Part (a)
It is the gradual or rather the progressive decline of one’s intellect-steady and gradual decline. The changes, caused by the progression of the disease are only noticeable after months or even years. It is usually evident in one’s behavior as far as social interactions are concerned. According to Dash and Villemerette-Pitman, “appropriate responses in social situations require normal functioning of the frontal lobes of the brain” and Alzheimer’s gradually impairs the functioning of the frontal lobes causing inappropriate social responses. The most vulnerable group in any given population is the elderly.
The signs and symptoms of the disease include (Dash and Villemarette-Pitman, 2005, p. 21)
- Forgetting things more often which can be can be associated with behaviors such as continued misplacing of items, forgetting recent events and names among others
- Being confused about both time and place
- Having problems with one’s routine tasks
- Experiencing erratic changes in mood as well as behavior
- Experiencing some unusual problems while communicating
- Experiencing changes in one’s personality
- Continual lack of sound judgment
- Loss of initiative
- Having problems with abstract thinking
The symptoms that are associated with the disease in its final stages are:
- Eventual complete loss of memory and speech
- Some muscles stop functioning especially those that are responsible for urinating and bowel movement
- Walking becomes difficult
- High temperament
The medications used to manage the disease include acetylcholinesterase inhibitors such as tetrahydroaminoacridine or tacrine, which have received approval in the US. Generally, anticholinesterases have been used in treating the disease.
Clinical diagnosis:
One of the primary aspects is to establish whether the patient is cognitively impaired. Cognitive impairment increases as the disease progresses thus the test should be done repeatedly over time. The patient should fulfill the criteria for dementia as given below
- Acquired deficit of cognition
- Cognitive impairment not due to the disturbance arousal
- Must include memory impairment
- Multiple domains of cognitive impairment
- Can be reversible
The extent of cognitive impairment can only be assessed effectively by interviewing a close relative or friend.
The diagnosis also includes a number of brief cognitive assessment schedules e.g. the mini state examination as well as the abbreviated mental test score. It is important to mention that these tests only support the histology results since they cannot be used to provide precise numerical cut offs.
The clinician should also find out whether the cognitive impairment is related to other secondary aspects such as depression and anxiety. Finally, he/she should determine whether the impairment occurs in context of other neurological or systemic abnormalities.
The top most complications for patients are:
- Restlessness
- Wandering
- Lack of sleep
The safety concerns for AD patients:
- They should be kept off some danger zones such as the kitchen
- Their rooms should be well lighted
- Should not have access to alcoholic drinks
- The home should be child proofed
- All the doors should be locked that the patient might not go out unassisted
Nursing interventions include:
- Administering the appropriate medication to the patient
- Ensuring that the patient stays in a safe environment
- Keeping away all beverages that contain alcohol/caffeine
- Work with the caregivers to come up with activities that keep the patient busy especially during the sleepless nights
- Teaching the caregivers how to take good care of the patient
Part (b)
The long-term goals include:
- Provision of a conducive environment for the patient to enhance their ability to cope with the disease
- Provision of a full range of all the facilities as well as the services that the patient needs
- Ensuring the well-being of the caregivers as it is the most important aspect in ensuring that the patient is well taken care of.
- Ensuring that the patient adhere to the drug prescriptions as given by the physician
- Enhancing good health of the patient e.g. regular exercise, balanced diet etc.
Part (c)
The medications of the disease are:
I. Memantine (Namenda)
- It is Available in 28mg dosage strength capsule (Nelson, 2006, p. 3)
- It is for moderate to severe AD
- It is an NMDA-receptor antagonist
- They are taken twice a day
II. Donepezil (Aricept)
- It has been approved for the treatment of moderate to severe Alzheimer’s disease
- It is available in a 23mg dosage strength for treatment of moderate-to-severe Alzheimer’s disease. It is taken once a day
- The side effects are primarily gastrointestinal symptoms, including nausea and diarrhea
- It is a cholinesterase inhibitor.
III. Rivastigmine (Exelon)
- A 13.3mg/24hr dosage strength is approved for the treatment of patients
- The side effects are nausea and diarrhea
- It is a cholinesterase inhibitor.
- It is indicated for the treatment of mild to moderate AD
Part (d): Prognosis of the disease
The treatment given to patients only helps to alleviate many of the symptoms-there is no cure. AD patients are usually cared for at the comfort of their homes provided that they have care givers e.g. close relatives. The caregivers ensure that the patients get actively involved in positive interactions since they remain able to give and receive love especially in warm interpersonal relationships. Death of the patients is usually caused by other health related problems but not directly from AD.
Part (e): Definition of terms
Hospice care is the care given to individuals who are terminally ill whose expected survival is less than six months. It seeks to meet the spiritual, physical and emotional needs of the patient thus involves professionals from different fields (Forman, 2003, p. 22). For instance, the care given to AD patients when in the severe stage of the disease coupled with another infection that has a high probability of causing their death in less than six months.
Palliative care is the care given to minimize the severity of symptoms associated with chronic diseases or rather incurable diseases. It focuses on the patient’s comfort as well as quality of life. An example is the care given to AD patients when the symptoms are still mild/moderate.
DNR stands for Do Not Resuscitate. It is a written order by a patient, which states that if they heart stopped functioning or if they stopped breathing, they should be left to die-they should not be put under any life support facilities.
References
Dash, P., & Villemarette-Pitman, N. (2005). Alzheimer’s Disease. New York: Demos Medical Publishing
Forman, W.B. (2003). Hospice and Palliative Care: Concepts and Practice. New Mexico: Jones & Bartlett
Learning.
Nelson, A. (2006). Medications for Memory Impairment. (Improving Memory: Understanding age-
related Memory Loss). Improving Memory (Harvard Special Health Report). 35 (3): 3.
