Chapter 10: Nursing Management of Dementia

1
Chapter 10 Nursing Management of Dementia
2
Learning Objectives

• Differentiate among dementia, depression, and
  delirium.
• Identify the stages and clinical features of
  dementia.
• Describe procedures for diagnosing dementia.
• Recognize and address the common causes of
  delirium.
• Discuss the theoretical foundations of nursing
  care for persons with dementia.
• Contrast pharmacological and nonpharmacological
  interventions for dementia, delirium, and
  depression.

3
Learning Objectives (contd)

• Apply basic principles to provide safe and
  effective care for persons with dementia.
• List specific nursing interventions for
  behavioral and psychological symptoms of
  dementia.
• Recognize the role of adult day services in the
  care of persons with dementia.
• Identify the role that palliative care/hospice
  care plays for individuals with dementia and
  their families.

4
Dementia

• Progressive, degenerative brain dysfunction,
  including deterioration in memory, concentration,
  language skills, visuospatial skills, and
  reasoning, that interferes with a persons daily
  functioning
• Not considered a normal part of aging

5
Dementia (contd)

• Most common types of dementia in older adults
• Alzheimers disease (most common)
• Vascular dementia (second most common)
• Mixed Alzheimers/vascular dementia
• Parkinsons dementia
• Lewy body dementia (LBD)
• Frontotemporal lobe dementia

6
Dementia (contd)

• Risk factors for dementia
• Age
• Family history
• Genetic factors
• apolipoprotein E-e4 (APOE-e4)
• History of head trauma
• Vascular disease
• Certain types of infections

7
Dementia (contd)

• Alzheimers Disease
• Medical diagnosis (Box 10-5, P. 382 Box 10-8, p.
  385)
• Stages (mild, moderate, severe) (Box 10-9, p.
  386)
• Pharmacological intervention
• cholinesterase inhibitors (CEIs) Aricept
• N-methyl-D-aspartate (NMDA) receptor antagonists
  Namenda
• Medications that cause or worsen confustion
• Anticholinergic (Box 10-6)
• Medications with central nervous system effects

8
Delirium

• Acute confusion (dementia-chronic confusion)
• Develops over hours or days
• Hyperalert (agitated) or hypoactive states
  (lethargic)
• Confusion Assessment Method (CAM) is developed
  based on 4 features of delirium
• Acute onset or fluctuating course
• Inattention
• Disorganized thinking
• Altered level of consciousness
• Common Causes of Delirium (Box 10-12, p. 391)

9
Sundowner Syndrome

• A form of delirium and refers to behavior
  problems that are sometimes seen in the late
  afternoon or early evening when the sun sets.
• Nocturnal confusion
• Confusion as the sun goes down
• Increased with unfamiliar surrounding
• Often disturbed sleep patterns
• May result from excess sensory stimulation or
  deprivation

10
Depression

• Risk increases in older adults with chronic
  illnesses or dementia (box 10-13)
• Symptoms
• can be incorrectly attributed to normal aging
• may overlap with dementia
• often include anxiety, agitation, and insomnia
• Potentially life-threatening
• Treatable
• Often under recognizing, undertreated

11
Caring for the Person with Dementia

• Behavioral and Psychological Symptoms (Box 10-15)
• Pharmacological Treatment (Box 10-16)
• Nonpharmacological Treatment for Dementia (Box
  10-17, 18)
• Pain Management and Alzheimers Disease (Box
  10-19, 20, 21)
• Activity Interventions
• Communication Interventions (Box 10-22)
• Interventions for Particular Behaviors (p.
  405-407)
• Activities of Daily Living

12
Settings for CareFocus on Adult Day Services

• Recreational therapy/activities
• Meals
• Social services
• Transportation
• Personal care bathing, hair and nail care
• Nursing services
• Rehabilitation services (less commonly offered)
• Medical services (less commonly offered)

13
Hospice/Palliative Care

• Palliative care
• comprehensive approach to improving the quality
  of life for people who are living with
  potentially fatal diseases. (Box 10-32)
• Advance directives

14
Legislative Action

• National Alzheimers Project Act (2011) calls for
  the expansion and coordination of research and
  health service delivery across federal agencies
  for Alzheimers disease and related dementias.
• The top priorities of the Act are to place
  significant focus on the dementia people to
  improve patient outcomes and to reduce
  disparities.

15
Summary

• As population ages, cases of dementia will grow
• Reliable assessment tools are available
• Interventions for the common behaviors
  encountered among persons with dementia can help
  those persons and their caregivers