NURSING MANAGEMENT OF PATIENT WITH DEMENTIA

 By Jones H.M- MBA/DMS

NURSING MANAGEMENT OF PATIENT WITH DEMENTIA

Develop a therapeutic relationship

Develop a relationship with the person based on empathy and trust. This will allow the patient to be more comfortable to verbalize feelings, challenges and also foster cooperation. This is especially so, since a person with dementia may have memory challenges and at times harbor paranoid thoughts.

Ward environment and patient’s safety

Maintain a safe environment for the person, yourself and other staff. Dementia patients may become agitated experience emotional instability from time to time and as such may harm self or become aggressive to others within the environment. In this regard, it is important to take the necessary environmental interventions to prevent any form of injury from taking place.

If the person is agitated, maintain a quiet environment. Check noise levels regularly and reduce them if necessary by turning off the radio and television. In addition, give the person a comfortable space. Any activity that involves invasion of personal space increases the risk of assault and aggression.

Taking into consideration the fact that persons with dementia usually experience memory challenges, it is helpful to provide an environment that supports a flexible but predictable routine for them to follow easily with reduced chances of confusion. Provide orientating cues such as a clock and calendar.

Social support

Promote the person’s engagement with their social and support network especially that individuals with dementia are likely to isolate themselves. A strong support network can provide an appropriate channel for coping with the challenges of everyday life that come with the disorder. In addition, ensure effective collaboration with other relevant service providers, through development of effective working relationships and communication.

Furthermore, Support and promote self-care activities for families and carers of the person with dementia because they are likely to be overburdened with caring for the family member with the disorder. Provide family members and carers with information about the illness if appropriate, as well as reassure and validate their experiences with the person. Encourage family members and carers to look after themselves and seek support if required.

Psychological Support

As a means of showing acceptance to the patient, supportive touch can be extended to the patient by the nurse. In addition, interactions with others can be enhanced to reduce on negative feelings of loneliness through activities such as group therapy and other social activities organized at ward level. Such activities promote raised self-esteem and act as diversion therapy.

Activities of Daily Living

In order to enhance a feeling of self-control, the patient should be allowed to make simple choices about their day to day life such as what to wear, what time to carry out some important activities etc. these tasks should be broken down into short, simple steps to make it easy for the patient to carry them out. Further, as a means of reducing excitement and wandering about in the evening, any form of exercise is of great help to the patient.

Maintaining adequate Nutrition Level

Patients should be reminded about meal times because of possible memory impairment and such time should be kept consistent to avoid confusion and foster self-care with regard to feeding. In restless patients, finger foods can be provided in form of a balanced diet high in calorie content.

Elimination

Provide to the patient enough fluids and meals that are rich in fiber to enable adequate peristalsis taking place. In addition, the patient should be reminded from time to time about the need to go to the toilet in order to prevent incontinence.

Administration and monitoring of Medication

Tacrine (Cognex), Donepezil (Aricept), Rivastigimine (Exelon), Galantamine (Reminyl)

Reversible Cholinesterase Inhibitors which slow the natural breakdown of ACh = ↑ ACh

Slows progression of memory loss

Anxiolytics

Short term use to ↓ anxiety ↓

Antipsychotics

↓Agitation ↓ Aggression ↓ Hallucinations

↓ Paranoid thinking

Antidepressants

↑ Sleeping ↑ Thinking ↑ Memory ↑ Appetite

Amitriptyline (Elavil) Trazodone (Desyrel) Bupropion (Wellbutrin)

SSRIs

No Fluoxetine (Prozac) inhibits liver enzymes & ↑ serum levels of other meds

Paroxetine (Paxil