DR. YANGA'S COLLEGES INC.

Wakas, Bocaue, Bulacan

College of Health Sciences

BS Nursing Program

“NURSING CASE STUDY”

In partial fulfilment
of the requirements in NCM 112
Related Learning Experience

CUNDANGAN, JUAN ANGELO D.

BSN- IIIB/ Group 5

December 21, 2021

I. INTRODUCTION
Alzheimer’s disease is a brain disorder that slowly destroys memory and thinking
skills and eventually, the ability to carry out the simplest tasks. In most people with the
disease, those with late-onset type symptoms first appear in their mid-60s. Early onset
Alzheimer’s occurs between a persons’s 30s and mid-60s and is very rare. Alzheimer’s
disease is the most common cause of dementia among older adults. The disease is named
after Dr. Alois Alzheimer. Plaques and tangles in the brain are still considered some of the
main features of Alzheimer’s disease. Another feature is the loss of connections between
nerve cells in the brain. Neurons transmit messages between different parts of the brain,
and from the brain to muscles and organs in the body.

This damage initially takes place in parts of the brain involved in memory,
including the entorhinal cortex and hippocampus. It later affects areas in the cerebral
cortex, such as those responsible for language, reasoning and social behavior. Eventually,
many other areas of the brain are damaged. Memory loss are the first sign of Alzheimer’s
disease, though initial symptoms may vary from person to person. A decline in other
aspects of thinking, such as finding the right words, vision and spatial issues, and
impaired reasoning or judgement may also signal early stages of Alzheimer’s disease.
Mild cognitive impairment is a condition that can be an early sign of Alzheimer’s but not
everyone with MCI will develop the disease.

People with Alzheimer’s have trouble doing everyday things like driving a car,
cooking a meal, or paying bills. They may ask the same questions over and over, get lost
easily, lose things or put them in odd places, and find even simple things confusing. As
the disease progresses, some people become worried, angry and violent. Alzheimer’s
disease is currently ranked as the sixth leading cause of death in the United States, but
recent estimates indicate that the disorder may rank third, just behind heart disease and
cancer, as a cause of death for older people. Currently, there is no cure for Alzheimer’s
disease, though there has been significant progress in recent years developing and testing
new treatments. Several medicines have been approved by the U.S. Food and Drug
Administration to treat people with Alzheimer’s.

References:
https://www.nia.nih.gov/health/what-alzheimers- disease#:~:text=Alzheimer%E2%80%99s
%20disease%20is%20the%20most%20common%20cause%20of,included%20memory%20loss
%2C%20language%20problems%2C%20and%20unpredictable%20behavior.

https://www.alzheimers.gov/
II. OBJECTIVES
General Objectives
At the end of the case study, student nurse will be able to apply the learnings about
Alzheimer’s Disease, its signs and symptoms as well as its medical and nursing
management. It is very significant to have knowledge to integrate related skills and
respond appropriately with the patient with such condition. This study aims to apply the
learning and management to the study in real life context with the same case also to
develop a holistic characteristic in concerning to the whole study of a patient.

Specific Objectives
At the end of the study, the student will be able to:
 Knowledge
 The nurse must defined the problem, signs and symptoms and its
management. Explain the case with the use of own learning.
 Skill
 The nurse must perform nursing interventions related to the problems
identified through assessment with proper management to the patient.
 Attitude
 The nurse must be compassionate in providing care to patients and elicit
good manners when dealing to patient.

At the end of the study, the patient will be able to:

 Knowledge
 Patient will provide understanding of the illness as well as self-awareness
about signs and symptoms of Alzheimer’s Disease.
 Skills
 Patient will apply the management by doing the interventions given and
perform independent management through nursing health teachings.
 Attitude
 Patient will show cooperation to the student nurse and show willingness to
resolve her problem.
 III.NURSING HISTORY

Personal Data
This is a case of patient M.E, 62 years old, Catholic in Religion, a retired Registered
Nurse of Bulacan District Hospital, currently living with her husband and children at Barangay
Tuktukan, Guiguinto, Bulacan. Her husband is her boyfriend since their teenage years. Her
husband is 61 years old. M.E. has 2 sons and 1 daughter. She was admitted at 3:00 pm today,
December 21, 2021 at Bulacan District Hospital with a chief complaint of progressive
forgetfulness. Her husband states that she is no longer able to care for herself and has become
increasingly depressed and paranoid. He also added, recently her wife started a fire in the
kitchen. M.E. is a Philhealth benificiary. Her husband is managing their hardware and metal
fabrication business near their house. Their oldest son is a Registered Nurse, while their second
son is an Engineer and their daughter is on her 4th year college.

Present Health History

2-days prior to admission, patient started to become depressed, headache and irritability.
1-day prior to admission, patient’s uncomfortable feeling continues, moderate headache and
depressed. 1-hour prior to admission, patient has become increasingly depressed and paranoid.
The patient also getting stressed because of light and loud noises which aggravates her
condition, her husband advices that they should get medical attention. Upon admission she was
observed at extensive neurologic evaluation. M.E. is diagnosed as having Alzheimer’s disease.
Her husband and children have come to the Alzheimer’s unit for information about this disease
and to discuss the possibility of placement for patient M.E. Patient undergo standard medical
tests such as blood and urine tests to identify possible cause of the problem. Physician and nurses
also conducted tests of memory, problem solving, attention, counting and language. They also
used CT (Computerized Tomography) and MRI (Magnetic Resonance Imaging) scan. This also
clarifies if what type of dementia the patient has. Cholinesterase inhibitors was administered for
treating the patient’s Alzheimer’s disease. Namely, Donepezil, Galantamine, and Rivastigmine.
Patient M.E was discharged to home and advices her husband and children to continue the
medication and close monitoring and observing for patient M.E.
 Past Health History
Patient M.E. barely gets sick because of having a strong immune system back in her
years. She is a Registered Nurse and has a complete immunization for any diseases. But due to
her workload as a Nurse, she is always stressed, depressed, over-fatigued, restless, and irritable
most of the time. She experienced motorcycle accident when she was a teenager but not too
serious damage. She also experienced chicken pox on her childhood years and some cough,
colds, and fever. At the age of 29 she experienced dengue and was confined to hospital. She also
gave birth to her children on a cesarean section.

Family History
 M.E.’s family have history of Alzheimer’s Disease. The patient’s aunt on her maternal
side died when the patient is young due to Alzheimer’s Disease. Her mother also died 4 years
ago due to Alzheimer’s also. While her aunt on her paternal side is now on stage 3 Alzheimer’s
Disease and under close monitoring of her children. Both parents of the patient are dead.
Patient’s younger brother has now early symptoms of Alzheimer’s Disease. He is under
medicines and under close monitoring and observation of his children. Now, Patient M.E. is
under medicines and close monitoring also by her husband and children.

Socio Economic History

Patient M.E. is an SSS member, and is also a member of Nurses’ Association. She also has
retirement funds. She is a retired Registered Nurse. After she retired, she managed her medical
supplies business together with her husband. Patient’s hobby is to watch TV, read magazines,
doing household chores and spending time with her grandchildren and her husband. Her husband
is a retired public teacher and also has retirement funds. They do not need to work hard because
their children have their own families and all are college graduates and each and every one of
them has a stable work. Their estimated daily expenses is at 1500 which is divided according to
their needs. 700 pesos for their food and the remaining is divided for water and electricity. Any
excess goes to their medications.

Nutrition and Metabolic Pattern

Patient M.E.’s usual diet is composed of vegetables, fruits and high in protein foods. Since she is
a Nurse, she always balances her daily intake of foods and she knows her limits. She usually eats
lettuce, broccoli, fish and a cup of tea. She usually eats 4 times a day and drinks tap water every
after meal and consumes 8glasses of water a day.
1st day 2nd day
8am – Breakfast -Biscuits -Lugaw
-Banana -Toge
-Cup of white coffee -Cup of white coffee

12nn - Lunch -Fish fillet -Eggplant

-1 cup rice -Tomatoes
-Tomatoes -Spinach
-1 glass of water -1cup rice
-1 glass of water
4pm - Snacks -Banana Cue -Palabok
-Cup of tea -Cup of tea

7pm - Dinner -Roasted Chicken -Fried egg

-1cup rice -Mixed vegetables
-Pineapple -Corn soup
-1 glass water -1 glass of water

Elimination Pattern
Patient M.E defecates normally with brown solid stools and pee around 800 – 1000mL of urine
per day. But when her Alzheimer’s Disease attacks, she always forgot to pee or even defecate at
the right time.
Home and Environment
M.E. lives in Tuktukan, Guiguinto Bulacan with her husband and their grandchildren on
weekdays. They are living near M. E’s relatives about two houses away. The house where they
live is made up of mixed materials and classified as solid concrete. The house has 3 doors, 7
windows, 5 bedrooms, 3 comfort rooms, 1 dining area and 2 living rooms. They also have big
garage that can fit 2 to 3 cars at the same time. They are getting their water source from Hiyas
Water Resources and they have also jetmatic. Their electricity is from Meralco. They live in a
subdivision and not living in a crowded community.

IV. Anatomy and Physiology

The Nervous System

The Nervous System helps all the parts of the body to communicate with each other. It
also reacts to changes both outside and inside the body. The nervous system uses both electrical
and chemical means to send and receive messages. There are two classifications of Nervous
System; Central Nervous System and Peripheral Nervous System.
The Central Nervous System is made up of the brain and spinal cord while the Peripheral
Nervous System is made up of nerves that branch off from the spinal cord and extend to all parts
of the body.
Cerebral Hemispheres
 Gyri. The entire surface of the cerebral hemispheres exhibits elevated ridges of tissue
called gyri, separated by shallow grooves called sulci.
 Fissures. Less numerous are the deeper grooves of tissue called fissures, which separate
large regions of the brain; the cerebral hemispheres are separated by a single deep fissure,
the longitudinal fissure.
 Lobes. Other fissures or sulci divide each hemisphere into a number of lobes, named for
the cranial bones that lie over them.
 Regions of cerebral hemisphere. Each cerebral hemisphere has three basic regions: a
superficial cortex of gray matter, an internal white matter, and the basal nuclei.
 Cerebral cortex. Speech, memory, logical and emotional response, as well as
consciousness, interpretation of sensation, and voluntary movement are all functions of
neurons of the cerebral cortex.
 Parietal lobe. The primary somatic sensory area is located in the parietal lobe posterior
to the central sulcus; impulses traveling from the body’s sensory receptors are localized
and interpreted in this area.
 Occipital lobe. The visual area is located in the posterior part of the occipital lobe.
 Temporal lobe. The auditory area is in the temporal lobe bordering the lateral sulcus,
and the olfactory area is found deep inside the temporal lobe.
 Frontal lobe. The primary motor area, which allows us to consciously move our
skeletal muscles, is anterior to the central sulcus in the front lobe.
 Pyramidal tract. The axons of these motor neurons form the major voluntary motor
tract- the corticospinal or pyramidal tract, which descends to the cord.
 Broca’s area. A specialized cortical area that is very involved in our ability to speak,
Broca’s area, is found at the base of the precentral gyrus (the gyrus anterior to the central
sulcus).
 Speech area. The speech area is located at the junction of the temporal, parietal, and
occipital lobes; the speech area allows one to sound out words.
 Cerebral white matter. The deeper cerebral white matter is compose of fiber tracts
carrying impulses to, from, and within the cortex.
 Corpus callosum. One very large fiber tract, the corpus callosum, connect the cerebral
hemispheres; such fiber tracts are called commissures.
 Fiber tracts. Association fiber tracts connect areas within a hemisphere, and projection
fiber tracts connect the cerebrum with lower CNS centers.
 Basal nuclei. There are several islands of gray matter, called the basal nuclei, or basal
ganglia, buried deep within the white matter of the cerebral hemispheres; it helps
regulate the voluntary motor activities by modifying instructions sent to the skeletal
muscles by the primary motor cortex.
Diencephalon
 Thalamus. The thalamus, which encloses the shallow third ventricle of the brain, is a
relay station for sensory impulses passing upward to the sensory cortex.
 Hypothalamus. The hypothalamus makes up the floor of the diencephalon; it is an
important autonomic nervous system center because it plays a role in the regulation of
body temperature, water balance, and metabolism; it is also the center for many drives
and emotions, and as such, it is an important part of the so-called limbic system or
“emotional-visceral brain”; the hypothalamus also regulates the pituitary gland and
produces two hormones of its own.
  Mammillary bodies. The mammillary bodies, reflex centers involved in olfaction (the
sense of smell), bulge from the floor of the hypothalamus posterior to the pituitary gland.
 Epithalamus. The epithalamus forms the roof of the third ventricle; important parts of
the epithalamus are the pineal body (part of the endocrine system) and the choroid
plexus of the third ventricle, which forms the cerebrospinal fluid.
Brain Stem
 Structures. Its structures are the midbrain, pons, and the medulla oblongata.
 Midbrain. The midbrain extends from the mammillary bodies to the pons inferiorly; it is
composed of two bulging fiber tracts, the cerebral peduncles, which convey descending
and ascending impulses.
 Corpora quadrigemina. Dorsally located are four rounded protrusions called the
corpora quadrigemina because they remind some anatomist of two pairs of twins; these
bulging nuclei are reflex centers involved in vision and hearing.
 Pons. The pons is a rounded structure that protrudes just below the midbrain, and this
area of the brain stem is mostly fiber tracts; however, it does have important nuclei
involved in the control of breathing.
 Medulla oblongata. The medulla oblongata is the most inferior part of the brain stem; it
contains nuclei that regulate vital visceral activities; it contains centers that control heart
rate, blood pressure, breathing, swallowing, and vomiting among others.
 Reticular formation. Extending the entire length of the brain stem is a diffuse mass of
gray matter, the reticular formation; the neurons of the reticular formation are involved in
motor control of the visceral organs; a special group of reticular formation neurons, the
reticular activating system (RAS), plays a role in consciousness and the awake/sleep
cycles.
Cerebellum
 Structure. Like the cerebrum. the cerebellum has two hemispheres and a convoluted
surface; it also has an outer cortex made up of gray matter and an inner region of white
matter.
 Function. The cerebellum provides precise timing for skeletal muscle activity and
controls our balance and equilibrium.
 Coverage. Fibers reach the cerebellum from the equilibrium apparatus of the inner ear,
the eye, the proprioceptors of the skeletal muscles and tendons, and many other areas.

V. Pathophysiology
 Pathophysiology of Alzheimer’s Disease

Brain

Hyperphosphorylate Metal Ion

Cholinergic Oxidative Stress
d Tau Protein Hypothesis

Free Radical Extracellular Deposition Metal

Reduction of Amyloid
Production Dyshomeostasis

Atrophy in Atrophy in

Antero Antero

fronta fronta

Inflammation AB- NFT

Alzheimer’s
 Neuronal loss or pathology may be seen particularly in the hippocampus,
amygdala, entorhinal cortex and the cortical association areas of the frontal, temporal, and
parietal cortices, but also with subcortical nuclei such as the serotonergic dorsal raphe,
noradrenergic locus coereleus, and the cholinergic basal nucleus. The deposition of tangles
follows a defined pattern, starting from the trans-entorhinal cortex; consequently, the entorhinal
cortex, the CA1 region of the hippocampus and the temporal lobes are particularly affected. The
extent and placement of tangle formation correlates well with the severity of dementia.
The accumulation of tau proteins correlates very closely with cognitive decline
and brain atrophy, including hippocampal atrophy. In the neuropathology of Alzheimer’s disease
there is a loss of neurons and atrophy in temporofrontal cortex, which causes inflammation and
deposit the amyloid plaques and an abnormal cluster of protein fragments and tangled bundles of
fibres due to increase in the presence of monocytes and macrophages in cerebral cortex and it
also activates the microglial cells. One of the main pathological hallmarks of AD is the formation
of senile plaques, which is caused by amyloid beta (AB) deposition that leads to Alzheimer’s.

VI. PHYSICAL ASSESSMENT

General Survey
Patient M.E. has a 5-year history of progressive forgetfulness. She is no longer able to
care for herself, and also became depressed and paranoid. Her blood pressure is 130/90. Her
heart rate is 95 beats per minute with an oral temperature of 36.9 degree Celsius. She weighs
about 154lbs with a height of 5’4. She is a type of mother and nurse who always maintain a
healthy lifestyle and keeping her body clean at all times. There are no lesions found on her skin.
Received patient from admission room, wearing a white blouse with black pants and doll
shoes. Patient is being held by her children and her husband as she sits down on the chair. Vital
signs taken as follows:
December 3, 2021
10: 00 11:00 am 12: 00 nn 1:00 pm 2:00 pm 3: 00 pm 4:00 pm Indicatio
am n
BP: 130/90 140/90 130/80 120/90 130/80 140/90 Systolic
130/90 hypertens
ion
H.R: 93 92 93 85 91 87 93 Normal
SpO2: 95 88 89 87 90 93 86 Normal
Rr: 23 20 21 19 20 24 22 Normal
Temp: 36.9 36.9 36.7 36.8 36.6 36.7 Normal
36.9

December 7, 2021
10: 00 11:00 am 12: 00 nn 1:00 pm 2:00 pm 3: 00 pm 4:00 pm Indicatio
am n
BP: 120/90 130/80 120/80 120/90 130/80 120/90 Normal
120/90
H.R: 92 92 86 89 91 85 92 Normal
SpO2: 93 89 88 91 89 94 92 Normal
Rr: 23 20 21 19 20 24 22 Normal
Temp: 36.9 36.9 36.7 36.8 36.6 36.7 Normal
36.9

REVIEW OF SYSTEM
PARTS METHODS NORMAL ACTUAL ACTUAL CLINICAL
FINDINGS FINDINGS FINDINGS SIGNIFICA
December 3, December 7, NCE
2021 2021
Skin Inspection Varies from Light brown Light brown Dry skin due
and Palpation light to deep complexion, complexion, to age.
brown. With dry and dry and
no masses or wrinkled wrinkled
swelling. skin. With no skin. With no
masses. masses.
Face Inspection No masses or No masses or No masses or Normal
swelling. swelling swelling
noted. noted.
Eyes Inspection Palpebral Palpebral Palpebral Normal
and Palpation conjunctiva conjunctiva is conjunctiva is
appears pink pink. pink.
Mouth and Inspection Pink, soft and Pink and dry Pink, soft and Due to
gums and Palpation smooth lips. lips. smooth lips. hydration,
there is a
reduced fluid
supply for the
body.
Abdomen APPI No masses or No masses or No masses or Normal
(Auscultation swelling swelling swelling
, Percussion, noted. noted. noted.
 Palpation, Presence of Presence of
Inspection) cesarean scar cesarean scar
noted. noted.

Upper and Inspection Uniform in Light brown Light brown Normal

lower and Palpation color with no complexion, complexion,
extremities lesions and dry skin with dry skin with
masses. no masses or no masses or
swelling swelling
noted. noted.

Neuromuscul Percussion Normal deep Normal deep Normal deep Normal

ar

VII. DRUG STUDY

Generic Actual Mechanism Indications Contraindi Adverse Nursing
Name dosage of Action cations Effect Responsibili
and route ties
Donepezil Tablet: Donepezil Donepezil Donepezil -Diarrhea -Monitor for
P.O reversibly hydrochlori is -Nausea any adverse
5mg inhibits de tablet contraindic -Vomiting effect of the
10mg acetylcholi USP is ated in -Muscle medication.
nesterase, indicated patients cramps Report to
Brand thereby for the with -Trouble physician if
Name blocking treatment known sleeping any.
Aricept the of hypersensit -Loss of
hydrolysis dementia ivity to appetite -Monitor
of the of the donepezil -Tiredness therapeutic
neurotrans Alzheimer' hydrochlori -Weakness effectivenes
Classificatio mitter s type. de or to s.
n acetylcholi piperidine
ne and, derivatives. -Monitor
Cholinester
consequent cardiovascul
ase
ly, ar status.
Inhibitors
increasing
its activity.
Generic Actual Mechanism Indications Contraindi Adverse Nursing
Name dosage of Action cations Effect Responsibili
and route ties
Galantamin Immediate Galantamin Galantamin Galantamin -Tiredness -Monitor for
e release e works by e tablets e is -Weakness any adverse
tablet and increasing are contraindic -Chest pain effect of the
oral the amount indicated ated to -Dizziness medication.
solution: of a certain for the patients -Shortness Report to
natural treatment with of breath physician if
Brand -Initial substance of mild to -Slow any.
Name asthma,
dose: 4 in the brain moderate heartbeat
Razadyne slow
mg orally that is dementia -Shakiness -Monitor
twice a needed for of the heartbeat, of legs, respiratory
day, memory Alzheimer’ liver arms and status.
preferably and s type. problems, feet.
obstructive
Classificatio with thought. -Monitor
n morning pulmonary cardiovascul
Acetylcholi and disease and ar status.
nesterase evening seizures.
Inhibitors meals -Monitor
appetite and
-After a food intake.
minimum
of four
weeks,
increase to
8 mg
twice a
day, then
after an
additional
4 weeks,
may
increase to
12 mg
twice a
day

Maintenan
ce dose:
16 to 24
mg per
day given
in 2
divided
doses
 Maximum
dose: 24
mg/day

Generic Actual Mechanism Indications Contraindi Adverse Nursing

Name dosage of Action cations Effect Responsibili
and route ties
Rivastigmin Oral Rivastigmi Rivastigmi Rivastigmi -Diarrhea -Monitor for
e dosages ne occurs ne tartrate ne tartrate -Nausea any adverse
(tablet or by capsules capsules -Vomiting effect of the
solution): inhibiting are are - medication.
the indicated contraindic Indigestion Report to
Adults— hydrolytic for the ated in -Trouble physician if
Brand At first, activity of treatment patients sleeping any.
Name 1.5 AChE and of mild-to- with -Loss of
Exelon milligram BChE and moderate known appetite -Monitor
s (mg) binding to dementia hypersensit -Weight cognitive
two times catalytic of the ivity to loss function and
a day. sites. Alzheimer' Rivastigmi ability to
Your s type ne, other perform
Classificatio doctor (AD). carbamate
n ADLs.
may derivatives
Cholinester gradually or other
ase -Monitor
increase component
Inhibitors ambulation
your dose s of the
as needed as dizziness
formulatio
and n is a common
tolerated. adverse
However, effect.
the dose is
usually -Monitor
not more diabetics for
than 6 mg loss of
two times glycemic
a day. control.

VIII. NURSING CARE PLAN

ASSESSMENT PLANNING INTERVENTIO RATIONALE EVALUATION
N
Subjective Cues: SHORT TERM -Facilitate on -Reality Goal met –
“Napapadalas orienting the orientation patient condition
ang pagkawala After 5 days of patient to the techniques help improved.
ko sa sarili ko. administration in environment as improve
Ano ito? the hospital, the needed if the patients’
Natatakot na patient will have patient’s short- awareness.
ko!” appropriate term memory is
As verbalized by maintenance of intact. Use of
the patient. mental and calendars,
psychological newspapers,
Objective Cues: function as long television and
-Restlessness as possible and radio are also
-Uncomfortable reversal of appropriate.
behaviors when
possible. -Encourage the -These activities
use of can help reduce
OREM complementary stress because
THEORY: and alternative stress can
Supportive therapies such as aggravate
educative exercise, guided memory loss.
meditation and
massage.

-Assist the client -A medication

in setting up a box can help
medication box. remind them to
take their
medication at
prescribed times
and refill the
-Facilitate on
box.
encouraging the
use of calendar -Written
or making a list reminders can
of reminders. help remind the
patient of certain
actions.
Nursing
Diagnosis:

Impaired
memory related
to Alzheimer’s
disease process
ASSESSMENT PLANNING INTERVENTIO RATIONALE EVALUATION
N
Subjective Cues: SHORT TERM -Facilitate on -Identifies Goal met –
“Di na po sya assessing problem areas patient was able
kumikibo After 5 days of patient’s ability and speech to have effective
madalas, administration in to speak, patterns to help verbal and non-
palaging the hospital, the language establish a plan verbal
nakatulala at patient will be deficits, of care. communication.
walang imik. able to have cognitive or
Wala rin po effective speech sensory
syang gustong and impairment. -Communication
kainin halos sa understanding of becomes
araw araw.” communication. -Facilitate on progressively
As verbalized by evaluating the impaired as AD
the patient’s OREM effects of advances.
relatives. THEORY: communication
Supportive deficit. -This indicates
Objective Cues: educative that feelings or
-Restlessness -Facilitate on needs are being
-Uncomfortable monitoring and expressed when
observing speech is
patient for impaired.
nonverbal
communication,
such as facial
grimacing,
smiling, pointing -To promote
and crying. clear
communication
-Facilitate on with the patient,
competing nurse should
stimuli and remain
provide a calm, unhurried during
unhurried interaction.
atmosphere for Reduction of
communication. noises and calm
environment
allows the
patient more
time to interpret
the conveyed
message.
Nursing
Diagnosis:

Impaired verbal
communication
related to
Alzheimer’s
disease

ASSESSMENT PLANNING INTERVENTIO RATIONALE EVALUATION

N
SHORT TERM -Facilitate on -Impairment of Goal met –
assessing the visual perception patient was able
Objective Cues: After 5 days of degree of increases the risk to remain safe
-Restlessness administration in impaired ability of falling and from
-Uncomfortable the hospital, the of competence, causing injuries. environmental
patient will the emergence of Identify hazards and
remain safe from impulsive potential risks in family was able
environmental behavior and the environment to ensure safety
hazards. Family decrease in and heighten precautions.
members will visual awareness.
ensure safety perception.
precautions are -Maintain
instituted and -Facilitate on security by
followed. eliminating avoiding a
sources of confrontation
OREM hazards in the that could
THEORY: environment improve the
Supportive behavior or
educative increase the risk
for injury.
-Instruct family -This prevents
regarding physical injuries
removal or from ingestions,
locking up burns, overdoses
knives and sharp and accidents.
objects away
from the patient.
-This prevents
-Instruct family accident injury
to apply and
protective guard electrocution.
over electrical
outlets,
thermostats, and
stove knobs. -This prevents
the risk for falls
-Instruct family that might cause
to keep serious
 pathways clear, accidents.
move furniture
against the wall,
remove small
rugs, remove
wheels on bed
and chairs or
lock them in
place.
Nursing
Diagnosis:

Risk for injury

related to
Alzheimer’s
disease process

IX. HEALTH TEACHING

M-edication -Educate the family on when the patient is
going to take her medicines such as
Dopenezil, Galantamine, and
Rivastigmine, also the purpose of the
drugs.
-Educate the family the possible side or
adverse effects of the medications.

E-nvironment -Educate the family members and also the

patient to maintain a peace and calm
environment.
-Educate the family about the use of
complementary and alternative therapies to
the patient such as exercise, guided
meditation and massage.
-Educate the family on competing stimuli
and provide a calm, unhurried atmosphere
for communication.

T-reatment -Explain to the family and to the patient

the importance of taking her prescribed
treatment plan and alternative therapies for
her condition.
H-ygiene -Educate the family proper ways on how to
assist patient when taking a bath, since the
 patient cannot do it alone.
-Educate the family proper ways to change
diapers for the patient.
O-ut-patient -Educate family the importance of regular
check-ups for the patient.
-Educate family to immediately seek
medical attention if patient condition
become worse.
D-iet -Encourage the family to provide
vegetables and fruits for the patient.
-Teach the family to avoid giving high in
sodium or high in cholesterol foods for the
patient.
-Teach the family to increase patient’s
fluid intake
S-afety/Spiritual/Sexual -Educate the family on eliminating sources
of hazards in the environment.
-Educate family on removing or locking up
knives and sharp objects away from the
patient.
-Educate the family to provide physical,
emotional and spiritual support for the
patient.
-Educate the family to prioritize the patient
at all times.

X. EVALUATION
After conducting the study, I obtained enough knowledge about
Alzheimer’s Disease, its signs and symptoms, different stages of Alzheimer’s
Disease, proper management, medications and proper treatments. I will now be
able to perform therapeutic intervention that will help family members of the
patient and as well as the patient to gain optimal health as much as possible and
wellness. And also for me, to develop interpersonal skills to gain client
cooperation and trust in the nursing plan of care. The family of the patient has
developed understanding about the patient’s condition. Family members of the
patient are now able to demonstrate proper care, proper techniques and proper
treatment for the patient. The family and the community are now able to
understand the disease process and gained awareness on the contributing factors
of Alzheimer’s Disease. They are now skilled to inform and educate people on the
family and community about the Alzheimer’s Disease. Although, the main cause
of Alzheimer’s Disease is still unknown, through proper medications and
treatment it can have a big impact for the people of the community and display
understanding and patience towards person who has the disease.

The best nursing theory I can highly relate to this situation is Dorothea
Orem’s self-care theory. Since we are dealing with a patient who has Alzheimer’s
Disease. This theory focuses on each individual’s ability to perform self-care.
This theory defined Nursing as “The act of assisting others in the provision and
management of self-care to maintain human functioning at the home level of
effectiveness.” Teaching patient about proper self-care can lead to optimal health.
This theory implies importance that we must always prioritize ourselves and we
must be independent as much as possible when doing self-care.This also implies
the possible problems that we can encounter when doing self-care. In addition, it
also focuses on family members to perform proper care and proper treatment for
the patient.