Dementia Nursing Care Plan- Self Care Deficit

Dementia is described as a cognitive impairment that commonly happens in senile people. But according to Shives (2008), it is characterized by impairment not only of cognition but also of judgment, orientation, memory, and attention or JOMAC. It is a debilitating disease that affects a person by either a slow, gradual deterioration or at times, rapid deterioration of said aspects.

Based on the DSM-IV-TR, there 12 subtypes of dementia which means that there are other factors by which dementia occurs. It could be due to simple head trauma, vascular origin, some medical condition like Huntington’s disease or Parkinson’s disease and basically because of Alzheimer’s disease.

The common manifestations of dementia are confusion, restlessness, agitation, wandering, aphasia, apraxia, agnosia, and amnesia. Nursing considerations should include safety and security, assisting in basic needs, enhancing memory and judgement, and promoting health.

Recently, a study published in Medscape.com about dementia reveals a result that long-term care based at home showed that those who received collaborated care less likely to leave the home than the traditional care being given. Those respondents have been diagnosed to have cognitive disorders. The study pointed out that the kind of intervention determines the quality of nursing care.

Dementia Nursing Care Plan 

Nursing Diagnosis

Self- Care Deficit

(Grooming and dressing)

Possible Etiologies: (Related to)

Difficulty in completing tasks/ loss of previous capabilities

Defining characteristics: (Evidenced by)

Subjective:

“Mama seems to forget herself nowadays. So, I help her clean herself and wear her clothes every day.” As verbalized by daughter.

Objective:

• Inability to maintain her appearance unlike before
• Forgetfulness (time and place where she is)
• Inability to recall previous tasks
•  Presence of urinary incontinence as claimed by daughter
• Difficulty articulating needs
• Poor judgement when assessed

Objectives

Short term goal:

Client will be able to maintain physical care with less assistance and on the level of her ability, after 2 weeks of intervention.

Long term goal:

Client will be able to participate in activities that would promote her level of functioning and learn and recall previous capabilities, at the end of nurse- patient social interaction.  

Nursing Interventions

1. Assess if how is the client able to meet her basic needs, who is she residing with, presence of visual or hearing disabilities, and her usual daily routine.
2. Observe and assess for her appearance i.e. appropriate dressing, disturbances in gait or movement, presence of injuries.
3. Check her judgement, orientation, memory and cognitive abilities.
4. Build rapport with client through a calm, supportive approach in interaction.
5. Organize a structured, routine schedule of activities considering client’s abilities while maximizing her independence.
6. Reorient client frequently by putting her name in bold big letters in her door or by calling her by name always, putting a clock and some familiar pictures in her room and even putting the schedule of activities for a given day.
7. Provide a safe, non-restrictive environment for the client through proper and adequate lighting, etc.
8. Encourage enough resting periods and adequate sleep.
9. Encourage client to engage in activities like music therapy and dancing; involve client in simple decision making.
10. Assist client in her ADLs but as much as possible let her regain independence depending on her abilities.

Rationale

1. It will provide important information as to how the client functions at home and indicate the need for the degree of assistance required by the client.
2. Clients with cognitive impairment often have some changes in appearance because of inability to assume previous role or functioning.
3. 3.These are indicators to the proper functioning of a person as client with dementia usually would require prompting to complete tasks.
4. Trust is the main key point in establishing relationship with the client. It would prevent the client from becoming suspicious or delinquent from asking assistance.
5. It would help client resume her ADLs without overstimulation.
6. This would help her enhance her memory and it would create a comfortable environment for her.
7. This would ensure her safety and would help prevent harm/ injury since client may be disoriented and confused at times.
8. This will help client regain strength and energy and would minimize mood changes like irritability and some agitation.
9. This will promote positive self- concept and her ability to solve or accomplish simple tasks.
10. By doing this, client will be able to lessen dependency and be able to function with integrity. 

Evaluation 

Client is able to groom and dress herself with minimal assistance or with assistance as necessary.

Client is participative in activities like fixing and feeding self at her own level of ability, reminiscing previous roles and capabilities, and learning or relearning tasks (enhancing memory) needed for her to accomplish her ADLs.