MED
EXAM 1 NEURO
Alzheimer’s Disease
Alzheimer’s disease (AD) is a progressive, irreversible,
degenerative
neurologic disease that begins insidiously and is
characterized
by gradual losses of cognitive function and disturbances
in behavior and affect. It is important to note that AD
is not a normal part of aging.
Although the greatest risk factor for AD is increasing age,
many environmental, dietary, and inflammatory factors
also
may determine whether a person suffers from this
cognitive disease.
AD is a complex brain disorder caused by a combination
of various factors that may include genetics,
neurotransmitter
changes, vascular abnormalities, stress hormones,
circadian
changes, head trauma, and the presence of seizure
disorders.
AD can be classified into two types: familial or early-onset
AD (which is rare, and accounts for less than 10% of
cases)
and sporadic or late-onset AD.
Clinical Manifestations
Symptoms are highly variable; some include the
following:
• In early disease there is forgetfulness and subtle
memory
loss, although social skills and behavioral patterns remain
intact. Forgetfulness is manifested in many daily actions
1
,with progression of the disease (eg, the patient gets lost
in
a familiar environment or repeats the same stories).
• Conversation becomes difficult, and word-finding
difficulties
occur.
• Ability to formulate concepts and think abstractly
disappears.
• Patient may exhibit inappropriate impulsive behavior.
• Personality changes are evident; patient may become
depressed, suspicious, paranoid, hostile, and combative.
• Speaking skills deteriorate to nonsense syllables;
agitation
and physical activity increase.
•Voracious appetite may develop from high activity level;
dysphagia is noted with disease progression.
• Eventually patient requires help with all aspects of daily
living,
including toileting because incontinence occurs.
• Terminal stage may last for months or years.
Assessment and Diagnostic Findings
The diagnosis, which is one of exclusion, is confirmed at
autopsy, but an accurate clinical diagnosis can be made
in
about 90% of cases.
• Clinical symptoms are found through health history,
including
physical findings and results from functional abilities
assessments (eg, Mini-Mental Status Examination)
• Electroencephalography (EEG)
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Laboratory tests (complete blood cell count, chemistry
profile,
2
,and vitamin B12 and thyroid hormone levels) and
examination
of the cerebrospinal fluid (CSF)
Medical Management
Without a cure or a way to slow progression of AD,
treatment
relies on managing cognitive symptoms with
cholinesterase
inhibitors, such as donepezil hydrochloride (Aricept),
rivastigmine
tartrate (Exelon), galantamine hydrobromide (Razadyne
[formerly known as Reminyl]), and tacrine (Cognex).
These
drugs enhance acetylcholine uptake in the brain to
maintain
memory skills for a period of time. Donepezil and the
newest
medication memantine (Namenda) can be used for
management
of moderate to severe AD symptoms.
NURSING PROCESS
THE PATIENT WITH AD
Assessment
Obtain health history with mental status examination
and physical examination, noting symptoms indicating
dementia. Report findings to physician. As indicated,
assist with diagnostic evaluation, promoting calm
environment to maximize patient safety and cooperation.
Nursing Diagnoses
• Impaired thought processes related to decline in
cognitive
function
• Risk for injury related to decline in cognitive function
• Anxiety related to confused thought processes
3
, • Imbalanced nutrition: less than body requirements
related
to cognitive decline
• Activity intolerance related to imbalance in activity/rest
pattern
• Deficient self-care, bathing/hygiene, feeding, toileting
related to cognitive decline
• Impaired social interaction related to cognitive decline
• Deficient knowledge of family/caregiver related to care
for
patient as cognitive function declines
• Ineffective family processes related to decline in
patient’s
cognitive function
Planning and Goals
Goals for the patient may include supporting cognitive
function, physical safety, reduced anxiety and agitation,
adequate nutrition, improved communication, activity
tolerance,
self-care, socialization, and support and education
of caregivers.
Nursing Interventions
Supporting Cognitive Function
• Provide a calm, predictable environment to minimize
confusion
and disorientation.
• Help patient feel a sense of security with a quiet,
pleasant
manner; clear, simple explanations; and use of memory
aids and cues.
Promoting Physical Safety
• Provide a safe environment (whether at home or in the
4
EXAM 1 NEURO
Alzheimer’s Disease
Alzheimer’s disease (AD) is a progressive, irreversible,
degenerative
neurologic disease that begins insidiously and is
characterized
by gradual losses of cognitive function and disturbances
in behavior and affect. It is important to note that AD
is not a normal part of aging.
Although the greatest risk factor for AD is increasing age,
many environmental, dietary, and inflammatory factors
also
may determine whether a person suffers from this
cognitive disease.
AD is a complex brain disorder caused by a combination
of various factors that may include genetics,
neurotransmitter
changes, vascular abnormalities, stress hormones,
circadian
changes, head trauma, and the presence of seizure
disorders.
AD can be classified into two types: familial or early-onset
AD (which is rare, and accounts for less than 10% of
cases)
and sporadic or late-onset AD.
Clinical Manifestations
Symptoms are highly variable; some include the
following:
• In early disease there is forgetfulness and subtle
memory
loss, although social skills and behavioral patterns remain
intact. Forgetfulness is manifested in many daily actions
1
,with progression of the disease (eg, the patient gets lost
in
a familiar environment or repeats the same stories).
• Conversation becomes difficult, and word-finding
difficulties
occur.
• Ability to formulate concepts and think abstractly
disappears.
• Patient may exhibit inappropriate impulsive behavior.
• Personality changes are evident; patient may become
depressed, suspicious, paranoid, hostile, and combative.
• Speaking skills deteriorate to nonsense syllables;
agitation
and physical activity increase.
•Voracious appetite may develop from high activity level;
dysphagia is noted with disease progression.
• Eventually patient requires help with all aspects of daily
living,
including toileting because incontinence occurs.
• Terminal stage may last for months or years.
Assessment and Diagnostic Findings
The diagnosis, which is one of exclusion, is confirmed at
autopsy, but an accurate clinical diagnosis can be made
in
about 90% of cases.
• Clinical symptoms are found through health history,
including
physical findings and results from functional abilities
assessments (eg, Mini-Mental Status Examination)
• Electroencephalography (EEG)
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Laboratory tests (complete blood cell count, chemistry
profile,
2
,and vitamin B12 and thyroid hormone levels) and
examination
of the cerebrospinal fluid (CSF)
Medical Management
Without a cure or a way to slow progression of AD,
treatment
relies on managing cognitive symptoms with
cholinesterase
inhibitors, such as donepezil hydrochloride (Aricept),
rivastigmine
tartrate (Exelon), galantamine hydrobromide (Razadyne
[formerly known as Reminyl]), and tacrine (Cognex).
These
drugs enhance acetylcholine uptake in the brain to
maintain
memory skills for a period of time. Donepezil and the
newest
medication memantine (Namenda) can be used for
management
of moderate to severe AD symptoms.
NURSING PROCESS
THE PATIENT WITH AD
Assessment
Obtain health history with mental status examination
and physical examination, noting symptoms indicating
dementia. Report findings to physician. As indicated,
assist with diagnostic evaluation, promoting calm
environment to maximize patient safety and cooperation.
Nursing Diagnoses
• Impaired thought processes related to decline in
cognitive
function
• Risk for injury related to decline in cognitive function
• Anxiety related to confused thought processes
3
, • Imbalanced nutrition: less than body requirements
related
to cognitive decline
• Activity intolerance related to imbalance in activity/rest
pattern
• Deficient self-care, bathing/hygiene, feeding, toileting
related to cognitive decline
• Impaired social interaction related to cognitive decline
• Deficient knowledge of family/caregiver related to care
for
patient as cognitive function declines
• Ineffective family processes related to decline in
patient’s
cognitive function
Planning and Goals
Goals for the patient may include supporting cognitive
function, physical safety, reduced anxiety and agitation,
adequate nutrition, improved communication, activity
tolerance,
self-care, socialization, and support and education
of caregivers.
Nursing Interventions
Supporting Cognitive Function
• Provide a calm, predictable environment to minimize
confusion
and disorientation.
• Help patient feel a sense of security with a quiet,
pleasant
manner; clear, simple explanations; and use of memory
aids and cues.
Promoting Physical Safety
• Provide a safe environment (whether at home or in the
4
