Case Analysis Scenario 3

8/9/2019 Case Analysis Scenario 3

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Case Analysis: Scenario 3

1. Ang Alzheimers po ay mas kilala natin sa tawag na dementia. Ito po aytinatawag na progressive disease, ibig sabihin po ay lumalala pa ito sa paglipas ngpanahon. Una po ay ang pagiging makakalimutin. Natural lang po na mas maalalaniya ang mga dating pangyayari sa buhay niya, dahil sa karamdaman pong ito ayhirap ang isang tao na matuto o makaalala ng bagong impormasyon. Sa paglala ngsakit, siya po tuluyang nakadepende sa inyo. akakalimutan na niya pati ang pag!alaga sa sarili, kung sino ang kaniyang mga kapamilya, kung bakit siya nasa ospital,at iba pa. Sa ngayon po ay wala pang lunas ang Alzheimers kaya yung mga gamutpo ay para lamang hindi bumilis ang paglala ng sakit.

"ukod naman po sa history ng pamilya o ang pagmana nitong sakit mula sa mgakapamilya, may iba pa pong mga maaaring naging dahilan kung bakit nagkaroon ngAlzheimers #isease ang inyong asawa. Ayon po sa mga pag!aaral, angpinakatinuturing na posibleng dahilan ay ang pagtanda. $aramihan daw po ngnagkakaroon ng ganitong sakit ay mga tao na may edad %& pataas. Sinasabi rin pona doble raw po ang bilang ng mga babaeng may ganitong sakit kaysa sa mgalalaki.

ay mga pag!aaral din pong nagsasabing ang matagal na paggamit ng an'iolyti(s ogamot laban sa madalas o grabeng pag!aalala, pagkabagabag, o an'iety sa Inglesay mas nakakataas ng tsansang magkaroon ng Alzheimers disease. $ung anginyong asawa ay gumagamit nito dati ng mayroong katagalan, maaaring ito angnagging sanhi ng sakit niya.

). *he (lient is in Stage % o+ Alzheimers wherein as mentioned in the alz.orgalzheimers asso(iation-, there is a personality or behavioural (hange whi(h isdepi(ted by the (lient as being depressed and paranoid. And also, the (lient is saidto be dependent +or sel+!(are.

StagesStage 1: No impairment (normal function)

*he person does not e'perien(e any memory problems. An interview with a medi(alpro+essional does not show any eviden(e o+ symptoms o+ dementia.

Stage 2: Very mild cognitive decline (may be normal agerelated c!angesor earliest signs of Al"!eimer#s disease)

*he person may +eel as i+ he or she is having memory lapses / +orgetting +amiliarwords or the lo(ation o+ everyday ob0e(ts. "ut no symptoms o+ dementia (an bedete(ted during a medi(al e'amination or by +riends, +amily or (o!workers.

Stage 3: $ild cognitive decline (earlystage Al"!eimer#s can be diagnosedin some% but not all% individuals &it! t!ese symptoms)riends, +amily or (o!workers begin to noti(e di2(ulties. #uring a detailed medi(alinterview, do(tors may be able to dete(t problems in memory or (on(entration.3ommon stage 4 di2(ulties in(lude

5 Noti(eable problems (oming up with the right word or name5 *rouble remembering names when introdu(ed to new people


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5 6aving noti(eably greater di2(ulty per+orming tasks in so(ial or worksettings orgetting material that one has 0ust read

5 7osing or mispla(ing a valuable ob0e(t5 In(reasing trouble with planning or organizing

Stage ': $oderate cognitive decline ($ild or earlystage Al"!eimer#s

disease)At this point, a (are+ul medi(al interview should be able to dete(t (lear!(utsymptoms in several areas

5 orget+ulness o+ re(ent events5 Impaired ability to per+orm (hallenging mental arithmeti( / +or

e'ample, (ounting ba(kward +rom 188 by 9s5 :reater di2(ulty per+orming (omple' tasks, su(h as planning dinner

+or guests, paying bills or managing ;nan(es5 orget+ulness about one8 by subtra(ting >s or +rom )8 by )s5 Need help (hoosing proper (lothing +or the season or the o((asion5 Still remember signi;(ant details about themselves and their +amily5 Still re?uire no assistan(e with eating or using the toilet

Stage : Severe cognitive decline ($oderately severe or midstageAl"!eimer#s disease)emory (ontinues to worsen, personality (hanges may take pla(e and individualsneed e'tensive help with daily a(tivities. At this stage, individuals may

5 7ose awareness o+ re(ent e'perien(es as well as o+ their surroundings5 @emember their own name but have di2(ulty with their personal

history5 #istinguish +amiliar and un+amiliar +a(es but have trouble remembering

the name o+ a spouse or (aregiver5 Need help dressing properly and may, without supervision, make

mistakes su(h as putting pa0amas over daytime (lothes or shoes onthe wrong +eet

5 'perien(e ma0or (hanges in sleep patterns / sleeping during the dayand be(oming restless at night

5 Need help handling details o+ toileting +or e'ample, Bushing the toilet,wiping or disposing o+ tissue properly-

5 6ave in(reasingly +re?uent trouble (ontrolling their bladder or bowels


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5 'perien(e ma0or personality and behavioral (hanges, in(ludingsuspi(iousness and delusions su(h as believing that their (aregiver isan impostor-or (ompulsive, repetitive behavior like hand!wringing ortissue shredding

5 *end to wander or be(ome lost

Stage *: Very severe cognitive decline (Severe or latestage Al"!eimer#sdisease)In the ;nal stage o+ this disease, individuals lose the ability to respond to theirenvironment, to (arry on a (onversation and, eventually, to (ontrol movement. *heymay still say words or phrases. At this stage, individuals need help with mu(h o+their daily personal (are, in(luding eating or using the toilet. *hey may also lose theability to smile, to sit without support and to hold their heads up. @eBe'es be(omeabnormal. us(les grow rigid. Swallowing impaired.4. *he tests that (an be per+ormed are ini!mental State 'am S-, moodassessment, and brain imaging tests like @I, 3* S(an, and C* S(an. *he S iswhere several ?uestions are asked to test +or everyday mental skills while the moodassessment is used to evaluate the emotional well!being o+ the (lient. or the brain

imaging tests, there are (ertain responsibilities that need to be (arried out by thenurse. In @I, the nurse should e'plain to the (lient that she will be pla(ed in a(on;ned tube and will be hearing noises while the images are being taken. *henurse should also make sure to note i+ the (lient has any metal implant orpa(emakers, and the like. *he nurse should also reassure the (lient that she 0ust hasto rela' and she (ould 0ust tell the personnel outside i+ ever she en(ountersdi2(ulty inside the tube. In 3* s(an, there may be a (ontrast to be in0e(ted to the(lient so the nurse should take note i+ the (lient has any allergies in iodine as mosto+ the (ontrast has this as the main ingredient and should make sure that the (lienthas normal "UN and 3reatinine +or proper e'(retion o+ the (ontrast.

>. 3ommon medi(ations given to patients with Alzheimers disease A#- are(holinesterase inhibitors and N!methyl!#!aspartate N#A- re(eptor antagonists.

*hese drugs do not e'a(tly treat the (ause o+ the disease, but rather, they help slowdown or mitigate +or some time the eDe(ts or symptom o+ Alzheimers.

C!olinesterase in!ibitorsprevent the breakdown o+ a(etyl(holine, a (hemi(alused by some nerve (ells as a (hemi(al messenger important +or learning andmemory, by a(etyl(holinesterase in the brain. 6owever, it only works +or some time,about %!1) months, sin(e the progression o+ the disease targets the nerve (ells anda(etyl(holine is produ(ed less. Soon, (holinesterase inhibitors would lose its eDe(tsin(e the number o+ nerve (ells using a(etyl(holine and a(etyl(holine itsel+ willbe(ome less and less.

:alantamine, donepezil hydro(hloride, and rivastigmine are (holinesteraseinhibitors widely used today. *a(rine is also a (holinesterase inhibitor, but is notused anymore due to the severity o+ its side eDe(ts. All three drugs are used to treatthe mild to moderate stages o+ Alzheimers alzheimers.org.uk-. 6owever somesour(es say that donepezil alz.org- and rivastigmine alz.org- (an be used +or allstages o+ Alzheimers. All three drugs prevent a(etyl(holine breakdown, but onlygalantine stimulates ni(otini( re(eptors to produ(e more a(etyl(holine and onlyrivastigmine inhibitis butyryl(holinesterase aside +rom


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a(etyl(holineEa(etyl(holinesterase-. It is important to note that there is no (leareviden(e yet that (holinesterase inhibitors (ould help redu(e behavioral symptomssu(h as aggression and agitation.

Fn the other hand, N$+A receptor antagonistblo(ks glutamate, a messenger(hemi(al involved in memory and learning. In large amounts su(h as in Alzheimers

disease patients, glutamate damages the brain +urther. Normally, glutamate is usedin the brain, but the disease pro(ess/brain (ell damage/(auses the in(reasedrelease o+ glutamate. emantine is an e'ample o+ this drug. It works by blo(kingthe to'i(ity o+ e'(essive glutamate produ(tion and also by regulating the glutamatea(tivation. "y these a(tions, patients (ould maintain independen(e in per+ormingsome A#7s a little longer +or several months than without the medi(ation.emantine is pres(ribed alone or in (ombination with (holinesterase inhibitors.

Catients with Alzheimers disease e'perien(e behavioral and psy(hologi(al de(lineas well. *hey will +eel aggressive or agitated as the disease takes their ability toremember or per+orm tasks away. Ghen it gets worse, other drugs su(h asantipsy(hoti(s, antidepressants, anti!seizure drugs, and sedatives are given to

alleviate some symptoms, espe(ially when these patients be(ome in(onsolable ore'tremely distressed and are be(oming a danger to themselves.

Antipsyc!otic drugsare sometimes pres(ribed in patients with A# sin(e it (anhelp with the aggression a((ompanying the disease. It also has some bene;ts inredu(ing delusional episodes or hallu(inations whi(h is why it is a drug that is usedin treating patients with mental health problems like s(hizophrenia-. *hese drugs(ould have a (alming eDe(t. 6owever, (are+ul use must be observed. Crolonged usegreater than 1) weeks- (ould present with side eDe(ts su(h as sedation,shakinessEunsteadiness, +alls, blood (lots, stroke, and overall worsening o+dementia. Fnly risperidone, whi(h is also used as a sedativein some (ases, isli(ensed +or use in people with dementia. alzheimers.org.uk-

"rain pla?ues are produ(ed in the brain and these pla?ues are linked to problems inmemory and (ognition in A#. Amyloid beta/a protein whi(h is produ(ed normally inunaDe(ted brains/is the primary (omponent o+ these pla?ues and anantidepressantwhi(h keep serotonin (ir(ulating +or a mu(h longer period-,(italopram an SS@I-, has been +ound to redu(e its produ(tion by 49 per(ent inhuman sub0e(ts, a((ording to new resear(h done at Gashington University S(hool o+edi(ine and University o+ Cennsylvania. Catients with A# have in(reasedprodu(tion o+ amyloid beta (ausing pla?ue buildup. Sometimes, pla?ues (an also beseen in brains without A#. It is also important to note that taking antidepressantsmay present with side eDe(ts. *hese side eDe(ts are yet to be studied +urther souse o+ antidepressants are still under very (lose monitoring.

Abnormal brain a(tivity seen in A# is suppressed by levetira(etam, an antiepileptic drug, a((ording to trials. 6owever, studies are still trying to solidi+y theeviden(es that an anti!epilepti( drug is able to blo(k the pro(ess o+ memory loss inA# patients sin(e it has been +ound that disruptions in the brain networks involvedin essential brain +un(tions e.g. memory- (an result in epilepti( seizures.medi(alnewstoday.(om-


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An,iolyticssu(h as benzodiazepines, lorazepam and o'azepam are given to A#patients who are e'perien(ing an'iety, restlessness, verbally disruptive behavior,and resistan(e to treatment= however, Honly (ommunity surveys show that thesedrugs are (ommonly used in these patients and no published studies support theroutine use o+ an'iolyti(s. *hese are used in the event o+ psy(hoti( episode oragitation that +ails to respond to reassuran(e. aa+p.org-

&. *op 4 nursing diagnosis identi;eda. #isturbed thought pro(ess related to irreversible neuronal degeneration

*his is the priority nursing problem be(ause all throughout the disease pro(ess, the(lient would have to deal with the A#s degenerative eDe(ts. Unlike other problemssu(h as risk +or in0ury whi(h (an be prevented by an e'(ellent nurse and health(are team and supportive +amily members- or sel+!(are de;(it whi(h the +amilymembers or nurse (ompensate +or-, the problem o+ disturbed thought pro(ess isHinside the patients mind and is mu(h more o+ a (onstant nursing problem(ompared to the others. *he nursing problem that is (hanges in per(eption (an alsobe (onsidered under this problem sin(e neuronal degeneration o+ A# aDe(ts howthe patient understands hisEher surroundings. 3on+usion and agitation (an be an

everyday thing and are most de;nitely e'pe(ted to get worse as the disease getsworse. *he (lient would +eel very angry +or +orgetting something or when heEshe;nds it di2(ult to per+orm a task. *he nurse would then be striving round the (lo(kto be as therapeuti(, (alm, patient, and pleasant as possible when intera(ting withthe patient in order to prevent an an'iety atta(k or aggression. *his would meanmanipulating the environment and tea(hing the +amily members to be supportive toma'imize (om+ort +or the patient.

b. Sel+!(are de;(it related to (ognitive de(line"e(ause there will most de;nitely be a disturbed thought pro(ess that (ould onlyget worse though (ould be slowed down with the help o+ A# medi(ations-, sel+!(arede;(it would +ollow. Ghen an A# patient starts +orgetting, heEshe would startnegle(ting hisEher sel+. 6e would +orget how to his A#7s and would most de;nitelyre?uire help to get through the day. *hough this would seem harder to address thanthe priority nursing problem, espe(ially at ;rst, it is a(tually manageable sin(e aroutine to help the (lient (are +or the sel+ (ould be set up. Unlike the priority nursingproblem whi(h (ould be unpredi(table, this sel+!(are de;(it problem 0ust needssome getting used to by the nurse and the +amily members. *his does not, however,dis(ount the +a(t that it (ould also be emotionally ta'ing +or the (aregivers to seetheir loved one this way.

(. @isk +or in0ury*here is a risk +or in0ury sin(e the A# patient is already disoriented. #e(ision!makingis impaired. urthermore, mus(le problems su(h as weakness and poor (oordinationin(rease the risks +or in0ury. Also, as previously mentioned in J>, one o+ the drugsused in A# patients is anti!epilepti( drugs. So seizures (ould be e'pe(ted +rom these(lients and this +a(t also puts the (lients at risk +or hurting themselves. Similarinterventions +rom sel+!(are de;(its (ould be applied here. Again, manipulating theenvironment to redu(e hazards is a must. du(ating the +amily members inidenti+ying seizure episodes is also important, as well as giving tips on how to betherapeuti( around the aDe(ted +amily member. *his nursing problem may alsoseem di2(ult to address at ;rst, but when the nurse and the +amily o+ the patient


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are eDe(tive providers o+ (are, the patient would have a lesser problems in dealingwith his disease, whether he or she is aware o+ it.

@e+eren(eshttpEEwww.alz.orgEalzheimersKdiseaseKstepsKtoKdiagnosis.asphttpEEwww.mayo(lini(.orgEdiseases!(onditionsEalzheimers!diseaseEbasi(sEtests!

diagnosisE(on!)88)4L91

httpEEwww.nia.nih.govEalzheimersEpubli(ationEalzheimers!disease!medi(ations!+a(t!sheethttpEEwww.alzheimers.org.ukEsiteEs(riptsEdo(umentsKin+o.phpMdo(umentI#1>9httpEEwww.alz.orgEalzheimersKdiseaseKstandardKpres(riptions.asphttpEEwww.alz.orgEresear(hEs(ien(eEalzheimersKdiseaseKtreatments.aspJhowhttpEEwww.webmd.(omEalzheimersEguideEtreatment!overviewhttpEEwww.webmd.(omEalzheimersEguideEtreatment!overviewMpage)httpEEwww.alzheimers.org.ukEsiteEs(riptsEdo(umentsKin+o.phpMdo(umentI#11O1PpageNumber)httpEEwww.alzheimers.org.ukEsiteEs(riptsEdo(umentsKin+o.phpMdo(umentI#118

httpEEnews.wustl.eduEnewsECagesE)%O)).asp'httpEEwww.webmd.(omEalzheimersEnewsE)81>8&1>E(ould!(ertain!antidepressants!slow!alzheimersMpage)httpEEwww.medi(alnewstoday.(omEarti(lesE)>LLOL.phphttpEEumm.eduEhealthEmedi(alEreportsEarti(lesEalzheimers!diseasehttpEEwww.alz.orgEpro+essionalsKandKresear(hersK1>418.asphttpEEwww.aa+p.orgEa+pE)88%E8)1&Ep%>9.html
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Case Analysis Scenario 3