Our role in dealing clients with dementia does not differ from our usual routine in the provision of nursing care, except for the fact that we need to value the memories that once have shaped their life.
Dementia is a slow, progressive disease which is accompanied by several impairments including the cognitive, behavioural, and psychiatric aspects. According to the National Institute of Neurological Disorders and Strokes, it is a group of symptoms which is brought about by disorders that basically affects the brain. Memory loss is the most common symptom but it may also include some behavioural changes, language impairments, inability to solve simple problems and some may even exhibit some psychiatric symptoms – which all in all, will later on affects his or her ability to assume previous roles and capabilities.
The key components of nursing management for clients with dementia revolve in the following essential priorities:
a. Safe environment and prevention from injury and harm
b. Independence in assuming basic needs
c. Learning and relearning memories, roles, and abilities
d. Adequate nutrition and health maintenance
e. Behavioural interventions (agitated, restless clients)
Utilizing the nursing process, the first component is assessment:
• Assess client’s impairment in judgment, orientation, memory, attention, and cognition (JOMAC)
a. Judgement: Impairment in this aspect may reflect his inability to solve certain problem situation through irrationality
b. Orientation: Observe for awareness of time, place, person, date and event.
c. Memory, Attention, and Cognition: Clients with dementia usually have short term memory and has deficits in attention and concentration.
• Assess client’s functional ability: like ability to do simple and complex tasks, relate to other people, assume his usual activities of daily living i.e. grooming, dressing, eating, toileting, etc.
• Also assess the environment where he lives and ask who he is residing with.
Take note that plan your goals together with the client or/ with his care giver. Always see to it to consider the cultural, spiritual, and family aspects.
• Involve the client in simple decision making and provide appraisals for tasks accomplished.
• Plan and provide activities which are routine and scheduled. This way, the client will be accustomed to activities and to minimize some disorientation or confusion.
• Plan activities which are realistic and depending to client’s ability.
Furthermore, the following nursing managements for dementia may differ depending on the needs of the client.
- Ensure safe environment, by providing enough lighting in the room and in the vicinity.
- Provide necessary hand rails/ support, place client’s bed in the lowest level, or/ and always raise side rails of bed
- Provide a comfortable, non-restrictive environment. Avoid the use of restraints.
- Let the client wear an identification tag and ensure that the client does not leave the premises (wandering).
- Assist client in his ADLs while at the same time providing some independence depending on client’s abilities.
- Reorient client frequently to his environment.
- Provide objects that would make client recall of and relate with, like pictures, significant objects, or even his name by putting his name in his room.
- Put a clock, schedule of activities or things he needs to do during the day.
- Avoid frequent changes in arrangements in furniture etc. to minimize disorientation.
- Remind him to eat nutritious foods and to drink enough fluids/ to take his medicines.
- Encourage him to have adequate rest and sleep.
- Speak in a slow paced manner, considering client’s limitations or abilities.
- Encourage him to use devices like eye glasses or hearing aids to improve his sensory inputs.
- For agitation, or restlessness, intervene appropriately and avoid situations which would even evoke unexpected behaviours.
- Encourage client to involve in productive, non stimulating activities to boosts his integrity and esteem.
- Educate client, family members, and care giver of his condition and the important things that needs to be addressed like his memory loss, impairments in communication, some psychiatric symptoms, and personality changes.