3 Important Things to Include in a Dementia Nursing Care Plan

Dementia is defined as a severe decrease in cognition that interferes with everyday activities in a person’s life. Alzheimer’s disease, as well as dementia with Lewy bodies, are considered as the most prevalent neurodegenerative dementias in elderly patients, whereas brain injury or brain tumors are the most common risk factors associated with younger individuals.

Those living with dementia experience issues with behavior, cognition, and deterioration in day-to-day activities. They may also suffer from memory impairment and a lack of understanding of their concerns.

To be more specific, Dementia is described as a spectrum, rather than a single disease. In a single patient, multiple disorders could be some of the common contributors to dementia syndrome.  Clinicians from various disciplines are trying to understand: the pain, treatment conditions, appropriate prescription, neuropsychiatric help, and functional impairment of those living with dementia.

The main role is to improve the quality of care for the person living with dementia and their families. It’s usually a gradual condition, and unfortunately, there is no cure for any type of dementia yet.

According to a US-based non-profit organization Alzheimer’s Association, there are 6.5 million people affected by Alzheimer’s Disease, and the figure will double to around 13 million within the coming decade. The worldwide figure is around 55 million, as per the WHO report, and the majority of them live in low to middle-income countries.

The challenges connected with dementia increase with time, and the need to hire nurses increases. Family members seek nurses to aid and guide those living with dementia.

At any given time, 25% of people in a public hospital may have dementia, and the risk for complications and mortality rate for such patients is higher as compared to other hospitalized individuals.

Observing and reporting any cogniton impairments is a crucial part of the nurse’s job. Even though early detection contributes to an improved and wide variety of alternative treatments, the ailment (illness) is still underdiagnosed.

The goal of nursing care for those living with dementia is to ensure safety and increase adherence to treatment. The nurses must conduct a complete examination on all those living with dementia to detect and monitor the cognitive deterioration. They must check for discomfort and stress or disclose it to the physician if needed. Finally, they must collaborate with the patient and the family members to create a patient-centered treatment that promotes life quality.

Nurses play a very crucial role in detecting dementia in hospitalized older patients by evaluating for indications/signs during the evaluation. Interventions for dementia help those living with dementia’s body functioning and independent as long as humanly possible.

Alzheimer’s disease is usually divided into four different stages, and every stage has its own set of symptoms. Loss of memory or cognitive impairment is noticeable in moderate to severe stages. The nurse must assess the patient in every stage of the disease.

Other essential objectives include: ensuring the patient’s safety, autonomy in self-care tasks, lowering anxiety and pain, enhancement in socializing and connection, giving enough nourishment, assisting, educating families and caregivers.

Personalized reminders can help in assisting those living with dementia in remembering specific actions. The relaxation techniques, massaging, and exercises are a few examples of supplementary and alternate therapy.

The nursing assessment plays a very important role in treating those living with dementia. A few of the points are listed down below:

• Carefully evaluate the condition of the patient’s cognitive and mental abilities.

• Some cognitive evaluation tools like Mini-Mental State Examination could effectively evaluate a patient’s mental abilities. The results of the assessment are used to diagnose patients and subsequent analysis.

• Check for sensory deprivation, poor nutrition, infections, dehydration, associated use of CNS medications, or even other pathological conditions in the individual.

• Perform thorough evaluations of the patient’s condition on a regular basis as the disease worsens over time.

• A very thorough assessment must be carried out and should involve doctors at least once every six months. This will help in finding difficulties and upcoming conditions.

Nurses play a crucial role in providing care to those living with dementia. A few important nursing diagnoses are listed down below:

• Thoroughly examining the patient’s overall condition and finding out where they are having trouble with so that a nurse can assist them in the future. This also provides a baseline for the patient’s state and aids in planning quality treatment.

• Inquire about the level of independence in doing self-care duties from the patient or even the family members. The nurse can use this information to determine whether a patient can fulfill a few tasks on his/her own, or may need help.

• Ensuring that all day-to-day supplies for self-care tasks are available when the patient requires them (i.e., bathing, eating, grooming, &g  toileting supplies.

• Encourage the patients to complete self-care duties as much as they can on their own as long as they are safe and able to do so, then provide supervision & assistance as needed. Enabling an individual to do self-care duties as much as he or she can on their own, aids in maintaining optimal function as well as encourages them to be prepared for it for the next day.

• Giving simple instructions to complete a task reduces misunderstanding and motivates the patient in ensuring that he/she completes the activity successfully. The nurse should always act calm and in a methodical manner while giving instructions to the patient.  It helps in minimizing patients’ anxiety and boosting their self-esteem.

• If applicable, include the patients and family members in the treatment plan. This will make them aware of what amount of supervision and assistance the patient requires on a daily basis to preserve autonomy and achieve maximum body functioning. The nurse shall provide full knowledge to the family members about the current conditions of the Dementia patient.

The nurse should keep an eye to identify for signs of confusion, memory gaps, changing from one topic to the next, or even the use of  language. Furthermore, taking note of any articulation issues is also one of the important tasks. These steps aid the nurse while detecting any changes in the patient’s mental health status, which could signal the disease’s progression or worsening.

Determine the patient’s level, remembering the location, people, and activities, while also noticing the decline in amnesia or cognitive ability( if becoming more severe). If necessary, the patient can be provided with products such as television, clocks, and a calendar to assist him and keep them occupied. The televisions or radio must be closely supervised to ensure that the shows/content do not cause any frustration, confusion or disorientation.

It can also be beneficial to create a schedule for the client and observe them. Washing, cleaning, feeding, resting, and other mental functions should all be included in the regimen. The patient may have fewer episodes of disorientation and cognitive processing impairments if they have an organized and predictable set of projects/tasks to complete. Allow patients to do other things like walking, studying, and painting. Such activities can give those living with dementia a sense of normalcy. This encourages appropriate behavior and boosts a patient’s self-assurance.

When asking a question, consider giving 2 alternatives (food, activities, colors, and others) to the patient; this will encourage them to take part in the conversation and a sense of freedom.

Empowering someone to make his/her own decisions gives them a feeling of security and trust in the capacity to make decisions on their own.

Examining the family’s comprehension of the patient’s condition, how something affects the person, as well as the care that is needed at every step is an important part of a nurse’s job. This serves as the basis for the patient’s state and aids in planning quality treatment.

Assisting the family members in identifying the signs and symptoms of coping and functioning of the patient is important. A series of questions may be helpful to evaluate how these illnesses affect family relationships, as this will help in deciding the appropriate amount of care that needs to be provided.

The other important job role of a nurse in assisting the family members are listed down below:

• Allow family members to openly share their opinions and emotions.

• Allowing the children in the family to express themselves. It can help gather more information.

• Educate the family about the disease’s course and the different dementia stages/phases, and how they affect a patient’s mental abilities. By providing accurate health and treatment education, ask them to be prepared for it in the future.

• When applicable, include the family while making the treatment plan, making them aware of what amount of support and direction the patient requires on a daily basis to preserve autonomy and achieve maximum functioning.

• Inform friends and family of the importance of maintaining their health and social connections. This relieves the stress, anxiety, and responsibility that comes with caring for those living with dementia. If necessary, refer the household to a support network. Support groups systems are comprised of people who’ve already gone through and are living through similar circumstances with what the families are going through.

Working or taking care of those living with dementia is both demanding and rewarding. Assessing the patient’s competency is one of the most important tasks of a nurse. Nursing is required to provide effective person-centered care in a variety of specialist domains for patients.

Adapting the communications to the patient’s level by speaking with them at a slow pace and using basic terms while retaining a firm loudness and low tone makes a nurse’s job much easier. Another important aspect of nursing care is educating the patient’s friends, family, and caregivers. These include coping with it, explaining the importance of carrying out risk assessments, how and where to interact with the client, and memory-enhancing measures.

Reference:

• https://rnspeak.com/alzheimers-disease-nursing-care-plan/

• https://medlineplus.gov/ency/article/007428.htm

• https://nurseslabs.com/alzheimers-disease-nursing-care-plans/

• https://www.alz.org/professionals/health-systems-clinicians/clinical-resources/cognitive-assessment-tools

• https://www.karger.com/Journal/Home/224226

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541590/

• https://pubmed.ncbi.nlm.nih.gov/27322590/

• https://www.ncbi.nlm.nih.gov/books/NBK570552/

• https://www.nursingtimes.net/clinical-archive/dementia/dementia-4-the-nurses-role-in-caring-for-people-with-dementia-04-07-2016/#:~:text=By%20taking%20simple%20actions%20such,their%20orientation%20and%20personal%20choice.

Legumes are a good source of many nutrients. They also have choline: a B vitamin that promotes the production of acetylcholine – a vital neurotransmitter for brain activity. They should be included in a well-balanced, nutritious diet, since they aid in mental clarity.

The antioxidant flavanols in cocoa powder aid to increase the circulation of the blood to the brain (3). Try and choose darker chocolate as it will have less sugar and more flavanols.

According to a research published by the American Academy of Neurology (4), people above 65 who chose to eat omega-3 rich fish three or sometimes more weekly portions roughly had a 26% decreased risk of brain abnormalities that cause Dementia,. The omega-3 fatty acids eicosapentaenoic (EPA) and docosahexaenoic (DHA) help to keep the brain in good form.

Seeds are high in Vitamin E, a nutrient linked to a reduced risk of cognitive impairment as people age (5). Sunflower seeds include choline, a nutrient that aids in brain function. Pumpkin seeds have zinc, which helps in memory and cognition, and tryptophan, which helps in depression. Flaxseeds which are high in memory-boosting omega-3 fatty acids, are a great alternative to fish.

According to a recent study from Temple University (6), extra virgin olive oil use in adulthood can safeguard against dementia. Extra virgin olive oil consumption appears to prevent the onset of cognitive decline and dementia by decreasing the progression of tauopathies, a group of disorders.

When a protein known as tau builds up in the brain, it causes tauopathy, also known as frontotemporal dementia, which is characterized by a loss in cognitive function.

Spices provide flavor to your favorite foods while providing antioxidants and memory-enhancing chemicals. Cinnamon, for example, improves cognitive processing just by smelling it. Participants who took sage fared better on cognitive tests in research (7). Curcumin, a key element in turmeric, has been found to break up cerebral plaque and decrease inflammation, both of which can lead to memory issues (8).

Everyone should enjoy eating and drinking, and it should be a group activity if possible. Meal times can be a highlight of the day where you can get together and talk with one another or with family and friends.

The benefits of drinking and eating with others can be huge. Sitting down to eat with a member of the family might bring up memories of previous mealtime experiences and encourage ‘copycat’ behavior, which can lead to increased eating and drinking.

There’s no reason why eating out shouldn’t be a social and fun activity anymore. Going to a favorite food joint or a cafe can evoke fond memories.

Eating may be challenging for our loved one suffering with Dementia, and their eating patterns and preferences may change. Changes in preferences can be abrupt, which can be upsetting for both the Dementia patient and those caring for them.

Make a list of the food preferences, and be sure to update it if their tastes change. Try not to rule out meals too early and reintroduce items they haven’t eaten in a while.

It might be difficult for Dementia patients to eat a well-balanced diet. Fish, nuts, green leafy vegetables, and soups and stews should all be included in a our loved one’s diet.

Swallowing difficulties are also a problem for some people with the disease. Dysphagia is the medical term for this disorder. Patients must be fed pureed veggies rather than raw vegetables to combat this. You might also concentrate on drinks and thicker soups. Spices and seasonings can be used to add flavor to them.

Also, keep in mind that not all fats are created equal. Avoid fatty cuts of meat and limit your usage of solid fats like butter. Instead, go for lean meats like chicken and fish. Opt for olive oil and other fats like avocado that are heart-healthy. In place of processed meals loaded with sugar, go for healthy alternatives like fruits or juices.

Hopefully, the points highlighted above will help you take better care of your loved one. Even though it can be frustrating at times, always try to be patient with them.

References:

• https://www.mdpi.com/1420-3049/21/4/518

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6930593/

• https://www.sciencedirect.com/science/article/abs/pii/S0891584911005764

• https://www.sciencedaily.com/releases/2008/08/080804165312.htm#:~:text=The%20study%20found%20that%20people,did%20not%20eat%20fish%20regularly

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276978/

• https://onlinelibrary.wiley.com/doi/full/10.1111/acel.13076

• https://www.sciencedaily.com/releases/2003/09/030901091846.htm

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781139/