Zcmiraflores, rn,mn

Are conditions that:

1. Have irreversible pathologies
2. Require long periods of supervision,
observation and care
3. Demand much responsibility from the
patients
4. Involve an interdisciplinary team of
professional and nonprofessional
caregivers
( families, friends, support groups)
5. Encompasses not only physical health, but
also functional, cognitive and social
dimensions
• FOCUS: HOLISTIC and LONGTERM

• Includes the following:

a. Promoting the bests quality of life
b. Delaying deterioration
c. Increase capacity for healthcare
d. Providing support in dying with
comfort and dignity
•CARE OF PERSONS WITH
DEMENTIA AND
DEPRESSION
• Environment PLAYS A BIG ROLE IN
KEEPING AN OLDER PERSON VERY
MUCH IN TOUCH WITH REALITY

• Thru PROVISION OF CONSTANT STIMULI

• CAN ONLY BE PERCEIVED IF client Can only be

remains alert , awake and oriented possible if
client has intact
thought
processes
• DEMENTIA is the most common
caused of altered thought
processes among older persons

• MOST common form is

ALZHIEMERS DISEASE
• Progressive, irreversible,
degenerative disease
attacking the brain and
resulting in impaired
thinking, behavior and
memory
• Cause: UNKNOWN

• Believe that reduce levels

of certain brain chemicals
caused degeneration of
nerve cells in the part of
the brain responsible for
memory and other thought
processes
• INTRINSIC Factors
EXTRINSIC factors

a.Regional differences in a. Exposure to

blood flow to the brain metals high
(blood brain barrier) aluminum content
b. Immunologic factors in their blood
common history of viruses
and infection
(measles,herpes due to cell death
simplex,polio)
c. Geneticssiblings
believed to be one in two
chances of carrying the
genes
•People are very frightened
of the possibility of having
Alzheimer's disease
because they know IT
REPRESENTS A LOSS OF
ONESELF
• Among relatives and
healthcare
providers/caregivers , the
main concern for people
with early dementia is HOW
TO REDUCE THE IMPACT
SO CLIENTS CAN LEAD A
NORMAL LIFE
• MEANS GETTING
OFF FROM
HOUSEWORK OR
QUITTING A JOB
JUST TO ATTEND
TO THE NEEDS OF
THE CLIENT
• IF 2 OR MORE OF THESE SIGNS IS
OBSERVED,SEEKING MEDICAL HELP
MIGHT BE WARRANTED

• 1. significant forgetfulness
-problems with long term and short
term memory
-recall 4-5 items from 5-9 items of
information possible short term
memory loss
• Normal retention is : 7+2 items
in a range of a few seconds to
a few minutes

• Inability to remember details of

one’s personal life (birthplace ,
name of children) is another
sign of impairment
• 2. Impaired cognitive functioning
Either impaired executive judgement or higher
cortical functions:

• A. impaired executive judgement means difficulty

in abstract thinking or impaired judgement

• B. altered higher cortical functions includes:

a. Aphasia- problems expressing speech or
understanding sounds
b. Apraxia-inability to transform thoughts
into actions
c. Agnosia- inability to recognize objects
• 3. Difficulty in performing
familiar task ; misplacing objects
constantly

• 4. Decline in social functions

Reisberg (1997) divides the

course of illness into seven stages:
• Common findings at each stage of Alzheimer's Disease
Stage Common manifestations Implications to caregivers
Stage 1 NORMAL .no objective nor subjective . Client will not require care since
evidence of cognitive client can still go on with her/his
impairment occupational and social
.no objective evidence of responsibilities
impairment but subjective
concern about memory loss

Stage 2 .can do familiar task in .If not observed closely, client will
FORGETFULNESS familiar settings not be suspected of having
Alzheimer's disease
.client will verbalize not being able
to recall names of people she or he
used to know; or have tendency to
misplaced things but can still carry
on with his or her occupational and
social responsibilities
Stage 3 EARLY .Decreased ability to perform
CONFUSIONAL in demanding employment
and social interactions
.deficit in memory and ability
to concentrate
.difficulty in serial 7’s
Stage 4 LATE . Increasing difficulty in
CONFUSIONAL performing complex tasks of
daily life including money
management
.can bathe, travel in familiar
setting
.paucity of speech may
begin
.can still go on with
occupational responsibilities
but inefficiency is
noticeable– e.g longer time
to finish task, be unable to do
complex procedures and
have decreasing ability to
concentrate
.Instrumental activities ADL
pose a difficulty due to some
psychomotor changes
.decreased interaction with
people sets in as client has
increasing difficulty
concentrating and starts to
grope for words
Stage 5 EARLY DEMENTIA .Unable to recall phone
number
.can recall own name and
name of spouse and children
.no assistance required with
eating or toileting
.difficulty choosing proper
clothing
.May require coaxing to bathe
.Difficulty subtracting 3’s from
20
Stage 6 MID DEMENTIA .More deliberate gait, smaller
steps
.Progressive deficits in
independent dressing, bathing ,
and toileting
.Eventual urinary and fecal
incontinence
.Threat to socialization increases
with difficulty in remembering
phone numbers
.Hygiene is starting to be a
problem since at times, will not
bathed unless coaxed
.starting to have sluggish
movement
.Will need a lot of caring since
unable to do activities of daily
living
.Hygiene is indeed a problem as
client becomes incontinent
.Frustration is markedly
manifested
Apraxia sets in
.Client starts wandering around
Stage 7 LATE DEMENTIA Progressive loss of speech,
locomotion, and
consciousness
.Client will need care 24
hours a day
.Inability to do things is not
due to poor musculoskeletal
structure but more of
inability to remember what
to do
.Total neglect of oneself due
to disorientation, confusion ,
agitation and at times,
extreme behavior such as
being violent or withdrawn
• SLOW ,STEADY,PROGRESSIVE nature of the
disease and its multifunctionality

• Present a challenge to all caregivers due to

demands for care is PROGRESSIVELY
INCREASING
As clients disease progressively losses control.
more and more caregiving activities are
requires and may INTERFERE with caregivers
own usual activities at home

BESTS: Caregiver should learn to acknowledge the

presence of the disease and REALIZE his/her own
personal capabilities in caring for the clients
• In acknowledging the disease,
caregiver should:

aim to know the disease process

and prognosis, armed with
knowledge and skills so will be able
to provide HOLISTIC care to clients
 Physiologic Psycho-
and physical social
needs needs

Limiting and
Caregivers
managing
needs
complications

The line inside is broken because the demand or focus changes

as the disease progresses.
• 1. keep client ambulatory as long as
possible and maintain daily exercise
regimen
- Measures alertness to environment and
more active
- Physical activities gives opportunity
for mental stimulation
- Awake during daytime: can sleep better
at night
• 2. Maintain optimal nutritional/vitamin status

-reduce saliva production and taste sensation-

common (deters desire to eat)
-Not to know the need to eat/know the proper
food to consume (vitamin supplements
should be given)
-maintenance of integrity of gums and mucus
membranes to preserve dental function is
important. Poor dental hygiene contribute
to poor nutritional status
• 3. Protect from sources of infection

• SLOW deterioration in both physical and cognitive

functions

• Immunocompromised situations

• Interventions:
.clean body and environment
.good nutrition
.vaccinations (pneumococcus)-during rainy
seasons)
• 4. Maintain bowel and bladder
elimination through routine
consistent toileting
• Avoid using catheters and urinary
incontinence devices
• Good bowel and bladder May not
elimination help maintain remaining be able to
physiologic activity
Intervention: recognize
a. anticipate urination desire to
b. encourage to empty bowel and urinate
bladder during scheduled time to
ensure proper emptying
• Not recognizing the
desire to urinate
leads to
embarrassment and
trigger irritability

• INT: limit fluid after

dinner decrease
nocturnal incontinence
Desire to defecate if nor recognized
leads to constipation aggravated by
decrease physical mobility

INTERVENTIONS:
1. If defecation occurs: AVOID
using oral laxatives or
enemas- decrease bowel
control
2. Use fiber, fluid and exercise-
maintain bowel regularity
3. Provide adequate time for
rests and sleep

Interventions:
1. quiet and peaceful environment
2. minimize or avoid caffeine
3. schedule rests periods mid-morning
and mid-afternoon for 40-90 minutes
each time
4. If patient is up at night increase
duration of rests periods
5. Institute safety measures
-Decreased mobility leads to injuries and
fall (due to inability to recognize and
interpret their environment)

Interventions:
1. Floor should be free of spills

2. Remove harmful objects

3. Due to poor memory, not be able to

return home (not allowed to go out
ALONE or leave the house , PROPER
IDENTIFICATION in important
4. Not allowed to be alone in the
kitchen (suffer from burns)

5. Knives and sharp objects should

be kept out of reach

6. Hazardous substances (eg

household
pesticides/cleaners should
be locked as clients may
accidentally ingests