Post on 01-Apr-2015
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ALZHEIMER'S DISEASE
Jerry Carley RN, MSN, MA, CNE
Concept Map: Selected Topics in Neurological Nursing
PATHOPHYSIOLOGY
Traumatic Brain InjurySpinal Cord Injury
Specific Disease Entities: Amyotropic Lateral Sclerosis Multiple Sclerosis Huntington’s Disease Alzheimer’s Disease Myasthenia Gravis Guillian-Barre’ Syndrome Meningitis Parkinson’s Disease
PHARMACOLOGY
--Decrease ICP--Disease Specific Meds
ASSESSMENTPhysical Assessment Inspection Palpation Percussion Auscultation
ICP Monitoring“Neuro Checks” Lab Monitoring
Care PlanningPlan for client adl’s, Monitoring, med admin.,Patient education, more…basedOn Nursing Process: A_D_O_P_I_E
Nursing Interventions & EvaluationExecute the care plan, evaluate for Efficacy, revise as necessary
Alzheimer's Disease
Non - reversible dementia that progressively develops through 3 stages over many years
Alzheimer's disease is the most common cause of dementia, or loss of intellectual function, among people aged 65 and older
Alzheimer's disease is NOT a normal part of aging
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Alzheimer's Disease
Non - reversible dementia that progressively develops through 3 stages over many years
Alzheimer's disease is the most common cause of dementia, or loss of intellectual function, among people aged 65 and older
Alzheimer's disease is NOT a normal part of aging
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Characteristics
Memory loss Impaired Judgment Personality changes Severe physical decline
with cognitive changes
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Pathophysiology
Neurons, which produce acetylcholine (neurotransmitter) break connections with other nerve cells and ultimately die
Two types of abnormal lesions clog the
brains of individuals with Alzheimer's disease:
Beta-amyloid plaques—sticky clumps of protein fragments and cellular material that form outside and around neurons
Neurofibrillary tangles—insoluble twisted fibers composed largely of the protein that build up inside nerve cells
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Pathophysiology
Neurons, which produce acetylcholine (neurotransmitter) break connections with other nerve cells and ultimately die
Two types of abnormal lesions clog the
brains of individuals with Alzheimer's disease:
Beta-amyloid plaques—sticky clumps of protein fragments and cellular material that form outside and around neurons
Neurofibrillary tangles—insoluble twisted fibers composed largely of the protein that build up inside nerve cells
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Stage 1
First 1-3 years:
-Short-term memory loss-Subtle personality changes-Shorter attention span-Mild cognitive deficits-Difficulty with money, numbers and bills-Difficulty with depth perception
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Stage 2From 2 – 10 years:
-Obvious memory loss-Wandering-Confabulation-“Sundowning”-Irritability / Agitation
-Impaired motor skills, judgment
-Self-care deficits 9
Stage 3
From 8 – 10 years:
-Severe impairment of all cognitive abilities
-Disoriented-B & B incontinence
-Inability to recognize family & friends
-Loss of speech 10
The 4 A’s of Alzheimer'sAmnesia
(inability to remember facts or events). Short-term memory is programmed in temporal lobe, while long-term memory is stored throughout extensive nerve cell networks in the temporal and parietal lobes. In Alzheimer's disease, short-term memory storage is damaged first
Aphasia (inability to communicate effectively). The loss of ability to speak and write is
called expressive aphasia. With receptive aphasia, an individual may be unable to understand spoken or written words. Sometimes an individual pretends to understand and even nods in agreement; this is to cover-up aphasia. Although individuals may not understand words and grammar, they may still understand non-verbal behavior, i.e. smiling
Apraxia (inability) to do pre-programmed motor tasks, or to perform activities of daily living
such as brushing teeth and dressing. Sophisticated motor skills that require extensive learning, such as job-related skills, are first functions that become impaired. More instinctive functions like chewing, swallowing and walking are lost in the last stages of the disease
Agnosia (inability to correctly interpret signals from their five senses). May not recognize
familiar people and objects. A common yet often unrecognized agnosia is the inability to appropriately perceive visceral, or internal, information such as a full bladder or chest pain.
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Diagnosis Clinicians can now diagnose with up to 90 % accuracy. But
it can only be confirmed by an autopsy, pathologists look for the disease's characteristic plaques and tangles in brain tissue
Clinicians diagnose "probable" Alzheimer's disease by
medical history, lab tests, physical exam, brain scans and neuropsychological tests that gauge memory, attention, language skills and problem-solving abilities
Proper diagnosis of Alzheimer's disease is critical since
there are dozens of other reversible causes for Sx’s
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Treatment U.S. Food and Drug Administration (FDA) has so far
approved four drugs for the treatment of mild to moderate Alzheimer's disease:
- Cognex®), introduced in 1993- Donepezil hydrochloride (Aricept®), marketed since 1996- Rivastigmine (Exelon®), available since the spring 2000 -Galantamine hydrobromide (RazadyneTM-formerly called Reminyl®)
approved in Feb/01
These drugs inhibit the enzyme that breaks down the brain chemical acetylcholine, and thereby may help slow the worsening of symptoms
The FDA in October 2003 approved memantine HCI (NamendaTM) for the treatment of moderate to severe Alzheimer's disease, which can slow the decline in mental function
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Risk Factors
People with a family history of Alzheimer's have a greater risk, implying that a genetic factor is involved. Some involve a mutation of the gene for the protein APP, found on chromosome 21
Adults who have had head injuries are three times more likely to develop Alzheimer's disease
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Nursing Care
CONSISTENCY - Introduce change gradually
Use repetition Therapeutic touch if able Avoid overstimulation and
clutter Don’t argue / Don’t reinforce –
Acknowledge feelings / Distract Regular toileting Reality orientation, memory training Meds as needed
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Safety Precautions Identification (on back of
gown, etc) Alarm systems / Lock exit
doors Keep up to date Picture Frequent supervision No throw rugs Fall Program Etc 16