DEMENTIA

Annisha rahmani Intan yuanita Murni esther vincentcya Rika pebriani Rizka meidina famela Theodora damarany

DEFINITION
Dementia is marked by progressive deterioration in intellectual function, memory, and ability to solve problems and learn new skills.

SIGN
Recent memory loss that affects day to day functions Difficulty performing familiar tasks Problems with language Disorientation to time and place Poor or decreased judgement

Problems with abstract thinking Misplacing things Changes in mood or behavior Changes in personality Loss of initiative

SYMPTOMS
Confusion Personality change Apathy and withdrawal Loss of ability to do everyday tasks

NURSING CARE
ASSESSMENT
Predisposition Factor

Vascular dementia (multi-infarct) HIV disease Creutzfeldt-Jakob disease General medical condition (brain tumors, subdural hematoma, etc.) Underlying cause : the client history Substance abuse Pernicious anemia

 Presipitory Factor

Head trauma Parkinson's disease Huntington's disease Pick's disease Depression

Behavior Cognitive impairment Aphasia Apraxia Agnosia

 Kopping Resources

Patients Family Friends

 Mechanism Kopping

Medical Treatment Psychopharmacology for Dementia 1. Alzheimer's disease (AD) is the most common dementia, accounting for 70% of all dementias , and is the fourth most prevalent cause of death in the adult population. Cholinesterase inhibitors can help in Alzheimer's dementia. 2. Tacrine ( Cognex) Was the firs anticholinesterase approved for the treatment of Alzheimer's diseasn. Because of liver toxicity, it is rarely used today. Other cholinesterase inhibitors have been useful for many AD clients.

3. Donepezil (Aricep) Another cholinesterase inhibitor, also appears to slow down deterioration in cognitive functions in individuals with mild-to-moderate dementia , without the serious liver toxicity that is attributed to tacrine. Rivastgmini (exelon) and Galantamine (razadyne) are two others in use today. 4. Memantine (Namenda) Is the most recent drug approved at this writing. This drug is the first in a new class of drugs. Memantine is an N-methyl-D-aspartate (NMDA) receptor antagonist that has demonstrated significant effectiveness in clients with moderateto-severe AD.

NURSING DIAGNOSIS
RISK FOR INJURY

Related to (etiology) Sensory dysfunction Cognitive or emotional difficulties Chemical (drugs, alcohol) Biochemical o Confusion, disorientation o Faulty judgment o Loss of short-term memory o Lack of knowledge of safety precautions o Previous falls o Unsteady gait o Wandering o Provocative behavior

Cont
As evidenced by (assessment findings/diagnostic cues) Getting into fights with others Choking on inedible object Wandering Burns Falls Getting lost Poisoning wrong medication, wrong dose

 SELF-CARE DEFICIT

Impaired ability to perform or complete feeding, bathing, toileting, dressing, and grooming activities for oneself. Related To (Etiology) Perceptual or cognitive impairment Neuromuscular impairment Decreased strength and endurance Confusion Apraxia (inability to perform tasks that were once routine) Severe memory impairment.

Cont
As Evidence By (Assessment Findings/ Diagnostic Cues) Inability to wash properly Impaired ability to put on or take off necessary items of clotting Inability to maintain appearance at a satisfactory level Inability to get to toilet or commode Inability to carry out proper toilet hygiene

IMPAIRED VERBAL COMMUNICATION Decreased, delayed, or absent ability to receive, process, transmit and use a system of symbols.

Related to (Etiology): 1. Decrease in circulating to the brain 2. Physical barrier (e.g., brain tumor, subdural hematoma) 3. Deterioration or damage to the neurologic centers in the brain that regulate speech and language 4. Biochemical changes in the brain/physiologic conditions
Severe memory impairment Escalating anxiety Delusions or illusions

Assessment Findings

a. b. c. d. e.

Difficult forming words or sentences Difficult expressing thoughts verbally Speaks or verbalize with difficult Does not cannot speak Has difficulty finding the right word for objects (aphasia)
Has difficulty identifying object (agnosia) Inability to focus or concentrates on a train thought Impaired comprehension Refers back to first language

PLANNING and INTERVENTION

RISK FOR INJURY Goal and Result Criteria

Long-term goals y With guidance and environmental manipulation, client will not hurt himself/hers elf if falls occur

Intervention
1. Restrict driving. 2. Remove throw rugs and other objects. 3. Minimize sensory stimulation. 4. If clients become verbally upset, listen briefly, give support, then change the topic. 5. Label all room and drawers with pictures. Label oftenused object (e.g. hairbrushes and toothbrushes) 6. Install safety bars in bathroom. 7. Surprise clients when they smoke. 8. If the client wanders during the night, put matters on the floor.

Rational
1. Impaired judgment can lead to accident. 2. Minimizes tripping and falling. 3. Decreased sensory overload, which can increase anxiety and confusion. 4. When attention span is short, clients can be distracted to more productive topics and activities. 5. Might keep client from wandering into other clients room. Increases environmental clues to familiar objects. 6. Prevents fall. 7. Danger of burn is always present. 8. Prevents falls when the client is confused.

With the aid of an identification bracelet, neighborhood or hospital alert, and enrollment in
the safe return program, client will be returned within 3 hours of wandering

Outcome criteria: Highest level of function will be supported Optimum health is maintained (nutrition, sleep, elimination) Free of fractures, bruises, contusions, burns and falls

SELF-CARE DEFICIT Goal and Result Criteria

Long-Term Goals y Client will participate in selfcare at optimal level with supervision and guidance. y Clients skin will remain intact despite incontinence or prolonged pressure. y Client will maintain nutrition, hygiene, dress and toileting activities with appropriate support from others (e.g., care giver, family and staff) Outcome Criteria y Clients self-care needs will be met with optimal participation by client.

Intervention
1. Always have client perform all tasks that they are capable of. 2. Always have client were own clothes, even if in the hospital. 3. Use clotting with elastic, and substitute fastening tape (Velcro) for buttons and zippers. 4. Label clotting items with name and name of item. 5. Give steps by step instructions whenever necessary (e.g. take this blouseput in one armnow the next armpull it together in the frontnow)

Rational
1. Maintain self-esteem, uses muscle groups, and minimizes further 2. Helps maintain clients identity and dignity. 3. Minimizes clients confusion, and increases independence of functioning. 4. Helps identify clients if they wander, and gives caregivers additional clues when aphasia or agnosia occurs. 5. Client can focus on small pieces of information more easily allows client to perform at optimum level.

IMPAIRED VERBAL COMMUNICATION Goal and Result Criteria Intervention Rational

Long-Terms Goals 1. Use of variety of nonverbal 1. Both delirium and Client will communicate techniques to enhance dementia can pose huge basic needs with the use of communication: communication problems, visual and verbal clues when a. Point, touch, or and often alternative needed demonstrate an action nonverbal or verbal Client will communicate while talking about it. methods have to be used. important thoughts with the b. Ask the clients to point to 2. Remembering parts of their body or accomplishments and use visual and verbal clues things that they want to shared joys helps distract when needed communicate about. client from deficit and 2. Encourage reminiscing gives meaning to Outcome Criteria Communicates with aid of about happy times in life. existence. variety of verbal and 3. If a client gets into an 3. Prevents escalation to nonverbal techniques for argument with another physical acting out. Shows optimum period of time. client, stop the argument respect for client s right to and get them out of each know. Explaining in an other s way. After a short adult manner helps while (5 minutes) explain maintain self-esteem. to each client matter-offactly why you had to