Nursing Care Plans for Alzheimer's Disease

Alzheimer's disease

Alzheimer's disease (AD) is the most common form of dementia among older people. Dementia is a brain disorder that seriously affects a person's ability to carry out daily activities.

AD begins slowly. It first involves the parts of the brain that control thought, memory and language. People with AD may have trouble remembering things that happened recently or names of people they know. Over time, symptoms get worse. People may not recognize family members or have trouble speaking, reading or writing. They may forget how to brush their teeth or comb their hair. Later on, they may become anxious or aggressive, or wander away from home. Eventually, they need total care. This can cause great stress for family members who must care for them.

AD usually begins after age 60. The risk goes up as you get older. Your risk is also higher if a family member has had the disease.

No treatment can stop the disease. However, some drugs may help keep symptoms from getting worse for a limited time.

NIH: National Institute on Aging

Nursing Care Plans for Alzheimer's Disease

Nursing Assessment

1. Activity / rest
   Symptoms: feeling melting / tired
   Signs: anxiety, helplessness, disruption
   Lethargy sleep patterns and impaired motor skills


2. Circulation
   Symptoms: History of cerebral vascular disease / systemic, hypertension, embolic episodes


3. Ego integrity
   Symptoms: suspicious or afraid of the situation / person fantasies, misperceptions of the environment, loss of multiple.
   Signs: hide incompetence, sit and watch the other, the first activity may accumulate objects are not moving and emotionally stable


4. Elimination
   Symptoms: The urge to urinate
   Signs: Incontinence of urine / feaces


5. Food / fluid
   Symptoms: Historical episodes of hypoglycemia, changes in taste, appetite, weight loss.
   Signs: loss of ability to chew, avoiding / refusing to eat and looked increasingly thin.


6. Hygiene
   Symptoms: Need help, depending on other people
   Signs: a lack of personal habits, forget to go to the bathroom and less interested in eating time


7. Neuro Sensory
   Symptoms: Improvement of existing symptoms, especially cognitive changes,
   a history of cerebral vascular disease / systemic as well as seizure activity


8. Comfort
   Symptoms: A history of serious head trauma, accident trauma
   Signs: ekimosis laceration and a sense of hostile / attack others


9. Social Integrity
   Symptoms: Feeling lost power
   Signs: Loss of social control, inappropriate behavior.
   

Impaired Social Interaction | Nursing Care Plan Obesity

Nursing diagnosis: impaired Social Interaction related to Verbalized or observed discomfort in social situations, Self-concept disturbance

Possibly evidenced by
Reluctance to participate in social gatherings
Verbalization of a sense of discomfort with others

Desired Outcomes/Evaluation Criteria—Client Will
Social Involvement
Verbalize awareness of feelings that lead to poor social interactions.
Become involved in achieving positive changes in social behaviors and interpersonal relationships.

Nursing intervention with rationale:
1. Review family patterns of relating and social behaviors.
Rationale: Social interaction is primarily learned within the family of origin. When inadequate patterns are identified, actions for change can be instituted.

2. Encourage client to express feelings and perceptions of problems.
Rationale: Helps identify and clarify reasons for difficulties in interacting with others, such as feeling unloved or unlovable and insecure about sexuality.

3. Assess client’s use of coping skills and defense mechanisms.
Rationale: May have coping skills that will be useful in the process of weight loss. Defense mechanisms used to protect the individual may contribute to feelings of aloneness or isolation.

4. Have client list behaviors that cause discomfort.
Rationale: Identifies specific concerns and suggests actions that can be taken to effect change.

5. Involve in role playing new ways to deal with identified behaviors or situations.
Rationale: Practicing these new behaviors enables the individual to become comfortable with them in a safe situation.

6. Discuss negative self-concepts and self-talk, such as, “No one wants to be with a fat person,” “Who would be interested in talking to me?”
Rationale: May be impeding positive social interactions.

7. Encourage use of positive self-talk such as telling oneself “I am OK,” or “I can enjoy social activities and do not need to be controlled by what others think or say.”
Rationale: Positive strategies enhance feelings of comfort and support efforts for change.

8. Refer for ongoing family or individual therapy, as indicated.
Rationale: Client benefits from involvement of SO to provide support and encouragement.

Disturbed Body Image/chronic low Self-Esteem | NCP Obesity

Nursing diagnosis: disturbed Body Image/chronic low Self-Esteem related to Biophysical factors—changes in health status, Psychosocial factors—client’s view of self; changes in body image, personal identity, Family or subculture encouragement of overeating—slimness is valued in this society, and mixed messages are received when thinness is stressed, Perceived failure at ability to control weight, Control, sex, and love issues

Possibly evidenced by
Verbalization of negative feelings about body—mental image often does not match physical reality
Fear of rejection or reaction by others
Feelings of hopelessness, powerlessness
Preoccupation with change—attempts to lose weight
Lack of follow-through with diet plan
Verbalization of powerlessness to change eating habits

Desired Outcomes/Evaluation Criteria—Client Will
Body Image
Verbalize a more realistic self-image.
Demonstrate some acceptance of self as is rather than an idealized image.
Self-Esteem
Seek information and actively pursue appropriate weight loss.
Acknowledge self as an individual who has responsibility for self.

Nursing intervention with rationale:
1. Determine client’s view of being fat and what it does for the individual.
Rationale: Mental image includes our ideal and is usually not up-to-date. Fat and compulsive eating behaviors may have deep-rooted psychological implications, such as compensation for lack of love and nurturing or a defense against intimacy. In addition, chronically obese client may report long-term discrimination in family, social, and professional settings. She or he may experience mixed feelings of fear and shame or compensate for psychological trauma by developing a strong or “big” personality.

2. Promote open communication, avoiding criticism or judgment about client’s behavior.
Rationale: Supports client’s own responsibility for weight loss, enhances sense of control, and promotes willingness to discuss difficulties and setbacks and to problem-solve. Note: Distrust and accusations of “cheating” on caloric intake are not helpful.

3. Outline and clearly state responsibilities of client and nurse.
Rationale: It is helpful for each individual to understand area of own responsibility in the program so that misunderstandings do not arise.

4. Graph weight on a weekly basis.
Rationale: Provides ongoing visual evidence of weight changes, reinforcing reality.

5. Ensure availability of properly sized equipment, including gowns; blood pressure cuff; wider and strong wheelchair, bed, commode, and transfer devices, when providing inpatient care.
Rationale: Healthcare providers have a moral and legal obligation to meet the client’s needs for comfort and safety.

6. Encourage client to use imagery to visualize self at desired weight and to practice handling of new behaviors.
Rationale: Mental rehearsal is very useful in helping the client plan for and deal with anticipated change in self-image or occasions that may arise, such as family gatherings or special dinners, where constant decisions about eating many foods will occur.

7. Provide information about the use of makeup, hairstyles, and ways of dressing to maximize figure assets.
Rationale: Enhances feelings of self-esteem and promotes improved body image.

8. Encourage buying clothes instead of food treats as a reward for weight loss and life successes.
Rationale: Properly fitting clothes enhance the body image as small losses are made and the individual feels more positive. Waiting until the desired weight loss is reached can become discouraging.

9. Suggest the client dispose of “fat clothes” as weight loss occurs.
Rationale: Removes the “safety valve” of having clothes available “in case” the weight is regained. Retaining fat clothes can convey the message that the weight loss will not occur or be maintained.

10. Be alert to myths the client and SO may have about weight and weight loss.
Rationale: Beliefs about what an ideal body looks like or unconscious motivations can sabotage efforts to lose weight. Some of these include the feminine thought of “If I become thin, men will view me as a sexual object”; the masculine counterpart, “I don’t trust myself to stay in control of my sexual feelings”; as well as issues of strength, power, or the “good cook” image.

wasting away in frequent flyerville

A small town hospital in my state decided to do something about the bane of every ER nurses life: frequent flyers. The ones that come up to the triage desk and you tell them to have a seat in the lobby, you don't need their name because it is etched in your brain.

Anyway, this hospital decided to hire a social worker whose job it became to identify these people and work with them to decrease their visits. She started with 24 people and reduced their visits from 294 to 178 in a years time. Saved almost 300,000 dollars. Many of the people had untreated mental illness or stress related problems, were unemployed or homeless. She hooked them up with psychiatrists or social workers, etc.

Why doesn't every ER do this? Sometimes I think that the hospital doesn't want them to stop coming. Medicaid money is better than no money I guess

You are what you love....

Not what loves you. I just keep telling myself that. Is there anything worse than loving someone who doesn't love you back? I doubt it. I've been in this cycle for 6 months now. It's maddening. I want to forget about him SO badly. Sigh. Too bad he lives near me and that doesn't make it easy to forget about him. Especially not when he is so effing charming and adorable. Sigh again.

US News Entrepreneurship Ranking 2012

Babson College's MBA program is ranked No. 1 in entrepreneurship in U.S. News & World Report's 2012 edition of “Best Graduate Schools”, followed by Stanford University (2nd) and MIT Sloan (3rd).

The University of Virginia Darden School of Business entrepreneurship program, part of Batten’s Center for Entrepreneurial Leadership, is placed in a tie for 14th in the category. Last September, the

Nursing Diagnosis for Risk for Imbalanced Body Temperature

NANDA Definition: At risk for failure to maintain body temperature within a normal range

Risks for altered body temperature exist for all persons, but some situations and individual physical capacities place greater risk on certain individuals. Neonates and elderly patients are physically incapable of compensating for environmental exposures and are at greater risk in life-threatening events. Healthy persons, such as the athlete who is performing under extremely hot conditions, are also at risk. Prevention is accomplished by providing education specific to individual needs. For the hospitalized patient, the nurse must recognize potential risks related to the diagnosis and the treatment a patient is receiving.

NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Risk Control
* Risk Detection
* Immune Status

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Temperature Regulation