A Case Study On Dementia: in Partial Fulfillment of The Requirement in Related Learning Experience

ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800
COLLEGE OF NURSING
A CASE STUDY ON
DEMENTIA
In Partial Fulfillment of the Requirement in

RELATED LEARNING EXPERIENCE
SUBMITTED BY:
ANN MONICA A. CLARITO, SN
AGATHA BABYET A. ALABATA, SN
WILHELMO DICON III, SN
DAXIE BENEDICT BAJIN, SN
JAY VILLASOTO, SN
JOAN MARIE BAGNATE, SN
LEA LARA RELOX, SN
CHRISTIAN MICHEAL REGACHO, SN
ARLAINE MAE BILLONES, SN
REGINA MAE FLORES, SN
NICA JOY BENEDICTO, SN
SUBMITTED TO:
MRS. EDRELYN VENTURANZA, RN, MSN
Clinical Instructor
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TABLE OF CONTENTS
INTRODUCTION------------------------------------------------------------------- 3
OBJECTIVES------------------------------------------------------------------------ 3
ANATOMY ANG PHYSIOLOGY---------------------------------------------- 4
TEXTBOOK DISCUSSION------------------------------------------------------- 17
VITAL INFORMATION----------------------------------------------------------- 26
CLINICAL ASSESSMENT-------------------------------------------------------- 27
PATTERNS OF FUNCTIONS ---------------------------------------------------- 28
PATHOPHYSIOLOGY--------------------------------------------------------------31
DIAGNOSTIC TESTS -------------------------------------------------------------- 32
DRUG TABULATION-------------------------------------------------------------- 32
NURSING CARE PLAN-------------------------------------------------------------36
DISCHARGE PLANNING---------------------------------------------------------- 49
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INTRODUCTION
Dementia is a syndrome it is usually of a chronic or progressive nature, in which there is

deterioration in cognitive function or the ability to process thought beyond what might be
expected from normal ageing. It affects memory, thinking, orientation, comprehension,
calculation, learning capacity, language, and judgement. Consciousness is not affected. The
impairment in cognitive function is commonly accompanied, and occasionally preceded, by
deterioration in emotional control, social behaviour, or motivation.Dementia results from a
variety of diseases and injuries that primarily or secondarily affect the brain, such as Alzheimer's
disease or stroke.
Dementia is one of the major causes of disability and dependency among older people
worldwide. It can be overwhelming, not only for the people who have it, but also for their carers
and families. There is often a lack of awareness and understanding of dementia, resulting in
stigmatization and barriers to diagnosis and care. The impact of dementia on carers, family and
society at large can be physical, psychological, social and economic.
According to the latest WHO data published in 2018 Alzheimers & Dementia Deaths in
Philippines reached 1,047 or 0.17% of total deaths. The age adjusted Death Rate is 1.98 per
100,000 of population ranks Philippines no. 177 in the world. To be able to acquire trusted and
reliable information about dementia in order for us students to become more knowledgeable: To
utilize skills, knowledge, and attitude cultivated in making of this case presentation to understand
what are the necessary nursing care for the client who has Dementia.
OBJECTIVES
GENERAL OBJECTIVES
 To practice clinical knowledge, skills and appreciate the importance and application of
the principles and theories learned in school.
 To acquire reliable information about Dementia in order to understand and perform

competent nursing care that will address the patient’s condition, and to demonstrate right
attitude as a member of health care team.
SPECIFIC OBJECTIVES
After the completion of this case presentation the student will be able to:
 Skills:
 To demonstrate good performance of health assessment
 To provide health teaching to the family of clients
 Knowledge:
 Gain knowledge about the underlying causes and factors of client’s
diagnosis
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 Be familiar with the structure and normal function of the body organs
involve
 Be informed in the laboratory and diagnostic procedures
 Be familiar with the client’s medication and their therapeutic side effects
 Attitude:
 Being able to recognize the client’s discomfort and empathize with her
 Apply the Vincetian Anthonian core values in performing the task as a
part of health care provider
ANATOMY AND PHYSIOLOGY
ANATOMY AND PHYSIOLOGY

The human brain serves many important functions ranging from imagination,
memory, speech, and limb movements to secretion hormones and control of various
organs within the body. These functions are controlled by many distinct parts that
serve specific and important tasks. These components and their functions are listed
below.
Brain Cells: The brain is made up of two types of cells: neurons (yellow cells in the
image below) and glial cells (pink and purple cells in the image below). Neurons are
responsible for all of the functions that are attributed to the brain while the glial cells
are non-neuronal cells that provide support for neurons. In an adult brain, the
predominant cell type is glial cells, which outnumber neurons by about 50 to 1.
Neurons communicate with one another through connections called synapses.
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Meninges: The bony covering around the brain is called the cranium, which
combines with the facial bones to create the skull. The brain and spinal cord are
covered by a tissue known as the meninges, which are made up of three layers: dura
mater, arachnoid layer, and pia mater. The dura mater is a whitish and nonelastic
membrane which, on its outer surface, is attached to the inside of the cranium. This
layer completely covers the brain and the spinal cord and has two major folds in the
brain that are called the falx and the tentorium. The falx separates the right and left
halves of the brain while the tentorium separates the upper and lower parts of the
brain. The arachnoid layer is a thin membrane that covers the entire brain and is
positioned between the dura mater and the pia mater, and for the most part does not
follow the folds of the brain. The pia mater, which is attached to the surface of the
entire brain, follows the folds of the brain and has many blood vessels that reach deep
into the brain. The space between the arachnoid layer and the pia mater is called the
subarachnoid space and it contains the cerebrospinal fluid.
Cerebrospinal Fluid (CSF): CSF is a clear fluid that surrounds the brain and spinal
cord, and helps to cushion these structures from injury. This fluid is constantly made
by structures deep within the brain called the choroid plexus which is housed inside
spaces within the brain called ventricles, after which it circulates through channels
around the spinal cord and brain where is it finally reabsorbed. If the delicate balance
between production and absorption of CSF is disrupted, then backup of this fluid
within the system of ventricles can cause hydrocephalus.
Ventricles: Brain ventricles are a system of four cavities, which are connected by a
series of tubes and holes and direct the flow of CSF within the brain. These cavities
are the lateral ventricles (right and left), which communicate with the third ventricle
in the center of the brain through an opening called the interventricular foramen. This
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ventricle is connected to the fourth ventricle through a long tube called the Cerebral
Aqueduct. CSF then exits the ventricular system through several holes in the wall of
the fourth ventricle (median and lateral apertures) after which it flow around the brain
and spinal cord.
Brainstem: The brainstem is the lower extension of the brain which connects the brain to the
spinal cord, and acts mainly as a relay station between the body and the brain. It also controls
various other functions, such as wakefulness, sleep patterns, and attention; and is the source for
ten of the twelve cranial nerves. It is made up of three structures: the midbrain, pons and medulla
oblongata. The midbrain is inovolved in eye motion while the pons coordinates eye and facial
movements, facial sensation, hearing, and balance. The medulla oblongata controls vegetative
functions such as breathing, blood pressure, and heart rate as well as swallowing.
Thalamus: The thalamus is a structure that is located above the brainstem and it serves as a relay
station for nearly all messages that travel from the cerebral cortex to the rest of the body/brain
and vice versa. As such, problems within the thalamus can cause significant symptoms with
regard to a variety of functions, including movement, sensation, and coordination. The thalamus
also functions as an important component of the pathways within the brain that control pain
sensation, attention, and wakefulness.
The cerebellum is located at the lower back of the brain beneath the occipital
lobesand is separated from them by the tentorium. This part of the brain is responsible
for maintaining balance and coordinating movements. Abnormalities in either side of
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the cerebellum produce symptoms on the same side of the body.
Cerebellum: The cerebellum is located at the lower back of the brain beneath the occipital
lobesand is separated from them by the tentorium. This part of the brain is responsible for
maintaining balance and coordinating movements. Abnormalities in either side of the cerebellum
produce symptoms on the same side of the body.
Cerebrum: The cerebrum forms the major portion of the brain, and is divided into the right and
left cerebral hemispheres. These hemispheres are separated by a groove called the great
longitudinal fissure and are joined at the bottom of this fissure by a struture called the corpus
callosum which allows communication between the two sides of the brain. The surface of the
cerebrum contains billions of neurons and glia that together form the cerebral cortex (brain
surface), also known as "gray matter." The surface of the cerebral cortex appears wrinkled with
small grooves that are called sulci and bulges between the grooves that are called gyri. Beneath
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the cerebral cortex are connecting fibers that interconnect the neurons and form a white-colored
area called the "white matter."

Lobes: Several large grooves (fissures) separate each side of the brain into four distinct regions
called lobes: frontal, temporal, parietal, and occipital. Each hemisphere has one of each of these
lobes, which generally control function on the opposite side of the body. The different portions
of each lobe and the four different lobes communicate and function together through very
complex relationships, but each one also has its own unique characteristics. The frontal lobes are
responsible for voluntary movement, speech, intellectual and behavioral functions, memory,
intelligence, concentration, temper and personality. The parietal lobe processes signals received
from other areas of the brain (such as vision, hearing, motor, sensory and memory) and uses it to
give meaning to objects. The occipital lobe is responsible for processing visual information. The
temporal lobe is involved in visual memory and allows for recognition of objects and peoples'
faces, as well as verbal memory which allows for remembering and understanding language.
Hypothalamus: The hypothalamus is a structure that communicates with the pituitary gland in
order to manage hormone secretions as well as controlling functions such as eating, drinking,
sexual behavior, sleep, body temperature, and emotions.
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Pituitary Gland: The pituitary gland is a small structure that is attached to the base of the brain
in an area called the sella turcica. This gland controls the secretion of several hormones which
regulate growth and development, function of various organs (kidneys, breasts, and uterus), and
the function of other glands (thyroid gland, gonads, and the adrenal glands).
Basal Ganglia: The basal ganglia are clusters of nerve cells around the thalamus which are
heavily connected to the cells of the cerebral cortex. The basal ganglia are associated with a
variety of functions, including voluntary movement, procedural learning, eye movements, and
cognitive/emotional functions. The various components of the basal ganglia include caudate
nucleus, putamen, globus pallidus, substantia nigra, and subthalamic nucleus. Diseases affecting
these parts can cause a number of neurological conditions, including Parkinson's disease and
Huntington's disease.
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Cranial Nerves: There are 12 pairs of nerves that originate from the brain itself, as compared to
spinal nerves that initiate in the spinal cord. These nerves are responsible for specific activities
and are named and numbered as follows:
Cranial nerve I (Olfactory nerve): Smell
Cranial nerve II (Optic nerve): Vision
Cranial nerve III (Oculomotor nerve): Eye movements and opening of the eyelid
Cranial nerve IV (Trochlear nerve): Eye movements
Cranial nerve V (Trigeminal nerve): Facial sensation and jaw movement
Cranial nerve VI (Abducens nerve): Eye movements
Cranial nerve VII (Facial nerve): Eyelid closing, facial expression and taste sensation
Cranial nerve VIII (Vestibulocochlear nerve): Hearing and sense of balance
Cranial nerve IX (Glossopharyngeal nerve): Taste sensation and swallowing
Cranial nerve X (Vagus nerve): Heart rate, swallowing, and taste sensation
Cranial nerve XI (Spinal accessory nerve): Control of neck and shoulder muscles
Cranial nerve XII (Hypoglossal nerve): Tongue movement
Pineal Gland: The pineal gland is an outgrowth from the back portion of the third ventricle, and
has some role in sexual maturation, although the exact function of the pineal gland in humans is
unclear.
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Spinal Cord
The spinal cord is a long, thin, tubular bundle of neurons and support cells that extends from the
bottom of the brain down to the space between the first and second lumbar vertebrae, and is
housed and protected by the bony vertebral column. The spinal cord functions primarily in the
transmission of signals between the brain and the rest of the body, allowing movement and
sensation, but it also contains neural circuits that can control numerous reflexes independent of
the brain.
General Structure: The length of the spinal cord is much shorter than the length of the bony
spinal column, extending about 45 cm (18 inches). It is ovoid in shape and is enlarged in the
cervical (neck) and lumbar (lower back) regions. Similar to the brain, the spinal cord is protected
by three layers of tissue, called spinal meninges. The dura mater is the outermost layer, and it
forms a tough protective coating. Between the dura mater and the surrounding bone of the
vertebrae is a space called the epidural space, which is filled with fatty tissue and a network of
blood vessels. The arachnoid mater is the middle protective layer. The space between the
arachnoid and the underlyng pia mater is called the subarachnoid space which
contains cerebrospinal fluid (CSF). The medical procedure known as a lumbar puncture (or
spinal tap) involves use of a needle to withdraw cerebrospinal fluid from the subarachnoid space,
usually from the lumbar (lower back) region of the spine. The pia mater is the innermost
protective layer. It is very delicate and it is tightly associated with the surface of the spinal cord.
In the upper part of the vertebral column, spinal nerves exit directly from the spinal cord,
whereas in the lower part of the vertebral column nerves pass further down the column before
exiting. The terminal portion of the spinal cord is called the conus medullaris. A collection of
nerves, called the cauda equina, continues to travel in the spinal column below the level of the
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conus medullaris. The cauda equina forms as a result of the fact that the spinal cord stops
growing in length at about age four, even though the vertebral column continues to lengthen until
adulthood.
Three arteries provide blood supply to the spinal cord by running along its length. These
are the two Posterior Spinal Arteries and the one Anterior Spinal Artery. These travel in the
subarachnoid space and send branches into the spinal cord that communicate with branches from
arteries on the other side.
Function: The spinal cord is divided into 33 different segments. At every segment, a pair of
spinal nerves (right and left) exit the spinal cord and carry motor (movement) and sensory
information. There are 8 pairs of cervical (neck) nerves named C1 through C8, 12 pairs of
thoracic (upper back) nerves termed T1 through T12, 5 pairs of lumbar (lower back) nerves
named L1 through L5, 5 pairs of sacral (pelvis) nerves numbered S1 through S5, and 3-4 pairs of
coccygeal (tailbone) nerves. These nerves combine to supply strength to various muscles
throughout the body as follows:
C1-C6: Neck flexion
C1-T1: Neck extension
C3-C5: Diaphragm
C5-C6: Shoulder movement and elbow flexion
C6-C8: Elbow and wrist extension
C7-T1: Wrist flexion
C8-T1: Hand movement
T1-T6: Trunk muscles above the waist
T7-L1: Abdominal muscles
L1-L4: Thigh flexion
L2-L4: Thigh adduction (movement toward the body)
L4-S1: Thigh abduction (movement away from the body)
L2-L4: Leg extension at the knee
L5-S2: Leg extension at the hip
L4-S2: Leg flexion at the knee
L4-S1: Foot dorsiflexion (move upward) and toe extension
L5-S2: Foot plantarflexion (move downward) and toe flexion
The spinal nerves also provide sensation to the skin in an organized manner as
depicted below.
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TEXTBOOK AND DISCUSSION
Dementia is a mental disorder that involves multiple cognitive deficits, primarily memory
impairment, and at least one of the following cognitive disturbances (APA, 2000):
• Aphasia, which is deterioration of language function
• Apraxia, which is impaired ability to execute motor functions despite intact motor abilities
• Agnosia, which is inability to recognize or name objects despite intact sensory abilities
• Disturbance in executive functioning, which is the ability to think abstractly and to plan,
initiate, sequence, monitor, and stop complex behavior.
A syndrome characterized by acquired, progressive cognitive impairment - Affects 10% of

individuals over 65 - Caused by at least 80 different diseases, many reversible. Unfortunately,
the most common diseases (85 – 90%) are irreversible.
Signs and Symptoms:

- Forgetfulness (progressive)
- Difﬁculty doing familiar tasks
- Confusion
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- Poor judgment
- Decline in intellectual functioning
CAUSES OF DEMENTIA
- Alzheimer’s disease (approximately 70%)
- Vascular dementia – (Strokes and TIA’s)
- Parkinson’s disease – Fronto temporal dementia (FTD)
- Normal-Pressure hydrocephalus (NPH)
- Dementia with Lewy Bodies
- Delirium/Depression
- Other, less common causes
These cognitive deficits must be sufficiently severe to impair social or occupational functioning
and must represent a decline from previous functioning. Dementia must be distinguished from
delirium; if the two diagnoses coexist, the symptoms of dementia remain even when the delirium
has cleared.
Memory impairment is the prominent early sign of dementia. Clients have difficulty learning
new material and forget previously learned material. Initially, recent memory is impaired—for
example, forgetting where certain objects were placed or that food is cooking on the stove. In
later stages, dementia affects remote memory; clients forget the names of adult children, their
lifelong occupations, and even their names.
Aphasia usually begins with the inability to name familiar objects or people and then progresses
to speech that becomes vague or empty with excessive use of terms such as it or thing. Clients
may exhibit echolalia (echoing what is heard) or palilalia (repeating words or sounds over and
over) (APA, 2000). Apraxia may cause clients to lose the ability to perform routine self-care
activities such as dressing or cooking.
Agnosia is frustrating for clients: they may look at a table and chair but are unable to name them.
Disturbances in executive functioning are evident as clients lose the ability to learn new material,
solve problems, or carry out daily activities such as meal planning or budgeting. Clients with
dementia also may underestimate the risks associated with activities or overestimate their ability
to function in certain situations. For example, while driving, clients may cut in front of other
drivers, sideswipe parked cars, or fail to slow down when they should.
DSM-IV-TR DIAGNOSTIC CRITERIA: S
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• Loss of memory (initial stages, recent memory loss such as forgetting food cooking on the
stove; later stages, remote memory loss such as forgetting names of children, occupation)
• Deterioration of language function (forgetting names of common objects such as chair or table,
palilalia [echoing sounds], and echoing words that are heard [echolalia])
• Loss of ability to think abstractly and to plan, initiate, sequence, monitor, or stop complex
behaviors (loss of executive function): the client loses the ability to perform self-care
activities
Onset and Clinical Course
When an underlying, treatable cause is not present, the course of dementia is usually progressive.
Dementia often is described in stages:
• Mild: Forgetfulness is the hallmark of beginning, mild dementia. It exceeds the normal,
occasional forgetfulness experienced as part of the aging process. The client has difficulty
finding words, frequently loses objects, and begins to experience anxiety about these losses.
Occupational and social settings are less enjoyable, and the person may avoid them. Most people
remain in the community during this stage.
• Moderate: Confusion is apparent, along with progressive memory loss. The client no longer
can perform complex tasks but remains oriented to person and place. He or she still recognizes
familiar people. Toward the end of this stage, the person loses the ability to live independently
and requires assistance because of disorientation to time and loss of information such as address
and telephone number. The person may remain in the community if adequate caregiver support is
available, but some people move to supervised living situations.
• Severe: Personality and emotional changes occur. The person may be delusional, wander at
night, forget the names of his or her spouse and children, and require assistance in activities of
daily living (ADLs). Most people live in nursing facilities when they reach this stage unless
extraordinary community support is available.
Etiology
Causes vary, although the clinical picture is similar for most dementias. Often, no definitive
diagnosis can be made until completion of a postmortem examination.
Metabolic activity is decreased in the brains of clients with dementia; it is not known whether
dementia causes decreased metabolic activity or if decreased metabolic activity results in
dementia.
 A genetic component has been identified for some dementias such as Huntington’s
disease.
 An abnormal APOE gene is known to be linked with Alzheimer’s disease.
 Other causes of dementia are related to infections such as human immunodeficiency virus
(HIV) infection or Creutzfeldt–Jakob disease. The most common types of dementia and
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their known or hypothesized causes follow (APA, 2000; Neugroschl et al., 2005):
• Alzheimer’s disease is a progressive brain disorder that has a gradual onset but causes an
increasing decline in functioning, including loss of speech, loss of motor function, and
profound personality and behavioral changes such as paranoia, delusions, hallucinations,
in- attention to hygiene, and belligerence. It is evidenced by atrophy of cerebral neurons,
senile plaque deposits, and enlargement of the third and fourth ventricles of the brain.
Risk for Alzheimer’s disease increases with age, and average duration from onset of
symptoms to death is 8 to 10 years. Dementia of the Alzheimer’s type, especially with
late onset (after 65 years of age), may have a genetic component. Research has shown
link- ages to chromosomes 21, 14, and 19 (APA, 2000).
• Vascular dementia has symptoms similar to those of Alzheimer’s disease, but onset is
typically abrupt, followed by rapid changes in functioning; a plateau, or leveling-off
period; more abrupt changes; another leveling-off period; and so on. Computed
tomography or magnetic resonance imaging usually shows multiple vascular lesions of
the cerebral cortex and subcortical structures resulting from the decreased blood supply to
the brain.
• Pick’s disease is a degenerative brain disease that particularly affects the frontal and temporal
lobes and results in a clinical picture similar to that of Alzheimer’s disease. Early signs
include personality changes, loss of social skills and inhibitions, emotional blunting, and
language abnormalities. Onset is most commonly 50 to 60 years of age; death occurs in 2
to 5 years.
• Creutzfeldt–Jakob disease is a central nervous system disorder that typically develops in

adults 40 to 60 years of age. It involves altered vision, loss of coordination or abnormal
movements, and dementia that usually progresses rapidly (a few months). The cause of
the encephalopathy is an infectious particle resistant to boiling, some disinfectants (e.g.,
formalin, alcohol), and ultraviolet radiation. Pressured autoclaving or bleach can
inactivate the particle.
HIV infection can lead to dementia and other neurologic problems; these may result directly
from invasion of nervous tissue by HIV or from other acquired immunodeficiency syndrome–
related illnesses such as toxoplasmosis and cytomegalovirus. This type of dementia can result in
a wide variety of symptoms ranging from mild sensory impairment to gross memory and
cognitive deficits to severe muscle dysfunction.
• Parkinson’s disease is a slowly progressive neurologic condition characterized by tremor,

rigidity, bradykinesia, and postural instability. It results from loss of neurons of the basal ganglia.
Dementia has been reported in approximately 20% to 60% of people with Parkinson’s disease
and is characterized by cognitive and motor slowing, impaired memory, and impaired executive
functioning.
• Huntington’s disease is an inherited, dominant gene disease that primarily involves cerebral
atrophy, demyelination, and enlargement of the brain ventricles. Initially, there are choreiform
movements that are continuous during waking hours and involve facial contortions, twisting,
turning, and tongue movements. Personality changes are the initial psychosocial manifestations,
followed by memory loss, decreased intellectual functioning, and other signs of dementia. The
disease begins in the late 30s or early 40s and may last 10 to 20 years or more before death.
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• Dementia can be a direct pathophysiologic consequence of head trauma. The degree and type of
cognitive impairment and behavioral disturbance depend on the location and extent of the brain
injury. When it occurs as a single injury, the dementia is usually stable rather than progressive.
Repeated head injury (e.g., from boxing) may lead to progressive dementia.
Treatment and Prognosis
Whenever possible, the underlying cause of dementia is identified so that treatment can be
instituted. For example, the progress of vascular dementia, the second most common type, may
be halted with appropriate treatment of the underlying vascular condition:
 changes in diet, exercise, control of hypertension, or diabetes. Improvement of cerebral

blood flow may arrest the progress of vascular dementia in some people (Neugroschl et
al., 2005).
The prognosis for the progressive types of dementia may vary as described earlier, but all
prognoses involve progressive deterioration of physical and mental abilities until death.
Typically, in the later stages, clients have minimal cognitive and motor function, are totally
dependent on caregivers, and are unaware of their surroundings or people in the environment.
They may be totally uncommunicative or make unintelligible sounds or attempts to verbalize.
Degenerative dementias
 No direct therapies have been found to reverse or retard the fundamental pathophys-
iologic processes. Levels of numerous neurotransmitters such as acetylcholine, dopamine,
norepinephrine, and serotonin are decreased in dementia.
Clients with dementia demonstrate a broad range of behaviors that can be treated
symptomatically. Doses of medications are one half to two thirds lower than usually prescribed.
 Antidepressants are effective for significant depressive symptoms; however, they can
cause delirium.
This section focuses on caring for clients with progressive dementia, which is the most common
type. The nurse can use these guidelines as indicated for clients with dementia that is not
progressive.
APPLICATION OF THE NURSING PROCESS: DIMENTIA: Assessment
 The nurse provides simple explanations as often as clients need them.

 Clients may become confused or tire easily, so frequent breaks in the interview may be
needed. It helps to ask simple rather than compound questions and to allow clients ample
time to answer.
A mental status examination can provide information about the client’s cognitive abilities such
as;
 Memory
 Concentration
 Abstract information processing.
Typically, the client is asked to
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 perform subtraction of figures without paper and pencil
 recall the names of objects
 make a complete sentence, and copy two intersecting pentagons.
Although this does not replace a thorough assessment, it gives a cursory evaluation of the client’s
cognitive abilities. It is important to remember that people with severe depression or psychosis
may also be unable to perform some of these cognitive tasks correctly.
History
 Interviews with family, friends, or caregivers may be necessary to obtain data.
General Appearance and Motor Behavior
 Clients display aphasia when they cannot name familiar objects or people.
 Conversation becomes repetitive because they often perseverate on one idea.
 Eventually, speech may become slurred, followed by a total loss of language function.
The initial finding with regard to motor behavior is the loss of ability to perform familiar tasks
(apraxia) such as;
 dressing or combing one’s hair although actual motor abilities are intact.
 Clients cannot imitate the task when others demonstrate it for them.
 In the severe stage, clients may experience a gait disturbance that makes unassisted
ambulation unsafe, if not impossible.
Some clients with dementia show uninhibited behavior, including making inappropriate jokes,
neglecting personal hygiene, showing undue familiarity with strangers, or dis- regarding social
conventions for acceptable behavior. This can include the use of profanity or making disparaging
remarks about others when clients have never displayed these behaviors before.
Mood and Affect
 Initially, clients with dementia experience anxiety and fear over the beginning losses of
memory and cognitive functions. Nevertheless, they may not express these feelings to
anyone.
 Mood becomes more labile over time and may shift rapidly and drastically for no
apparent reason. Emotional outbursts are common and usually pass quickly.
 Clients may display anger and hostility, sometimes toward other people.
 They begin to demonstrate catastrophic emotional reactions in response to environmental
changes that clients may not perceive or understand accurately or when they cannot
respond adaptively. These catastrophic reactions may include verbal or physical
aggression, wandering at night, agitation, or other behaviors that seem to indicate a loss
of personal control.
Clients may display a pattern of withdrawal from the world they no longer understand. They are
lethargic, look apathetic, and pay little attention to the environment or the people in it. They
appear to lose all emotional affect and seem dazed and listless.
Thought Process and Content
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Initially, the ability to think abstractly is impaired, resulting in loss of the ability to plan,
sequence, monitor, initiate, or stop complex behavior (APA, 2000).
 The client loses the ability to solve problems or to take action in new situations because
he or she cannot think about what to do.
 The ability to generalize knowledge from one situation to another is lost because the
client cannot recognize similarities or differences in situations.
 These problems with cognition make it impossible for the employed client to continue
working. The client’s ability to perform tasks such as planning activities, budgeting, or
planning meals is lost.
As the dementia progresses, delusions of persecution are common. The client may accuse others
of stealing objects he or she has lost or may believe he or she is being cheated or pursued.
Sensorium and Intellectual Processes
 Clients lose intellectual function, which eventually involves the complete loss of their
abilities. Memory deficits are the initial and essential feature of dementia.
 Dementia first affects recent and immediate memory and then eventually impairs the
ability to recognize close family members and even oneself. In mild and moderate
dementia, clients may make up answers to fill in memory gaps (confabulation).
 Agnosia is another hallmark of dementia. Clients lose visual spatial relations, which is
often evidenced by deterioration of the ability to write or draw simple objects.
Attention span and ability to concentrate are increasingly impaired until clients lose the ability to
do either.
Clients are chronically confused about the environment, other people, and eventually themselves.
Initially, they are disoriented to;
 time in mild dementia

 time and place in moderate dementia
 self in the severe stage.
Hallucinations are a frequent problem. Visual hallucinations are most common and generally
unpleasant. Clients are likely to believe the hallucination is reality.
Judgment and Insight
 Clients with dementia have poor judgment in light of the cognitive impairment.
 They underestimate risks and unrealistically appraise their abilities, which result in a high
risk for injury.
 Clients cannot evaluate situations for risks or danger.
Self-Concept
 Initially, clients may be angry or frustrated with themselves for losing objects or
forgetting important things.
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COLLEGE OF NURSING
Judgment
 Some clients’ express sadness at their bodies for getting old and at the loss of
functioning. Soon, though, clients lose that awareness of self, which gradually
deteriorates until they can look in a mirror and fail to recognize their own reflections.
Roles and Relationships
Dementia profoundly affects the client’s roles and relationships. If the client is still employed,
work performance suffers, even in the mild stage of dementia, to the point that work is no longer
possible given the memory and cognitive deficits.
 Roles as spouse, partner, or parent deteriorate as clients lose the ability to perform even
routine tasks or recognize familiar people. Eventually, clients cannot meet even the most
basic needs.
 Inability to participate in meaningful conversation or social events severely limits
relationships.
 Clients quickly become confined to the house or apartment because they are unable to
venture outside unassisted.
 Close family members often begin to assume caregiver roles; this can change previously
established relationships.
 Grown children of clients with dementia experience role reversal; that is, they care for
parents who once cared for them.
 Spouses or partners may feel as if they have lost the previous relationship and now are in
the role of custodian.
Physiologic and Self-Care Considerations
 Clients with dementia often experience disturbed sleep– wake cycles; they nap during
the day and wander at night.
 Some clients ignore internal cues such as hunger or thirst; others have little difficulty
with eating and drinking until dementia is severe.
 Clients may experience bladder and even bowel incontinence or have difficulty cleaning
themselves after elimination.
 They frequently neglect bathing and grooming. Eventually, clients are likely to require
complete care from someone else to meet these basic physiologic needs.
Intervention
 Focus on demonstrating caring, keeping clients involved by relating to the environment

and other people, and validating feelings and dignity of clients by being responsive to
them, offering choices, and reframing (offering alternative points of view to explain
events). This is in contrast to medical models of care that focus on progressive loss of
function and identity (McCabe, 2012).
 Education for family members caring for clients at home and for professional caregivers
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COLLEGE OF NURSING
in residential or skilled facilities is an essential component of providing safe and
supportive care.
Promoting the Client’s Safety
Safety considerations involve protecting against injury, meeting physiologic needs, and
managing risks posed by the environment, including internal stimuli such as delusions and
hallucinations.
Promoting client’s safety and protecting from injury Offer unobtrusive assistance with or
supervision of cooking, bathing, or self-care activities.Identify environmental triggers to help
client avoid them.
 Don’t let them exercise normal caution in daily life.

 Assistance or supervision that is as unobtrusive as possible protects clients from injury
while preserving their dignity.
Promoting Adequate Sleep and Proper Nutrition, Hygiene, and Activity
 Prepare desirable foods and foods client can self-feed; sit with client while eating.
 Monitor bowel elimination patterns; intervene with fluids and fiber or prompts.
 Remind client to urinate; provide pads or diapers as needed, checking and changing them
frequently to avoid infection, skin irritation, unpleasant odors.
 Daily physical activity also helps clients to sleep at night.
 Provide rest periods so clients can conserve and regain energy, but extensive daytime
napping may interfere with nighttime sleep.
 Balance between rest and activity is an essential component of the daily routine. Mild
physical activity such as walking promotes physical health but is not a cognitive
challenge.
 Encourage mild physical activity such as walking.
Structuring the Environment and Routine
A structured environment and established routines can reassure clients with dementia. Familiar
surroundings and routines help to eliminate some confusion and frustration from memory loss.
 Encourage clients to follow their usual routines and habits of bathing and dressing
(Yuhas et al., 2010).
 Monitor amount of environmental stimulation, and adjust when needed.
 The nurse needs to monitor and manage the client’s tolerance of stimulation. Generally,
clients can tolerate less stimulation when they are fatigued, hungry, or stressed.
Providing Emotional Support
The therapeutic relationship between client and nurse involves “empathic caring,” which
includes being kind, respectful, calm, and reassuring and paying attention to the client.
 The nurse can convey reassurance by approaching the client in a calm, supportive
manner, as if nurse and client are a team—a “we can do it together” approach.
 The nurse reassures the client that he or she knows what is happening and can take care
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COLLEGE OF NURSING
of things when the client is confused and cannot do so.
Supportive touch is effective with many clients.
 Touch can provide reassurance and convey caring when words may not be
understood.
 Holding the hand of the client who is tearful and sad and tucking the client into bed at
night are examples of ways to use supportive touch.
As with any use of touch, the nurse must evaluate each client’s response.
 Clients who respond positively will smile or move closer toward the nurse.
 Those who are threatened by physical touch will look frightened or pull away
from the nurse, especially if the touch is sudden or unexpected or if the client
misperceives the nurse’s intent.
Promoting Interaction and Involvement
 Plan activities geared to client’s interests and abilities. Reminisce with client about the
past.If client is nonverbal, remain alert to nonverbal behavior. Employ techniques of
distraction, time away, going along, or reframing to calm clients who are agitated,
suspicious, or confused.
Clients engaged in activities are more likely to stay calm. A wide variety of activities have
proven beneficial for clients with dementia. Music, dancing, pet or animal-assisted therapy,
aromatherapy, and multisensory stimulation are examples of activities that can be explored to
maximize the client’s involvement with the environment and enhance the quality of his or her
life (Milev, 2020; Ouldred & Bryant, 2020; Raglio et al., 2020).
Reminiscence therapy (thinking about or relating personally significant past experiences) is

an effective intervention for clients with dementia.
 Photo albums may be useful in stimulating remote memory

 local or national events and talk about their roles or what they were doing at the time.
 accomplishments.
 Engaging in active listening, asking questions, and providing cues to continue
promote successful use of this technique.
Distraction involves shifting the client’s attention and energy to a more neutral topic. Clients
usually calm down when the nurse directs their attention away from the triggering situation.
Time away involves leaving clients for a short period and then returning to them to re-engage in
interaction.
Going along means providing emotional reassurance to clients without correcting their
misperception or delusion. The nurse does not engage in delusional ideas or reinforce them, but
he or she does not deny or confront their existence.
The nurse can use reframing techniques to offer clients different points of view or explanations
for situations or events. Because of their perceptual difficulties and confusion, clients frequently
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COLLEGE OF NURSING
interpret environmental stimuli as threatening.
 Loud noises often frighten and agitate them.

 Alternative explanations often reassure clients with dementia and help them become less
frightened and agitated.
VITAL INFORMTION
Name: A.B.C
Age: 68 years old
Sex: Female
Citizenship: Filipino
Civil status: Married
Religion: Roman Catholic
Date of Birth: November 26, 1950
Place of birth: Roxas City Capiz
City Address: Brgy. Mongpong Roxas City, Capiz
Highest Educational Attainment: College Graduate
Current Vital Signs:
Weight: 61 kg
Height: 5’1’’
Temperature: 36.7º C
CR: 90 bpm
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Respiratory Rate: 22 cpm
Blood pressure: 130/60 mmHg
CLINICAL ASSESSMENT
Chief Complaint
According to patient’s A.B.C.’s daughter, she has a chief complaint of being forgetful and does
not remember recent activities.
Present Medical History

According to patient’s daughter, patient A.B.C. started to be forgetful a year ago. They did not
consult a doctor about it because they thought it was because patient A.B.C. is already old. There
was once an incident that patient A.B.C. took a jeepney but passed by her destination. She is not
allowed to go out alone. During the interview, patient A.B.C. gave relevant answers but there
were information given by her that are not true as the interviewer confirmed to her daughter.
Past Medical History

She cannot remember if she had completed her immunization during childhood. patient A.B.C.
had chicken pox and measles. However, she cannot remember when it was. There were times
that she fell and her head bled.
The patient A.B.C. also verbalized that she takes over the counter drugs for fever, cough and
cold; she directly consults her doctor for serious illness and comply with her doctor’s order. She
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COLLEGE OF NURSING
prefers to go to professional doctors than quack doctors. She also takes herbal medicine like
lagundi.
According to patient A.B.C. she has never been hospitalized. patient A.B.C. has no vices. She is
hypertensive. According to her, she takes Losartan daily. She takes it in the morning after eating
breakfast.
PATTERNS OF FUNCTIONS
Health Management Health Perception
The patient A.B.C. is optimistic when it comes to her health. The patient consider herself as
healthy and can do anything such as household chores. She also admitted that she is experiencing
some cognitive impairment and hypertension, she always tend to forget things, the patient also
verbalized that “permi lang ko gakaliapt sa mga bagay” The patient is also using herbal
medicines such as lagundi because she has a cough and taking her maintenance for her
hypertension. Losartan is only taken by the patient once a day before her breakfast. According to
the daughter of the client her mother has a monthly check up with the barangay health center and
in the hospital.
Nutritional Pattern
According to the patient her appetite was good. The patient only prefer healthy food such as
fruits, vegetables and fish. The patient also mentioned that her snack always is a single pack of
biscuit and she always drink 8 glasses of water daily, she also drink milk every morning. The
fluid intake of the client is normal because it is only 1760 ml of water in 3days.The BMI was
found out that it was normal in weight.
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Activity Exercise Pattern
KATZ index
Activities Independence = 1 pt. Dependence = 0 pt.

Bathing 1
Dressing 1
Toileting 1
Transferring 1
Continence 1
Feeding 1
Total Points: 6
Patient was able to do her activities of daily living such as bathing, dressing, toileting,
transferring, continence and feeding without the assistance of any health care provider. Using the
Katz Index of Independence in activities of daily living, it shows that patient is basically
independent.
Sleep Rest Pattern

Patient used to have 6 to 8 hours of sleep and does take her medication in order to fall asleep
and have no bed time rituals, feels rested upon waking up with enough rest periods during the
day.
According to Weber and Kelley, the optimal sleep duration for adults is approximately 6-8 hours.
Cognitive- Perceptual Pattern
According to the patient, she has a blurry vision although she can still perform her daily tasks
with her glasses on. The hearing ability is not in good condition because her both ears have a
negative result in whisper test (1-2 feet distance). During the conversation, according to folks the
person should speak louder for her to respond. However, her smell and taste preferences have not
been changed.
Patient was able to express her feelings and thoughts verbally and through body language but
there are times that she forgets some words and cannot complete the sentence. She also forgets
some of her short and long term memory. When she asked about her children, she was not able to
answer the names in chronological order. She also forgets some special occasions in their family
like wedding anniversary, exact date of death of her husband, etc.
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In assessing her short term memory, she got five errors in Short Portable Mental Status
Questionnaire by Pfeiffer which means she has moderate intellectual impairment. Her family is
not permitting her to go far places alone because there are circumstances that she was not able to
reach her destination properly. And they are not giving her money because the patient was not
able to recall where she placed it.
Self- Perception= Self- Concept Pattern

“ Mabakod paman ako galing malipaton lang kag gasakit akun ulo.” as stated by the
patient. She was aware of her condition but she’s trying to be physically powerful than she is.
Value- Belief Pattern

The patient believes first and foremost to God – which He exists, He guides us and for every
struggle in life that came, He is just testing our faith. Patient always attends the mass every
Sunday and seeks for guidance as she verbalized “permi ko gasimba kada dominggo sang aga”.
For her, God and her family are the most important persons in her life that she won’t trade for
anything in this world.
Patient also practices the values such as respect for the people around her most especially in
elderly age and she teaches the young generation to behave properly. She also practices
hospitality and gratitude. During the interaction with the client, she offers anything to the visitor.
PATHOPHYSIOLOGY OF DEMENTIA (ALZHEIMER’S DISEASE)
Now there’s many different types different types of dementia, for example, vascular dementia
and that’s associated with arteriosclerosis, infection induced dementia, toxin induced dementia,
genetic cause of dementia, and the most common type of dementia which is called Alzheimer’s
disease. It is the most common neurodegenerative disease that accounts for up to 70% of older
adults with dementia (Grossman & Porth, 2014). The age of onset in Dementia: Early onset
advanced age is (30-65 years old) and Late onset advanced age is (65 years and above). Most
common in ages 85 years old and above. And both genders can be affected.
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The brains of people with AD have an abundance of two abnormal features such as, amyloid
plaques and neuro-brillary tangles that are made of misfolded proteins. And the third main
feature of AD is the loss of connections between cells. This leads to diminished cell function and
cell death.
The first hallmark of AD, is amyloid plaques. These are found in the spaces between the brain’s
nerve cells. They were first described by Dr. Alois Alzheimer in 1906. Plaques consist of largely
insoluble deposits of an apparently toxic protein peptide, or fragment, called beta-amyloid. We
now know that some people develop some plaques in their brain tissue as they age. However, the
AD brain has many more plaques in particular brain regions. We still do not know whether
amyloid plaques themselves cause AD or whether they are a by-product of the AD process. We
do know that genetic mutations can increase production of beta-amyloid and can cause rare,
inherited forms of AD.
The second hallmark of AD, also described by Dr. Alzheimer, is neurofibrillary tangles. Tangles
are abnormal collections of twisted protein threads found inside nerve cells. The chief
component of tangles is a protein called tau. Healthy neurons are internally supported in part by
structures called microtubules, which help transport nutrients and other cellular components,
such as neurotransmitter containing vesicles, from the cell body down the axon. Tau, which
usually has a certain number of phosphate molecules attached to it, binds to microtubules and
appears to stabilize them. In AD, an abnormally large number of additional phosphate molecules
attach to tau. As a result of this “hyperphosphorylation,” tau disengages from the microtubules
and begins to come together with other tau threads. These tau threads form structures called
paired helical filaments, which can become enmeshed with one another, forming tangles within
the cell. e microtubules can disintegrate in the process, collapsing the neuron’s internal transport
network. is collapse damages the ability of neurons to communicate with each other.
Finally, the third and the last hallmark of AD is the gradual loss of connections between neurons.
Neurons live to communicate with each other, and this vital function takes place at the synapse.
Since the 1980s, new knowledge about plaques and tangles has provided important insights into
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COLLEGE OF NURSING
their possible damage to synapses and on the development of AD. The AD process not only
inhibits communication between neurons but can also damage neurons to the point that they
cannot function properly and eventually die. As neurons die throughout the brain, affected
regions begin to shrink in a process called brain atrophy. By the final stage of AD, damage is
widespread, and brain tissue has shrunk significantly.
LABORATORY AND DIAGNOSTIC TESTS
Primary care doctors:
 A neurologist, who specializes in the brain and nervous system
 A psychiatrist or another mental health specialist

 A psychologist or neuropsychologist, who specializes in memory and mental functions
 A geriatrician, who specializes in the care of older adults
Tests used to diagnose Dementia
The following procedures that may use to diagnose dementia:
The primary care doctor probably will start with a physical exam and ask questions about the
medical history of the patient and other things like:
• Does dementia run in your family?

• When did the symptoms start?
• Have you noticed changes in behavior or personality?
• Do you have any other medical problems, or are you taking any medications?
The physician will ask someone close to the patient, like a friend or family member, those same
questions, too, because people with dementia aren’t always aware of their condition.
Tests:
Cognitive tests: These measure your ability to think. They focus on things like memory, counting,
reasoning, and language skills.
For example, the physician/doctor might ask the patient to draw a clock and mark the hands at a
specific time, or give a short list of words and ask the patient to remember and repeat them. They
also might ask patient to make easy calculations, such as counting backward from 100 by seven.
Neurological tests: The physician/doctor will test the patient balance, reflexes, eye movements, and
see how well the patient senses work.
To do this, the physician/doctor might ask the patient to push or pull their hands using their arms or
to stand with your eyes closed and touch your nose. To check the patient reflexes, the doctor may tap
a small rubber hammer against parts of the patient body and watch how they respond.
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COLLEGE OF NURSING
Lab tests: A blood test can find problems such as a lack of certain vitamins or a thyroid issue,
which can affect how your brain works.
Brain scans: The physician/doctor may use one or more of these to get a closer look at your
brain and how it’s working. They also can help rule out other problems like bleeding, a stroke, or a
brain tumor:
1. CT (computerized tomography) scan: The doctor will take a series of X-rays and put them
together to make a more complete picture.
2. MRI (magnetic resonance imaging) scan: This uses powerful magnets and radio waves to
make detailed images of your brain and the tissue and nerves around it.
3. PET (positron emission tomography) scan: This shows the activity in your brain and can
be used to check for a certain protein (the amyloid protein) that can be a sign of Alzheimer’s
disease.
Psychiatric evaluation: The physician/doctor will ask questions about the patient mood and sense
of well-being to see if depression or another mental health condition might be causing symptoms of
dementia.
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COLLEGE OF NURSING
DRUG TABULATION
Drug Action Indication/ Contraindication Nursing responsibilities

Generic Name: Memantine Mechanism of action : Indication:  Monitor respiratory and CV
status, especially with
 A low to moderate affinity NMDA  Indicated for the treatment of preexisting heart disease.
receptor antagonist is thought to moderate to severe dementia of the  Monitor diabetics for loss of
Brand Name: Namenda selectively block the effects associated Alzheimer’s type glycemic control
with abnormal transmission of the
 Assess for and report signs
neurotransmitter glutamate, while
Contraindication: and symptoms of focal
Classification: NMDA allowing for the physiological
neurologic deficits.
receptor antagonists transmission associated with normal cell  Hypersensitivity to memantine
functioning hydrochloride
Side Effects:
Dosage: 5 mg  Fatigue, pain
Adverse Reactions:
Route: PO  CNS: Dizziness, headache, confusion,

depression
 CV: hypertension, cardiac failure
 GI: constipation, vomiting, diarrhea
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COLLEGE OF NURSING
Drug Action Indication/ Contraindication Nursing responsibilities
Generic Name: Mechanism of action: Indication:  Monitor closely the signs and
symptoms of GI ulceration
Donepezil  The main pharmacological actions of  Indicated for the treatment of and bleeding especially with
this drug are believed to occur as the dementia of the Alzheimer's type concurrent use of NSAIDS.
result of this enzyme inhibition,  Monitor carefully patients
Brand Name: enhancing cholinergic transmission, with a history of asthma or
which relieves the symptoms of Contraindication:
obstructive pulmonary
Aricept Alzheimer's dementia.  Donepezil is not recommended for disease.
patients with known  Report immediately to
Side Effects: nausea, vomiting, tiredness hypersensitivity to donepezil physician any signs and
Classification: hydrochloride or piperidine symptoms of bleeding.
Adverse Reactions: derivatives
Cholinesterase inhibitors
 CV: Chest pain, Hypertension
 GI: Diarrhea,
Dosage: 5 mg  CNS: insomnia, depression, headache
Route: PO
DRUG TABULATION
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COLLEGE OF NURSING
NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Risk for injury At the end of the Assess the degree of impaired Assessing the degree of Goal met as evidenced by:
related to loss nursing intervention the ability of competence, impaired ability will help in
of memory, patient and the folks emergence of impulsive planning care for the patient
“Gusto namon siya mabuligan language, would be able to: behavior and a decrease in and Impairment of visual -Folks were able to identify
nga mangabuhi sang normal problem- visual perception. perception increase the risk and remove hazards with in
nga malayo sa disgrasya kay solving and of falling. their home making the patient
indi siya makaintindi sa amon other thinking -Folks of the patient free of injury.
badlong sa iya” as verbalized abilities. would be able to Promoting and ensuring safety
by folks. Identify and remove by :
potential risk in the -Folks were able to provide a
-Assisting the folks of the Identifying potential risks in
environment and responsible person in
patient in identifying potential the environment heightens
provide a safe and free supervision and support
risk/hazards in the the awareness of folks about
of injury environment. making ADLs less risky.
Objective data environment. the possible risks. And
Visual-perceptual deficits
- Disorientation increase the risk of falls.
-Patient would be able Patient was able to perform
-Eliminating and minimizing
-inability to recognize objects to perform ADLs ADLs without injury.
identified hazards. (covering of
without acquiring any
- inability to identify danger sharp edges, removing sharp
possible injuries.
objects nearby, providing non-
in the environment Preventive measures can
slippery floors/ minimizing
contain patient without
elevated ones making room
-weakness constant supervision.
and amenities easy to locate)
-balancing difficulties
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COLLEGE OF NURSING
- Maintain adequate lighting
and clear pathways.
It allows patient to see and

-Providing one responsible find the way around the
folks to accompany patient at room without danger of
all times. tripping or falling and even
getting lost around the area.
34
“Indi siya kaintindi sang Chronic ST. ANTHONY COLLEGE

At the end of the nursing OF ROXAS
-Assess CITY,
degree of INC. Provides baseline for Goal partially met as
amon instruction, confusion intervention the patient and EXTENSION,
SAN ROQUE the cognitive impairment
ROXAS CITY, CAPIZ 5800 future evaluation and evidenced by increase in
irritable siya kag kis’a related to folks of the patient would be able including changes in
COLLEGE OF NURSING
comparison and cooperation of the patient
nahadlok man siya sa irreversible to: orientation to person, influences choice of during ADLs and therapies.
amon kag wala gd ga neuronal place, and time and interventions
kooperar” as verbalized degeneration attention span and
by folks. -Patient Experience a decrease in thinking ability.
level of frustration, especially
-Note behavioral changes
when participating in daily
and length of time
activities.
problem has existed and
Objective data inform the psychiatrist
upon check- ups (if
-irritablity (short -Patient will be able to tolerate behavior worsens the
tempered) stimuli when introduced slowly in need to refer
nonthreatening manner, with one immediately may arise).
- Decreased ability to
item at a time.
interpret one’s
environment
-Provide a rest conducive Reduces distorted input,
-Decreased capacity for Patient of the patient would be environment
able to: whereas crowds, clutter,
thought and noise generate
(free from noise and
- impaired Short term -Verbalize understanding about crowd). sensory overload that
memory disease process and client’s needs. stresses the impaired
neurons.
-Identify and participate in
-Disturbed personality;
interventions to deal effectively
impaired socialization
with situation.
Any provocation
-Disturbed
-Reduce provocative decreases self-esteem and
interpretation / response
stimuli, such as negative may be interpreted
to stimuli
criticism, arguments, and as a threat, which may
confrontations. trigger agitation or
increase inappropriate
behavior
35 The communication
-Give simple directions, centers in the brain
one at a time, or step-by- become impaired,
Self Care At the endST.

ofANTHONY COLLEGE
the nursing OF ROXAS
-Identify CITY,
reason forINC. -Underlying cause affects Goal met as evidenced by:
deficit related intervention the patient
SAN ROQUE difficulty
EXTENSION, in self-care
ROXAS CITY, CAPIZ 5800 helps in deciding choice
“nabudlayan siya sa iya
to cognitive and the folks of the COLLEGErelated to physical of interventions and
pang adlaw-adlaw nga OF NURSING
decline and patient would be able to: limitations in motion, strategies. -Patient was able to
pang tatapsa kaugalingon,
physical depression, cognitive perform ADLs and self
kay kis’a natak an siya kag
limitations decline, or environment. care with minimal
kis’a nalipat na siya kung
-The patient would be assistance.
paano, depende sa
able to perform self-care
madumduman niya” as
activities within level of
verbalized by folks.
own ability with minimal -Folks showed
-Determine hygienic
assistance form understanding of the
needs and provide -Basic hygienic needs
folks/caregiver. client’s current condition
Objective data assistance as needed may be forgotten.
and the need for assistance
Infection, gum disease,
-Inability to perform With activities, including by responsible family
disheveled appearance, or
Activities of daily -The folks of the patient care of hair, nails, and member.
harm may occur when
Living(ADL) would be able to promote skin; brushing teeth, and
client or caregivers
feasible independence and cleaning of glasses.
specifically become frustrated,
be able to assist and guide Provide reminders for
irritated, or intimidated by
Bathing/Hygiene the patient in performing elimination need
degree of care required.
self care and ADLs when
eating Tasks that were once easy,
needed.
such as dressing or
Toileting . bathing, are now
complicated by decreased
Dressing motor skills or cognitive
and physical changes
Forgetfulness/Memory
loss -Loss of control and
independence in this self-
care activity can have a
- Disorientation -Supervise activities but great impact on self-
allow as much autonomy esteem and may limit
as possible. socialization.
- Weakness
36
This will lessen the risk
for injury during ADLs
and promote proper
COLLEGE OF NURSING
Assessment Nursing Diagnoses Planning Intervention Rationale Evaluation

Compromised After the nursing Assess family’s knowledge of Knowledge will enhance family’s After the nursing
Family Coping intervention the patient’s disease and erratic understanding of the dementia intervention the family
Subjective:
related to Family members behaviors, and possible associated with the disease and members achieved
“busy abi kami Progressive will achieve violent reactions. development. increased coping ability
tanan permi sa amon dependence of the increased coping concerning patient’s
trabaho kag wala patient on the family ability concerning dementia and care
permi tawo ang as evidenced by patient’s dementia needs.
amon balay” as and care needs.
withdrawal from
verbalize by the
patient at his time of
folks
need. Assess for level of family’s
fatigue, reduced social
exposure of family, feelings
about role reversal in caring -
Objective: for patient and increasing
demands of patient.
Social isolation
Provide for opportunity for
family to express concerns It promotes venting of feelings and
and lack of control of reduces anxiety.
situation.
37
COLLEGE OF NURSING
Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation

Subjective Impaired Verbal After the nursing Monitor the patient for Indicates that feelings or needs are After the nursing
Communication intervention patient nonverbal communication, being expressed when speech is intervention, the patient
‘Nabudlayan kami
related to Dementia. will be able to have such as facial grimacing, impaired. was able to have an
mag intindi sang iya
effective speech and smiling, pointing and crying; effective
gina hambal kun communication as
understanding of encourage use of speech when
siya maghala’as evidenced the patient
communication, or possible.
verbalized by the didn’t stutter and have
will be able to use
folks of the patient. a repetitive speech.
another method of
communication and Anticipate patient’s needs. Helps to prevent frustration and
anxiety.
make needs known.
Objective:
Promotes self-confidence of the

Stuttering Use simple, direct questions patient and will be able to achieve
requiring one-word answers. some degree of speech or
Repeat and reword questions communication.
Repetitive speech if misunderstanding occurs.
Difficulty in
comprehending
communication.
Promotes coordinated breathing

pattern
Encourage patient to breath
prior to speaking, pause
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COLLEGE OF NURSING
between words.
Avoid rushing the patient

when struggling to express
feelings and thoughts.
Encourage patient to take part

in social activities.
Helps reduce feelings of isolation,
which then result in further
depression and unwillingness to
communicate.
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COLLEGE OF NURSING
40
COLLEGE OF NURSING
Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation

Subjective: Disturbed Sleep After the nursing Ensure External stimuli can interfere After the nursing intervention the
Pattern related to intervention the environment is with sleeping pattern and with patient have achieve and maintain
“Ganereklamo siya na di environment patient would be quiet, well- frequent awakenings. a restful sleep pattern
siya katulog mayad kun stimuli able to achieve ventilated, absence
and maintain of odor, and has
gabi” as verbalized by the restful sleep comfortable
family. temperature.
Prevents disruption of
Provide ritualistic established pattern and
Objective: procedures of warm promotes comfort and
drink, extra covers, relaxation before sleep.
Difficulty of falling to sleep clean linens, or
warm baths prior to
Irritability bedtime.
41
HEALTH TEACHINGS
 Do not use any medicines that are not ordered ST. ANTHONY COLLEGE OF ROXAS CITY, INC.

 Inform significant other to avoid places that can cause injury
COLLEGE OF NURSING
 Inform S.O to always check and look out for the patient
 Do not drink alcohol while taking medicine for dementia.
 Encourage best exercise program for you. It is best to start slowly and do more as you get stronger. Exercising makes the heart stronger, lowers blood pressure,
and keeps you healthy. Exercise also makes you feel better and happier.
 Smoking harms the heart, lungs, and the blood. You are more likely to have a heart attack, lung disease, and cancer if you smoke. You will help yourself and
those around you by not smoking.
 Inform significant others to let the patient have regular sleep is very important. Try to get 6 to 8 hours of sleep each night.
 Inform significant others to always consult your healthcare provider to ensure the information
Environment:
1. Reduce stressful environments
 Stress may slow healing and cause illness later. Since it is hard to avoid stress, learn to control it. Learn new ways to relax (deep breathing, relaxing muscles,
meditation, or biofeedback). Talk to your caregiver about things that upset you.
2. Promote relaxing atmosphere

Treatments:
 Take medications with 12 Rights.
 Taking vitamins is very important because many people do not eat a healthy diet. Always tell caregivers if you are taking any vitamins, herbs, or other
supplements to make sure they are the best ones
Outpatient/Inpatient Referral:
42
Instructed to:
 Follow monthly check up/ regular check up

A Case Study On Dementia: in Partial Fulfillment of The Requirement in Related Learning Experience

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ST. ANTHONY COLLEGE OF ROXAS CITY, INC.

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

In Partial Fulfillment of the Requirement in

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

ANATOMY ANG PHYSIOLOGY---------------------------------------------- 4

PATTERNS OF FUNCTIONS ---------------------------------------------------- 28

DIAGNOSTIC TESTS -------------------------------------------------------------- 32

NURSING CARE PLAN-------------------------------------------------------------36

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

Dementia is a syndrome it is usually of a chronic or progressive nature, in which there is

 To acquire reliable information about Dementia in order to understand and perform

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

ANATOMY AND PHYSIOLOGY

ANATOMY AND PHYSIOLOGY

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

TEXTBOOK AND DISCUSSION

A syndrome characterized by acquired, progressive cognitive impairment - Affects 10% of

Signs and Symptoms:

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

DSM-IV-TR DIAGNOSTIC CRITERIA: S

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

Onset and Clinical Course

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

• Creutzfeldt–Jakob disease is a central nervous system disorder that typically develops in

• Parkinson’s disease is a slowly progressive neurologic condition characterized by tremor,

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

Treatment and Prognosis

 changes in diet, exercise, control of hypertension, or diabetes. Improvement of cerebral

APPLICATION OF THE NURSING PROCESS: DIMENTIA: Assessment

 The nurse provides simple explanations as often as clients need them.

Typically, the client is asked to

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

 Interviews with family, friends, or caregivers may be necessary to obtain data.

General Appearance and Motor Behavior

Mood and Affect

Thought Process and Content

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

Sensorium and Intellectual Processes

 time in mild dementia

Judgment and Insight

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

Roles and Relationships

Physiologic and Self-Care Considerations

 Focus on demonstrating caring, keeping clients involved by relating to the environment

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

Promoting the Client’s Safety

 Don’t let them exercise normal caution in daily life.

Promoting Adequate Sleep and Proper Nutrition, Hygiene, and Activity

Structuring the Environment and Routine

Providing Emotional Support

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800

Supportive touch is effective with many clients.

Promoting Interaction and Involvement

Reminiscence therapy (thinking about or relating personally significant past experiences) is