alzheimers nursing care plan One of the most common forms of dementia affecting the elderly population is Alzheimer’s disease. It is an irreversible and progressive disease that can lead to a fatal condition at the late stages. AD usually affects people 60 years and older, with the risk of having the disease rising significantly higher as the person gets older. Moreover, AD also has familial tendencies, so the risk of developing the condition also increases.

The disease follows an insidious onset, with the patient starting to manifest symptoms of forgetfulness which would later on progress to his inability to carry out activities of daily living independently. In some cases, patients diagnosed with late-stage Alzheimer’s Disease are no longer able to feed, bathe themselves, talk or even control other bodily functions.

The cause of the disease is not yet fully known, although studies support a link between the development of AD and hereditary factors. There are also links to enzyme production and functioning and neuronal damages in the brain of affected individuals.

Alzheimer’s disease and its progression are divided into four distinct phases. Marked by changes in memory loss and cognition. Due to the nature and the impacts of the disease on affected individuals, the nurse must be able to determine which phase of the disease progression the patient is currently on and plan care accordingly. These four phases are:

  • Pre-dementia phase. This phase presents with marked forgetfulness and irritability, which the patient and his significant others may pass on for a normal-age-related change. Symptoms present in this stage also include:
    • Problems in abstract thinking
    • Problems with the ability to do problem-solving
    • Impaired judgment (usually evident in activities that the patient does regularly)
    • Sadness, or a general loss of interest in life
  • Early dementia phase. This phase typically lasts for 2-4 years on average and is marked by the patient’s inability to manage his personal life efficiently. Symptoms in the first stage may also intensify, making the patient feel more anxious, restless, and irritable. Other issues may also arise in this phase, such as:
    • Perseveration
    • Agnosia
    • Apraxia
    • Dysphasia
    • Sundowning and night wandering
  • Moderate stage dementia. A disease progression that lasts anywhere between 2 to 12 years or more; this phase is marked by impairment of the patient’s ability to speak and worsening of the symptoms suffered in phase 2. Patients may also experience bowel and bladder incontinence and lint-picking motions.
  • Advanced stage. The final stage of the disease, and probably the shortest, presents with the patient initially exhibiting fetal-like behaviors and then progressing to general apathy. Patients also no longer communicate at this stage and remain immobile. Because of the inability to carry out activities of daily living, they grow weaker and more emaciated.

Until now, there is no treatment yet proven to arrest the progression of AD among patients nor reverse its course. While medications may help delay the progression of the disease for some time, they would not be able to stop it from getting worse. This becomes the focus of nursing care. Nurses caring for patients with AD should ensure that an accurate assessment is performed and the patient’s priority health problems are addressed immediately.

While the goal of care is to ensure that the patient will be able to function at the highest possible level in his condition, independence must also be given importance. Family members must also be involved in planning care since caregiver burnout is a common dilemma they face in caring for patients with progressive conditions. The following are some of the 8 most common nursing diagnoses for patients with AD:

  1. Self-care deficit
  2. Impaired sensory perception
  3. Impaired thought processes (confusion)
  4. Impaired memory
  5. Disturbed sleep patterns
  6. Ineffective family coping
  7. Risk for injury
  8. Altered nutrition: less than body requirements

The above includes only the most commonly seen health problems among these patients and assessment of the nurse may also reveal other issues, especially among those patients with other comorbid conditions. Below are care plans crafted for some of the nursing diagnoses identified.

Self-Care Deficit

Self-care deficit related to impairment in cognitive and motor functions secondary to degenerative changes due to a diagnosis of Alzheimer’s Disease as evidenced by (include assessment findings specific to which particular type of deficit the patient is manifesting such as:

  • Inability to bathe oneself (you may describe the difficulties the patient manifests, such as recognizing objects used for bathing)
  • Feed oneself (describe difficulties in feeding)
  • Toileting

Desired Outcomes

After nursing interventions, the patient is expected to:

  • Have self-care needs met
  • Participate in self-care activities
  • Perform self-care requisites within the level of ability

Alzheimer’s Disease Nursing Care Plan

Nursing Action Rationale
Assess the patient’s current level of self-care and identify areas of challenges and difficulty in performing such tasks.

 

This creates baseline information for patient condition and helps plan for effective care.
Ask the patient (if possible) or significant others the patient’s level of independence in the performance of self-care tasks. Ascertaining level of independence can help the nurse decide which activities that the patient can perform independently and which ones he would need attention.
Arrange for all items required for self-care activities are present when the patient needs them (i.e., bathing implements, toileting materials, eating utensils, grooming materials).

 

NOTE:  For patients needing assistance with bathing, ensure adequate water temperature to prevent accidental burns or hypothermia.

Having all necessary items available and within the reach of the patient allows him to perform the task easier and prevents him from having to leave to look for them.
Encourage the patient to perform self-care tasks independently, guiding or assisting him only when needed. Allowing the patient to perform his self-care tasks independently helps maintain his optimal function and promotes self-care for as long as possible. Note that once patients with AD lose the capacity to perform self-care independently, it will be irreversible.
Guide the patient while doing the activity, providing him with detailed instructions for each step. When needed, demonstrate the action for him to follow. Telling the patient the succeeding steps in performance of a task helps reduce confusion and successful accomplishment on the part of the patient. When the nurse provides instructions in a calm and unhurried fashion, the act lessens frustrations on the part of the patient and contributes to increased self-esteem.
Involve the family in the care plan, letting them know the level of guidance and assistance the patient needs daily, ensuring that independence and optimal levels of functioning are maintained. Having the family know the care protocols for the patient, its rationale and how it affects overall patient wellbeing.

Impaired Thought Processes

Impaired thought processes related to changes in cognitive abilities (or others such as chemical imbalances in the brain, neuronal brain destruction evidenced by (include assessment findings indicating the identified nursing problem the patient is manifesting such as:

  • Disorientation (i.e., to time, place, person and events)
  • Difficulty in thinking abstract thoughts
  • Forgetfulness or memory losses
  • Problems with attention span (shortened; difficulty focusing)
  • Easily distracted
  • Inability to speak coherently
  • Mumbling, saying unintelligible thoughts

Desired Outcomes

After nursing interventions, the patient/family is expected to:

  • Achieve functional ability at the highest possible level
  • Manifest improved thought processes
  • Access community resources to help them manage patient’s long term care
Nursing Action Rationale
Assess the patient’s ability to think and speak coherently, noting for indications of disorientation, memory lapses, shifting from one topic to another, and even using words. Also, note if there are problems in articulation.

 

This helps the nurse determine any changes in the patient’s mental status, which may indicate possible improvement or deterioration of the condition.
Identify the patient’s level of orientation to time, place, persons, and events, noting when the forgetfulness or impairment in thought processes becomes more pronounced. Assessment of the level of orientation and any trigger to confusion and alteration helps in planning for interventions.
Orient the patient to his current environment, time, place, and person. If needed, provide the patient with aids to help him stay oriented, such as television, clocks, and calendars.

 

NOTE:  Some facilities may also allow the patient to use mobile phones since these devices can also display time and date.

Orientation of the patient to his immediate environment and reality can help ease his confusion and prevent delirium or depression. Note, however, that television and radio should be monitored so that the programs/stations that the patient is allowed to tune in to do not cause him confusion or disorientation.
Establish a routine for the patient to follow. Include activities such as bathing, grooming, eating, rest, and other cognitive activities as part of the routine. Having a structured and predictable list of activities that the patient can follow helps the patient have fewer episodes of confusion and thought process impairment. It also sets a routine for him to follow while helping him maintain a degree of autonomy in his activities of daily living.
Allow the patient to engage in other activities such as walking, drawing, and reading books and magazines. These activities can help the patient focus more on a sense of reality and normality and the other things that he can do and control.
Allow the patient to wander around or collect other items within acceptable limits. Allowing them to spend their energy on wandering or tinkering with other items (within safe and acceptable limits) reduces their agitation and stress and increases their feelings of security.
Provide the patient positive reinforcement when he behaves within acceptable limits. This helps encourage acceptable behaviors and increases the confidence level of the patient.
Provide the patient two options when deciding on something (food, activities, colors, and others). Ensure that he can decide on what he thinks is best and that you are there to support him. Limiting the choices from which he can choose helps reduce confusion. Allowing him to decide for himself increases his sense of security and confidence in his ability to make independent choices.
Involve the family in the care plan, letting them know the level of guidance and assistance the patient needs daily, ensuring that independence and optimal levels of functioning are maintained. Having the family know the care protocols for the patient, its rationale and how it affects overall patient wellbeing.

Ineffective Family Coping           

Ineffective family coping related to the presence of a chronic disease on a family member that exhausts the family as a unit as evidenced by (include assessment findings specific to which particular type of deficit the patient is manifesting such as:

  • Family verbalization of anxiety
  • Fatigue and stress
  • Expression of the financial burden of the disease on the family
  • Ignoring the patient and his needs (indicate signs of ignoring)
  • Poor patient prognosis

Desired Outcomes

After nursing interventions, the patient/family is expected to:

  • Identify behaviors that promote ineffective family coping
  • Work on interventions that would foster adjustment to their current situation
Nursing Action Rationale
Assess the family’s understanding of the disease process, how it affects the patient, and the care required to be provided in each stage of the disease. This creates baseline information for patient condition and helps plan for effective care.
Assist the family in exploring the possible causes of ineffective coping and what coping techniques they have employed. Giving the family the importance of identifying their own problem helps establish rapport and facilitates better nurse-patient relationships.
Help the family in ascertaining the manifestations of ineffective coping seen among them. Provide guide questions to determine the degree to which these symptoms affect their family dynamics. This allows the family to determine the potential long-term effects of these manifestations upon them. Providing them a guide on gauging its impact on their family dynamics helps stress the importance of addressing these problems immediately.
Allow members of the family to express their thoughts and feelings freely. Provide a safe environment for them to do so, conveying acceptance and willingness of the nurse to listen. When family members can verbalize their thoughts and feelings, the action helps reduce stress and anxiety. Also, allowing them to verbalize may help the nurse find more information that can be useful in planning for interventions.
Orient the family on the disease progression and the various needs of patients with Alzheimer’s disease across all phases/stages and how these affect the patient’s functioning. Proving accurate information and health education about the condition of their loved one allows the other family members to prepare themselves for what is to come. This can also help them to anticipate their responses and actions when discussed symptoms appear.
Involve the family in the care plan, letting them know the level of guidance and assistance the patient needs daily, ensuring that independence and optimal levels of functioning are maintained. Having the family know the care protocols for the patient, its rationale and how it affects overall patient wellbeing.
Remind members of the family of the need to maintain their health and social contacts. This helps relieve feelings of stress, fatigue, and burden from caring for an ailing family member. Meeting with friends or colleagues also helps divert from their usual responsibility in caring for their loved ones.
Refer the family to support groups when needed. Support groups are composed of people who have faced or are facing situations similar to what the family is going through. By being part of a community with the same situations, family members would feel that they are not alone and may gain insight into ways to handle their loved ones.

Risk for Injury

Risk for injury (specify which type of injury)  related to inability of the patient to identify and recognize environmental hazards, disorientation, and confusion secondary to a diagnosis of Alzheimer’s ‘Disease (Note: Risk diagnoses may or may not have  as evidence by in the statement. However, if there are conditions present that help supports the diagnosis, they may be added to the statement.)

Desired Outcomes

After nursing interventions, the patient/family is expected to:

  • Remain free from injury
  • The family will be able to secure the patient’s immediate environment and eliminate hazards.
Nursing Action Rationale
Assess the level of impairment the patient is currently suffering, including confusion, speech and cognition problems as well as motor movements

 

This creates baseline information for patient condition and helps plan for effective care.
Involve the family in assessing the patient’s immediate surroundings for potential hazards and take actions to remove them accordingly. A patient with advanced-stage AD would not assess environmental risks and hazards, which increases their risk for injury. Involving the family in this step helps the nurse to ensure sustained care of the patient.
Provide the patient with a non-stimulating environment, removing causes of excessive noise and other stimuli which can aggravate confusion and agitation. Limiting stimuli that the patient needs to help ease his anxiety, reduce agitation, limit wandering behavior and decrease the risk for injury.
Provide relaxing and calming activities when there are indications of starting agitation, restlessness, or anxiety. Activities such as meditation, breathing, reading a book, or walking can help reduce the patient’s anxiety and risk of injury.
Ensure that the patient in the late stages of the disease is monitored regularly and not left unattended. Impairment in judgment and thought processes at the later stages of the disease can cause the patient to wander outside their homes, get lost, or suffer from extreme environmental elements. Having someone to ensure that the patient is in a safe environment promotes safety.
Remind the family members to secure potentially harmful items such as knives and sharp objects, corrosive cleaning materials, insecticides, poisonous substances, and even medications under lock and key. The patient may inadvertently use these items to cause himself harm due to problems in cognition and decision making. Keeping things that can harm the patient helps ensure safetSaSampleAAlzheimer’ss Nursing Care Plan.

Nursing Diagnosis: Risk for Injury Possible Etiologies: (Related to) disorientation to time and place

Nursing DiagnosisObjectivesNursing InterventionsRationaleEvaluation
Risk for Injury

Possible Etiologies: (Related to) Disorientation to time and place

Confusion (wandering at night)

Forgetfulness and increased memory loss
Presence of motor disturbance i.e. apraxia

Defining characteristics:
(Evidenced by)
*Not Applicable
Short term goal: Within the whole duration of nursing care, the client will be free from injury.

Long term goal: After 2 weeks of nursing care, the client will be able to demonstrate behaviors that protect self from injury and will have reality orientation necessary in learning/ retaining essential aspects in daily living.
1. Evaluate client’s level of competence and ability to participate in preventive measures.

2. Adapt communication to the level of client and speak with the client using slow pace and simple words while maintaining a firm volume and low pitch.

3. Observe for nonverbal behaviours and intervene if client becomes angry or hostile by decreasing stressful stimuli and approaching client in calm, reassuring manner.

4. Frequently reorient of time, place, date, and person; place a clock and a calendar in his room; allow him to reminisce; and repeat instructions as necessary.

4. Assess environment for potential factors indicating risk for injury like dim lighted room, absence of hand rails, slippery floor, and high bed

5. Provide adequate lighting, reduce client’s bed to lower position, put necessary devices in aiding client’s mobility around the house and remove harmful objects like slippery rug etc.

6. Ensure that client cannot leave the premises without being noticed; provide an identification bracelet or tag for the client to wear at all times.

7. Educate family members and care giver of client’s condition and how to deal and care the client; the need for safe environment; how to communicate with the client; and measures that enhance memory.
1. This is to assess the degree of risk for injury of client and aids in detecting what appropriate measures you will include in the plan of care.

2. Communicating with the client in this way promotes positive atmosphere and a relaxed pace for learning.

3. Some personality changes may occur in client’s with Alzheimer’s such as irritability, suspiciousness, and indifference. This would also aid in reducing demands on client.

4. These measures are necessary in enhancing client’s memory.

4. This will provide information on what safety devices are necessary to be instituted.

5. These measures minimize client’s misperception of his environment and his risk for injury.

6. Client’s with Alzheimer’s disease are sometimes confused making them wanders without valid reason (especially during night time); this will avoid the client from being missing or face accidents outside the institution.

7. Providing health teachings regarding client’s condition could assist family members in understanding the manifestations elicited by the client and would reassure them that peculiar personality changes and increasing memory loss is part of this condition; it would aid them cope and take care with the client at home upon discharge.


Within the whole duration of nursing care, client should be free from any sorts of injury.

After 2 weeks of nursing care, client should have demonstrated behaviours like enhanced memory and orientation to time, place and significant person, and ability to participate in doing self-care and other activities of daily living with minimal assistance in a safe environment.

References

  1. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2021 Nurse’s pocket guide: diagnoses, prioritized interventions, and rationales. Philadelphia: F.A. Davis.
  2. Carpenito, L. (2016). Handbook of Nursing Diagnosis (15th ed.).
  3. Herdman, T., & Kamitsuru, S. (2018). NANDA International, Inc. nursing diagnoses (11th ed.).
  4. Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., Bucher, L., & Harding, M.M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (10th ed.). St. Louis: Elsevier.
  5. McCance, K.L. & Huether, S.E. (2017). Understanding Pathophysiology: The Biologic Basis for Disease in Adults and Children (6th ed.). St. Louis: Elsevier/Mosby.
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