven, lock the door, or get dressed.

content

interest in a favorite hobby or activity, a change in

appetite, insomnia or sleeping too much, lack of energy,
and hopelessness.

4. Difficulty expressing thoughts: It's common for people

with Alzheimer's disease to have trouble with language.
The individual may try describing an object rather than
using its name for example, referring to the telephone as
"the ringer" or "that thing I call people with." Reading or
writing may also be impaired.
5. Impaired judgment: The individual might have trouble
making decisions, solving problems, or planning. For
example, he may no longer be able to balance a
checkbook or pay bills.
6. Disorientation: We all know what it's like to be
driving and momentarily forget where we're going. But
those with Alzheimer's disease may get lost in their own
neighborhood. They may also lose track of dates and the

time.
7. Unusual behavior: The individual may wander,
become agitated, hide things, wear too few or too many
clothes, become overly suspicious, engage in unsafe
behaviors, or use foul language. (Alzheimers Disease
Education & Referral Center, (2011)

State the
causes/risk
factors for
Alzheimers
disease

Teacher will ask

Four students

four students seated

the middle of

in the middle of the

invite one per

class to invite one

their choice e

person of their

identify one c

choice each to

Alzheimers

According to Frisch & Frisch, 2006 the causes of

Alzheimers are unknown, but factors such as genetic,
viral, environmental, nutritional, insulin resistance, head
trauma, depression and immunological are being
explored.
Genetic:

identify one cause

for Alzheimers
Although most cases of AD are sporadic (not inherited),
familial forms of AD do exist. Autosomal dominant AD,
Teacher will state

Students will

the diagnostic tests

follow on Pow

for Alzheimers

as the cause/r

using PowerPoint

for Alzheime

presentation

stated.

AD. In familial clustering, at least 2 of the affected

Teacher will ask

Students seat

individuals are third-degree relatives or closer.

students seated in

second row w

(Anderson, 2012).

the second row to

the causes/ris

state the causes/risk

for Alzheime

for Alzheimers

according to

content

content

which accounts for less than 5% of cases, is almost

exclusively early onset AD; cases occur in at least 3
individuals in 2 or more generations, with 2 of the
individuals being first-degree relatives.
Familial clustering represents approximately 1525% of
late-onset AD cases and most often involves late-onset

Insulin Resistance:
Disturbances in insulin metabolism may not cause
neurological changes but may influence and accelerate
these changes, leading to an earlier onset of AD.
Infection
An emerging field of research suggests a significant
association between AD and chronic infection with
various species of spirochetes, including the periodontal
pathogen Treponemas and Borrelia burgdorferi, as well

as pathogens such as herpes simplex virus type 1

(Anderson, 2012)
Depression:
Depression has been identified as a risk factor for AD
and other dementias. Studies have showed a 50%
increase in AD and dementia in those who were
depressed at baseline. During a 17-year follow-up period,
a total of 21.6% of participants who were depressed at
baseline developed dementia, as compared with 16.6% of
those who were not (Anderson, 2012)
Head Trauma:
A study that followed over 7,000 US veterans of World
War II showed that those who had sustained head injuries
had twice the risk of developing dementia later in life,
with veterans who suffered more severe head trauma
being at an even higher risk. A cholesterol carrying
protein apolipoprotein E (APOE) and head injury seem to
increase the risk. (Anderson, 2012).

Describe the
Nursing
management for
Alzheimers
disease

There is no cure for Alzheimer's disease; available

Teacher will ask

Three studen

treatments offer relatively small symptomatic benefit but

three students to

come to the b

remain palliative in nature. Current treatments can be

come to the board

write down o

divided into pharmaceutical, psychosocial and care

and write down one

diagnosis eac

giving.

diagnosis each and

three others w

Pharmaceutical: There are five Medications which have

proven to have some effect on the cognitive
manifestation of Alzheimers. These medications are
acetylcholinesterase inhibitors; Rivastigmine (Exelon),
Galantamine, Tacrine and Donepezil (Aricept). These
medications are used to reduce the rate at which
acetylcholine is broken down, thereby increasing the
concentration of acetylcholine in the brain and combating

three others to write down corresp

down

interventions

corresponding

Alzheimer, t

interventions for

solicit help fr

Alzheimers, they

individuals o

may solicit help

choice

from someone of
their choice

the loss of Ach caused by the death of cholinergic

neurons. (Crystal, 2012)
. Care giving
Since Alzheimer's has no cure and it gradually renders

Teacher will

Students will

describe the

listen attentiv

management of

management

Alzheimers

Alzheimers i

people incapable of tending for their own needs, care

according to the

discussed usi

giving essentially is the treatment and must be carefully

content using

of PowerPoin

managed over the course of the disease.

PowerPoint

presentation

During the early and moderate stages, modifications to

presentation.

the living environment and lifestyle can increase patient

safety and reduce caretaker burden. (Hauk & Winter,
2005) Examples of such modifications are the adherence
to simplified routines, the placing of safety locks, the
labeling of household items to cue the person with the
disease or the use of modified daily life objects. ,
(Neargarder , Cipolloni & Cronin-Golomb, 2004) The
patient may also become incapable of feeding
themselves, so they require food in smaller pieces or
pureed (Dudek, 2007).
As the disease progresses, different medical issues can
appear, such as oral and dental disease, pressure
ulcers, malnutrition, hygiene problems,
or respiratory, skin, or eye infections, to name a few
(Dudek, 2007)
Nursing Diagnoses
I.

Bathing or hygiene self-care deficit

II.

Constipation

Teacher will ask

Three studen

three students

in the fourth

seated in the fourth

identify one n

row to identify one

intervention e

nursing

Alzheimers

intervention each

according to

for Alzheimers

content

according to the
contents

III.

Disturbed thought processes

IV.

Dressing or grooming self-care deficit

V.

Feeding self-care deficit

VI.

Imbalanced nutrition: Less than body

requirements

VII.

Impaired verbal communication

VIII.

Ineffective coping

IX.

Risk for infection

X.

Toileting self-care deficit

XI.

Disabled family coping

XII.

Interrupted family processes

XIII.

Risk for injury (Ackley and Gulanick, 2011)

NURSING INTERVENTIONS
- Establish an effective communication system with the
patient and his family to help them adjust to the patient's
altered cognitive abilities.
-Provide emotional support to the patient and his family.
Encourage them to talk about their concerns. Listen
carefully to them, and answer their questions honestly
and completely. Because the patient may misperceive his
environment, use a soft tone and a slow, calm manner
when speaking to him.

-Allow the patient sufficient time to answer your

questions because his thought processes are slow,
impairing his ability to communicate verbally.
-Administer ordered medications to the patient and note
their effects.
-If the patient has trouble swallowing, check with a
pharmacist to see if tablets can be crushed or capsules
can be opened and mixed with a semi-soft food protect
the patient from injury by providing a safe, structured
environment. Provide rest periods between activities
because these patients tire easily.
-Encourage the patient to exercise, as ordered, to help
maintain mobility. Encourage patient independence,
and allow ample time for the patient to perform tasks.
-Encourage sufficient fluid intake and adequate nutrition.
Provide assistance with menu selection, and allow the
patient to feed himself as much as he can. Because the
patient may be disoriented or neuromuscular functioning
may be impaired, take the patient to the bathroom at least
every 2 hours, and make sure he knows the location of
the bathroom.
-Assist the patient with hygiene and dressing as

necessary. Many patients with Alzheimer's disease are

incapable of performing these tasks. (Doenges,
Moorhouse & Mishler, 2008)

EVALUATION

QUIZ

QUESTIONS
1.
2.
3.
4.

Define the term Alzheimers disease

Identify three major symptoms
State three causative/risk factors
Give three nursing diagnoses and four nursing interventions

ANSWERS
1. Alzheimer's disease is a degenerative brain disorder marked by a continual loss of
neurons (nerve cells) and their connections with other neurons (synapses) that are crucial
to memory and other mental functions and a decrease in neuro chemical especially
Acetylcholine which carries complex messages back and forth.(The Free Dictionary)
2. Trouble remembering things, mood or personality changes, trouble remembering things,
Difficulty expressing thoughts, impaired judgement, disorientation and unusual behaviour
3. According to Frisch & Frisch, 2006 the causes of Alzheimers are unknown, but factors
such as genetic, viral, environmental, nutritional, insulin resistance, head trauma,
depression and immunological are being explored.
NURSING DIAGNOSES
4. Bathing or hygiene self-care deficit, Constipation, Disturbed thought processes, Dressing
or grooming self-care deficit, Feeding self-care deficit, Imbalanced nutrition: Less than
body requirements, Impaired verbal communication, Ineffective coping, Risk for
infection, Toileting self-care deficit, Disabled family coping, Interrupted family
processes, Risk for injury (Ackley and Gulanick, 2011)
NURSING INTERVENTIONS
- Establish an effective communication system with the patient and his family to help them adjust
to the patient's altered cognitive abilities.

-Provide emotional support to the patient and his family. Encourage them to talk about their
concerns. Listen carefully to them, and answer their questions honestly and completely. Because
the patient may misperceive his environment, use a soft tone and a slow, calm manner when
speaking to him.
-Allow the patient sufficient time to answer your questions because his thought processes are
slow, impairing his ability to communicate verbally.
-Administer ordered medications to the patient and note their effects.
-If the patient has trouble swallowing, check with a pharmacist to see if tablets can be crushed or
capsules can be opened and mixed with a semi-soft food protect the patient from injury by
providing a safe, structured environment. Provide rest periods between activities because these
patients tire easily.
-Encourage the patient to exercise, as ordered, to help maintain mobility. Encourage patient
independence, and allow ample time for the patient to perform tasks.
-Encourage sufficient fluid intake and adequate nutrition. Provide assistance with menu
selection, and allow the patient to feed himself as much as he can. Because the patient may be
disoriented or neuromuscular functioning may be impaired, take the patient to the bathroom at
least every 2 hours, and make sure he knows the location of the bathroom.
-Assist the patient with hygiene and dressing as necessary. Many patients with Alzheimer's
disease are incapable of performing these tasks. (Doenges, Moorhouse & Mishler, 2008)

SUMMARY: The patient with Alzheimers disease

The Nursing care of the client with Alzheimers disease was presented on March 22nd, 2012 at
the In-service Education Department Bellevue Hospital. The purpose of the teaching session was
to educate senior nursing students from Northern Caribbean University (NCU) and University of
Technology (UTECH) how to care for clients with Alzheimers disease. The teaching
methodology used was lecture discussion
The learning theories used were: Ausubel who served to break the ice, introduce and sequence
the topic, since it was his theory that spoke about the use of an advance organizer in teaching.
Rogers: who posited that for the adult, learning is student centered and personalized and that the
educator act as a facilitator; Bruner: who posited that learners were not blank slate, but brought
their past experiences to this learning situation; Vygotsky: posited that individuals learn from
each other through social interaction and the teacher and the learner collaborate in a reciprocal
relationship where each learns from each other through the same process of social interaction and
Bandura: who posited that people learn from each other through observation, imitation and
modeling. This was not a new topic for the students; they found the topic interesting, thus they
participated freely in the discussions.
The scientific principle of equilibrium was used since it focused on any unchanging condition or
state of the body resulting from the balancing out processes to which it is subjected
The session was evaluated using formative and summative evaluation method, which is
questions were asked before and after each objective and a quiz at the end.

At the end of the 45mins interactive session students were able to:

1. Define the term Alzheimers according to The Free Dictionary

2. Identify the major signs and symptoms for Alzheimers Disease
3. State the causes of Alzheimers Disease
4. Describe the nursing management for Alzheimers Disease

the massive loss of brain cells that occurs in

advanced Alzheimer's disease causes the brain to wither and shrink, as shown in these crosswise slices
through the middle of the brain between the ears. In the Alzheimer's brain, the outer layer (cortex) shrivels
up, damaging areas involved in thinking, planning, and remembering. The hippocampus, a structure that
plays a vital role in memory formation, is one of the hardest-hit areas (see Figure 6).