Management and Nursing Care Plan for Dementia

Definition of Dementia

Dementia can be defined as cognitive and memory disorders that can affect daily activities. People with dementia often show some disturbances and changes in daily behavior (behavioral symptoms) that interfere with (disruptive) or do not disturb (non-disruptive) (Volicer, L., Hurley, AC, Mahoney, E. 1998). Grayson (2004) states that dementia is not just ordinary disease, but rather a collection of symptoms caused by multiple diseases or conditions resulting in changes in personality and behavior.


Causes of Dementia


Causes of dementia according to Nugroho (2008) can be classified into 3 major categories:

1. Syndrome dementia with disease essentially unknown etiology, often not found in this class of cerebral atrophy, abnormalities may be present in sub-cellular or biochemical level on enzyme systems, or on the metabolism such as those found in Alzheimer's disease and senile dementia.

2. Syndrome dementia with known etiology but can not be treated,
The main cause in this class include:

• Spinocerebellar degeneration disease.
• Subacute sclerosing leukoencephalitis (van Bogaert).
• Huntington's chorea.
• Creutzfeldt-Jakob disease, etc.

3. Syndrome dementia by etiology of the disease that can be treated, in this class include:
Cerebrovascular disease.

• Metabolic diseases.
• Nutrition disorder.
• Due to chronic intoxication.
• Communicating hydrocephalus.

Dementia (senility) is a severe cognitive decline such that it interferes with activities of daily living and social activities. Cognitive decline in dementia usually begins with the deterioration of memory or memory (forgetful). Dementia mainly caused by Alzheimer's disease is closely related to old age. Alzheimer's disease causes 60% of senility or dementia and is expected to continue.

The classic symptoms of Alzheimer's disease dementia is memory loss happens gradually, including difficulty finding the right word or mention, is not able to recognize the object, forgetting how to use plain and simple objects, such as pencils, forgot to turn off the stove, close the window or close the door, the mood and personality may change, agitation, trouble with memory, and made ​​a bad decision can lead to unusual behavior.

These symptoms are very varied and individual. Gradually the symptoms of Alzheimer's disease may occur in a different time, could be faster or slower. The symptoms are not always an Alzheimer's disease, but if the symptoms lasted more frequent and real, to consider the possibility of Alzheimer's disease (Nugroho, 2008).



Signs and Symptoms of Dementia

In general, signs and symptoms of dementia are as follows:

1. Decline in memory that continues to happen. In patients with dementia, "forget" become a part of daily life that can not be separated.
2. Impaired orientation of time and place, for example: forget the day, week, month, year, where people with dementia are.
3. The decline and inability to arrange words into correct sentences, using words that are not appropriate for a condition, repeat the word or the same story many times.
4. Excessive expression, for example, excessive crying when she saw a television drama, furious at small mistakes committed by others, fear and nervousness that is not grounded. People with dementia often do not understand why these feelings arise.
5. The change of behavior, such as: indifferent, withdrawn and anxious.
6. The whole range of cognitive function is damaged.
7. Originally impaired short-term memory.
8. Personality and behavioral disorders, mood swings.
9. Motors and focal neurologic deficits.
10. Irritability, hostility, agitation and seizures.
11. Psychotic Disorders: hallucinations, illusions, delusions and paranoia.
12. Aphasia, apraxia, agnosia and.
13. ADL (Activities of Daily Living) difficult.
14. Difficult to regulate the use of finances.
15. Not be able to go home when traveling.
16. Forgot to put the important stuff.

Patient Examination

1. Patients routine laboratory examination.
Laboratory tests are only done once a clinical diagnosis of dementia is made to help search the etiology of dementia, especially in reversible dementia, although 50% of people with dementia is Alzheimer's dementia with normal laboratory results, laboratory tests should be performed routinely. Laboratory tests are routinely done include: complete blood count, urinalysis, serum electrolytes, blood calcium, urea, liver function, thyroid hormone, folic acid levels.

2. Imaging
Computed Tomography (CT) scan and MRI (magnetic resonance imaging) has become a routine examination in the examination even if the results are still questionable dementia.

3. Examination of EEG
Electroencephalogram (EEG) does not provide specific features and in most EEG was normal. In the advanced stages of Alzheimer's can illustrate diffuse slowing, and periodic complexes.

4. Examination of cerebrospinal fluid
Lumbar puncture is indicated when clinically encountered acute onset dementia, persons with immunosuppressants, meninges and heat stimuli encountered, atypical presentations of dementia, normotensive hydrocephalus, syphilis test (+), meningeal stinger on CT scans.


Management for Dementia

Psychosocial therapy

Deterioration in mental status has a significant meaning in patients with dementia. The desire to continue living depends on the memory. Short-term memory is lost before the loss of long-term memory in most cases of dementia, and many patients typically experience distress as a result of thinking about how they use more memory function in addition to thinking about the disease being experienced. The identity of the patient has faded over the course of the disease, and they can only use a little bit and getting his memory. Emotional reactions ranging from severe depression to kecemasanyang and catastrophic terrorism is rooted in the realization that understanding itself (sense of self) disappeared.

Patients usually will benefit from supportive psychotherapy and educational so that they can understand the journey and the nature of the illness. They can also get support in her grief and acceptance of worsening disability and attention to the problems of self-esteem. Many functions are still intact can be maximized by helping patients identify activities that can still be doing. A psychodynamic approach to the defect in the function of the ego and the limitations of cognitive function can also be beneficial. The doctor can help the patient to find a way of "peace" with defects ego functions, such as saving a calendar for a patient with a problem orientation, create a schedule to help organize the structure of their activities, and make notes to memory problems.

Psychodynamic interventions involving the patient's family can be very helpful. It helps patients to fight feelings of guilt, sadness, anger, and despair as he slowly felt shunned by the family.

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Disturbed Thought Processes and Disturbed Sensory Perception - NCP for Dementia

Definition of Dementia

Dementia is a decline in intellectual functioning which leads to loss of social independence. (William F. Ganong, 2010)

According to Grayson (2004) states that dementia is not just ordinary disease, but rather a collection of symptoms caused by multiple diseases or conditions resulting in changes in personality and behavior.


Etiology of Dementia

1. The main cause of dementia is Alzheimer's disease, the cause is not known for certain, but suspected Alzheimer's disease due to a genetic abnormality, or abnormalities of certain genes. In Alzheimer's disease, some parts of the brain decline, resulting in cell damage and reduced response to a chemical signal channel in the brain. Found in the brain of abnormal tissue (called senile plaques and tangled nerve fibers) and abnormal proteins, which can be seen at autopsy.
2. The second cause of dementia that is a stroke that row. Single stroke is small in size and cause mild weakness or weaknesses that arise slowly. This small strokes gradually cause damage to brain tissue, brain regions that were damaged due to blockage of blood flow called infarction. Dementia caused by small strokes called multi - infarct dementia. Most sufferers have high blood pressure or diabetes, both of which cause damage to blood vessels in the brain.

Signs and Symptoms of Dementia 

1. Damage to the whole range of cognitive functions.
2. Originally impaired short-term memory.
3. Personality and behavioral disorders (mood swings).
4. Neurological deficits and focal.
5. Irritability, hostility, agitation and seizures.
6. Psychotic Disorders : hallucinations, illusions, delusions and paranoia.
7. Limitations in ADL (Activities of Daily Living)
8. Regulate the use of financial difficulties.
9. Can not go home when traveling.
10. Forgot to put the important stuff.
11. Difficult bathing, eating, dressing and toileting.
12. Easy drop and poor balance.
13. Unable to eat and swallow.
14. Urinary incontinence.
15. Can run away from home and can not go home.
16. Decline in memory that continues to happen. In patients with dementia, "forget" become a part of daily life that can not be separated.
17. Impaired orientation of time and place, for example: forget the day, week, month, year, where people with dementia.
18. The decline and inability to arrange words into correct sentences, using words that are not appropriate for a condition, repeat the word or the same story many times
19. Excessive expression, for example, excessive crying when she saw a television drama, furious at small mistakes committed by others, fear and nervousness unwarranted. People with dementia often do not understand why these feelings arise.
20. The change of behavior, such as : indifferent, withdrawn and anxiety.

Nursing Diagnosis for Dementia

Disturbed Thought Processes

related to physiological changes (degeneration of neurons reversible)

characterized by:

• loss of memory,
• loss of concentration,
• not able to interpret the stimulation and assess reality accurately.

Goal: The client is able to recognize a change in thinking.

Outcomes:

• Able to demonstrate the cognitive ability to undergo the consequences of stressful events on the emotions and thoughts of self-own.
• Able to develop strategies to overcome negative self-perception.
• Able to recognize the behavior and the causes.

Interventions:

1. Develop a supportive environment and nurse-client relationship is therapeutic.
2. Maintain a pleasant and quiet environment.
3. Face-to-face when talking to clients.
4. Call client by name.
5. Use a rather low voice and speak slowly to the client.

Rational:

1. Reduce anxiety and emotional.
2. Excessive noise is a sensory neuron disorders that increase.
3. Raises concern, especially in clients with perceptual disorders.
4. The name is a form of self-identity and lead to the introduction of the reality and the client.
5. Improve understanding. Speech high and hard, stressful sparking angry confrontation and response.

Disturbed Sensory Perception

related to changes in perception, transmission or sensory integration (neurological disease, unable to communicate, sleep disorders, pain)

characterized by:

• anxiety,
• apathy,
• restless,
• hallucinations.

Goal: changes in sensory perception of the client can be reduced or controlled.

Outcomes:

• Decrease hallucinations.
• Developing strategies to reduce psychosocial stress.
• Demonstrate appropriate response stimulation.

Interventions :

1. Develop a supportive environment and nurse-client relationship is therapeutic.
2. Help clients to understand hallucinations.
3. Assess the degree of sensory or perceptual disorder and how it affects the client, including a decrease in vision or hearing.
4. Teach strategies to reduce stress.
5. Take a simple picnic, a walk around the hospital. Monitor activity.

Rational:

1. Improve comfort and reduce anxiety on the client.
2. Improving coping and decrease hallucinations.
3. Involvement of the brain showed asymmetric problem causing the client to lose the ability on one side of the body.
4. To decrease the need for hallucinations.
5. Picnic shows reality and provide sensory stimulation that decreases feelings of suspicion and hallucinations caused by feeling constrained.

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Definition, Clinical Manifestations and Etiology Dementia

Definition of Dementia

Dementia is a decline in mental ability that usually progresses slowly, where there is a disturbance of memory, thought, judgment and ability to focus, and personality deterioration can occur. At a young age, dementia may occur suddenly if severe injury, disease or toxic substances (eg carbon monoxide) causing the destruction of brain cells. But dementia usually occurs slowly and attack aged over 60 years. But dementia is not part of the normal aging process.

Along with age, the changes in the brain can cause a loss of some memory (especially short-term memory) and a decrease in some learning abilities. These changes do not affect the normal function. Forgotten in the elderly bukn a sign of dementia or early-stage disease Alzameir. Dementia is a decline in mental abilities are more serious, that the longer
getting worse.

In normal aging , a person may forget the details of things but people with dementia may forget the whole event has just occurred .

Dementia is a condition of progressive collapse intellectual ability after reaching the highest growth and development (age 15 years) due to organic brain disorder, followed by the collapse of behavior and personality, manifested in the form of impaired cognitive functions such as memory, orientation, sense of heart and formation of the conceptual mind. Usually this condition is not reversible, otherwise progressive. Diagnosis is carried out by clinical examination, and imaging studies laboratorlum (imaging), is intended to look for treatable causes. Treatment is usually supportive only. Kolines feels inhibitor (cholinesterase inhibitors) may improve cognitive function for a while, and make some antipsychotics drugs are more effective than just with one drug alone. Dementia can occur at any age, but more on the elderly.

Most of them were treated in homes and occupy some 50% of the bed. Dementia can be defined as cognitive and memory disorders that can affect daily activities. People with dementia often show some disturbances and changes in daily behavior (behavioral symptoms) that interfere with (disruptive) or do not disturb (non-disruptive) (Voicer. L., Hurley, AC, Mahoney, E.1998). Grayson (2004) states that dementia is not just ordinary disease, but rather a collection of symptoms caused by multiple diseases or conditions resulting in changes in personality and behavior.

Dementia is an illness that involves the brain cells that die abnormally. Only the terminology used to describe progressive degenerative brain disease. This disease may be experienced by all people of various educational and cultural backgrounds. Although there is not yet any treatment for dementia care to deal with the symptoms may be obtained through. Dementia is a decline in mental ability that usually progresses slowly, where there is a disturbance of memory, thought, judgment and ability to focus, and personality deterioration can occur.


Clinical Manifestations of Dementia

1. Decline in memory that continues to happen. In patients with dementia, "forget" become a part of daily life that can not be separated.
2. Impaired orientation of time and place, for example : forget the day, week, month, year, where people with dementia are.
3. The decline and inability to arrange words into correct sentences, using words that are not appropriate for a condition, repeat the word or the same story many times.
4. Excessive expression, for example, excessive crying when she saw a television drama, furious at small mistakes committed by others, fear and nervousness unwarranted. People with dementia often do not understand why these feelings arise.
5. The change of behavior, such as : indifferent, withdrawn and anxious.
6. The whole range of cognitive function is damaged.
7. Originally impaired short-term memory.
8. Personality and behavioral disorders, mood swings.
9. Motors and focal neurologic deficits.
10. Irritability, hostility , agitation and seizures.
11. Psychotic Disorders : hallucinations, illusions, delusions and paranoia.
12. Agnosia, apraxia, aphasia.
13. ADL ( Activities of Daily Living ) difficult.
14. Regulate the use of financial difficulties.
15. Not be able to go home when traveling.
16. Forgot to put the important stuff.
17. Difficult bathing, eating, dressing, toileting.
18. Patients can walk away from the house and can not go home.
19. Easy to fall, bad balance.
20. Finally paralysis, incontinence of urine and bowel movements.
21. Unable to eat and swallow.
22. Coma and death.

Etiology of Dementia

The most frequent cause of dementia is Alzheimer's disease. The cause of Alzheimer's disease is unknown, but is thought to involve genetic factors, because the disease seems to be found in some families and are caused or influenced by some specific gene abnormality. In Alzheimer's disease, some parts of the brain decline, resulting in cell damage and reduced response to a chemical signal channel in the brain. Found in the brain of abnormal tissue (called senile plaques and tangled nerve fibers) and abnormal proteins, which can be seen at autopsy. Dementia Lewy figure closely resembles Alzheimer's disease, but have differences in the microscopic changes that occur in the brain. The second most common cause of dementia is a stroke that row. Single stroke is small and causes mild weakness or weaknesses that arise slowly. This small strokes gradually cause damage to brain tissue, brain regions that were damaged due to blockage of blood flow is called infarction. Dementia is derived from several small strokes called multi - infarct dementia. The majority of sufferers have high blood pressure or diabetes, both of which cause damage to blood vessels in the brain.

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Risk for Injury related to Dementia

Dementia can be defined as cognitive and memory impairment that can affect daily activities. People with dementia often show some disruption and changes in daily behavior (behavioral symptoms) that interfere (disruptive) or do not disturb (non-disruptive) (Volicer, L., Hurley, AC, Mahoney, E. 1998). Grayson (2004) mentioned that dementia is not just an ordinary disease, but rather a collection of symptoms caused by multiple diseases or conditions resulting in changes in personality and behavior.

Mentioned in the literature that a disease that can cause symptoms of dementia there are some seventy-five. Some diseases can be cured while most can not be cured. (Mace, N.L. & Rabins, P.V. 2006). Most researchers in the research agreed that the main cause of the symptoms of dementia is Alzheimer's disease, vascular disease (blood vessel), Lewy body dementia, frontotemporal dementia and ten percent of which are caused by other diseases.

Fifty to sixty percent of the causes of dementia is Alzheimer's disease. Alzhaimer is a condition in which nerve cells in the brain die, making the signal from the brain can not be transmitted as it should (Grayson, C. 2004). Alzheimer's sufferers experiencing memory impairment, the ability to make decisions and also a decrease in the thinking process.

Nursing Diagnosis : Risk for Injury related to Dementia


Nursing Interventions Risk for Injury related to Dementia

A. Action for patients with Dementia 

Goal:

1. Patients are spared from injury
2. Patients are able to control activities that can prevent injuries.

Action

1. Describe risk factors that could cause injury, with simple language
2. Teach ways to prevent injuries: if the fall do not panic but cry out for help
3. Give praise to the patient's ability mentions ways to prevent injuries.

B. Action for patients families

Goal: Families of patients are able to:

1. Identifying factors that could cause injury to the patient
2. Families are able to provide a safe environment to prevent injury

Action

1. Discuss with family factors that may cause injury to the patient
2. Encourage families to create a safe environment such as: floors are not slippery, keep sharp objects out of reach of patients, provide adequate lighting, the lights on during the day, give the tool handle and watch if the patient smokes, cap plugs and other electrical equipment with plaster, avoid power tools other than the reach of the client, provide a low bed
3. Encourage families to always accompany the patient at home and monitor the daily activities undertaken

Evaluation  Risk for Injury related to Dementia

To measure the success of nursing care that you do, it can be done by assessing the ability of clients and families:

The ability of the patient:
1. Mention the simple language of the factors that cause injury
2. Using the proper way to prevent injury
3. Controlling the activity according to ability

The ability of family
1. Families can reveal factors that may cause injury to the patient
2. Providing safety in the home
3. Distancing power tools out of reach of patients
4. Always accompany the patient at home
5. Monitor the daily activities of patients conducted

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Nursing Diagnosis for Dementia NANDA

Dementia is a medical condition that affects the brain. It is more common in older people, starting at about the age of sixty years and over.

Ageing is one cause of this condition, but there are other causes such as a stroke, Alzheimer's disease, or an injury to the brain from head trauma. Someone with Dementia may forget simple things that should be familiar to them.

People generally go through Dementia in three stages. During the first stage, a person will have trouble remembering things that they would typically know otherwise. Things such as phone numbers, how to get home, where they parked their car, and other common daily tasks are some of the things that will not be remembered by a person affected by Dementia. The next stage of Dementia is more serious and noticeable by people that know the person. In this stage the individual often does not know how to complete tasks around their own home such as cooking, getting dressed properly and washing themselves. Sometimes in this stage, the person affected also has trouble with their speech. The last stage begins to affect the body as well as the mind. The person may have weakness in certain parts of their body. It may cause them to not be able to move their arms and legs. Their ability to speak may worsen to the point of not making any sense when they talk.

Nursing Diagnosis for Dementia NANDA

1. Impaired Verbal Communication

related to cerebral impairment as demonstrated by altered memory, judgment, and word finding

2. Bathing or Hygiene Self-Care Deficit

related to cognitive impairment as demonstrated by inattention and inability to complete ADLs

3. Risk for Injury

related to cognitive impairment and wandering behavior

4. Impaired Social Interaction

related to cognitive impairment

5. Risk for Violence: Self-directed or Other-directed

related to suspicion and inability to recognize people or places

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