Nursing Intervention Paper
Running head: NURSING ASSESSMENT AND INTERVENTIONS 1
Nursing Assessment and Interventions to Older Adults With Dementia
Karen Montanez
Trinitas School of Nursing
Abstract
This paper explores three published articles that report the different nursing assessments, strategies and interventions for patients with dementia. The paper explains the meaning of dementia, how to communicate properly with patients who suffer from the disease and techniques to achieve a good understanding of the patient’s needs. Also, this paper examines different ways on how to properly assess and deal with the disease, nursing care strategies for older adults with dementia, and how to avoid restrains or any invasive procedures that might agitate or confuse the patient.
Keywords: dementia, older patient care, nursing care
Nursing Assessment and Interventions to Older Adults with Dementia
The term dementia is used to describe the symptoms that occur when the brain is affected by specific diseases and conditions. These include Alzheimer 's disease and strokes. Dementia is progressive, which means the symptoms will gradually get worse. How quickly dementia progresses will depend on the individual. Some of the symptoms are memory loss, mood changes, and communication problems. Each …show more content…
person is different and unique; therefore, individuals will experience dementia in their own way. Is it important to know what type of dementia a person has to begin to understand the individual challenges they might face. Dementia affects about 5% of individuals 65 and older and 4 to 5 million Americans have Alzheimer’s disease (Fletcher, 2012). As nurses, is necessary to understand the best practices to facilitate communication, nursing care, and individualized care that permit nursing the patient safely and without restraints.
Dementia impairs a person’s ability to communicate effectively (Zembrzuski, 2013). The person looses the ability to decode and understand information and the ability to encode and express information. The combination of language deficits and other symptoms related to dementia, like memory loss or impaired judgment, result in serious communication difficulties for the older adult with dementia. The responsibility to facilitate communication lies on the person giving care to the patient because the patient’s communication deficit and cognitive impairments are caused by his or her dementia (Zembrzuski, 2013). An assessment of the patient’s particular communication pattern is essential. The assessment is based on your own observation and the information obtained from the family about the patient. This would help the caretaker compensate for language and other impairments and facilitate understanding of the patients needs. For people with dementia behavior is also a form a communication, such as agitation, restlessness, aggression, and combativeness are often expressions of unmet needs. Caretakers have to interpret the meaning of certain behaviors to understand the patients unmet needs (Zembrzuski, 2013). One of the tools to assess language deficits and facilitate communication is the assessment of “specific receptive and expressive language abilities are needed in order to understand the patient’s communication difficulties and facilitate communication” (Zembrzuski, 2013). Some examples on how to assess receptive anilities and expressive abilities are below:
Receptive abilities: ask simple direct questions that only require a yes or no answer; this tells you if the patient understands a yes or no choice.
Use one-step instructions and short simple sentences to enhance the patient’s ability to process instructions and information. Use of gestures is very important! Even if the patient cannot understand what you are saying verbally they can read your body language; therefore, caretakers have to be sensitive, and last but not least, if the patient is presented with two objects or options, you may want to limit the choices because too many options will cause confusion and frustration (Zembrzuski,
2013).
Expressive abilities: if patient is trying to communicate something and you are sure of the word the person is trying to say, repeat it. If not sure, don’t guess what the patient is trying to say because it will increase the anxiety and confusion of the patient. When talking to the patient listen for the meaningful words and ideas and try to identify the person thoughts. If the patient is aggressive, offensive or shows combative behavior, validate the patient’s feelings and assess for unmet needs, and read nonverbal communication, such as patient’s body language (Zembrzuski, 2013). Also, the usage of general communication tips is very helpful when trying to communicate with the patient. When taking care of an older adult with dementia, the caregiver has a goal to appropriately manage strategies in the care of these individuals, “nurses have a central role in assessment and management of individuals with progressive dementia” (Fletcher, 2012).
Parameters of assessment Assessment domains include cognitive, functional, behavioral, physical, caregiver, and environment (Fletcher, 2012).
Cognitive: when assessing the patient’s cognitive parameters we want to know how oriented is the patient to person, time, and place. Assess memory, attention, and the ability to organize and communicate ideas, language, and ability to coordinate movements. Also, mental status screening tools are used to assess cognitive change (Fletcher, 2012).
Functional: functional activities questionnaire (FAQ) are useful in monitoring the progression of functional decline. The severity of the disease progression is demonstrated by the decline in activities of daily living (Fletcher, 2012).
Behavioral: monitor behavioral changes as agitation, anxiety, delusions and hallucinations. Evaluate for depression using the Geriatric Depression Scale (GDS) since depression is very common for patients with dementia (Fletcher, 2012).
Physical: a full assessment focusing on the neurological and cardiovascular system. An evaluation of all medications taken at home or prescribed is done to determine the potential impact these might on had on the patient’s cognitive status. Laboratory tests are also a valuable in differentiating irreversible from reversible forms of dementia (Fletcher, 2012).
Caregiver/ environment: is essential to know the caregiver’s perspective of patient function and the level of support provided. It is also important to evaluate the impact that the patient’s cognitive impairment have on the caregiver and the evaluation of the caregiver experience and patient-caregiver relationship (Fletcher, 2012).
Some of the nursing care strategies for the care of patient’s with dementia are the following:
-Monitor effectiveness and side effects of medications given to improve cognitive function.
-Ensure the patient has adequate sleep, fluid, nutrition, and elimination, pain control and comfort measures.
-Avoid usage of restrains: the usage of physical restrains in older adults is associated with poor outcomes. Patients may try to resist or “escape” because the feel lost and afraid, and since the language deficits do not let them communicate their needs, older adults with dementia are more likely to be restrained when hospitalized, especially when agitation is present, confusion, pulling at medical devices, or getting out of bed unassisted is seems as unsafe and/or interfering with treatment (Cotter, 2012). The best practice is to nurse the patient safely without the use of pharmacologic or physical restraints. It is very important for the caregiver to assess behaviors that place the patient at risk for restraint use! (Cotter, 2012)
-Encourage independence as long as possible.
-Address behavioral issues. Identify environmental triggers, medical conditions, or caregiver-patient conflict that might be causing the behavior.
-Ensure a therapeutic and safe environment
-Explain trajectory of progressive dementia, treatment options, and advance directives.
-Provide caregiver education and support
-Integrate community resources into the plan of care.
Conclusion
Nurses play a very important role in the care of older adults with dementia. Caregivers should demonstrate effective caregiving skills, reflect a safe and enabling environment for delivering care to individuals with progressive dementia, communication skills, and quality improvement plans addressing high-risk problem-prone areas for individuals with dementia, such as the use of restrains.
References
Cotter, V. (2012). Avoiding restraints in hospitalized older adults with dementia. Try This, (D1). Retrieved January 1, 2014.
Fletcher, K. (2012). Dementia geriatric nursing protocol: Recognition and management of dementia. Hartford Institute for Geriatric Nursing. Retrieved November 1, 2014, from http://consultgerin.org/topics/dementia/want_to_know_more
Zembrzuski, C. (2013). Communication Difficulties: Assessment and interventions in hospitalized older adults with dementia. New York University College of Nursing, (D7). Retrieved January 1, 2014.
Nursing Assessment and Interventions to Older Adults With Dementia
Karen Montanez
Trinitas School of Nursing
Abstract
This paper explores three published articles that report the different nursing assessments, strategies and interventions for patients with dementia. The paper explains the meaning of dementia, how to communicate properly with patients who suffer from the disease and techniques to achieve a good understanding of the patient’s needs. Also, this paper examines different ways on how to properly assess and deal with the disease, nursing care strategies for older adults with dementia, and how to avoid restrains or any invasive procedures that might agitate or confuse the patient.
Keywords: dementia, older patient care, nursing care
Nursing Assessment and Interventions to Older Adults with Dementia
The term dementia is used to describe the symptoms that occur when the brain is affected by specific diseases and conditions. These include Alzheimer 's disease and strokes. Dementia is progressive, which means the symptoms will gradually get worse. How quickly dementia progresses will depend on the individual. Some of the symptoms are memory loss, mood changes, and communication problems. Each …show more content…
person is different and unique; therefore, individuals will experience dementia in their own way. Is it important to know what type of dementia a person has to begin to understand the individual challenges they might face. Dementia affects about 5% of individuals 65 and older and 4 to 5 million Americans have Alzheimer’s disease (Fletcher, 2012). As nurses, is necessary to understand the best practices to facilitate communication, nursing care, and individualized care that permit nursing the patient safely and without restraints.
Dementia impairs a person’s ability to communicate effectively (Zembrzuski, 2013). The person looses the ability to decode and understand information and the ability to encode and express information. The combination of language deficits and other symptoms related to dementia, like memory loss or impaired judgment, result in serious communication difficulties for the older adult with dementia. The responsibility to facilitate communication lies on the person giving care to the patient because the patient’s communication deficit and cognitive impairments are caused by his or her dementia (Zembrzuski, 2013). An assessment of the patient’s particular communication pattern is essential. The assessment is based on your own observation and the information obtained from the family about the patient. This would help the caretaker compensate for language and other impairments and facilitate understanding of the patients needs. For people with dementia behavior is also a form a communication, such as agitation, restlessness, aggression, and combativeness are often expressions of unmet needs. Caretakers have to interpret the meaning of certain behaviors to understand the patients unmet needs (Zembrzuski, 2013). One of the tools to assess language deficits and facilitate communication is the assessment of “specific receptive and expressive language abilities are needed in order to understand the patient’s communication difficulties and facilitate communication” (Zembrzuski, 2013). Some examples on how to assess receptive anilities and expressive abilities are below:
Receptive abilities: ask simple direct questions that only require a yes or no answer; this tells you if the patient understands a yes or no choice.
Use one-step instructions and short simple sentences to enhance the patient’s ability to process instructions and information. Use of gestures is very important! Even if the patient cannot understand what you are saying verbally they can read your body language; therefore, caretakers have to be sensitive, and last but not least, if the patient is presented with two objects or options, you may want to limit the choices because too many options will cause confusion and frustration (Zembrzuski,
2013).
Expressive abilities: if patient is trying to communicate something and you are sure of the word the person is trying to say, repeat it. If not sure, don’t guess what the patient is trying to say because it will increase the anxiety and confusion of the patient. When talking to the patient listen for the meaningful words and ideas and try to identify the person thoughts. If the patient is aggressive, offensive or shows combative behavior, validate the patient’s feelings and assess for unmet needs, and read nonverbal communication, such as patient’s body language (Zembrzuski, 2013). Also, the usage of general communication tips is very helpful when trying to communicate with the patient. When taking care of an older adult with dementia, the caregiver has a goal to appropriately manage strategies in the care of these individuals, “nurses have a central role in assessment and management of individuals with progressive dementia” (Fletcher, 2012).
Parameters of assessment Assessment domains include cognitive, functional, behavioral, physical, caregiver, and environment (Fletcher, 2012).
Cognitive: when assessing the patient’s cognitive parameters we want to know how oriented is the patient to person, time, and place. Assess memory, attention, and the ability to organize and communicate ideas, language, and ability to coordinate movements. Also, mental status screening tools are used to assess cognitive change (Fletcher, 2012).
Functional: functional activities questionnaire (FAQ) are useful in monitoring the progression of functional decline. The severity of the disease progression is demonstrated by the decline in activities of daily living (Fletcher, 2012).
Behavioral: monitor behavioral changes as agitation, anxiety, delusions and hallucinations. Evaluate for depression using the Geriatric Depression Scale (GDS) since depression is very common for patients with dementia (Fletcher, 2012).
Physical: a full assessment focusing on the neurological and cardiovascular system. An evaluation of all medications taken at home or prescribed is done to determine the potential impact these might on had on the patient’s cognitive status. Laboratory tests are also a valuable in differentiating irreversible from reversible forms of dementia (Fletcher, 2012).
Caregiver/ environment: is essential to know the caregiver’s perspective of patient function and the level of support provided. It is also important to evaluate the impact that the patient’s cognitive impairment have on the caregiver and the evaluation of the caregiver experience and patient-caregiver relationship (Fletcher, 2012).
Some of the nursing care strategies for the care of patient’s with dementia are the following:
-Monitor effectiveness and side effects of medications given to improve cognitive function.
-Ensure the patient has adequate sleep, fluid, nutrition, and elimination, pain control and comfort measures.
-Avoid usage of restrains: the usage of physical restrains in older adults is associated with poor outcomes. Patients may try to resist or “escape” because the feel lost and afraid, and since the language deficits do not let them communicate their needs, older adults with dementia are more likely to be restrained when hospitalized, especially when agitation is present, confusion, pulling at medical devices, or getting out of bed unassisted is seems as unsafe and/or interfering with treatment (Cotter, 2012). The best practice is to nurse the patient safely without the use of pharmacologic or physical restraints. It is very important for the caregiver to assess behaviors that place the patient at risk for restraint use! (Cotter, 2012)
-Encourage independence as long as possible.
-Address behavioral issues. Identify environmental triggers, medical conditions, or caregiver-patient conflict that might be causing the behavior.
-Ensure a therapeutic and safe environment
-Explain trajectory of progressive dementia, treatment options, and advance directives.
-Provide caregiver education and support
-Integrate community resources into the plan of care.
Conclusion
Nurses play a very important role in the care of older adults with dementia. Caregivers should demonstrate effective caregiving skills, reflect a safe and enabling environment for delivering care to individuals with progressive dementia, communication skills, and quality improvement plans addressing high-risk problem-prone areas for individuals with dementia, such as the use of restrains.
References
Cotter, V. (2012). Avoiding restraints in hospitalized older adults with dementia. Try This, (D1). Retrieved January 1, 2014.
Fletcher, K. (2012). Dementia geriatric nursing protocol: Recognition and management of dementia. Hartford Institute for Geriatric Nursing. Retrieved November 1, 2014, from http://consultgerin.org/topics/dementia/want_to_know_more
Zembrzuski, C. (2013). Communication Difficulties: Assessment and interventions in hospitalized older adults with dementia. New York University College of Nursing, (D7). Retrieved January 1, 2014.