Patient/family Teaching To Identify And Live With Dementia

Dementia is known as a neurological disorder in which the person’s cognitive abilities progressively decline. It can cause a person to become depressed and can cause negative effects on a person’s health and their relationships with others (Robinson, 2019). Family members need to be able to properly identify early signs of dementia before it progresses to a more serious stage. It is important for the nurse to teach the family and patient signs of dementia prior to its occurrence if there is an increased chance of the patient developing it later on in life.

Client JTS arrived at Mercy Hospital with an altered mental status. She is 70 years old who was brought into the hospital by her sons. Her health history stated that she has anemia, hypertension, iron deficiency, peripheral vascular disease, and type 2 diabetes. She weighs 70.5kg (155.1lbs) and her chart indicated that she is obese. After looking over the patient’s health history and completing the initial assessment, her provider determined that the patient has early signs of dementia. During her assessment, she was confused about the situation but was alert to person, time, and place. Due to the doctors believing that she was in the early stages of dementia JTS was placed on a Mediterranean diet and was listed as a high fall risk patient due to her confusion. Once the patient was assessed fully and doctors determined that the patient was in the early stages the family needed to be educated about dementia and what to expect when caring for the patient.

For the patient teaching, it is important to speak with the family about the patient’s disorder and the proper care to provide. While teaching the family is the main focus in the teaching plan, the patient still needs to be included and needs to be the main focal point when speaking. Due to the patient experiencing early signs of dementia such as confusion the patient and family need to be taught about other signs and symptoms that will come about later on as the disorder continues to progress. Some signs and symptoms that they need to be educated on are changes in memory that can result in memory loss, personality changes, change in cognitive function, behavioral changes, poor judgment, increased confusion, continuously repeating themselves, restlessness, difficulty completing routine task and withdrawal from social interaction (Robinson, 2019). These signs and symptoms will continue to progress which places the client at an increased risk for falls and injuries. The patient should be monitored frequently and any items that could potentially cause the patient to fall or harm themselves need to be removed such as rugs or boxes.

While being able to identify the signs and symptoms is very important there are ways in which the patient and family can help slow the progression of the disorder. Currently, there is no cure for dementia but there are some steps that can be taken in order to slow down the disorder and decrease the symptoms. Lifestyle modifications are another important part of the patient and family teaching. It includes talking about modifications that can help keep the patient healthy and choices that can help slow the onset. According to Neergaard et al. (2016) alcohol consumption, smoking, increased weight, physical inactivity, and poor diet all contribute to an increased risk of getting dementia and by adjusting these lifestyle choices the progression of dementia can be slowed. Physical activities such as walking, swimming, gardening, and dancing can help the patient stay active and lose weight. Maintaining a healthy diet is also important because it can help the patient lose weight and control their blood sugar. The patient’s diet should consist of decreased sugar intake, decreased fried foods, decreased salt intake, drinking plenty of water, decrease alcohol consumption, increased fruits and vegetables, and increased whole-grain intake (Sindi et al., 2018). By having the patient adjust their diet and some lifestyle choices, the progression of dementia can be altered. The patient and/or family will be able to identify different lifestyle modifications and teach the nurse about foods that are good to eat, and foods that should be avoided once they have learned this information.

As the disorder progresses to the more serious stages, it is important to teach the patient and family about the treatment options. Treatment options can be discussed during the first visit if they are concerned about the disorder progressing quickly. While there is no cure, there are medications that can decrease some of the symptoms that the patient is experiencing. The type of medication prescribed will depend on the type of dementia the patient has, and the stage they are in. The medications are only a temporary option but they can help improve the patient’s health. Drugs such as cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and NMDA antagonists (memantine) are approved for patients with dementia due to their ability to improve cognitive function (Shaji, Sivakumar, Rao, Paul, 2018). While these drugs are useful in improving cognitive ability the patient and family need to contact the doctor to discuss treatment options that would work best with the patient’s type of dementia. Once they have learned about the patient treatment options, the patient and/or family will be able to teach back the options to the nurse and if they have any questions regarding any other treatment options they will know who to contact.

References

1. Dementia Society of America. Retrieved from https://www.dementiasociety.org/
2. Neergaard, J. S., Dragsbaek K., Hansen, H. B., Henriksen, K., Christiansen, C., & Karsdal, M. A. (2016). Late-life risk factors for all-cause dementia and differential dementia diagnoses in women: A prospective cohort study. Medicine, 95(11), 3112. doi:10.1097/MD.000000000000311
3. Perry-Young, L., Owen, G., Kelly, S., & Owens, C. (2018). How people come to recognize a problem and seek medical help for a person showing early signs of dementia: A systematic review and meta-ethnography. Dementia, 17(1), 34–60. doi: 10.1177/1471301215626889
4. Robinson, G. (2019) Supporting the careers of people with dementia. Nursing Standard, 34(1), 44. doi:10.7748
5. Shaji, K. S., Sivakumar, P. T., Rao, G. P., & Paul, N. (2018). Clinical practice guidelines for management of dementia. Indian journal of psychiatry, 60(3), 312–328. doi:10.4103/0019-5545.224472
6. Sindi, S., Kåreholt, I., Eskelinen, M., Hooshmand, B., Lehtisalo, J., Soininen, H., Ngandu, T., & Kivipelto, M. (2018). Healthy dietary changes in midlife are associated with reduced dementia risk later in life. Nutrients, 10(11), 1649. doi:10.3390/nu10111649
7. Trueland, J. (2016). Spotting signs of dementia. Nursing Standard, 30(28), 20. doi:10.7748/ns.30.28.20.s22