Nursing Process Nursing Care Plan for Alzheimer’s Disease

Old and aged patients with AD are usually agitated and increasingly forgetful. They can perform physical ADLs independently but
Nursing depends on others for domestic chores. They might be oriented to time, person and places but irrational to the consequences of every
Assessment events that’s why they are asking the same question over and over again repeatedly. They are weak and high risk for fall and
functional disabilities.
Altered health maintenance; Knowledge deficit; Impaired communication; Altered verbal and thought process; Ineffective individual
and family coping; Impaired home maintenance management; Potential/Actual for physical injury; Impaired physical mobility;
Nursing
Altered protection; Potential/Actual for trauma; Anxiety; Activity intolerance; Sleep pattern disturbance; Potential for disuse
Diagnoses
syndrome; Altered role performance; Chronic low self-esteem; Impaired social interaction; Social isolation; Spiritual distress; Self-
care deficit; Hygiene; Altered sensory-perceptual; Altered compliance; Altered nutrition less than body requirements.
Nursing interventions are intended to sustain the physical safety of the patient; to support cognitive functions; to reduce agitation and
anxiety; to improve communication; to promote independence in self-care tasks; to provide for the needs of the patient for intimacy,
Planning
self-esteem and socialization; to maintain sufficient nutrition; to manage disturbances on sleep patterns; and to support and educate
family caregivers.
Promoting physical safety:

1. Remove all environmental hazards. Turn on nightlights.

2. Monitor food, intake and medication intake of patient.
3. Diversional activities and encouragement hasten wandering behavior caused by forgetfulness and short attention span.
4. Avoid restraints as it may increase agitation.
5. Provide identification band.
Implementation
Supporting cognitive functions:

1. Provide calm and predictable environment with routine activities that helps the patient interpret his or her surroundings and
activities.
2. Limit environmental stimuli. Follow a regular routine of activities. A quiet, pleasant manner of speaking with clear and simple
explanation, use of memory aids and cues help to minimize confusion and disorientation and give the patient a sense of
security.
3. Provide clocks and calendars to promote orientation to time.
 4. Color coding the doors may help in identifying his or her room.

Reducing anxiety and agitation:

1. Reinforce a positive self-image through constant emotional support.

2. The environment should be kept uncluttered, familiar and noise free. Excitement and confusion can be upsetting and may
precipitate a combative, agitated state known as a catastrophic reaction. During such a reaction, the patient responds by
screaming, crying or becoming abusive (physically or verbally). This may be the patient’s only way of expressing an inability
to cope with the environment. When this occurs, it is important to remain calm and unhurried.
3. Diversional activities such as listening to music, stroking, rocking or distraction may calm down the patient. Frequently, the
patient forgets what triggered the reaction.
4. Structured routine activities are helpful to aid with patient’s forgetfulness.
5. Be familiarized and predict the patient’s responses to certain stimuli will help the nurse and caregivers to avoid untoward
situations.
6. Dementia education for caregivers will get the family’s support, participation and cooperation with the care.

Improving communication:

1. Use clear, easy-to-understand and concise sentences in conveying messages because the patient frequently forgets the meaning
of words or has difficulty organizing and expressing thoughts.
2. The nurse must remain unhurried, reduce noise and avoid distractions to promote the patient’s interpretation of messages.
3. Provide list of reminders and written instructions.
4. Be aware to non-verbal cues and language since patient often used it to communicate.
5. Tactile stimuli, such as a hug or a hand pat, are usually interpreted as signs of affection, concern and security.

Promoting independence in self-care activities:

1. Routine, predictable and simplified daily activities organized into short, free and easy achievable steps so that the patient
experiences a sense of accomplishment. Follow the SMART rule.
2. Provide a room for patient’s independence rather than dependence, direct supervision is a must but preserve the person’s
autonomy and dignity during the nursing care.
3. The patient is encouraged to make choices and decision when appropriate and encouragement is needed to participate in self-
care activities.
Providing patient’s needs for socialization, self-esteem, and intimacy:

1. Letters, phone calls and visits from old friends and socialization can be comforting.
2. Plan for a brief and non-stressful visits and socialization, limiting visitors to one or two at a time helps to reduce over-
stimulation.
3. Program recreational activities not contraindicated to patient and encourage enjoying simple activities.
4. Simple expressions of love, such as touching and holding, are often meaningful. Encourage love ones and relatives bonding
and affectionate time together.

Maintaining adequate nutrition:

1. Mealtime should be simple and calm without confrontations, AD patients may perceive this as a pleasant time, social occasion
or an upsetting activity.
2. Prepare a meal served with patient’s food of choice that look so appetizing and taste good.
3. Serve one dish at a time to avoid patient’s playing with food.
4. Cut food into small pieces to avoid choking.
5. Serve gelatins instead of liquids.
6. Check food temperature to prevent accidents and burns. Foods should be served warm.
7. Adaptive equipment can be use if lack of coordination interferes with self-feeding.
8. Apron and smock gown but never a bib can be use to protect clothing, especially when eating with fingers.
9. As deficits progress, it is necessary to feed the patient.

Managing sleep pattern disturbances:

1. Assess patient’s physical and psychological conditions, sleep pattern disturbances usually arise due to unmet needs.
2. It is imperative that caregivers seek to learn the needs of the patient who is exhibiting sleeping problems, because further
health decline can ensue if the source of the problem is not corrected.
3. Adequate sleep and physical exercise are essential. If sleep is interrupted or the patient is unable to fall asleep, music, warm
milk, or a back rub may help the person relax.
4. During daytime, the patient should be given sufficient opportunity to participate in passive exercise activities, because a
regular pattern of activity and rest will enhance nighttime.

Supporting and educating family caregivers:

 1. The family can be referred to a group that provides the opportunity to congregate with others who are experiencing the same
condition.
2. The nurse should be aware and sensitive to the highly emotional issues that the family experience and empathize with the
family’s ordeal.
3. Support and education of the caregivers are essential components of care.

Active participation may help the patient to maintain cognitive, functional and social interaction abilities for a longer period. Physical
activity and communication have also been demonstrated to slow some of the cognitive decline of Alzheimer's disease. Forgetfulness,
disinterest, dental problems, incoordination, overstimulation and choking can all serve as barriers to good nutrition. Many patients
with Alzheimers disease exhibit sleep disturbances, wandering and behaviors that may be deemed inappropriate. These behaviors are
Evaluation
most likely to occur when there are underlying physical or psychological needs that are unmet. Side rails are always secured for
patient’s safety. Always observe therapeutic environment. Provide adequate time for sleep, rest and activities through well-planned
nursing interventions. Significant others always observed therapeutic communication with full of encouragements. It is imperative that
family members are always supportive and participative in the activities and nursing interventions.