Nursing diagnoses are potential or current problems that nurses base their care around to best serve and care for their patients. Below is a set of most prominent nursing diagnoses that should be addressed in the care of a patient with Alzheimer's disease. Included are also some suggestions on what to do as a nurse to address and help manage these problems.
1. Risk for violence: self-directed or other-directed
This problem can be due to many other problems, including impaired perception of reality, impaired frustration tolerance, decreased self-esteem, perceived threat to self, impaired coping skills, drug intoxication, physical discomfort, etc.
Assessment to detect and monitor this nursing diagnosis:
-assess cognitive factors that may contribute to violent behaviors such as impairment in judgment, delusional thought patterns, and impaired concentration or decreased response to redirection
-assess for physical factors that may foster violence (discomfort, sensory overload, noise, etc.)
-assess emotional factors that can lead to violence (inability to cope, expressions of low self-esteem, noncompliance with treatment plan, history of aggressive behaviors)
-evaluate the impact of the medication regimen on behaviors
Therapeutic interventions:
-involve the patient on a cognitive level as much as possible
-reorient, reduce stimuli, and keep constant schedules with patient
-attempt feedback on behavior inappropriateness
-allow patient with more personal space and independence if possible
-provide with diversional activities
-permit verbalization of patient feelings
-offer acceptable alternatives to unacceptable behaviors
-initiate safety measures
2. Self-care deficit: bathing, dressing, feeding
This problem can occur in the presence of impaired memory, disorientation, impaired judgment, or impaired sense of social self.
Assessments to detect and monitor problem:
-assess for cognitive deficits or behaviors that could create difficulty in performing personal hygiene
-assess level of independence in completing self-care
Therapeutic interventions:
-instruct caregiver in strategies to improve self-care activities
-stay with patient during self-care activities if judgement is impaired
-allow enough time with limited distractions in environment
-follow established routine for self-care
-provide easy-to-read reminders of self-care activities
-assist with care as needed, but always encourage patient independence
-limit number of choices of food on plates or trays
-provide easy-to-eat finger foods if motor coordination is impaired
3. Impaired social interaction
This problem can occurs with impaired sense of social self, memory deficits, disturbed thought processes, social isolation, and impaired judgment.
Assessments to detect and monitor problem:
-assess for cognitive deficits or behaviors that inter ere with forming relationships with others
-assess for previous patterns of interactions
-assess patient's potential to interact in a community day care situation
Therapeutic interventions:
-provide regular opportunities for frequent, brief contacts within a nurse-patient relationship
-encourage regular opportunities for interpersonal contacts and relationships
-assist caregiver with supporting participation in social activities as appropriate
-redirect patient when behaviors become socially embarrassing or when the patient expresses delusional ideas
-discuss subjects with patient that is of interest but does not require short-term recall
-consider impact of environment on social interactions, avoiding overstimulating environments
-involve the patient in a daily schedule that allows for social activity as well as quiet time
-provide information on community day care programs
4. Impaired home maintenance
This problem can become present due to impaired memory, disorientation, or impaired judgment in the patient.
Assessments to detect and monitor problem:
-determine the adequacy of the home environment
-assess patient's ability to recognize dangers or hazards in the home
-assess frequency of disorientation, wandering, and becoming lost in familiar surroundings
-assess family's and/or caregiver's understanding of patient needs and deficits, resources, and family's ability to cope and find support systems
Therapeutic interventions:
-involve the patient, family and/or caregiver in all home planning
-discuss need to wear identification bracelet at all times
-suggest daily supervised exercise or a walking program
-identify and encourage the correction of obstacles and hazards in the home
-provide information about home security devices
-recommend procedures for getting help in case patient becomes lost
-help family to identify and mobilize available support networks (home health services, support groups, church groups, senior citizen organizations, etc.)
-provide literature and references related to caring for cognitively impaired people in the home
5. Caregiver role strain
This problem can sometimes be overlooked, but it is an important aspect of patient care. This problem can occur when caregivers have knowledge deficit regarding management of care, personal and social life disruptions due to caregiving, multiple competing roles, no respite from caregiver demands, or do not have community resources available.
Assessments to detect and monitor problem:
-assess caregiver-care recipient relationship
-assess family communication patterns
-assess family resources and support systems
-determine caregiver's knowledge and ability to provide patient care
Therapeutic interventions:
-provide information and instruction on disease process and management strategies
-encourage caregiver to identify available family and friends who can assist with caregiving
-suggest that caregiver use available community resources
-consult a social worker for referral for community resources and/or financial aid as needed
-encourage the caregiver to set aside time for self
-acknowledge to caregiver his or her role and its value
Source:
Gulanick, Meg, and Judith L. Myers.
Nursing Care Plans: Diagnoses, Interventions, and Outcomes. 8th ed. Philadelphia: Elsevier Mosby. Print.
