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for more than half of all cases of dementia. An estimated 5% of people older than age 65 have a
severe form of this disease, and 12% suffer from mild to moderate dementia. Alzheimer's
disease is a slowly progressive disease of the brain that is characterized by impairment of
memory and eventually by disturbances in reasoning, planning, language, and perception. Many
scientists believe that Alzheimer's disease results from an increase in the production or
accumulation of a specific protein (beta-amyloid protein) in the brain that leads to nerve cell
death.
• Patient history shows very small changes, such as forgetfulness and subtle memory loss
without loss of social skills and behavior patterns.
• Over time the patient began experiencing recent memory loss and had difficulty learning
and remembering..
• General deterioration in personal hygiene and appearance and an inability to concentrate.
• Difficulty with abstract thinking and activities that require judgment;
• Progressive difficulty in communicating; and a severe deterioration of memory, language,
and motor function that in the more severe cases finally results in coordination loss and
an inability to speak or write.
• Repetitive actions and experience restlessness;
• Negative personality changes e.g. Irritability, depression, paranoia, hostility, and
combativeness, nocturnal awakening, disorientation.
• Suspicious and fearful of imaginary people and situations
• Misperceives his environment
• Misidentifies objects and people
• Difficulty using correct words, possibly even substituting meaningless words. He may
report that conversations with the patient drift off into nonsensical phrases. The patient's
• Labile Emotions
Neurologic examination
1. Memory loss
2. Disorientation to time and place
3. Difficulty performing familiar tasks
4. Problems with language
5. Poor or decreased judgment,
6. Problems with abstract thinking
7. Misplacing things
8. Changes in mood or behavior
9. Changes in personality
10. Loss of initiative.
• Cognitive Ability
• Distorted Thought Control
• Safety Behavior: Personal
• Mood Equilibrium
• Delusion Management
• Dementia Management
• Presence
• Behavior Management
Cognitive processes include those mental processes by which knowledge is acquired. These
mental processes include reality orientation, comprehension, awareness, and judgment. A
disruption in these mental processes may lead to inaccurate interpretations of the environment
and may result in an inability to evaluate reality accurately. Alterations in thought processes are
not limited to any one age group, gender, or clinical problem. The nurse may encounter the
patient with a thought disorder in the hospital or community, but patients with significant
thought disorders are likely to be hospitalized or housed in extended care facilities until their
symptoms can be reduced sufficiently for them to be safe in a community setting. Wherever the
patient is encountered, the nurse is responsible for effecting a treatment plan that responds to the
specific needs of the patient for structure and safety, as well as effective treatment for the
presenting symptoms. This care plan discusses management in the acute phase of the disorder for
the hospitalized patient.
Defining Characteristics:
Expected Outcomes
Ongoing Assessment
• Assess degree of disorientation to time, place, person, and situation regularly and
frequently. This will determine the amount of reorientation and intervention the patient
will need to evaluate reality accurately.
Therapeutic Interventions
• Use the words "you" and "I," instead of "we." This increases orientation and
encourages patient to maintain his or her sense of separateness and personal boundary.
* Cognitive Ability
* Distorted Thought Control
* Safety Behavior: Personal
* Mood Equilibrium
* Delusion Management
* Dementia Management
* Presence
* Behavior Management
Ongoing Assessment
* Assess degree of disorientation to time, place, person, and situation regularly and
frequently. This will determine the amount of reorientation and intervention the
patient will need to evaluate reality accurately.
Therapeutic Interventions