Alzheimers disease is a progressive and irreversible, degenerative, fatal disease and is the most

common form of dementia among older people. Dementia is a brain disorder that seriously affects a
persons ability to carry out daily activities. It usually begins after age 60 and the risk goes up as
you get older. Risk is also higher if a family member has the disease.
Progression of the disease is done in phases until all cognitive function is destroyed. Pathologic
consequences include the loss of neurons in multiple areas within the brain, atrophy with wide sulci
and dilated ventricles of the brain, the presence of plaques composed of neurites, astrocytes, and
glial cells that surround an amyloid center, and neurofibrillary tangles.
Symptoms seen in AD are the result of the destruction of numerous neurons in the hippocampus and
the cerebral cortex. The enzyme choline acetyltransferase, has a decreased action with AD patients,
which results in impaired conduction of impulses between the nerve cells caused by lack of
acetylcholine production.
Currently, no treatment can stop the progression of the disease. However, some drugs may help
keep symptoms from getting worse for a limited time.

Nursing Care Plans

Nurses play a key role in the recognition of dementia among hospitalized elderly, by assessing for
signs during the nursing admission assessment. Interventions for dementia are aimed at promoting
patient function and independence for as long as possible. Other important goals include promoting
the patients safety, independence in self-care activities, reducing anxiety and agitation, improving
communication, providing for socialization and intimacy, adequate nutrition and supporting and
educating the family caregivers.
Here are 13 nursing care plans for patients with Alzheimers Disease.
1. Disturbed Thought Process
May be related to

Alzheimers Disease
Changes in cognitive abilities
Impaired memory
Disorientation
Chemical imbalances in the brain
Dementia
Neuronal destruction in the brain

Possibly evidenced by

Disorientation to time, place, person, and circumstance

Decreased ability to reason or conceptualize
Inability to reason
Inability to calculate
Memory loss
Decreased attention span
Easy distractibility
Inability to follow simple or complex commands
Deterioration in personal care and appearance
Dysarthria

Dysphagia
Convulsions
Inappropriate social behavior
Paranoia
Combativeness
Inability to cooperate
Wandering
Disturbance in judgement and abstract thoughts
Explosive behavior
Illusions, delusions, hallucinations
Deterioration of intellect
Loss of sexual drive and desire, reduced control of sexual behavior
Inappropriate behavior
Lack of inhibitions
Hypervigilance or hypovigilance
Alteration in sleep pattern
Lethargy
Egocentricity

Desired Outcomes
Patient will have appropriate maintenance of mental and psychological function as long as
possible, and reversal of behaviors when possible.
Family members will be able to exhibits understanding of required care and will
demonstrate appropriate coping skills and ability to utilize community resources.
Patient will achieve functional ability at his optimum level with modifications and
alterations within his environment to compensate for deficits.
Patient will have improved thought processing or will be maintained at a baseline level.
Patient will be aware and oriented if possible, and reality will be maintain at an optimal
level.
Patients will have behavioral problems identified and controlled.
Patients family will be able to access community resources and make informed choices
regarding patients care, both currently and for future care.
Nursing Interventions
Assess patients ability for
thought processing every shift.
Observe patient for cognitive
functioning, memory changes,
disorientation, difficulty with
communication, or changes in
thinking patterns.
Assess the level of cognitive
disorders such as change to
orientation to people, places and
times, range, attention, thinking
skills.
Assess level of confusion and
disorientation.

Rationale

Changes in status may indicate progression of deterioration or

improvement in condition.

Provide the basis for the evaluation or comparison that will come,
and influencing the choice of intervention.
Confusion may range from slight disorientation to agitation and
may develop over a short period of time or slowly over several
months. May indicate effectiveness of treatment or decline in
condition.

The elderly may have a decrease in memory for more recent

events and more active memory for past events and more active
memory for past events and reminisce about the pleasant ones.
Patient may exhibit assertiveness or aggressiveness to
compensate for feelings of insecurity, or develop more narrowed
interests and have difficulty accepting changes in lifestyle.
Reality orientation techniques help improve patients awareness
of self and environment only for patients with confusion related
Orient patient to environment as to delirium or with depression. Depending on the stage of AD, it
needed, if patients short term
may be reassuring for patients in the very early states who are
memory is intact. Using of
aware that they are losing their sense of reality, but it does not
calendars, radio, newspapers,
work when dementia becomes irreversible because the patient
television and so forth, are also can no longer understand reality. Television and radio programs
appropriate.
may be overstimulating and may increase agitation, and can be
disorientating to patients who cannot make a distinction between
reality and fantasy or what they may view on television.
Assess patient for sensory
deprivation, concurrent use of
CNS drugs, poor nutrition,
May cause confusion and change in mental status.
dehydration, infection, or other
concomitant disease processes.
Maintain a regular daily
If the needs of a patient with AD are not met, it may cause the
schedule routine to prevent
patient to become agitated and anxious. Predictable behavior is
problems that may result from
less threatening to the patient and does not tax limited ability to
thirst, hunger, lack of sleep, or
function with ADLs.
inadequate exercise.
Allow patient the freedom to sit
Validates patients sense of reality and assists the patient in
in a chair near the window,
differentiating between day and night. Respect for the patients
utilize books and magazines as
personal space allows patient to exert some control.
desired.
Label drawers, use written
reminders notes, pictures, or
Assists patients memory by use of reminders of what to do and
color-coding articles to assist
location of articles.
patients.
Allow hoarding and wandering
Increases patients security and decreases hostility and agitation
in a controlled environment, as
by permitting behaviors that are difficulty to prevent, to be
appropriate or within acceptable
allowed within the confines of a safe supervised environment.
limitations.
Provide positive reinforcement
and feedback for positive
Promotes patient confidence and reinforces progress.
behaviors.
Patient may be unable to make even the simplest choice decisions
Limit decisions that patient
and this will result in frustration and distraction. By avoiding
makes. Be supportive and
this, the patient has an increased feeling of security. Patients
convey warmth and concern
frequently have feelings of loneliness, isolation and depression,
when communicating with the
and they respond positively to a smile, friendly voice, and gentle
patient.
touch.
Provide opportunity for social
Helps prevent isolation. Forcing interaction usually results in
interaction, but to do not force
confusion, agitation, and hostility.
interaction.
Assess patients ability to cope
with events, interests in
surroundings and activity,
motivation, and changes in
memory pattern.

Inform patient of care to be

done, with one instruction at a
time.
Maintain a nice quiet
neighborhood.
Instruct family in methods to use
with communication with
patient: listen carefully, listen to
stories even if theyve heard
them many times previously, and
to avoid asking questions that
the patient may not be able to
answer.

Patients with AD require extended time for processing

information. Removal of decision making may facilitate
improved compliance and feelings of security.
Noise, crowds, the crowds are usually the excessive sensory
neurons and can increase interference.
Comments from the patients may involve reliving experiences
from previous years and may be totally appropriate within that
context. In early stages of AD, questions may cause
embarrassment and frustration when the patient is presented with
another reminder that abilities are decreasing.

Instruct family members in the

disease process, what can be
expected, and assist with
providing a list of community
resources for support.

Once diagnosis of AD is made, the family should be prepared to

make long-term plans in order to discuss problems before they
arise. Choices for resuscitation, legal competency and
guardianship including financial responsibility needed to be
addressed The care of a person with AD is expensive and timeconsuming, as well as energy-draining and emotionally
devastating for the family. Community resources can help delay
the need for placement in a long-term care facility and may help
defray some costs.

Face-to-face when talking with

patients.

Cause concern, especially in people with perceptual disorders.

Call patient by name.

The name is a form of self-identity and lead to recognition of

reality and the individual.

Use a rather low voice and spoke

Increasing the possibility of understanding.
slowly in patients.
Assess the degree of impaired
ability of competence,
Impairment of visual perception increase the risk of falling.
emergence of impulsive
Identify potential risks in the environment and heighten
behavior, and a decrease in
awareness so that caregivers more aware of the danger.
visual perception.
An impaired cognitive and perceptual disorders are beginning to
Help the people closest to
experience the trauma as a result of the inability to take
identify the risk of hazards that
responsibility for basic security capabilities, or evaluating a
may arise.
particular situation.
Eliminate or minimize sources Maintain security by avoiding a confrontation that could improve
of hazards in the environment
the behavior or increase the risk for injury.
Divert attention to a client when
agitated or dangerous behaviors
To promote safety and prevent risk for injury.
like getting out of bed by
climbing the fence bed.
2. Chronic Confusion
May be related to
Alzheimers disease
Dementia

Possibly evidenced by

Decreased ability to interpret ones environment

Decreased capacity for thought
Memory impairment
Disorientation
Behavioral changes
Personality changes
Altered interpretation
Response to stimuli

Desired Outcomes
Patient will have minimal confusion, cognitive impairment, and other dementia
manifestations.
Patient will have stable, safe environment with routine scheduling of activities to decrease
anxiety and confusion.
Patient will exhibit minimal or reduced confusion, memory loss, and cognitive disturbances,
depending upon stage of AD.
Patient will be able to tolerate stimuli when introduced slowly in nonthreatening manner,
with one item at a time.
Patient will be able to be distracted or use other techniques to avoid stressful situations that
may cause aggressive, hostile behaviors or frustration.
Family will be able to utilize information effectively in dealing with patient with confusion
with regard to limitations of stimulation and validation of patients thoughts.
Family will be able to utilize information to begin making decisions for long-term plans for
patient.
Nursing Interventions
Assess patient for reversible or irreversible
dementia, causes, ability to interpret
environment, intellectual thought processes,
memory loss, disturbances with orientation,
behavior, and socialization.
Utilize cognitive function testing.

Rationale
Determines type and extent of dementia to
establish a plan of care to enhance cognition and
emotional functioning at optimal levels.

Identifies current level of dementia.

Prevents patient agitation, erratic behaviors, and
Maintain consistent scheduling with allowances
combative reactions. Scheduling may need
for patients specific needs, and avoid
revision to show respect for the patients sense of
frustrating situations and overstimulation.
worth and to facilitate completion of tasks.
Avoid or terminate emotionally charged
Catastrophic emotional response are prompted by
situations or conversations. Avoid anger and
task failure when the patient feels expected to
expectation of patient to remember or follow
perform beyond ability and becomes frustrated
instructions. Do not expect more than the
and angry. Responding calmly to the patient
patient is capable of doing.
validates feeling and causes less stress.
Allows for memory of past pleasant events.
Provide time for reminiscing if patient so
Patient may be reliving events in the past and the
desires.
caregiver should identify this behavior and respect
it.
Decreases frustration and distractions from
Limit sensory stimuli and independent
environment. Decreasing stress of making a
decision-making.
choice helps to promote security.
Assist with establishing cues and reminders for Assists patients with early AD to remember

patients assistance.
Identify family members and/or support
systems for the patient.
Ask family members about their ability to
provide care for patient.
Instruct family and provide them with
information regarding community services and
long-term health care facilities.

location of articles and facilitates some

orientation.
Helps to determine appropriate person to notify
for changes, to assist with care, and someone
familiar to patient to help deal with his confusion.
Identifies familys need for assistance.

Patient may require ongoing skilled nursing care

that the patients family is unable or unwilling to
provide.
Patient may have delusions and hallucinations,
Instruct family regarding avoidance of arguing that are real to the patient, and no amount of
with patient about what he thinks, sees, or
persuasion will convince him or her otherwise.
hears.
The patient may become agitated or violent if
contradicted.
Instruct family to consider if what patient
Sometimes portions of conversations can be heard
believes has some basis in reality.
and misinterpreted by the patient.
Instruct family to consider if what patient
Patient may be reliving times in the past and the
believes has some basis in reality from previous
reality may be decades ago.
years ago.
Patient cannot make distinction of reality from
Instruct family to avoid having patient watch
fiction, and witnessing violent acts on the screen
violent TV shows.
may be frightening to the patient.
Instruct family to utilize distraction techniques,
such as soothing music, going for a walk, or
Distraction may be effective to calm patient if
looking at picture albums if patient has
stressful situations occur.
delusions.
3. Impaired Verbal Communication
May be related to

Alzheimers disease
Dementia
Psychological barriers
Psychosis
Decreased circulation to brain
Age-related factors
Lack of stimuli

Possibly evidenced by
Confusion, anxiety, restlessness, disorientation to person, place, time and circumstance,
agitation, flight of ideas
Repetitive speech, inability to speak [properly], stuttering, slurring, impaired articulation,
difficulty with phonation, inability to name words, inability to identify objects, difficulty
comprehending communication, difficulty forming words or sentences
Aphonia, dyslalia, dysarthria, inappropriate verbalizations, aphasia, dysphasia, apraxia,
dyslexia.
Desired Outcomes

 Patient will be able to have effective speech and understanding of communication, or will be
able to use another method of communication and make needs known.
Nursing Interventions
Rationale
Assess the patients ability to
speak, language deficit,
cognitive or sensory impairment,
presence of aphasia, dysarthria, Identifies problem areas and speech patterns to help establish a
aphonia, dyslalia, or apraxia.
plan of care.
Presence of psychosis, and/or
other neurologic disorders
affecting speech.
Communication becomes progressively impaired as AD
advances. The left side cerebral functions consisting of language
reasoning, and calculation are decreased. Receptive and
expressive aphasia are major symptoms of AD and affects
speaking, reading, writing, and math.
The mechanics of speech production is usually intact until the last
stages of AD but the patient has difficulty concentrating on what
has been said, understanding and processing what was said, and
Assess effects of communication
then preparing a response. In the first stage of AD, vocabulary
deficit.
skill decreases and the patient has trouble finding the correct
word to use, resulting in word substitution. The patient can
usually understand most messages but forgets them because of
memory deficits. As the disease evolves, the ability to
comprehend written and spoken language is decreased. False
details about past events may be invented to try to camouflage
the inability to remember. Ultimately the patient will become
mute.
Monitor the patient for
nonverbal communication, such Indicates that feelings or needs are being expressed when speech
as facial grimacing, smiling,
is impaired. Excessive mumbling, striking out, or non
pointing, crying, and so forth;
verbalization clues may b e the only method left for the patient to
encourage use of speech when express discomfort.
possible.
Attempt to anticipate patients
Helps to prevent frustration and anxiety.
needs.
When communicating with
patient, face patient and maintain Clarity, brevity, and time provided for responses promotes the
eye contact, speaking slowly and opportunity for successful speech by allowing patient time to
enunciating clearly in a
receive and process the information.
moderate or low-pitched tone.
Remove competing stimuli, and
Reduces unnecessary noise and distraction and allows patient
provide a calm, unhurried
time to decrease frustration.
atmosphere for communication.
Use simple, direct questions
requiring one-word answers.
Promotes self-confidence of the patient who is able to achieve
Repeat and reword questions if some degree of speech or communication.
misunderstanding occurs.

Utilize pencil and paper to write

messages.
Assess patient for hearing
deficits, and use of appropriate
adaptive devices if needed.
Minimizes glare in room, speak
normally, but distinctly, and use
short phrases with speech
attempts.
Encourage patient to breath prior
to speaking, pause between
words, and use tongue, lips, and
jaw to speak.
Encourage patient to control the
length and rate of phrases, over
articulate words, and separate
syllables, emphasizing
consonants.

Provides an alternative method of communication if fine motor

function is not impaired; use of magic slate is also suitable.
If patient is deaf or requires hearing aids, make sure battery is
working and aid is correctly placed to enhance hearing ability.
Shouting usually increases the pitch of the voice and does not
help with hearing. Glare makes it more difficult for patient to
read your lips.

Promotes coordinated speech breathing.

Helps to promote speech in the presence of dysarthria.

Impaired verbal communication results in patients feeling of

isolation, despair, depression, and frustration. Compassion helps
to foster a therapeutic relationship and sense of trust and is
important for continuing communication.
Helps reduce feelings of isolation, which then result in further
Encourage patient to take part in
depression and unwillingness to communicate, even if patient is
social activities.
physically able to do so.
Instruct patient and/or SO
regarding need to use glasses,
Helps promote communication with sensory or other deficits.
hearing aids, dentures
Provide consultation with speech Helps facilitate speech ability and provides potential alternatives
therapists, as appropriate.
for communication needs.
Instruct patient and/or SO in the
performance of facial muscle
exercises, such as smiling,
Promotes facial expressions used to communicate by increasing
frowning, sticking tongue out, muscle coordination and tone.
moving tongue from side to side
and up and down.
May be related to
Avoid rushing the patient when
struggling to express feelings
and thoughts.

Alzheimers disease
Dementia
Memory loss
Cognitive impairment
Neuromuscular impairment

Possibly evidenced by
Inability to:
Wash body parts
Obtain baths supplies
Obtain water source
Get into and out of bathroom

Dry body
Take off necessary clothing
Brush or comb hair
Shave
Brush teeth
Maintain appearance at satisfactory level

Desired Outcomes

Patient will have self-care needs met and have few, if any complications.
Patients family will be able to carry out self-care program on a daily basis.
Patient will maintain an acceptable appearance.
Patient will be able to perform a portion of self-care within the limitations of the disease.
Patient will accept assistance with self-care when needed.
Patient and family will use assistive devices to perform self-care for the patient.
Family will be able to competently provide bathing and hygiene care for patient.

Nursing Interventions
Assess patients appearance, body
odors, ability to recognize and user
articles for washing and grooming, and
any other self-care deficits.
Assess and identify patients previous
history of grooming and bathing, and
attempt to maintain similar caare.
Ensure all needed items are present in
bathroom prior to the patients arrival.
Ensure that water temperature in tube
is appropriate.
Allow patient to perform as much of
the task as able.

Rationale
Identifies specific needs and the amount of assistance that
the patient will require in order to establish a plan of care.
Promotes familiarity with routine bathing time time and
type of bath or shower, and lessens further confusion and
agitation.
Prevents the need to leave the patient unattended, which
may result in injury. Elderly are easily child and have
fragile skin that is susceptible to scalding.

Fosters independence and promotes self-care as long as

possible. Once the skill is lost, it is lost forever with AD.
Promotes independence and self-esteem when patient is
Assist with as much activity as needed.
allowed to control situation. Patients with AD frequently
Give patient a washcloth or hand towel
will grasp the hand of the nurse during a bath, and use of
to hold on to.
washcloth helps them to have something to hold on to.
Provides the opportunity to observe for presence of rashes,
Inspect the patients skin during and
lesions, pressure areas, ulcers, bruises, growths, or unclean
after bath.
skin areas, which may require more assistance with
hygiene to prevent further skin deterioration.
Instruct patient in activity with short
Promotes self-esteem and feelings of accomplishment;
step-by-step method; do not rush
rushing the patient causes frustration.
patient.
Instruct family members in bathing
technique and what to observe for
Provides knowledge and decreases anxiety.
during bath.
5. Self-Care Deficit: Dressing and Grooming
May be related to
Alzheimers disease

 Dementia
Musculoskeletal impairment
Cognitive impairment
Possibly evidenced by

Inability to wear on or take off clothing

Inability to choose clothing
Inability to maintain proper and appropriate appearance
Inability to obtain clothing
Inability to pick up clothing
Inability to brush or comb hair
Inability to shave
Inability to brush teeth

Desired Outcomes
Patient will be appropriately groomed and dressed independently with or with minimal
assistance.
Nursing Interventions
Assess patients functional and cognitive
ability to provide self-care.
Provide assistive devices as needed.
Allow patient to perform as much care as
able, giving simple instructions, step-bystep.

Assist patient with dressing and grooming as

needed.

Rationale
Identifies functional level and helps establish plan of
care to meet patients needs.
Facilitates independence on some tasks.
Fosters self-confidence and self-esteem.
Patients with AD have difficulty with dressing
because of the need to have a fine and gross motor
skills, balance, sequencing ability, and the ability to
tell right from left and top from bottom.
Dressing up is less difficult if the patients clothes are
large enough and made of material that is soft, slick,
and stretchy.

Patient requires oral care to remove any leftover food

particles, to prevent decay, and promote dental
hygiene. Patients may be unable to understand
directions for spitting out toothpaste or rinsing with
Provide oral care after meals and at bedtime.
water, and may unable to open mouth during flossing.
Use adaptive devices as required.
Adaptive devices may be used to facilitate proper
dental hygiene.
Instruct family regarding removal of
clothing that is out of season or no longer
fits; lay out clothes in the order they are to
be put on; use larger sized clothing with
fasteners or Velcro that are easier to handle.
Instruct family in the use of electric razors
for men and cream depilatory products for

Assists AD patients with self-care while still able to

do part of care, and will assist the caregivers when
they assume this duty.
Helps facilitate easier grooming process.

women.
Daily oral care will help lower significantly the risks
of needing extensive dental care later on. Oral care
may be difficult in the later stages of AD because the
patient may not be able to spit out toothpaste or rinse
Instruct family that patient will require oral
with water.
care at least twice daily, and in the use of
artificial saliva.
Artificial saliva may be required for patients who
suffer from dry mouth caused by medications or lack
of fluid intake.
Helps keeps the appearance of the patient neat and
tidy.
Instruct family regarding the possibility of
cutting the patients hair and keeping it in a Longer hair requires more brushing and intensive
short and simple style.
care; it may also cause aggressive behavior and
frustration in the AD patient.
6. Self-Care Deficit: Toileting
May be related to
Alzheimers
Possibly evidenced by

Inability to carry out toileting routine

Inability to flush toilet
Inability to get to bathroom
Inability to manipulate clothing for toileting
Inability to sit on

Desired Outcomes
Patient will have self-care needs met without any complications
Patients family will be able to carry out toileting program.
Nursing Interventions
Assess patient for functional, perceptual, or
cognitive ability for self-care.
Allow patient to perform toileting routine, as
able, and provide sufficient time so as to avoid
rushing patient.
Assist patient with toileting as necessary.
Establish urinary and bowel care program if
patient is unable to complete toileting.
Monitor patient for sudden changes in urinary
status.

Rationale
Identifies problems to help establish a plan of care.
Facilitates patients independence as much as
condition will allow. Rushing promotes excessive
stress and leads to failure.
Allows patient to perform independently for as
long as possible.
Monitoring success or failure of the plan of care
helps to identify and resolve areas of failure.
Incontinence is usually not occurring until the
latter stages of AD, so sudden UI may indicate the
presence of infection, prostatic hyperplasia,
urethral sphincter failure, bladder irritation, or

certain medication effects.

Observe patient and monitor for wandering,
May indicate that his or her bladder is full.
rubbing the genital area, or irritability.
Encourage fluid intake of at least 2-3 L per day
unless contraindicated; ensure that the patient Provides hydration and enhances renal function.
actually drinks the fluid.
Establish a scheduled toileting and habit
training program. Take the patient to the
bathroom every 2 hours, run the water, and
place the patients hands in warm water, or pour
warm water over the genitalia.
Helps establish toileting routines.
Administer stool softeners, laxatives, or
suppositories and take patient to bathroom at
same time each day to promote stool
evacuation.
Instruct family regarding toileting program,
Promotes knowledge, and facilitates continuity of
times to take patient to the bathroom, and need
care to promote toileting routines.
to maintain consistent schedule.
Provides knowledge and helps to instill confidence
Instruct family in procedure for administration in family members who provide care. This may
of suppositories or enemas, and potential for
also induce family members to realistically decide
manual removal of stool.
if they can provide personal care for patient or will
need a long-term care facility for the patient.

Object 1

May be related to

Alzheimers disease progression

Dementia
Inability to bear weight
Poor nutrition
Perceptual impairment
Cognitive impairment

Possibly evidenced by
Weakness
Inability to move at will, bear weight

Immobility
Gait disturbances
Balance and coordination deficits
Difficulty turning
Decreased fine and gross motor movement
Decreased range of motion
Tremors
Instability while standing
Dyspnea
Decreased reaction time
Incoordination
Jerky movement
Shuffling
Swaying

Desired Outcomes
Patient will maintain functional mobility as long as possible within limitations of disease
process
Patient will have a few, if any, complications related to immobility as disease condition
progresses
Nursing Interventions

Rationale
Identifies problems and helps to establish a
Assess patients functional ability for mobility and plan of care. Mobility deteriorates as AD
note changes.
progresses, but most patients are ambulatory
until the latter stages.
Assess patients degree of cognitive impairment
and ability to follow commands, and adapt
Helps to determine the presence of deficits.
interventions as needed.
Provide patients with enough time to perform a
Patient may need repetitive instruction and
mobility related assignment. Use simple
comprehensive assistance to perform the task.
instructions.
Provide range of motion exercises every shift.
Helps to prevent joint contractures and muscle
Encourage active range of motion exercises.
atrophy.
Turning at regular intervals prevents skin
Reposition patient every 2 hours and prn.
breakdown from pressure injury.
Apply trochanter rolls and/or pillows to maintain
Prevents musculoskeletal deformities.
joint alignment.
Assist patient with walking if at all possible,
utilizing sufficient help. A one or two-person pivot Preserves patients muscle tone and helps
transfer utilizing a transfer belt can be used if
prevent complications of immobility.
patient has weight-bearing ability.
Use mechanical lift for patients who cannot bear
Provides change of scenery, movement, and
weight, and help them out of bed at least daily.
encourages participation in activities.
Inactivity created by the use of restraints may
Avoid restraints as possible.
increase muscle weakness and poor balance.
Most AD patients cannot use them properly
Avoid the use of walkers and canes.
because of their cognitive impairment, and
they may actually increase potential for injury.

Instruct family regarding ROM exercises, methods Prevents complications of immobility and
of transferring patients from bed to wheelchair, and knowledge assists family members to be better
turning at routine intervals.
prepared for home care.
8. Disturbed Sleep Pattern
May be related to

Alzheimers disease progression

Depression
Confusion
Boredom
Environmental stimuli
Obstructive sleep apnea

Possibly evidenced by

Interrupted sleep
Difficulty falling asleep
Awakening early
Fatigue
Lethargy
Irritability
Insomnia
Sleeplessness
Yawning
Morning headache
Loss of libido

Desired Outcomes
Patient will achieve and maintain restorative restful sleep.
Patient will exhibit no behavioral symptoms, such as restlessness, irritability, or lethargy.
Nursing Interventions
Assess patients sleep patterns and changes,
naps, and frequency, amount of activity,
sedentary status, number and time of
awakenings during night, and patients
complaints of fatigue apathy, lethargy, and
impotence.
Assess patient for complaints or signs of
pain, dyspnea, nocturia or cramps.
Monitor patients medications, use of
alcohol (if any), and caffeine.
Ensure environment is quiet, wellventilated, absence of odor, and has
comfortable temperature.
Provide ritualistic procedures of warm
drink, extra covers, clean linens, or warm

Rationale
Provide information on which to establish a plan of
care for correction of sleep deprivation. If patient is
sleeping during the day, Sundowning syndrome may
be the problem, with the patients day and night
mixed up. By keeping the patient up during the day,
sleeping at night may return.
May be causes of frequent awakenings and
interruptions of sleep cycle.
These drugs can alter REM sleep, which may cause
irritability and lethargy. Drug action, absorption and
excretion may be delayed in the elderly patient, and
toxicity may place the patient at risk.
External stimuli can interfere with going to sleep with
frequent awakenings.
Prevents disruption of established pattern and
promotes comfort and relaxation before sleep.

baths prior to bedtime.

Provide backrubs, music other relaxation
techniques.
Provide sleep apnea apparatus if required.

Helps in relaxation before sleep and reduces anxiety

and tension. AD patients respond well to therapeutic
touch.
Provides for completion of all stages of sleep
resulting in restorative rest.
Provides for surveillance of the patient, and the
patient may willingly return to bed later.
The patient may not be able to revert back to a
normal day-night cycle, and either the caregiver
will have to change his own sleeping pattern, hire a
sitter during night time, or placement in a long-term
facility.

If all efforts fail, allow patient to remain

awake in a recliner by the nurses station.
Instruct family regarding Sundowning
syndrome, methods of coping, and
possibility of changing their sleeping cycle
to match that of the patients once
discharged.
Instruct family to avoid putting out patients
Patient may assume she is supposed to get dressed
clothes for the next day if the patient
and go somewhere.
exhibits a sleep disorder.
Help patient do exercises
May promote sleep.
9. Disturbed Sensory Perception
May be related to

Alzheimers disease progression

Dementia
Altered sensory reception
Transmission and/or integration of neurologic disease or deficit
Altered status of sensory organs
Inability to communicate, understand, speak, or respond
Sleep deprivation
CNS stimulants or depressants
Chronic illness
Aging

Possibly evidenced by

Disorientation to time, place, person, or events

Change in sensory acuity
Altered abstraction or conceptualization
Changes in problem solving abilities
Apathy
Complaints of fatigue
Altered patterns of communication
Lack of concentration
Noncompliance
Disordered thought processing/sequencing
Changes in behavior
Rapid mood swings
Exaggerated emotional responses
Anger
Irritability

 Bizarre thinking
Restlessness
Desired Outcomes
Patient will have preservation of sensory/perceptual function and controlled effects of
deficits within limits of disease process.
Patient will be able to identify sounds and objects correctly.
Patient will be able to use assistive devices to minimize deficits.
Family will be compliant with making adjustments n the patients environment for
prevention of accidents or injuries.
Nursing Interventions
Assess for confusional state, disorientation,
difficulty and slowing of mental ability, changes in
behavior and emotional responses
Assess visual acuity, visual difficulties or loss and
its effect from these changes; presence of cataract,
glaucoma, and status of remaining vision.
Assess auditory acuity, cerumen in ears, responses
to noises and effect on hearing, ability to
communicate, amount of loss and effect, and
difficulty in locating and identifying sounds.
Assess olfactory or gustatory loss, changes in
appetite and eating patterns, and amount of loss and
effect on nutritional status.
Assess tactile changes tingling or numbness in
extremities, loss of sensation, pain, or pressure.
Assess kinesthetic perception, expression or
behavior indicating awareness, extent and direction
of movement.
Administer eye drops as ordered.
Administer softening agent to ear and irrigate with
bulb syringe or low-pulsating water pik.
Promote use of assistive devices: hearing aid,
corrective glasses, or contact lenses.
Provide reading materials with larger print,
recorded material, or phone numbers with large
font, and posters with contrasting colors.
Provide magnifying glass, reading stand with
magnifier attached, or brighter lights
Suggest sunglasses or use of visor.
Arrange articles in familiar fashion and maintain
same location. Follow through with food on table,

Rationale
Cognitive dysfunction behavior changes may
result from sensory deficits/deprivation caused
by physiologic, psychological, and/or
environmental factors.
Presbyopia is common among elderly, other
visual changes caused by physiologic changes
require correction by surgery or with eye
glasses. Visual deficits create mobility and
socialization changes.
Presbycusis is common in the elderly.
Conductive hearing loss results in false
interpretation of words and creates poor
communication, isolation and depression.
Deterioration results from physiologic changes
of aging and creates loss of interest and
pleasure of eating.
Tactile perception is reduced in the aged and
discriminating different sensations is
decreased and creates risk of injury.
Cognitive deficits or aging neurologic changes
may prevent awareness, control of muscles,
muscles movements and create risk of falls.
Mydriatics act to improve vision with
cataracts; miotics facilitate flow of aqueous
humor through canal of Schlemm.
Soften and emulsifies cerumen for easier
removal to facilitate hearing.
Provides for correction of deficit.
Provides for visual aids that allow for more
control and independence.
Promotes visual acuity.
Reduces glare that is a common complaint
among elderly.
Provides alteration in environment that
facilitates independence with limited vision

personal hygiene articles, furniture including

clothing.
Suggest to use colors that are bright and
contrasting; avoid hues of blues and greens.
Provide for adequate lighting at night; avoid abrupt
movement from bright to dim light.
Provide telephone amplifier on receiver and bell
tone, flashing light on phone, loud speaker for TV,
radio, etc.

and promotes safety.

Minimizes problem of distinguishing items
from one another as colors tend to blend.
Prevents confusion and accidents as ability to
adjust to differences in lighting is decreased.
Promotes auditory perception and acuity.

The elderly with conductive loss experiences

Determine type of hearing loss if head turned to
loss of hearing of all frequencies and will hear
hear, asks for repeat of conversations frequently, or any loudly spoken words. Sensorineural loss
has inability to follow verbal conversation.
experiences loss of hearing even when speech
is loud enough to be heard.
Eliminate background noise.
Interferes with hearing.
Face the patient, use eye contact and speak loud
enough to be heard, speak slowly and clearly with Enhances communication if hearing is
proper pitch, use short clear sentences and gestures, impaired and promotes feeling of warmth and
maintain position even with patient to allow view of caring.
lips, and use touch to hold attention.
Allow time for answers and be patient. Rephrase
May need time to sort out and identify sounds
message using different words if patient is
or may not understand certain frequency
confused, puzzled or gives inappropriate response. sounds.
Hearing horns and speaking tubes enhances
Use hand-held device if appropriate.
communication.
Helps satisfy desire for these tastes as taste
Offer sweet and salt substitutes.
buds decrease with aging without
compromising diet.
Allow for interaction during mealtime.
Promotes interest in eating.
Provide alarm and flashing light type smoke
Reduces risk of injury if olfactory perception
detector, and safety alarms for stoves and heating
is reduced.
units.
Prevent any exposure to extreme temperatures, and Reduces risk of burns or injury if tactile
pressure to skin.
perception is impaired.
Reduces risk of falls or injury if visual acuity
Provide assistance when ambulating or performing
is reduced or if kinesthetic perception is
ADLs as appropriate.
impaired.
Encourage participation in physical or social
Prevents isolation and sensory deficit.
interactions.
Instruct patient and/or family in the application of Preserves visual acuity and prevents vision
eye and/or ear medications. Stress importance of
loss, and otic solutions promote auditory
drug compliance.
acuity.
Instruct patient and/or family in application of
hearing aids, removal of them 2 times per week,
Prevents cerumen buildup and enhances
and cleaning ear and device. Instruct about
hearing.
troubleshooting device according to manufacturers
recommendation.
Instruct family the patient requires screening exams
For adjust in corrective devices.
for vision and hearing at least yearly.

Instruct family in environmental modifications to

enhance vision, hearing, taste, smell, and touch as
appropriate.

Provides for patient safety by preventing

injury in the presence of sensory impairment.

Small pets provide sensory stimulation,

encourage movement, as well as facilitating
Inform and instruct patient about pet therapy.
social interaction and nonverbal
communication.
Plants grow and provide patients with the
Instruct family regarding horticulture activities and prospect of caring and nurturing, as well as
their healing and therapeutic properties.
sensory stimulation when working in the
garden.
May be related to

Alzheimers disease progression

Alterations in mental status
Confusion
Memory loss
Agitation
Combativeness
Unacceptable social behavior

Possibly evidenced by

Uncommunicative
Withdrawn
Cognitive impairment
Impaired sleep pattern
Hostile behavior
Feelings of rejection
Indifference of others
Isolation from others

Desired Outcomes
Patient will be able to maintain effective social interaction with others within limitations of
disease process.
Family will maintain their own optimal health.
Family will be able to access support groups, counseling, for assistance as needed.
Family will increase their knowledge about the disease and the care of the patient to enable
them to feel more in control of their situation
Family will have reduced anxiety and be able to cope and use problem-solving techniques.
Family will be able to adjust role reversal status and resolve conflicts regarding the care of
the patient.
Nursing Interventions
Assess patients feelings about his behavioral
problems, negative feelings about self, ability to
communicate, anxiety, depression, and feeling of
powerlessness.
Identify possible support systems and ability to
participate in social activities.
Provide diversional activities as appropriate for

Rationale
Determines extent of loneliness and
isolation and reasons for it.
Community resources are available for
clients and families dealing with stages of
AD that provide information and assistance.
Provides stimuli and promote psychosocial

functional ability.
Provide rest and sleep periods; avoid situation that
cause frustration, agitation, or sensory overload.
Instruct patient/family regarding plan for periods of
rest and activities during the day.
Instruct family regarding establishing a consistent
bedtime routine.

functioning.
Permits coping with stimuli and prevents
violent reactions.
Promotes social interaction and activity.
Promotes sleep and helps to avoid
frustration and confusion from sleep
deprivation.

11. Compromised Family Coping

May be related to

Alzheimers disease progression

Dementia
Chronic illness
Progression of the disease that exhausts the caregiver or family unit
Progressive dependence of the patient on the family

Possibly evidenced by
Fatigue
Anxiety
Stress
Social isolation
Financial insecurity
Expression of inadequate understanding of criss and patients responses to health problems
and necessary supportive behaviors
Unsatisfactory results of attempts to assist patient
Withdrawal from patient at his time of need

Desired Outcomes
Family members will achieve increased coping ability concerning patients dementia and
care needs.
Nursing Interventions
Assess familys knowledge of patients
disease and erratic behaviors, and
possible violent reactions.
Assess for level of familys fatigue,
reduced social exposure of family,
feelings about role reversal in caring
for patient and increasing demands of
patient.
Provide for opportunity for family to
express concerns and lack of control of
situation.
Assist in defining problem and use of
techniques to cope and solve problems.
Assist family to identify patients
reactions and behaviors and reasons for

Rationale
Knowledge will enhance the familys understanding of the
dementia associated with the disease and development of
coping skills and strategies.
Long-term needs of the patient may affect the physical and
psychosocial health of the caregiver, their economic status,
and prevent the family from achieving their own goals in
life.
Promotes venting of feelings and reduces anxiety.
Provides support for problem solving and management of
familys fatigue and chronic stress.
May indicate onset of agitation and allow for interventions
to prevent or reduce frustration.

them.
Instruct family and demonstrate timesaving, energy-conserving techniques
to be used to assist patient.
Instruct family regarding the need to
maintain their own health and social
contacts.

Assists family to prevent injury or accident to patient or

themselves.
Fatigue, isolation, and anxiety will affect the physical
health and care capabilities of the caregiver.

Provides information and support from those people that

Instruct family regarding community
understand and empathize with these families. Respite care
resources available for AD, their
may help facilitate caregivers sense of well-being. Some
families, as well as utilization of respite
families may feel that asking help from others indicates
care.
lack of caring for the patient.
May be helpful for providing assistance for financial help
Consult with social workers as
and respite services, as well as identifying need for longappropriate.
term care facility need.
12. Wandering
May be related to

Alzheimers disease
Dementia
Aging
Previous use of wandering as a coping mechanism
Mental illness

Possibly evidenced by

AImless ambulation
Frequent or continuous movement
Persistent searching for people or objects
Movement without planned destination
Shadowing
Pacing
Inability to locate familiar landmarks
Inability to be persuaded to remain in present location
Pain
Neurosensory deficits
Attraction to random stimuli

Desired Outcomes

Patient will have minimized wandering behavior.

Patient will be able to ambulate safely, and will not have unplanned outings.
Patient will be able to participate in activities.
Patient will have minimal wandering behaviors, and will experience no injuries.

Nursing Interventions
Assess patient for presence
of wandering behavior,
noting time, place, and
people whom he ambulates

Rationale
Helps to identify the gravity of the problem and to establish a plan of
care. Purposeful wandering occurs when the patient has some intent
for his movement, such as to escape boredom, or for exercises.
Aimless wandering is usually purposeless and involves disoriented

patients who may enter other patients rooms and take their
belongings. The escapist wandered usually has a destination in mind
and is able to leave the premises undetected even though closely
supervised.

with.

Assess specific reasons for

Helps identify possible causes for wandering and the needs that this
wandering, if patient is able
behavior may be a meeting.
to verbalize motivation.
Inquire how family handles
Helps to identify potential appropriate methods of management of
the patients wandering
patients behavior by using consistent method.
behavior.
Maintain safe environment
Allow patient to wander within boundaries in a safe environment.
and structured routine for
Structure in the patients routine may decrease wandering tendencies.
patient.
Encourage patient to
Exercise helps to decrease restlessness and may decrease potential
participate in activities if
wandering.
able to do so.
Install bed alarms or pressure Provides alarm to alert nurses of movement and help prevent injury
sensitive doormats.
to patient.
Restraints increase agitation, anxiety, and cause complications of
Avoid using restraints if at
immobility, feelings of powerlessness, and actual increase tendency
all possible.
for wandering.
Assess patient for thirst,
hunger, pain, or discomfort May wander about looking for these needs to be fulfilled.
and need for toileting.
Instruct family regarding
installing deadbolt locks,
Helps to prevent unsafe exists from home and for the protection of
fences, locks on gates, and the patient.
locks on doors and windows.
Instruct family to notify
neighbors and/or local police Provides awareness of others to prevent patient from becoming lost
regarding patients condition of injured.
and penchant for wandering.
Instruct family to be
prepared for possible escape
attempts and to keep up-to- Provides for information that may be used by police or other
date pictures of the patient, authorities to find a lost person.
and other information
available.
13. Risk for Injury
Related to

Alzheimers disease
Unable to recognize / identify hazards in the environment.
Disorientation, confusion, impaired decision making.
Weakness, the muscles are not coordinated, the presence of seizure activity.
Choking
Hyperorality

Possibly evidenced by

Confusion
Disorientation
Malnutrition
Altered mobility
Skin breakdown
Agitation
Physical discomfort
Choking
Wounds
Falls
Wandering and shadowing
Sundowning
Pillaging
Hoarding
Aggression
Hallucinations and/or delusions

Desired Outcomes

Patient will remain safe from environmental hazards resulting from cognitive impairment.
Family will ensure safety precautions are instituted and followed.
Patient will remain in a safe environment with no complications or injuries obtained.
Family will be able to identify and eliminate hazards in the patients environment.
Nursing Interventions

Assess the degree of impaired ability of

competence, emergence of impulsive behavior,
and a decrease in visual perception.
Assess patients surroundings for hazards and
remove them.

Help the people closest to identify the risk of

hazards that may arise.

Eliminate or minimize sources of hazards in the

environment
Divert attention to a client when agitated or
dangerous behaviors like getting out of bed by
climbing the fence bed.
Maintain adequate lighting and clear pathways.
Assess patient for hyperorality.

Rationale
Impairment of visual perception increase the
risk of falling. Identify potential risks in the
environment and heighten awareness so that
caregivers more aware of the danger.
AD decreases awareness of potential dangers,
and disease progression coupled with hazardous
environment that could lead to accidents.
An impaired cognitive and perceptual disorders
are beginning to experience the trauma as a
result of the inability to take responsibility for
basic security capabilities, or evaluating a
particular situation.
Maintain security by avoiding a confrontation
that could improve the behavior or increase the
risk for injury.
To promote safety and prevent risk for injury.
Allows patient to be able to see and find the
way around room without danger of tripping or
falling.
AD patients frequently have unexplained
movement of the mouth and tongue. The patient
may chew on fingers or put other items in

Nursing Interventions

During the middle and later stages of AD, the

patient must not be left unattended.
Instruct family regarding removal or locking up
knives and sharp objects away from the patient,
these includes cleaning supplies, insecticides,
other household chemicals, all medications,
aerosol sprays, weapons, power tools, small
appliances, smoking materials, and breakable
items.
Instruct family to apply protective guard over
electrical outlets, thermostats, and stove knobs.
Instruct family to keep pathways clear, move
furniture against the wall, remove throw rugs,
remove wheels on beds and chairs or set lock
them in place, and keep rooms and hallways well
lighted.
Instruct family to double lock doors and windows,
swimming pool areas, and install pressuresensitive buzzers on doors.
Instruct family to ensure that patient has hearing
aids, glasses, and others if they have a sensory
deficit.
Instruct family to provide non slip shoes, and
shoes without laces when possible.
Assess the level of cognitive disorders such as
change to orientation to people, places and times,
range, attention, thinking skills.
Maintain a nice quiet neighborhood.
Face-to-face when talking with patients.
Call patient by name.
Use a rather low voice and spoke slowly in
patients.

Rationale
mouth that can potentially be dangerous or
poisonous.
Patients with AD have impaired thinking and
cannot rationalize cause and effect. This can
result in wandering outside without clothes on,
exposure to extreme cold or heat, and may
cause dehydration in the long run.

Prevents physical injury from ingestion, burns,

overdoses, or accidents.

Prevents accident injury.

Prevents risk of falls.

Helps reduce risks to AD patients who wander.

Reduces the risk for patients who need
supplemental assistance with sensory status.
Helps to prevent tripping and falls.
Provide the basis for the evaluation /
comparison that will come, and influencing the
choice of intervention.
Noise, crowds, the crowds are usually the
excessive sensory neurons and can increase
interference.
Cause concern, especially in people with
perceptual disorders.
The name is a form of self-identity and lead to
recognition of reality and the individual.
Increasing the possibility of understanding.

Further Reading
The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimers Disease,
Related Dementias, and Memory Loss
Clinical Practice of Neurological & Neurosurgical Nursing
Neuroscience Nursing: A Spectrum of Care

References
Dementia World Health Organization
About Alzheimers Disease National Institute of Nursing