Alzheimer’s Disease

Alzheimer’s Disease

Objectives:

After you take this class, you will be able to:

  1. List the signs of Alzheimer’s disease.
  2. Discuss the stages of this disease.
  3. Provide quality care to patients with Alzheimer’s disease.

What is Alzheimer’s Disease?


Alzheimer’s disease is a very common problem among older adults. It is sometimes found in younger adults but it is most often seen in older adults. Nursing assistants and others provide care to patients with Alzheimer’s disease almost on a daily basis. The class will give you the information you need to make sure that you are giving these patients the best care possible you can.

This disease continues to get worse after it starts. There is no cure for it. People with Alzheimer’s disease can not think and act in a normal way when they get to the last or worst stage of this disease. Some very known people, like former U.S. President Ronald Reagan, have it.

Some people become completely dependent on others for their care and basic safety needs become very great. When this happens, the patient can no longer live on their own. They need the help of healthcare workers, like a nursing assistant. Some patients live in their own homes with the help of home healthcare aides and a home health agency. Others live in a nursing home or in an assisted living home because they need the care that they will get in these places.

This class will teach you about Alzheimer’s disease, some of its signs and how you, the nursing assistant, can take care of people that have it.

What are the Signs of Alzheimer’s Disease?

The 3 stages of Alzheimer’s disease are:

  • The early stage
  • The middle stage
  • The late stage

The signs of this disease get worse as time goes on and the disease continues to progress. The signs of each of the 3 stages are below.

Early Signs

The first sign of this disease is usually short-term memory loss. The person may forget things that have recently happened. They can remember things that have happened a long time ago but they may not be able to remember what they had for lunch or dinner the day before or they may not be able to find their car keys because they forgot where they put them the day before. These people can remember things that happened a long time ago (long-term memory) but they forget things that are recent (short-term memory loss).


People in the early stage also:

  • Repeat what they have already said. They forget what they have already said when they are speaking with other people.
  • Forget the word they want to use. These people just can not find the right word to use in a sentence. They may even use a word that makes no sense at all.
  • Forget how to do some simple things. Some may forget how to make their favorite stew, for example.
  • Stop being able to do some “hands on” things. They may no longer be able to knit or drive a car as well as they did in the past.
  • Have personality changes. They may become angry, aggressive, depressed and “moody”.
  • Become disoriented. They may forget what day of the week it is.

Some of these changes are very small and hard to notice. It is often the family that notices it. The person may not even know they are having trouble.

The Middle Stage Signs

As it continues to progress, the person will become more forgetful, confused and disoriented. They will have both short-term and long-term memory loss. The early stage signs get worse during the middle stage and the patient may also:

  • Be restless and confused at night. This is often called “sun downer’s”.
  • Have trouble reading and writing.
  • Repeat actions over and over again. These acts have no purpose but they are done over and over again anyway.
  • Wander and get lost. This is a big safety concern.
  • Be at risk for harm. Falls, self harm and getting lost are a problem. These patients no longer see and stay away from danger. They do not have good judgment and common sense.
  • Become aggressive and very angry. These behaviors may place the patient, staff and other patients at risk for harm.
  • Not recognize family, friends and familiar place.
  • No longer be able to take care of themselves without the help of others.
  • Have hallucinations and delusions.
  • Personality changes. They may be sad and depressed, have fears, anxiety and other personality changes.

  • Lose social skills. These patients may stop spending time with others and doing things that you used to like doing.

The Late Stage Signs

During the late stage, the patient can no longer care for himself or herself. They need complete care. All of the early and late stage signs continue to get worse and the patient also:

  • Loses control of urine. They become incontinent of urine.
  • Loses control of stool. They become incontinent of stool.
  • Can no longer eat without a lot of help or a feeding tube. Patients may have eating and swallowing problems..
  • Becomes underweight and thin. These patients are at risk for malnutrition, dehydration, infections and aspiration.
  • Is highly irritable.
  • Very sleepy and not responsive.

How do People Find Out that They Have Alzheimer’s Disease?

The diagnosis of Alzheimer's disease is not easy in the early stage of the disease. It is hard to separate normal forgetting things from the short term memory loss that marks this disease.

The doctor diagnoses this disease after a complete history and physical examination of the patient. Some mental tests and laboratory tests are also done. There is no blood test for Alzheimer’s disease. The lab and mental tests that are done help the doctor to rule out other diseases that may be causing the patient’s memory loss and other signs.

Caring for Alzheimer’s Patients

Nursing assistants and others in healthcare provide care to Alzheimer’s patients according to their own needs. For example, if a patient in the early stage of the disease is able to dress and bath without help, we should help them to remain as active and as independent as possible. If the patient is at risk for falls, we must make sure that their room and the nursing unit is safe, secure, neat and uncluttered.

Below are some Alzheimer’s disease health problems and ways that nursing assistants must provide care, as specific to these problems.

Confusion.

  • Keep the patient care area bright.
  • Keep stimulation and noise to a minimum.

  • Use large clocks, calendars and other things to orient the patient. Spend time with the patient. Remind them about the date, time of day and where they are.

Falls and other safety risks.

  • Keep the patient care area safe. Safety is VERY important. Keep the patient’s room and the patient care area. Take away all clutter and dangerous chemicals, like medicines and cleaning liquids. Use non skid slippers and shoes for those at high risk for falls.

  • Answer call bells promptly.
  • Follow patient identification procedures. Very careful patient identification must be used to prevent medical errors and mistakes.

Wandering risk.

  • Use and attend to alarms. Bed alarms, alarms that ring when a wandering person tries to leave the building help keep patients safe. Listen for and respond to alarms immediately.
  • Try to re-direct wandering. Some nursing homes have wandering or exercise tracks so that people can safely wander outside the building and in a big circle that ends in another entrance to the same building.

Lack of rest.

  • Alternate rest periods with activity. Tired patients may act out with behaviors that are disruptive, unacceptable or dangerous.
  • Encourage sleep and rest by keeping a regular bed time. Give the patient a quiet room for rest. Have the person change into pajamas and keep a regular routine so that the person is able to sleep at night.

Eating problems.

  • Encourage as much independence as possible.
  • Know what the patient can and can not have. Some patients with a swallowing problem can not have plain water or other liquids. They may need honey thick fluids instead.

Behavior problems.

The best way to manage poor behavior is to prevent it. The best way to manage it is to stop it before it starts. The prevention of poor behavior needs the help of the whole team, including nursing assistants.

PREVENT poor behaviors.

  • Know your patients and residents. Know what kinds of things lead to poor behavior. Know the things that help your patient to behave correctly. For example, give the patient a bath in the morning if they are less confused and agitated in the morning. A bath during the afternoon or evening may make this patient angry and resist care completely. Very often, poor behavior happens while care is being given to a patient or resident. Try to calm a patient during care. Keep things the same and keep things simple to prevent poor behavior. Know the best routine for the person and stick to it.
  • Know what triggers poor behavior and try to keep the person from these triggers. Eliminate all physical, emotional, environmental, communication and care triggers. Meet the person's needs so they do NOT react with disturbed behavior.
  • Give simple instructions and repeat instructions if needed.
  • Listen to the patient or resident. Many patients and residents will act out with poor behavior when they can't make their needs known. Spend time with your patient. Let them ask you questions. Help them tell you about their feelings. Help them tell you what they want. Use pictures if needed. Repeat back to them what you think they said or wanted to make sure you have really heard and understood them. Be clear and calm when communicating with these patients.
  • Observe your patients and how they act with others. If another easily annoys a patient, encourage both patients to go to a different place for an activity or event.
  • Approach a very confused patient from the side and speak face to face. Speak slowly, calmly and use simple words. Ask simple 'yes', 'no' questions.
  • Keep the patient care area simple. Keep noise down. Make sure that there is enough light. Keep schedules and routines the same for people who act out when things are changed. Limit choices if needed. Some patients and residents get nervous and frustrated if they have too many choices. Encourage patients and residents to go to well supervised and structured activities if they are at risk for poor behavior when things are not structured.
  • Keep your attention on the person and not the task. It is the person and how they are feeling that is important. If a person gets angry during an activity of daily living, break the task down into small parts. Encourage the person to be as independent as possible. Praise the person for their self care efforts.
  • Provide activities that meet the patients' and residents' needs and prevents poor behaviors. Clocks and a large calendar or poster with the day of the week, the date, the season and the day's weather often help to orient people to time and current reality. Other socialization and activity groups, like reality orientation groups, holiday parties and reminiscence groups are often helpful.
  • Relieve stress. Promote relaxation and other things that lower stress. Pet therapy, music therapy and socialization or exercise groups can lower stress.
  • Report all patient changes to the nurse in charge. If a patient condition or behavior changes they may be at risk for acting out behaviors. Report all patient changes.
  • Be a team member. Follow the patient's behavior management plan of care. Everyone on the team must be consistent. They must all say and do the same things with the patient.

MANAGE disruptive, unacceptable or dangerous behaviors when they occur.

  • Stay calm, speak softly and show respect. If inappropriate, dangerous or disruptive behavior occurs, speak to the patient(s) calmly, slowly and with respect. Have them sit to chat. Sit next to them.
  • Stop the task you are doing.
  • Call for help if you need it.
  • Protect all the residents from injury. Stay far enough away from a person so that they can't hit you. Try to sit the person down. Put a pillow on your chest if a person is trying to punch you in the chest. Do NOT fight back. Do NOT pull away if you are grabbed. Stay calm and talk with the person. Remove the person(s) from harm if your words and instructions do not stop the dangerous behavior.
  • Meet patient needs. If a person is making noise, find out if they are hungry, thirsty, wet, dirty, in pain, too hot, too cold or tired. Meet these needs. Feed the person that is hungry. Give water to the person who is thirsty, etc.
  • Report any disturbed behavior. What triggered the behavior? What happened? When time was it? Where did it happen? How long did the poor behavior continue? Was the behavior mild, moderate or very severe? Who else was involved? What did you do to stop the behavior? Did it work?

Infection risk.

  • Wash your hands before and after each patient contact. Handwashing is the single most important thing that you can do to prevent the spread of infection.
  • Follow Standard Precautions procedures.

Summary

Caring for patients with Alzheimer’s disease requires skill, patience and a team effort.

The nursing assistant is a very important member of the team’s effort. EVERYONE must follow the plan of care in order to insure that the patient and family members receive the highest possible quality of care filled with dignity and respect.

References

American Psychiatric Association (APA). (2007). “Practice guideline for the treatment of patients with Alzheimer's disease and other dementias”. [online] http://www.guideline.gov/summary/summary.aspx?doc_id=11533&nbr=005974&string=alzheimer

Eliopoulos, Charlotte. Manual of Gerontologic Nursing. (1995). St. Louis: Mosby –Year Book Inc.

Lantz, John. (1996). Major Issues in Gerontological Nursing. South Easton, MA: Western Schools.

Monahan, Frances Donovan and Wilma J. Phipps (2007). Phipps’ Medical-Surgical Nursing: Health and Illness Perspectives. 8th Edition. Elsevier Mosby.

Nettina, Sandra M. (2009). The Lippincott Manual of Nursing Practice. 7th Ed. Lippincott, Williams and Wilkins.

Pulliam, Jo Lynn. (1998). The Nursing Assistant: Acute, Subacute and Long-Term Care. New Jersey: Brady, Prentice Hall.

Tierney LM, McPhee SJ and Papadakis MA. (2000) Current Medical Diagnosis and Treatment: New York

 

Wold, Gloria Hoffmann. (2008). Basic Geriatric Nursing. Elsevier Mosby.

Copyright © 2010 Alene Burke


 

 

 

 


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