Alzheimer’s Disease: Creating a Plan of Care

Introduction

Dementia is characterized by a steady deterioration of a person’s cognitive abilities – thinking, memorizing, processing information, and drawing sound conclusions. It is readily imaginable how this disorder and its most common subtype, Alzheimer’s, may interfere with the normal course of life and prevent an individual from participating in his or her usual activities. Healthy People 2020 initiative makes it a point to draw more attention to the described issue.

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A valid rationale based on relevant statistics is provided: worldwide, Alzheimer’s is the 6th leading cause of death among people aged 18 and older. In the United States, up to 11% of individuals aged 65 and older, which amounts to 5.2 million citizens, suffer from dementia. Treating Alzheimer’s puts a significant financial burden on the healthcare system, with yearly expenses estimated at $236 billion (Healthy People 2020, n.d.). This paper summarizes nursing diagnoses, assessment data, and Alzheimer’s patient interview results and provides a comprehensive plan of care that pertains to health workers, affected individuals, and their families.

Nursing Diagnoses

When it comes to dementia and Alzheimer’s in particular, a nurse can make three diagnoses that will point to the condition in question. The first diagnosis is so-called wandering: a patient can move back and forth erratically with no sense of direction (Centers for Disease Control and Prevention, 2018). To him or her, these actions can make a lot of sense: for instance, they may explain that they are looking for something. However, their search is ungrounded, and, therefore, based on this phenomenon, a nurse can suspect dementia. Another diagnosis is language impairment that is characterized by the inability to provide cohesive and coherent oral messages (Centers for Disease Control and Prevention, 2018). Lastly, with the help of caregivers or independently, a nurse can notice serious memory loss in a patient.

Assessment Data (Objective and Subjective)

To diagnose Alzheimer’s dementia, a medical doctor need to draw and assess both objective and subjective data. First, mental status testing can be conducted with the objective to evaluate a patient’s cognitive and memory skills (Tew, Ng, Cheong, & Yap, 2015). The scores on such tests usually help to conclude about the degree of cognitive impairment in a patient. The next step could be a neurophysiological test that is usually run by a specialist with expertise in both brain and mental health conditions.

These tests not only determine whether a person has Alzheimer’s but also whether he or she is able to run daily errands such as driving a vehicle or managing finances. Neurophysiological testing can also reveal such comorbidities as depression, which may be a contributing factor and aggravate already existing dementia. Personal information can also be of use and enhance the credibility of a diagnosis. Depending on a patient’s health status, a doctor can either interview him or her directly or contact friends and family. The data that may be drawn in the process include the presence of such symptoms as mood swings, memory loss, and language impairment.

Interview Results

During Week 2, an Alzheimer’s patient, K.L., 81, was interviewed to grasp a better understanding of how the condition impacts his lifestyle and his relationships. From the interview, it became clear that K.L.’s case is not as pessimistic as it is for many other affected individuals. K.L. was diagnosed with Alzheimer’s early on, which can be attributed to his neat self-observation during the early stages. As the interviewee reports, he contacted a doctor one and a half years after the alleged onset of the disease. Since then, K.L. has followed the treatment plan and has been taking such medications as Aricept, Celexa, Sonata, and some vitamins.

The man is making a conscious effort to stay active and enjoy his hobbies even though two co-occurring conditions, dementia and arthritis, sometimes make it difficult. K.L. is lucky to have a support system, namely, his family, who helps him to go about his daily errands. He has a live-in younger sister who does not only remind him to take his medication but also helps him to be emotionally engaged. For instance, some of their beloved pastimes include reminiscing their childhood and adolescence and looking at old pictures. The right diagnosis and K.L.’s readiness to comply with the plan of care are what make his life with dementia bearable.

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Desired Outcomes

The desired outcomes for Alzheimer’s patients are aligned with the key objectives of the Healthy People 2020 initiative. The first objective, encoded as DIA-1, involves increasing the number of older adults and their caregivers who are knowledgeable about the condition (Healthy People 2020, n.d.). The desired outcome, in this case, is the dissemination of information about Alzheimer’s and enhanced health literacy, which is likely to account for early examinations and follow-ups.

In accordance with the second objective, or DIA-2, set by the Healthy People 2020 initiative, readmission rates for Alzheimer’s patients should be reduced. The fewer accidents a person has due to the memory problems and other issues related to the condition, the less likely he or she is to be hospitalized. Lastly, the third objective to be considered is maintaining a healthy and active lifestyle in persons with Alzheimer’s.

Evaluation Criteria

The National Institute on Aging (NIA) focuses on three stages of Alzheimer’s disease when making a differential diagnosis:

  1. Dementia due to Alzheimer’s;
  2. Mild cognitive impairment (MCI) due to Alzheimer’s;
  3. Preclinical Alzheimer’s (Sharma & Singh, 2016).

The stage that a patient is at can be determined based on certain biomarkers developed for dementia. Traditionally, these include amyloid beta, tau protein, and phosphor tau, which is recognized by the medical community. However, as Sharma and Singh (2016) point out, due to the dire need to make diagnoses as early as possible, other biomarkers should also be considered. Valid options include blood-based biomarkers such as circulatory miRNA and inflammatory biomarkers.

Actions and Interventions

An action plan for K.L. and other Alzheimer’s patients demonstrating similar symptoms may include the following strategies that can be adopted by both nurses and family:

  1. Share information about the condition and promote safe and healthy practices. People with no expertise in the medical field may be naturally clueless about the particularities of Alzheimer’s. It is a nurse’s responsibility to explain the development of dementia and self-management and care strategies. On top of that, a nurse can refer patients and caregivers to reputable sources about Alzheimer’s and support groups.
  2. Assess a patient’s cognitive abilities such as memory, orientation, and communication every shift (or every day for family and caregivers). This type of testing does not have to be formal or structured; instead, a simple conversation may help with the assessment (“Helping Alzheimer’s caregivers,” 2018). Continuous monitoring can reveal both positive and negative tendencies in the development of Alzheimer’s.
  3. Orient a patient to the environment as needed in case his or her short term memory is intact. As a patient’s condition progresses, he or she may become increasingly confused and disoriented. In this case, a nurse or caregiver should try to familiarize an affected individual with their surroundings. Some means of orientation may be more appropriate than others: for instance, calendars, books, and newspapers are less overwhelming than television. In the case of the latter, a patient may struggle with discerning reality from fiction. Another strategy to consider is labeling drawers and personal belongings.
  4. Make up a comprehensive schedule for a patient’s daily routines. In the early stages of dementia, many patients would like to commit to the treatment plan and continue with their usual hobbies and activities. They understand what is happening and are ready to take measures to improve their situation. A schedule or a calendar with notes may help them to take medication on time and run errands.

Evaluation of Patient Outcomes

Patient outcomes should be evaluated based on their compliance with the relevant objectives set by Healthy People 2020. First, health workers can run a survey among dementia patients and their caregivers to test their knowledge and awareness concerning the disease. In case the previous interventions were successful, and nurses and other health workers played their role well, the respondents should prove knowledgeable and conscientious.

They need to know not only key facts about the condition but also have an action plan in case an accident happens. The second evaluation criteria would be reduced readmission rates in patients with Alzheimer’s. Researchers can calculate rehospitalization rates at different points after the first admission. Lastly, a nurse should assess how actively a patient engages in his or her preferred activities. The desired outcome would be Alzheimer’s patients living their lives to the fullest despite possible inhibitions.

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References

Centers for Disease Control and Prevention. (2018). Alzheimer’s disease. Web.

Healthy People 2020. (n.d.) Dementias, including Alzheimer’s disease. Web.

Helping Alzheimer’s caregivers. (2018). Web.

Sharma, N., & Singh, A. N. (2016). Exploring biomarkers for Alzheimer’s disease. Journal of Clinical and Diagnostic Research: JCDR, 10(7), KE01–KE6.

Tew, C. W., Ng, T. P., Cheong, C. Y., & Yap, P. (2015). A brief dementia test with subjective and objective measures. Dementia and Geriatric Cognitive Disorders Extra, 5(3), 341-349.

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