Praxis Note on Alzheimer’s Disease

This semester I have been assigned to a specialty care home specifically design to accommodate people with dementia. More than ninety percent of the resident in the home has been diagnosed with dementia. After semester three, which is approx one year and a half ago, I remembered I learned about Alzheimer’s Disease (AD). As time and stress has continuously catches me from school, work, and family. I admit that I have forgotten many details of caring for an AD patient in a nursing perspective.

I know there is an urgent need for me to refresh my memory and gain new knowledge about the care that Alzheimer patient need in general. Elaborate As I have entered into the home, I do not have much of an idea of what I am going to encounter for the next 12 weeks. When I learnt that this is a home for a high population of individual’s with AD. I was quite shocking. I know that AD is a condition that affects cognition function. People with AD will generally have an irreversible decrease cognitive function that will gradually progress over time.

I also remember there are three different stages of AD, early stage, intermediate stage, and late stage. The later the stages the more advance the condition is. Depending on the development of AD, individual may have memory difficulties of where item should be place and repetition of takes and doing the same or similar task respectively. In terms of nursing care, I know that redirection is the key to nursing care. Nurses also have to cope with each individual’s difficulties and needs.

For the past two weeks for observing in home, I got a glimpsed of different stages of AD and what AD is. There are resident where I can make a rational conversation with while some requires total care, and there are many who are in-between of those two stages. It is because I have a limited knowledge on their diagnosis, I felt every hesitant to act upon their needs. I felt the need of understanding this disease is vital for me to be efficient in this community.

Thus I have decided to focus this praxis note on the nature of AD, I want to gain a strong understanding of what AD is and how to care those who is diagnosed with it. I want to know their risk factors, their diagnostic guidelines, commonly used medications, and nursing caring and techniques involved. Analyze AD is the most common type of dementia, a clinical syndrome marked by progressive impairment of cognitive functions that does not affect by delirium. It is cause by plaques development between neurons and neurofibrillary tangles within neurons (Lewis, Heitkemper & Dirksen,2004).

Individuals suffers from AD will experience a decline in cognitive function, memory impairment, and impairment of behaviour and thinking, with changes in intellect, mood, personality, and social behaviour (Lewis, Heitkemper & Dirksen,2004). The Diagnostic and Statisical Manual of Mental Disorders has defined a set of criteria for the diagnosis of AD: probable AD, Possible AD, Definite AD. The individual with AD must show signs of cognitive impairment that is severe enough to interfere with daily life (Belavic, 2009).

The criteria are listed below at the end of the praxis note. After a diagnosis has been made, AD can be divided into two different types: familial (early onset) and sporadic (late onset). Familial AD is rage and is associated with genetic mutation; it is commonly occurs in middle ages-adult. Sporadic AD usually occurs in people older than 65 years old (Belavic, 2009). The risk factors involved has advanced age, family history, genetic markers, and cardiovascular disease such as hypertension diabetes, obesity, and hypercholesterolemia.

Possible risk factors included head injury, hyperthomcocyteinemia (high levels of homcyteine in blood), and hyperinsulinemia. AD can also be divided into three stages, early stage, intermediate stage, and late stage. Each stage signifies the progression degree of the condition from short-term of impairment loss and reduced ability of judgment skills to severe deterioration of all cognitive abilities. Individuals with advances progression of the condition will also losses urinary and bowl control and experiences myoclonus or seizures.

Unfortunate diagnosis can only be made after damages have been made and there is no cure for the condition. There is also no proven preventative screening for AD. Medications for AD are only use to manage symptoms but not to treat the condition. Only four approved drugs are available in Canada. Aricept, Exelon, and Reminyl are use to treat symptoms in people with early and intermediate stages of AD, and Ebixa can be use to for all stages of AD (Alzheimer Society, 2009).

It is especially important to note that all these medication should be taken with cautiousness and exactly as directed by physician. Dosages of medication should not be adjusted without prescriber’s notice and never double dose medication even if previous dosage is missed. If medication has been overdose, physician should be notified as soon as possible for further direction. Common adverse effect of theses medication includes nausea, diarrhea, insomnia, vomiting, muscle cramps, fatigue and loss of appetite (Alzheimer Society, 2009).

These symptoms should go way with continuous treatment. If patient experiences other undesired symptoms, physician should also be notified. Since no treatment is available, thus early diagnosis is important for assessing and monitoring daily functions, and initiate medications. Revise It kind of saddens me when I need to care for patients that cannot get better but progress in their condition in distress. It feels like looking at a deteriorating patient on the side while I am helplessly standing there doing nothing to stop it from happening.

The sense of that feeling truly distresses me. This always reminds me of the nature of what nursing is all about. Nursing is not always about the end result my patient’s condition but the process of me being there, establishing a therapeutic relationship with the people whom are involved, to do what I professionally can to release their suffering. My nursing role in the Alzheimer’s community is to establish different skill to assist the AD population in the home by health promotion, or advocating for their needs.

AD resident is especially vulnerable for power imbalances due to cognitive impairment and requires others to advocate for them, such as right and dignity. Such changes may not have a significant long impact on their health but it can prevent physical and emotional distress and reduce distributive behaviours as they often use it as a sign of communications. With a better understanding of AD, now I further understand their needs and act upon them to create changes for and around them to maintaining their functional and cognitive abilities as well as on preventing further disability and decline.

New Trail In the coming weeks on the semester, no matter what the situation, I will first learn about the situation, listen and understand their needs, look for possible solution, implement on selected solution, and evaluate for the result. The needs of the resident in the home are very diverse. Needs and values that are important to them can change instantly and frequently. From now on, I should change my approach towards individual with AD and plan of care to act upon what they value that specific moment.

My goals towards any people with any degenerative illness or condition will no longer base on their health condition as my final goal. Although giving care to these people still saddens me in many ways but on the other hands I am also very bliss to have these feelings for them, to me it is a sign that I still truly cares for them.

Reference Belavic, J. M. (2009). Alzheimer’s disease: a tangle of the mind. Nursing Made Incredibly Easy, 7(5), 26-33. Lewis, S. M. , Heitkemper, M. M. , & Dirksen, S. R. (2004). Medical-surgical nursing: Assessment and management of clinical problems (6th ed. ). St. Louis, MO: Mosby.

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