NUR2755 Section BTP3 Multidimensional Care IV
Module 01 Overview and Activities
Readings
Activity Time: 5 hours
Medical-Surgical Nursing: Patient-Centered Collaborative Care, Chapters 42-43
Recommended Reading -
Medical-Surgical Nursing: Patient-Centered Collaborative Care, Chapter 41
ATI: RN Adult Medical Surgical Nursing – Chapters 3, 5-8, 10-11, 16
ATI: RN Community Health
Module 01 Alzheimer’s Disease
Alzheimer’s Disease
Alzheimer’s disease (AD) affects mainly females, specifically females over the age of 65 (Ignatavicius,
Workman, & Rebar, 2018). The disease produces a steady and gradual decline of cognitive function. This
gradual decline includes the ability to learn new information and will eventually impair language,
judgment, and behavior. As the disease continues, the client’s functional ability declines. Death results
from complications of immobility. The challenges that arise for caregivers is client safety. These
challenges can occur both in the home environment and in healthcare settings.
Being diagnosed with AD can be overwhelming to the client. In the early stages, the client recognizes that
changes in cognition are occurring. This may be a source of frustration and cause irritability. The goal of
care is to maintain cognitive function for as long as possible as well as to keep the client safe. Maintaining
a consistent routine is a key part of care for the client with AD.
One of the familiar heartaches associated with AD is the loss of the ability to recognize family members.
As the disease progresses, the client may lose the ability to recognize their own image. The use of
reminiscence therapy is appropriate. The recommendation is having labeled photos of family members
and friends for the client to view. The environment should be calm, well light, and have minimal
distractions. Currently, the recommendation is to keep abstract art at a minimum (Ignatavicius, et.al.,
2018). As the client’s cognitive ability declines, the client may interpret art as threatening.
Orientation as the disease progresses can be challenging. Keep a clock and a single date calendar visible
for clients. This helps with day-to-day orientation in the early stages of AD. As the client progresses in
middle and late stages, orientation therapy is no longer effective. Orientation therapy shifts to validation
therapy (Ignatavicius, et.al., 2018). The difference is that the healthcare worker does not argue with the
client, but validates their concerns. One important nugget to remember as a nurse is to not assume that
the client with AD is always confused. This dismissive behavior by nurses can endanger the client for
complications. For example, if a client is more restless than usual, they could be experiencing pain, but
may have difficulty communicating this to the nurse.
1
, NUR2755 Section BTP3 Multidimensional Care IV
The drug of choice is memantine (Namenda), which slows the pace of deterioration. Other medications
may be antidepressants. The category of antidepressant acceptable to use for the AD client is selective
serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil) or sertraline (Zoloft). Tricyclic
antidepressants should not be used due to their anticholinergic effect. The use of psychotropic
medications can be considered a form of restraint if used for agitation, combativeness, or restlessness.
Psychotropic drugs decrease mobility and therefore should be considered a last resort for the client with
AD. (Ignatavicius, et.al., 2018).
Module 01 Parkinson’s Disease
Parkinson’s Disease
Parkinson’s Disease (PD) is a progressive neurodegenerative disease. It is a debilitating disease
affecting mobility.
There are four cardinal symptoms of PD:
Tremor
Muscle rigidity
Bradykinesia or akinesia
Postural instability
The most famous person that has PD is actor Michael J. Fox. His symptoms started in his little
finger, which would not stop moving. As his symptoms continued, he, like other clients, had great
difficulty controlling voluntary muscle movements. He has brought awareness to the disorder over
the years as well as funding for research. The disease occurs because of a lack of dopamine in the
brain. The lack of dopamine interferes with movement, but also decreases the influence of the
sympathetic nervous system on the body. The diminished ability of the sympathetic nervous system
on the body results in orthostatic hypotension, drooling, nocturia, and other autonomic symptoms.
There are five stages of PD:
Stage 1: Initial stage
Stage 2: Mild stage
Stage 3: Moderate stage
Stage 4: Severe disability
Stage 5: Complete dependence for activities of daily living (ADLs)
As the client progresses through the stages, the symptoms worsen as well as an overall decrease in
2
Module 01 Overview and Activities
Readings
Activity Time: 5 hours
Medical-Surgical Nursing: Patient-Centered Collaborative Care, Chapters 42-43
Recommended Reading -
Medical-Surgical Nursing: Patient-Centered Collaborative Care, Chapter 41
ATI: RN Adult Medical Surgical Nursing – Chapters 3, 5-8, 10-11, 16
ATI: RN Community Health
Module 01 Alzheimer’s Disease
Alzheimer’s Disease
Alzheimer’s disease (AD) affects mainly females, specifically females over the age of 65 (Ignatavicius,
Workman, & Rebar, 2018). The disease produces a steady and gradual decline of cognitive function. This
gradual decline includes the ability to learn new information and will eventually impair language,
judgment, and behavior. As the disease continues, the client’s functional ability declines. Death results
from complications of immobility. The challenges that arise for caregivers is client safety. These
challenges can occur both in the home environment and in healthcare settings.
Being diagnosed with AD can be overwhelming to the client. In the early stages, the client recognizes that
changes in cognition are occurring. This may be a source of frustration and cause irritability. The goal of
care is to maintain cognitive function for as long as possible as well as to keep the client safe. Maintaining
a consistent routine is a key part of care for the client with AD.
One of the familiar heartaches associated with AD is the loss of the ability to recognize family members.
As the disease progresses, the client may lose the ability to recognize their own image. The use of
reminiscence therapy is appropriate. The recommendation is having labeled photos of family members
and friends for the client to view. The environment should be calm, well light, and have minimal
distractions. Currently, the recommendation is to keep abstract art at a minimum (Ignatavicius, et.al.,
2018). As the client’s cognitive ability declines, the client may interpret art as threatening.
Orientation as the disease progresses can be challenging. Keep a clock and a single date calendar visible
for clients. This helps with day-to-day orientation in the early stages of AD. As the client progresses in
middle and late stages, orientation therapy is no longer effective. Orientation therapy shifts to validation
therapy (Ignatavicius, et.al., 2018). The difference is that the healthcare worker does not argue with the
client, but validates their concerns. One important nugget to remember as a nurse is to not assume that
the client with AD is always confused. This dismissive behavior by nurses can endanger the client for
complications. For example, if a client is more restless than usual, they could be experiencing pain, but
may have difficulty communicating this to the nurse.
1
, NUR2755 Section BTP3 Multidimensional Care IV
The drug of choice is memantine (Namenda), which slows the pace of deterioration. Other medications
may be antidepressants. The category of antidepressant acceptable to use for the AD client is selective
serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil) or sertraline (Zoloft). Tricyclic
antidepressants should not be used due to their anticholinergic effect. The use of psychotropic
medications can be considered a form of restraint if used for agitation, combativeness, or restlessness.
Psychotropic drugs decrease mobility and therefore should be considered a last resort for the client with
AD. (Ignatavicius, et.al., 2018).
Module 01 Parkinson’s Disease
Parkinson’s Disease
Parkinson’s Disease (PD) is a progressive neurodegenerative disease. It is a debilitating disease
affecting mobility.
There are four cardinal symptoms of PD:
Tremor
Muscle rigidity
Bradykinesia or akinesia
Postural instability
The most famous person that has PD is actor Michael J. Fox. His symptoms started in his little
finger, which would not stop moving. As his symptoms continued, he, like other clients, had great
difficulty controlling voluntary muscle movements. He has brought awareness to the disorder over
the years as well as funding for research. The disease occurs because of a lack of dopamine in the
brain. The lack of dopamine interferes with movement, but also decreases the influence of the
sympathetic nervous system on the body. The diminished ability of the sympathetic nervous system
on the body results in orthostatic hypotension, drooling, nocturia, and other autonomic symptoms.
There are five stages of PD:
Stage 1: Initial stage
Stage 2: Mild stage
Stage 3: Moderate stage
Stage 4: Severe disability
Stage 5: Complete dependence for activities of daily living (ADLs)
As the client progresses through the stages, the symptoms worsen as well as an overall decrease in
2
