Nursing Care Plan for Dementia

Dementia refers to the loss of previous levels of cognitive, executive, and memory function in a state of full alertness. The condition has a slow, insidious onset, and degenerates into a chronic, progressive and irreversible state. With the longer life expectance of the world population, cases of dementia have continued to increase.

What causes Dementia?

Dementia is caused by various factors. However, the following are major etiologic classifications for the syndrome of dementia:

• Dementia of the Alzheimer’s type: The actual cause of Alzheimer’s disease is not known, but several theories have been proposed and they include reduction in brain acetylcholine, formation of plagues and tangles, serious head trauma, and genetic factors.
• Dementia due to HIV: The immune dysfunction related to HIV can lead to brain infections by other organisms. As such, HIV seems to cause dementia quite directly.
• Dementia due to Parkinson’s disease: Parkinson’s disease is occasioned by the loss of nerve cells in the substantia nigra of the basal ganglia. As such, the symptoms of dementia-related to Parkinson’s disease is similar to those of AD.
• Vascular Dementia: Vascular dementia is caused by substantial cerebrovascular disease. The patient suffers the equivalent of small strokes caused by arterial hypertension or cerebral emboli or thrombi that destroys many areas of the brain. The onset of this type of dementia is more abrupt than in AD.
• Dementia due to head trauma: The signs and symptoms related to dementia can be occasioned by a traumatic head injury.
• Dementia due to Creutzfeldt-Jacob disease: This type of dementia is caused by a transmissible agent “slow virus” or prion. Its clinical presentation is typical of the condition of dementia and the progression is quite rapid with progressive deterioration and death within a year after onset.
• Dementia due to Huntington’s Disease: This type of dementia is transmitted as a Mendelian dominant gene, and the damage occurs in the areas of the basal ganglia and the cerebral cortex.
• Dementia due to Lewy Body Disease: Lewy Body disease is relatively similar to AD. However, it progresses more rapidly and there is an earlier appearance of visual hallucinations and parkinsonian features. This condition is distinctive by the presence of Lewy bodies-eosinophilic inclusion bodies- seen in the cerebral cortex and brainstem.
• Substance-induced Persisting Dementia: This kind of dementia is associated with the persisting effects of substances like alcohol, sedatives, inhalants, anxiolytics, hypnotics, various medications, and environmental toxins.

Clinical manifestations of Dementia

The following have some of the clinical manifestations related to the condition of dementia:

• Impairment in abstract thinking, judgment, and impulse control
• Memory impairment with the inability to learn new information or to recall previously learned information
• Personality changes
• Impairment in language ability with difficulty in naming objects or in some cases, the patient might not speak at all
• Wandering due to disorientation of the mind
• Disorientation. The patient may feel disoriented regarding time, names of close family members, or current place.
• Delusions especially of persecution
• Impaired ability to execute motor activities despite intact motor abilities

Nursing Assessment for Dementia

The nursing assessment of a patient with dementia involves the following:

• Psychiatric interview

The nurse must conduct a psychiatric interview and must contain a description of the patient’s mental condition with an extensive description of behavior, the flow of thought and speech, affect, mental content and thought processes, cognitive status, sensorium, insight, intellectual resources, and judgment.

• Serial assessment

The nurse should perform a serial assessment of the psychiatric status. This is necessary to determine the fluctuating course and acute changes in mental condition. The interview with family members should be included as it will be crucial in the treatment of infants and young children with cognitive conditions.

Nursing Diagnosis

• Chronic mix-up associated with alteration in structures or function of the brain tissue
• Risk for trauma associated with disorientation or confusion
• Self-care impairment associated with cognitive disorders
• Risk for falls occasioned by cognitive impairment
• Risk for self-directed or other-directed violence related to delusional thinking

Nursing Care Planning and Goals

There are two major nursing care planning and goal for dementia and they are:

• The patient will accept explanations of inaccurate interpretation within the environment
• With the help of the nurse or caregiver, the patient will be able to interrupt non-reality-based thinking.

Nursing Interventions

The following are nursing interventions for a dementia patient. The interventions include:

• Orient the patient: Regularly orient the patient to reality and the current environment. Let the patient familiarize with the objects around them, use items such as a calendar, watch or clock, and daily schedules to help in maintaining reality orientation.
• Encourage caregivers about patient reorientation: Guide prospective caregivers on how to orient the patient to time, place, person, and circumstances as needed. The caregiver will be responsible for the patient’s safety after discharge from the hospital.
• Discourage suspiciousness of others: Express reasonable doubt if the patient communicates suspicious beliefs in response to delusional thinking. Talk with the patient about the possible personal negative effects of frequent suspiciousness of others. 
• Implement with positive feedback: Give positive feedback when the patient’s behavior and thinking are appropriate or when the patient verbalizes those ideas expressed are not founded in reality. Positive feedback improves self-esteem and increases the desire to repeat appropriate behavior.
• Simply explain: Use of simple explanations and face-to-face interaction when conversing or communicating with the patient instead of shouting into the patient’s ear. Speaking slowly and in a face-to-face position is an effective way of communicating with a dementia patient experiencing a hearing loss.
• Observe the patient closely: Closely observe the patient’s behavior can help find out if delusional thinking reveals an intention for violence. The patient’s safety is a nursing priority.
• Avoid cultivation of false ideas: Don’t allow rumination of false ideas and once observed, talk to the patient about real people and real events.

Nursing Evaluation

The nursing outcome criteria for a dementia patient include:

• With the help of a caregiver, the patient can differentiate between reality-based and non-reality-based thinking.
• Potential caregivers can verbalize ways to orient the patient to reality as required.

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