Health Promotion and Maintenance

Presented by Margaret Smallwood

ALZHEIMER’S

Pathophysiology

Alzheimer’s disease produces a steady and gradual decline of a client’s cognitive function. Amyloid plaques containing fragments of protein mix with neuron remnants, and other nerve cell pieces. The neurofibrillary tangles, found inside neurons, form a tau which clumps together. Failure function and immobility of the neurons leading to death. As the disease progresses the client’s ability to learn new information and will eventually impair language, judgment, and behavior (Ignatavicius & Workman, 2021).

Etiology

Alzheimer’s is caused by genetic and environmental factors (viral). The amyloid plaques containing fragments of protein mix with neuron remnants, and other nerve cell pieces. The neurofibrillary tangles, found inside neurons, form a tau which clumps together. Failure function and immobility of the neurons leading to death. As the disease progresses the client’s ability to learn new information and will eventually impair language, judgment, and behavior. Neurons cannot survive when their connections to other neurons are lost. As neurons die throughout the brain, the affected regions begin to atrophy or shrink. The damage is widespread and brain tissue has shrunk significantly (Story, 2017).

Many Alzheimer’s clients have chronic health problems such as diabetes mellitus, strokes, and atherosclerosis. Preventive methods such as smoking and excessive alcohol consumption increase the risk of stroke and cardiovascular disease (Ignatavicius & Workman, 2021).

Health Promotion and Maintenance

Eating a well-balanced diet Using soy products Consuming sufficient amounts of folate and vitamins B12, C, and E. Walking and swimming Other exercises not only increase tone and muscle strength but also may decrease cognitive decline. (Ignatavicius & Workman, 2021).

Maintaining a healthy lifestyle such as:

Risk Factors / History

Female Over 65 years of age Down syndrome Traumatic brain injury chemical imbalances Environmental agents Immunologic changes Excessive stress Ethnicity/race.

Environmental agents such as herpes zoster and herpes simplex, and toxic metals (zinc and copper) increase the risk of AD. Patients who have experienced a traumatic brain injury such as war veterans or repeated head trauma such as boxers may experience AD at an early age (Story, 2017)

Short-term memory impairment. Alterations in communication such as apraxia, aphasia, anomia, and agnosia. Impaired judgment such as inability to make decisions, decreased attention span, and decreased ability to concentrate.

CHANGES IN COGNITION

Aggressiveness, especially verbal and physically abusive tendencies. Rapid mood swings Increased confusion at night/sundowning or excessively fatigued. The client wanders and become lost / may go into other rooms to rummage through anothers belonging.

CHANGES IN BEHAVIOR & PERSONALITY

Decreased interest in personal appearance. Selection of clothing that is inappropriate for the weather or event. Loss of bowel and bladder control. Decreased appetite or ability to eat (Ignatavicius & Workman, 2021).

CHANGES IN SELF-MANAGEMENT SKILLS

Physical Signs and Symtoms

CT scan shows cerebral atrophy and ventricular enlargement, wide sulci, and shrunken gyri MRI scan rule out other causes of the neurological disease (Ignatavicius & Workman, 2021).

Diagnostics

Genetic testing (apooliprotien E4 (APOE 4)) Amyloid beta-protein precursor (soluble) (sBPP).

Laboratory Imaging assessment

Planning and Implementation

Interprofessional collaborative Implement a structured and consistent plan of care and environment. Provide a complete evaluation and assistance in helping the client become more independent. Promote cognitive stimulation and memory training such as interactive pet therapy. Promoting bowel and bladder continence. Promoting communication and self-management such as communication board or digital handheld device for scheduled activities. Encourage the family to provide pictures of family and friends that are labeled with the person’s name on the pictures. Encourage family and staff to frequently reorient the patient such as “what day is it” (Ignatavicius & Workman, 2021).

Psychosocial Integrity

The client experience the grieving process; the client anticipates loss, experiencing denial, anger, bargaining, and depression at varying times. After diagnosis one or more family members may desire genetic testing. Support the client and family’s decisions regarding testing Ensure the family finds credible resources for testing and professional genetics counseling.

Help client with change in routine and environment since the client experiences changes in emotional and behavioral affect. The client experience sexual disinhibition such as masturbating publicly. The client is unaware of their behavior, therefore, provide support to both family and client (Ignatavicius & Workman, 2021).

This drug blocks excess amount of glutamate that can demage nreve cells. Helps maintain clients function for few months longer. Improve memory and thinking skills

For AD client who develop depression SSRIs such as paroxetine and sertraline

Memantine (Namenda):

Antidepressants :

Medications

This drug slows the onset of cognitive decline.

These drugs are prescribed for clients with mental/behavioral health problems. This drug should be used as a last resort due to the decreasing mobility and self management ability (Story, 2017)

Cholinesterase inhibitors: Aricept, Reminyl, and Exelon

Psychotropic drugs such as antipsychotic or neuroleptic

The client room should have adequate, nonglare lighting and no potentially lightening shadows. A private room is needed if the client has a history of agitation or wandering. The television should remain off unless the client turns it on or requests it on When communicating with the client use short sentences and one-step instructions. Never assume. that the client is totally confused and can’t understand what is being communicated.

Safety Considerations Keep the client away from stairs or elevators. Avoid physical or chemical restraints and assess and treat pain. Place the client in an area that provides maximum observation but not in the nurse’s station. Use family members, friends, volunteers, and sitters as needed to monitor the client. Provide frequent toileting and incontinence care as needed (Ignatavicius & Workman, 2021).

Ignatavicius, D.D., & Workman, M.L., Rebar, C. & Heimgartner, N. M. (2021). Medical-surgical nursing: Concepts for interprofessional care (10th ed.). Elsevier.

Story, L. (20170301). Pathophysiology: A Practical Approach, 3rd Edition. [VitalSource Bookshelf 10.0.2]. Retrieved from vbk://9781284142983

References