Dementia
The primary feature of
dementia is impaired memory, with at least one of the following cognitive deficits:
aphasia (impaired language),
apraxia (impaired motor function),
agnosia (impaired object recognition), and impaired
executive functioning (abstract thinking and the ability to plan and execute complex behaviors). Symptoms of dementia can also include disorientation, poor judgment, lack of insight, socially inappropriate behavior, anxiety, mood disturbances, sleep disturbances, delusions, and hallucinations. Dementia results from the direct effects of one or more medical conditions or the persistent effects of substance use (
APA, 2000).
The major disorders that result in dementia include the following:
Vascular dementia results from a decreased blood supply to and hypoxia of the cerebral cortex. Initial symptoms are forgetfulness and a short attention and concentration span. It usually occurs between the ages of 60 and 70, is progressive, and may result in psychosis.
Alzheimer’s disease has organic pathology that includes atrophy of cerebral neurons, plaque deposits, and enlargement of the third and fourth ventricles of the brain. It usually begins in people older than 50 years (and incidence increases with increasing age), may last 5 years or more, and includes progressive loss of speech and motor function, profound personality and behavioral changes (such as paranoia, delusions, and hallucinations), and inattention to hygiene.
Pick’s disease involves frontal and temporal lobe atrophy and results in a clinical picture similar to Alzheimer’s disease. Death usually occurs in 2 to 5 years.
Creutzfeldt-Jakob disease is a central nervous system disorder, an encephalopathy caused by a “slow virus” or prion (
APA, 2000). It can occur at any age in adults but most commonly develops between ages 40 and 60. This disease involves altered vision, loss of coordination or abnormal movements, and dementia that usually progresses quite rapidly (over the course of a few months).
AIDS dementia complex (ADC) results from direct invasion of nervous tissue by human immunodeficiency virus as well as from other illnesses that can be present in AIDS, such as toxoplasmosis and cytomegalovirus. ADC can result in a wide variety of symptoms, ranging from mild sensory impairment to gross memory and cognitive deficits.
Parkinson’s disease is a progressive disease involving loss of neurons of the basal ganglia that produces tremor, muscle rigidity, and loss of postural reflexes. Psychiatric manifestations include depression, dementia, and delirium, which have become more prevalent as successful medical treatment has extended life expectancy.
The prevalence of severe dementia has been reported to be 3% in adults, with increasing prevalence in older age groups, to as high as 25% in people older than 85 years (
APA, 2000). Some minor forgetfulness usually occurs in elderly clients, but this differs drastically from the changes seen in dementia. The prevalence of chronic illnesses, including dementia, increases as average life expectancy increases. However, dementia is not necessarily a component of the aging process, and it is erroneous to assume that because a client is elderly he or she will be confused, forgetful, or demented.
Although dementia is generally considered to be progressive, symptoms can also stabilize for a period or resolve, as sometimes seen in vascular dementia. In progressive dementia, symptoms may begin as mild memory impairment with slight cognitive disturbance and progress to profoundly impaired memory and cognitive functioning. The specific course of dementia varies according to the underlying disorder.
Clients with dementia have an impaired ability to learn new material and eventually forget previously learned material. Deterioration of memory and language function, including loss of the ability to correctly identify familiar people or objects or remember their relationships or function, and the loss of ability to comprehend written or spoken language, as well as speech pattern disturbances (e.g., echolalia, perseveration) present tremendous challenges for both the client and caregiver(s). Wandering, confusion, disorientation, and the inability to correctly use items such as eating utensils produce significant safety issues and profound functional impairment.
Nursing care of a client with dementia is focused on ensuring the client’s safety and meeting needs for adequate nutrition, hydration, rest, and activity. Nursing objectives also include helping the client attain and maintain his or her optimal level of functioning, providing support and education to the client and significant others, and working with the rest of the health care team to ensure appropriate follow-up care and continued support in the community.
NURSING DIAGNOSES ADDRESSED IN THIS CARE PLAN
Bathing Self-Care Deficit
Dressing Self-Care Deficit
Feeding Self-Care Deficit
Toileting Self-Care Deficit
Impaired Memory
Impaired Environmental Interpretation Syndrome
Impaired Social Interaction
RELATED NURSING DIAGNOSES ADDRESSED IN THE MANUAL
Risk for Other-Directed Violence
Risk for Injury
Insomnia
Interrupted Family Processes
Ineffective Role Performance
