Application of the Nursing Process:

Dementia (Continuation)
Data Analysis
Commonly used nursing diagnoses for dementia are as follows:

• Risk for Injury

• Disturbed Sleep Pattern
• Risk for Deficient Fluid Volume
• Risk for Imbalanced Nutrition: Less than Body Requirements
• Impaired Environmental Interpretation Syndrome
• Impaired Memory
• Impaired Social Interaction
• Impaired Verbal Communication
• Ineffective Role Performance

Additional Diagnoses:
• Disturbed Thought Processes
• Disturbed Sensory Perception
OUTCOME
IDENTIFICATION
Outcome Identification
Treatment outcomes for the client with dementia may
include the following:

• The client will be free of injury.

• The client will maintain an adequate balance of activity and rest,
nutrition, hydration and elimination.
• The client will function as independently as possible given his or her
limitations.
• The client will feel respected and supported.
• The client will remain involved in his or her surroundings.
• The client will interact with others in the environment.
INTERVENTIONS
Interventions

1. Promoting the Client’s Safety

2. Promoting Adequate Sleep and Proper
Nutrition, Hygiene, and Activity
3. Structuring the Environment and Routine
4. Providing Emotional Support
5. Promoting Interaction and Involvement
1. Promoting Client’s Safety

 Protecting against injury

 Meeting physiologic needs
 Managing risks posed by the environment
Delusions
Hallucinations
2. Promoting Adequate Sleep and Proper Nutrition,
Hygiene and Activity

Nutrition
Monitor food and fluid intake.
Provide foods
Sitting with clients at meals
Having nutritious snacks available
Minimizing noise and undue distraction at meal times
The food should be cut up when it is prepared
Providing low-calorie snacks
Enteral nutrition (severe dementia)
Hygiene
Reminders to urinate maybe helpful
Adult diapers is indicated for incontinence rather than
indwelling catheters
Check disposable pads and diapers and change soiled items
frequently
Provide good hygiene

Activity
Mild physical activity
Daily physical activities
Provide rest periods
Encourage client to engage in physical activity
3. Structuring the Environment and Routine

Familiar surroundings and routines

The nurse encourages client’s to follow their usual
routines and habits of bathing and dressing
Monitoring response to daily routine
Monitor and manage the client’s tolerance of
stimulation.
Clients need a quieter environment with fewer people
and less noise or distraction.
4. Providing Emotional Support

“Empathic caring”
• Nurses and caregivers must maintain all the qualities of the
therapeutic relationship even when client do not seem to
respond.
• Patients with dementia often becomes anxious and require
much patience and reassurance.
For example, if the client is confused about getting dressed, the
nurse must say:
“I’ll be glad to help you with that shirt. I’ll hold it for you while you put
your arms in the sleeves.” (offering self/suggesting
collaboration)

“Supportive Touch”
5. Promoting Interaction and Involvement

• The nurse or caregiver plans activities that reinforce the client’s identity
and keep him or her engaged and involved in the business of living.

• “Reminiscence therapy”

 It is an effective intervention for clients with dementia

 Uses the client’s remote memory (photo albums)
 Sometimes clients like to reminisce about local or national events and
talk about their roles or what they were doing at that time
 This builds client’s self-esteem
 Can also be effective with small groups of clients as they collectively
remember their early life activities
The nurse must listen carefully to the client and try to
determine the meaning behind what is being said. The
nurse must say,
“Are you trying to say you want to use the bathroom?”
“Did I get that right, you are hungry?” (seeking information)

It is also important not to interrupt clients or to finish

their thoughts. If a client becomes frustrated when the
nurse cannot understand his or her meaning, the nurse
must say,
“Can you show me what you mean or where you want to go?”
(assisting to take action)
When verbal language becomes less coherent, the nurse
should remain alert to the client’s non-verbal behavior.

Example:
A client is pacing and looks upset but cannot indicate what is
bothering her, the nurse says,

“You look worried. I don’t know what’s wrong, but let’s go

for a walk.” (making an observation/offering self)
Distraction – involves shifting the client's attention and energy
to a more neutral topic.
Example:
The client may display a catastrophic reaction to the
current situation such as jumping up from dinner and
saying,

“My food tastes like poison!”

The nurse must intervene with distraction by saying,

“Can you come to the kitchen with me and find

something you’d like to eat?”

“You can leave that food. Can you help me find a good
program on television?” (Redirection/distraction)
Time away – involves leaving clients for a short period and
then returning to them to reengage in interaction.
Going along – means providing emotional reassurance to
clients without correcting their misperception or delusion.
Example:
A client is fretful, repeatedly saying,
“I’m so worried about the children. I hope they’re okay,”
and speaking as though his adult children were small and
needed protection. The nurse could reassure the client by
saying,
“There’s no need to worry; the children are just fine.”
(going along)
The nurse can use reframing techniques to offer clients
different point of view or explanation for situations or
events.

Example:
One client may interpret another’s yelling as direct threat.
The nurse can provide an alternative explanation such as,

“That lady has many family problems, and she yells

sometimes because she’s frustrated.” (reframing)
 Concept Mastery Alert

Remember:
• Different interventions are indicated for dealing with
psychotic symptoms depending on the cause.

• People with dementia cannot regain their cognitive

functions, so techniques like redirection or going along
with the person are indicated.

• However, when psychotic symptoms are due to a treatable

illness, such as schizophrenia, the nurse should not say or do
anything to reinforce the notion that the delusions or
hallucinations are real in any way.
Evaluation

• Treatment outcomes changes constantly as the

disease progresses.
• Maintaining independence (in early stage)
• The client may maintain independence by wearing
his or her own clothing. May keep some
independence by selecting what foods to eat.
(in late stage)
• The nurse must assess clients for changes.
COMMUNITY BASED CARE
Community Based Care
• Home care is available through home health
agencies, public health agencies and visiting nurses.
• Periodic nursing assessment ensures that the level
of care provided is appropriate to the clients current
needs
• Adult day care centers provides supervision, meals,
support, and recreational activities in group setting.
• Residential facilities are available for clients who do
not have in-home caregivers or whose needs have
progressed beyond the care that could be provided
at home.
MENTAL HEALTH
PROMOTION
Mental Health Promotion
• People with elevated levels of plasma homocysteine are at
increased risk for dementia.
• Clinical trials currently are in progress to see if lowering
homocysteine levels actually decreases the risk for
dementia and whether taking high supplemental doses of
vitamin B vitamins slows the progression of Alzheimer's
disease.
• People who regularly participate in brain-stimulating
activities such as reading books and newspapers doing
crossword puzzles are LESS likely to develop Alzheimer’s
disease than those who do not.
• Healthy eating habits, physical activity, and minimizing
health risks help to decrease or delay cognitive decline
 Roles of the Caregiver
• Caregivers need to know about dementia and the
required client care as well as how client care will change
as the disease progresses.
• Caring for clients with dementia can be emotionally and
physically exhausting and stressful.
• Role strain is identified when the demands of
providing care threaten to overwhelm a caregiver

INDICATION:
Fatigue
Increased use of alcohol or drugs
Social isolation
Inattention to personal needs
Inability or unwillingness to accept help from others
• Caregivers need education about dementia and the
type of care that clients need.
• Caregivers need outlets for dealing with their own
feelings.
• Support group can help them to express
frustrations, sadness, anger, guilt, or ambivalence.
• Caregivers should be able to seek and accept
assistance from other people or agencies.
• Caregivers must maintain their own well-being and
not wait until they are exhausted before seeking
help.
• Caregivers needs support to maintain personal
lives.
Self-Awareness Issues

• Teaching clients who have dementia can be

especially challenging and frustrating.
• The nurse must be careful not to lose patience.
• The nurse may get little or no response or feedback
from clients with dementia.
• The nurse may need to deal with personal feelings
of depression and grief as the dementia progresses.
Points to Consider When Working with Clients with
Dementia

• Remember how important it is to provide dignity for the

client and family as the client’s life ends.
• Remember that death is the last stage of life. The nurse can
provide emotional support for the client and family during
this period.
• Clients may not notice the caring, patience, and support the
nurse offers, but these qualities will mean a great deal to the
family for a long time.