Transcript Slide 1

ALZHEIMER'S DISEASE
Jerry Carley RN, MSN, MA, CNE
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Concept Map: Selected Topics in Neurological Nursing
ASSESSMENT
Physical Assessment
Inspection
Palpation
Percussion
Auscultation
ICP Monitoring
“Neuro Checks”
Lab Monitoring
PATHOPHYSIOLOGY
PHARMACOLOGY
Traumatic Brain Injury
Spinal Cord Injury
Specific Disease Entities:
Amyotropic Lateral Sclerosis
Multiple Sclerosis
Huntington’s Disease
Alzheimer’s Disease
Myasthenia Gravis
Guillian-Barre’ Syndrome
Meningitis
Parkinson’s Disease
Care Planning
Plan for client adl’s,
Monitoring, med admin.,
Patient education, more…based
On Nursing Process:
A_D_O_P_I_E
--Decrease ICP
--Disease Specific
Meds
Nursing Interventions & Evaluation
Execute the care plan, evaluate for
Efficacy, revise as necessary
Alzheimer's Disease
 Non - reversible dementia that
progressively develops through 3 stages over
many years
 Alzheimer's disease is the most common
cause of dementia, or loss of intellectual
function, among people aged 65 and older
 Alzheimer's disease is NOT a normal part of
aging
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Alzheimer's Disease
 Non - reversible dementia that
progressively develops through 3 stages over
many years
 Alzheimer's disease is the most common
cause of dementia, or loss of intellectual
function, among people aged 65 and older
 Alzheimer's disease is NOT a normal part of
aging
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Characteristics
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Memory loss
Impaired Judgment
Personality changes
Severe physical decline with
cognitive changes
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Pathophysiology
 Neurons, which produce acetylcholine
(neurotransmitter) break connections with
other nerve cells and ultimately die
 Two types of abnormal lesions clog the
brains of individuals with Alzheimer's disease:
 Beta-amyloid plaques—sticky clumps of
protein fragments and cellular material that
form outside and around neurons
 Neurofibrillary tangles—insoluble twisted
fibers composed largely of the protein that
build up inside nerve cells
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Pathophysiology
 Neurons, which produce acetylcholine
(neurotransmitter) break connections with
other nerve cells and ultimately die
 Two types of abnormal lesions clog the
brains of individuals with Alzheimer's disease:
 Beta-amyloid plaques—sticky clumps of
protein fragments and cellular material that
form outside and around neurons
 Neurofibrillary tangles—insoluble twisted
fibers composed largely of the protein that
build up inside nerve cells
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Stage 1
First 1-3 years:
-Short-term memory loss
-Subtle personality changes
-Shorter attention span
-Mild cognitive deficits
-Difficulty with money, numbers and
bills
-Difficulty with depth perception
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Stage 2
From 2 – 10 years:
-Obvious memory loss
-Wandering
-Confabulation
-“Sundowning”
-Irritability / Agitation
-Impaired motor skills, judgment
-Self-care deficits
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Stage 3
From 8 – 10 years:
-Severe impairment of all cognitive
abilities
-Disoriented
-B & B incontinence
-Inability to recognize family & friends
-Loss of speech
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The 4 A’s of Alzheimer's
Amnesia
(inability to remember facts or events). Short-term memory is programmed in temporal lobe, while
long-term memory is stored throughout extensive nerve cell networks in the temporal and parietal
lobes. In Alzheimer's disease, short-term memory storage is damaged first
 Aphasia
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(inability to communicate effectively). The loss of ability to speak and write is called expressive
aphasia. With receptive aphasia, an individual may be unable to understand spoken or written words.
Sometimes an individual pretends to understand and even nods in agreement; this is to cover-up
aphasia. Although individuals may not understand words and grammar, they may still understand nonverbal behavior, i.e. smiling
 Apraxia
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(inability) to do pre-programmed motor tasks, or to perform activities of daily living such as brushing
teeth and dressing. Sophisticated motor skills that require extensive learning, such as job-related
skills, are first functions that become impaired. More instinctive functions like chewing, swallowing
and walking are lost in the last stages of the disease
 Agnosia
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(inability to correctly interpret signals from their five senses). May not recognize familiar people and
objects. A common yet often unrecognized agnosia is the inability to appropriately perceive visceral,
or internal, information such as a full bladder or chest pain.
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Diagnosis
 Clinicians can now diagnose with up to 90 % accuracy. But it can only be
confirmed by an autopsy, pathologists look for the disease's
characteristic plaques and tangles in brain tissue
 Clinicians diagnose "probable" Alzheimer's disease by medical history,
lab tests, physical exam, brain scans and neuropsychological tests that
gauge memory, attention, language skills and problem-solving abilities
 Proper diagnosis of Alzheimer's disease is critical since there are dozens
of other reversible causes for Sx’s
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Treatment
 U.S. Food and Drug Administration (FDA) has so far
approved four drugs for the treatment of mild to
moderate Alzheimer's disease:
- Cognex®), introduced in 1993
- Donepezil hydrochloride (Aricept®), marketed since 1996
- Rivastigmine (Exelon®), available since the spring 2000
-Galantamine hydrobromide (RazadyneTM-formerly called Reminyl®)
approved in Feb/01
 These drugs inhibit the enzyme that breaks down
the brain chemical acetylcholine, and thereby may
help slow the worsening of symptoms
 The FDA in October 2003 approved memantine HCI
(NamendaTM) for the treatment of moderate to
severe Alzheimer's disease, which can slow the
decline in mental function
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Risk Factors
 People with a family history of
Alzheimer's have a greater risk, implying
that a genetic factor is involved. Some
involve a mutation of the gene for the
protein APP, found on chromosome 21
 Adults who have had head injuries are
three times more likely to develop
Alzheimer's disease
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Nursing Care
 CONSISTENCY - Introduce change
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gradually
Use repetition
Therapeutic touch if able
Avoid overstimulation and clutter
Don’t argue / Don’t reinforce –
Acknowledge feelings / Distract
Regular toileting
Reality orientation, memory training
Meds as needed
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Safety Precautions
 Identification (on back of gown,
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etc)
Alarm systems / Lock exit doors
Keep up to date Picture
Frequent supervision
No throw rugs
Fall Program
Etc
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