Alzheimer's Disease - Assessment, Nursing Diagnosis and Interventions

Definition of Alzheimer's Disease

Alzheimer's disease is a disorder of cognitive function is slow and gradual onset, degenerative, progressive and permanent nature. Initially the patient will experience impaired cognitive function and slowly will experience severe mental disfunction.

Alzheimer's disease was first discovered in 1907 by a German Psychiatry namely Alois Alzheimer. He discovered the disease after observing a woman named Auguste D (51 years) from 1901 until she died in 1906. The woman suffered intellectual impairment and memory but not impaired limb, coordination and reflexes.


Etiology of Alzheimer's Disease

The exact cause is unknown. Some alternative causes, which have been hypothesized are metal intoxication, impaired immune function, viral infections, air pollution / industrial, trauma, neurotransmitters, formation deficit filament cells, hereditary predisposition. Basic pathology of Alzheimer's disease consists of neuronal degeneration, death of a specific area of brain tissue resulting in impaired cognitive function with progressive memory loss.

Deficiency of growth factors or amino acids may play a role in the selective death of neurons. The possibility of these cells undergo degeneration caused by an increase in intracellular calcium, failure of energy metabolism, the presence of free radical formation or presence of abnormal protein production that is non-specific.

Alzheimer's disease is a genetic disease, but some studies have shown that the role of genetic factors, but some studies have shown that the role of non-genetic factors (environment) is also involved, in which environmental factors only as the originator of genetic factors.


Symptoms and Signs of Alzheimer's Disease

Alzheimer's disease may begin with slight memory loss and confusion, but in the end will lead to mental impairment which is irreversible and destroys a person's ability to remember, think, learn, and imagine.

1. Memory loss
Everyone has lapses in memory. It is normal when you forget where you put your car keys or forget the name of the person you rarely see. But the memory problems associated with Alzhaimer, lasts longer and worse. People with Alzhaimer possible:

• Repeating something she had done.
• Often forget the words and promises he does.
• Often misplaced something, often put things in unusual places.
• Eventually forget the names of family members and objects used in daily life.

2. Problematic when thinking abstractly
People with Alzheimer's have trouble thinking about something, especially in the form of numbers.

3. Difficulty in finding the right words
It is difficult for people with Alzhaimer to find the right words to express their thoughts, or when they engage conversation. Will ultimately affect their ability to read and write.

4. Disorientation
People with Alzheimer's often lose the ability to remember the time and date, and will find themselves lost in the actual environment familiar to them.

5. Lost the ability to judge
Resolve everyday problems is a difficult and becomes increasingly difficult until the end is something that feels impossible for those who have Alzheimer's. Alzheimer's has characteristics very difficult to do something that requires planning , decision making and judgment.

6. Difficult to perform familiar tasks
Difficult to perform routine tasks that require sustained steps in the process of completion, for example cooking. Eventually, people with Alzheimer's may forget how to do even the most basic things.

7. Changes in personality
People with Alzheimer's show :

• Mood swings.
• Lost the confidence of others.
• Increased stubbornness.
• Depression.
• Restless.
• Aggressive.

Neuropsychological Examination

Alzheimer's Disease is always cause symptoms of dementia. Function neuropsychological examination to determine the presence or absence of general cognitive impairment and determine in detail the pattern of deficits. Psychological test also aims to assess the function displayed by some parts of the brain that is different such as memory impairment, loss of expression, calculation, attention and language understanding. A systematic evaluation of neuropsychological function have important diagnostic as:

• The presence of cognitive deficits associated with early dementia who may know if there are changes that occur due to minor normal aging.
• Comprehensive neuropsychological examination allows to distinguish cognitive abnormalities in global dementia with selective deficits caused by focal dysfunction, metabolic factors, and psychiatric disorders.
• Identify overview of neuropsychological disorders caused by dementia due to various causes. The Consortium to establish a Registry for Alzheimer's Disease (CERALD) presents a neuropsychological assessment procedure by using the tools batrey, which manifest cognitive impairment, where the examination consists of:

1. Verbal Fluency animal category
2. Modified boston naming test
3. Mini-mental state
4. Word list memory
5. Constructional praxis
6. Word list recall
7. Word recognition list
This test takes 30-40 minutes, and less than 20-30 minutes at the controls.

Assessment 

Assessment needs to be asked of clients which includes the presence of a history of hypertension, diabetes mellitus, heart disease, use of anti-anxiety drugs, the use of anticholinergic drugs in the long term, and a history of down syndrome at some point later developed Alzheimer's disease at age 40's

1. Activity / rest
Symptoms: Feeling tired.
Signs: Day / night restless, helpless, disruption of sleep patterns.
Lethargy: decreased interest or concern in usual activities, hobbies, inability to mention again what is read / follow event television programs.

2. Circulation
Symptoms: History of cerebral vascular disease / systemic hypertension, embolic episodes (a predisposing factor).

3. Ego integrity
Symptoms: Suspicious or afraid of the situation / person fantasies, misperceptions about the environment, fault identification of objects and people, hoarding objects: objects that one believes that the placement has been stolen, lost multiple, changes in body image and self-esteem felt.
Signs: Hiding inability (many reasons not able to perform the obligations, might also open the hand without reading the book yet), sit and watch the others, the first activity might accumulate object is not moving and emotionally stable, repetitive movements (folded unfolded folded cloth) , hide stuff, or take a walk.

4. Elimination
Symptoms: The urge to urinate.
Signs: Incontinence of urine / feaces, tend constipation / diarrhea imfaksi.

5. Food / fluid
Symptoms: History of episodes of hypoglycemia (a predisposing factor) changes in taste, appetite, weight loss, deny the hunger / need to eat.
Symptoms: Loss of ability to chew, avoiding / refusing to eat (probably trying to hide skill) and looks even thinner (advanced stage).

6. Hiygene
Symptoms: Need help / dependent of others.
Signs: not able to maintain the appearance, personal habits are lacking, poor cleaning habits, forget to go to the bathroom, forget the steps to pee, can not find the bathroom and less interested in or have forgotten at meal time: depend on others to cook food and prepare it at the table, eating, using cutlery.

7. Neurosensory

Symptoms : The denial of existing symptoms, especially cognitive changes, and or a vague notion, hypochondria complaints about fatigue, dizziness or headache sometimes. Complaints in cognitive abilities, decision-making, given that passed, the decrease behavior (observable by people nearby). Loss of sensation of proprioception (body position or a certain part of the body in space) and a history of cerebral vascular disease / systemic embolism or hypoxia which took place periodically (as a predisposing factor) as well as seizure activity (secondary to brain damage).
Symptoms: Damage communication : aphasia and dysphasia ; difficulty in finding the right words (especially nouns) ; asked repeatedly or conversations with the substance of the word that has no meaning ; fragmented, or speech not audible. Losing the ability to read and write stages (loss of fine motor skills).

8. Comfort

Symptoms: A history of serious head trauma (may be a predisposing factor or acceleration factor), traumatic accidents (falls, burns and so on).
Signs: Ecchymosis, lacerations and hostile / attack others.

9. Social interaction

Symptoms: Feeling lost power. Psychosocial factors previously; influence of personal and individual that appears to change patterns of behavior that emerge.
Symptoms: Loss of social control, improper behavior.


Nursing Diagnosis for Alzheimer's Disease

1. Self-care deficit (eating, drinking, personal hygiene) related to changes in the process of thinking.
2. Imbalanced Nutrition: Less Than Body Requirements related to inadequate intake, changes in thinking process.
3. Impaired verbal communication related to the change in thinking process.
4. Ineffective individual coping related to process changes and think the dysfunction due to disease progression.

Nursing Interventions for Alzheimer's Disease

Imbalanced Nutrition: Less Than Body Requirements related to inadequate intake, changes in thinking process.

Goal: Client needs are met.

Outcomes:
Understand the importance of nutrition in the body.
Showed weight gain in accordance with the criteria of the lab results.

1. Evaluation of the ability of the client to eat.
R :/ clients have difficulty in maintaining weight loss, dry mouth due to medications and have difficulty chewing and swallowing.

2. Observation / measuring weight if possible.
R :/ signs of weight loss (7-10 %) and the lack of support the nutritional intake of a problem catabolism, glycogen content in the muscle, and the sensitivity of the ventilator.

3. Monitor the use of tools.
R :/ electric heater used to keep food warm.

4. Assess the function of the gastrointestinal system include bowel sounds, record a change in the stomach such as nausea, vomiting, changes in bowel movements observation eg diarrhea, constipation.
R :/ gastrointestinal system functions is essential to include food, a ventilator can cause bloating in the stomach and gastric bleeding.

5. Give fluids 2500 cc / day for heart problems do not occur.
R :/ Prevent dehydration as a result of the use of ventilaltor during unconscious and prevent constipation.

6. Perform laboratory tests are indicated as serum, transferrin, BUN / creatine and glucose.
R :/ Providing accurate information on the state of the client needed nutrients.

Tag : Alzheimer's Disease, Nursing Assessment, Nursing Diagnosis and Interventions