Saint Mary’s University

School of Health and Natural Sciences

Nursing Department
Bayombong, Nueva Vizcaya

A Group Case Study Entitled:

Dementia in Alzheimer’s Disease

Presented to the Faculty of the School of Health and Natural Sciences

Saint Mary’s University
Bayombong, Nueva Vizcaya

In Partial Fulfillment
Of the requirements for Care of Older Adults
NCM 112 RLE

Submitted by:
MENDOZA, EZECHIEL JAN KARLO D.
MERCADO, BENEDICK CAYLE R.
PANGANIBAN, PHIL MADELIENE D.
QUINTO, VANESSA XEN G.
RAGUAL, MICA T.
ROSARIO, YUVIA KAMIL A.
SURIL, JEANETTE V.
TAGUILING, NANCY JANE D.
TAYABAN, SUMMER JANIE A.
THIAM, JEWEL BRITNEY P.
TOLENTINO, JAMIE ANN NICOLE P.
VALDEZ, MAURICE
NURSING CARE PLAN
ANATOMY AND PHYSIOLOGY
PATHOPHYSIOLOGY
DRUGS STUDY
PERSONAL, PAST, AND PRESENT
HISTORY
COMPREHENSIVE GERIATRIC
ASSESSMENT
COMPREHENSIVE GERIATRIC
ASSESSMENT
NURSING CARE PLAN
LABORATORY TESTS AND DIAGNOSTIC
RESULTS
BRIEF DESCRIPTION
COURSE IN THE WARD
PERSONAL, PAST, AND PRESENT
HISTORY

Zia Nicole M. Arquero, RN, MSN (c)

Clinical Instructor

October 2021
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TABLE OF CONTENTS

TABLE OF CONTENTS..................................................................................................................................... 2
PERSONAL, PAST, AND PRESENT HISTORY .................................................................................................... 3
BRIEF DESCRIPTION....................................................................................................................................... 6
ANATOMY AND PHYSIOLOGY ..................................................................................................................... 12
PATHOPHYSIOLOGY .................................................................................................................................... 19
DRUG STUDY ............................................................................................................................................... 21
LABORATORY RESULTS AND DIAGNOSTIC STUDIES.................................................................................... 25
COMPREHENSIVE GERIATRIC ASSESSMENT................................................................................................ 33
COURSE IN THE WARD ................................................................................................................................ 55
NURSING CARE PLANS ................................................................................................................................ 59
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PERSONAL, PAST, AND PRESENT HISTORY

Personal Profile
Name: Mr. B
Age: 70
Birthdate: January 11, 1951
Birthplace: Bayombong, Nueva Vizcaya
Sex: Male
Blood Type: A+
Address: Zamora St., Brgy. Don Domingo Maddela (District I), Bayombong, Nueva Vizcaya
Religion: Roman Catholic
Height: 5’2”
Marital Status: Married
Occupation: Retired English Teacher
Educational Attainment: College Graduate
Nationality: Filipino
Ethnicity: Ilokano
Dialect: Ilokano and Tagalog

Significant Others:
Name of Spouse: Mrs. C (+)

Name of Child: Mr. V

Age: 42
Educational Attainment: College Graduate
Occupation:

Objective
● The patient suffers from hallucination (seeing things that are not there), memory loss, and
distinct images
● He needs help with some daily activities such as dressing, washing, and toileting
● He was getting agitated and upset easily.

Subjective
● The son verbalized that “ang hirap ng komunikasyon namin ng papa ko”

Admitting Diagnosis: Moderate to Severe Alzheimer’s Disease

Admitting Physician: Dr. Z

Date of Admission: October 01, 2020

Date of Discharge: October 04, 2020
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Health History

I. Present History

Mr. B, the son's 70-year-old father, was admitted to a geriatric hospital on October 1, 2021,
due to his worsening forgetfulness. Communication with his father, the son claims, has gotten
more difficult. He asserts that the patient struggles to comprehend what others are saying after
he has ceased speaking. When my father discusses anything, he frequently forgets and repeats
it. "Where is my key, where is my key," the patient expresses verbally. Over the next four years,
his intellect and function declined to the point that he required admission to a care facility and
required assistance with basic daily chores. Family members saw this prior to the resident's
relocation to the long-term care institution. He was residing at his son's house during this period.
He gradually lost his perceptual and linguistic abilities and became completely dependent on
others to do his daily duties. He suffers from hallucination (seeing things that are not there),
memory loss, and distinct images. Mr. B's disposition seems to have shifted significantly. He was
quickly agitated and upset. He was unable to handle household duties and was frequently late in
responding to queries from others. Functional impairments include a slower ability to comprehend
and follow directions, as well as an inability to turn off the television. Among other difficulties, he
need assistance with dressing, washing, and toileting.

The doctor performed some tests and found out that he has moderate to severe
Alzheimer’s disease. Doctor Z, a geriatric psychiatrist administers a test to measure memory
impairment and other cognitive skills, as well as functioning abilities and behavioral changes. He
also does a battery of tests to rule out other potential sources of impairment. Mr. B’s medical
history, medication history, and symptoms was reviewed by the doctor. Then, several tests were
performed and additional laboratory tests, brain testing, memory testing, and neuropsychological
tests were ordered by the doctor. Magnetic resonance imaging (MRI), computerized tomography
(CT), and positron emission tomography (PET) are the most often utilized brain imaging methods.
The doctor also did a physical examination to look for any health issues that may be causing or
contributing to the symptoms, such as previous strokes, or other related conditions.

II. History of Past Illness

When Mr. B was younger, he has a major health issues. When he was 12 years old, Mr.
B suffered from dengue and was hospitalized for 1 week. At the age of 21, Mr. B suffered from
depression when his father died in 1972. And he suffered again from depression at the age of 35
when her mother died for unknown reason. He sought a psychiatrist when he was suffering from
depression due to the death of her mother.

He had no prior surgical experience. He did not have a history of smoking, drinking, or
using any other drugs. Mr B’s son claimed that his father received a full round of vaccinations
when he was a child prescribed by the Department of Health at the Municipal Health Office in
Bayombong.The vaccinations are, Vitamin K, Hepa B1 and BCG that was scheduled at birth
which was dated last January 11, 1951. For the second vaccination, Hepa B2, DPT1 and OPv1
was administered 6 weeks after birth to Mr. B which is February 15, 1951. For DPt2 and OPV2 it
was given last March 15,1951 prior for the schedule of administration which is 10 weeks after
birth. Next one, Hepa B3, DPT3 and OPV3 was administered 14 weeks after birth and it was given
last April 15, 1951. And lastly for measles,it was given last August 17, 1951 prior for the schedule
of administration of 7 months. He has no previous allergies to food, weather and medication. In
the previous year, he suffered from cough and colds for three days.
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III. Family Health History

Mr. B was the eldest of three siblings. He has a family history of depression. His younger
brother suffered from depression when their parents died. Then at the age of 65 years old, he
died from dementia. His father was killed in a car accident, while his mother died at the age of 88
from an unexplained reason. Mr. B has a first cousin on his mother's side who died last 2015 due
to hypertension at the age of 40 years old.

IV. Social Health History

Mr. B was a 70-year-old married male who was born and raised in Brgy. Don Domingo
Maddela, Bayombong, Nueva Vizcaya. When the pandemic strikes, Mr. B remains at their home,
as senior patients are more susceptible to infection. The family was following proper health
practices. On their doorway is a foot bath. Additionally, Mr. B's son stated that before entering the
house, there is a sink outside with soap for handwashing. Mr. B received his first dosage of
Sinovac, the only COVID 19 vaccine available in their Barangay, on October 1, 2021, and is
currently awaiting his second dose. He has been living with his son since his wife died five years
ago of hypertension. Mr. B is a retired teacher with a pension from his previous school, where he
worked for 40 years. He retired in 2011 at the age of 60. Additionally, his son, who is also a private
school teacher, controls his father's money and household costs such as energy and water bills.
Mr. B's son's wife is presently working in Canada as an overseas Filipino worker. Mr. B has a
housemaid who looks after him weekdays while his son is at work. Mr. V looked after Mr. B on
the weekend. The son mentioned that they live in a town, they can easily access their basic
necessities for the family. Moreover, His friends in college check up on her every saturday. He
does not consume tobacco products. He denies using alcohol and abusing drugs.

V. Lifestyle and Health Practices

Mr. B was a daily consumer of green, leafy vegetables and fruits. Their housemaid
provides his breakfast and lunch, since their housemaid works from 7:30 a.m. to 5:00 p.m. Mr. V
cooks dinner for the family in the evening. The patient watches television in the evening but
frequently forgets to turn off the television, which remains on till the next morning. Sleep
disruptions are becoming more common each day, and he was waking up more frequently and
staying awake longer during the night. Mr. B takes his afternoon sleep between 1:30 and 3:00.
He opens the radio in the afternoon but forgets to switch it off before proceeding to their terrace.
On weekends, they gather on the terrace for coffee and warm bread, with Mr. V assisting his
father in avoiding spilling the coffee or breaking the mug. Mr. B occasionally loves taking a
morning stroll with his son, but requires assistance because he frequently forgets where they are
going.
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BRIEF DESCRIPTION
Definition
What is dementia?
Dementia is not a specific disease, but rather a broad term for the reduced ability to recall,
analyze, or make judgments, which interferes with doing daily tasks. The most common type of
dementia is Alzheimer's disease. Though dementia primarily affects the elderly, it is not a
normal part of the aging process.
Types of dementia includes Alzheimer's disease, Vascular dementia, Lewy body dementia,
Frontotemporal dementia, Mixed dementia, Huntington's disease, Creutzfeldt-Jakob disease,
Traumatic brain injury (TBI), and Parkinson's disease – Alzheimer’s disease as the most
common type of dementia and is what our patient have.

What is Alzheimer’s Disease?

Alzheimer’s disease is the most common type of dementia. It is a progressive condition that
begins with mild memory loss and may proceed to loss of capacity to carry on a conversation
and respond to the environment. Alzheimer's disease affects regions of the brain that control
thought, memory, and language. It can substantially impair a person's capacity to carry out daily
activities.

Etiology
The precise causes of Alzheimer's disease remain unclear. However, on a fundamental level,
brain proteins fail to function appropriately, which disturbs the work of brain cells (neurons) and
sets off a chain of harmful events. Neurons are damaged, lose their connections, and eventually
die.
Researchers trying to understand the cause of Alzheimer's disease are focused on the role of
two proteins:
• Plaques. The protein beta-amyloid is a fragment of a larger protein. When these
fragments cluster, it appears that they have a toxic effect on neurons and disrupt cell-to-cell
transmission. These clusters combine to produce larger deposits known as amyloid plaques,
which also contain other cellular debris.

• Tangles. Tau proteins contribute to a neuron's internal support and transport system,
which transports nutrients and other essential materials. Tau proteins change shape and
assemble themselves into structures known as neurofibrillary tangles in Alzheimer's disease.
The tangles are harmful to cells and disrupt the transport mechanism.

Predisposing factors
• Gender. Women get the disease more often than men.
• Down syndrome. It’s not clear why, but people with this disorder often get Alzheimer's
disease in their 30s and 40s.
• Head injury. Some studies have shown a link between Alzheimer's disease and a major
head injury.
• Age: The strongest known risk factor for dementia is increasing age, with most cases
affecting those of 65 years and older
• Family history: Those who have parents or siblings with dementia are more likely to
develop dementia themselves.
• Race/ethnicity: Older African Americans are twice more likely to have dementia than
whites. Hispanics 1.5 times more likely to have dementia than whites.
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• Poor heart health: High blood pressure, high cholesterol, and smoking increase the risk
of dementia if not treated properly.
• Traumatic brain injury: Head injuries can increase the risk of dementia, especially if they
are severe or occur repeatedly.
Signs and symptoms
Memory loss that disrupts daily life
One of the most common signs of Alzheimer’s disease, especially in the early stage, is
forgetting recently learned information. Others include forgetting important dates or events,
asking for the same questions over and over, and increasingly needing to rely on memory aids
(e.g., reminder notes or electronic devices) or family members for things they used to handle on
their own.
Challenges in planning or solving problems
Some people living with dementia may experience changes in their ability to develop and follow
a plan or work with numbers. They may have trouble following a familiar recipe or keeping track
of monthly bills. They may have difficulty concentrating and take much longer to do things than
they did before.

Difficulty completing familiar tasks

People with Alzheimer's often find it hard to complete daily tasks. Sometimes they may have
trouble driving to a familiar location, organizing a grocery list or remembering the rules of a
favorite game.

Confusion with time or place

People living with Alzheimer's can lose track of dates, seasons and the passage of time. They
may have trouble understanding something if it is not happening immediately. Sometimes they
may forget where they are or how they got there.

Trouble understanding visual images and spatial relationships

For some people, having vision problems is a sign of Alzheimer's. This may lead to difficulty with
balance or trouble reading. They may also have problems judging distance and determining
color or contrast, causing issues with driving.

New problems with words in speaking or writing

People living with Alzheimer's may have trouble following or joining a conversation. They may
stop in the middle of a conversation and have no idea how to continue or they may repeat
themselves. They may struggle with vocabulary, have trouble naming a familiar object or use
the wrong name (e.g., calling a "watch" a "hand-clock").

Misplacing things and losing the ability to retrace steps

A person living with Alzheimer's disease may put things in unusual places. They may lose things
and be unable to go back over their steps to find them again. He or she may accuse others of
stealing, especially as the disease progresses.

Decreased or poor judgment

Individuals may experience changes in judgment or decision-making. For example, they may
use poor judgment when dealing with money or pay less attention to grooming or keeping
themselves clean.
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Withdrawal from work or social activities

A person living with Alzheimer’s disease may experience changes in the ability to hold or follow
a conversation. As a result, he or she may withdraw from hobbies, social activities or other
engagements. They may have trouble
keeping up with a favorite team or activity.

Changes in mood and personality

Individuals living with Alzheimer’s may experience mood and personality changes. They can
become confused, suspicious, depressed, fearful or anxious. They may be easily upset at
home, with friends or when out of their comfort zone.

Epidemiology
Approximately 5.8 million people in the United States age 65 and older live with Alzheimer's
disease. Of those, 80% are 75 years old and older. Out of the approximately 50 million people
worldwide with dementia, between 60% and 70% are estimated to have Alzheimer's disease. In
according to DOH, 11 million people suffer worldwide. About 5% of people reaching 65 are
affected. 5-25% of people reaching 85 are affected. Late stage of disease requires one total
dependence and inactivity representing an enormous burden on family and health care delivery.

Worldwide, an estimated 46.8 million people suffer from dementia, described by Dr. Socorro
Martinez as the “gradual decline in an individual’s total mental function.” From 2003-2004, the
Philippines had a population of 84 million, 2.9 percent of which were 65 years old and above. Of
this figure, 11.9 percent, or 289,884 had dementia. From 2003-2007, some 179,000 Filipinos
had dementia of varying types, not only AD. According to Martinez, Population Commission
(PopCom) statistics have indicated that from the 2.9 percent of Filipinos beyond 65 years old
almost a decade ago, the elderly population has increased to 4.3 percent of total population
from 2014 to 2015. By extrapolation, there would be 490,000 Filipinos over 65 who have varying
types of dementia, said Martinez, the president of the Alzheimer’s Disease Association of the
Philippines.

Diagnostic Procedure

Diagnostic Procedure Definition/Purpose How it is done Nursing Consideration

Magnetic Resonance Imaging (MRI) Magnetic resonance imaging (MRI) is a medical imaging
technique that uses a magnetic field and computer-generated radio waves to create detailed
images of the organs and tissues in your body.

Most MRI machines are large, tube-shaped magnets. When you lie inside an MRI machine, the
magnetic field temporarily realigns water molecules in your body. Radio waves cause these
aligned atoms to produce faint signals, which are used to create cross-sectional MRI images —
like slices in a loaf of bread. During an MRI scan:

Once in the scanner, the MRI technician will communicate with the patient via the intercom to
make sure that they are comfortable. They will not start the scan until the patient is ready.

During the scan, it is vital to stay still. Any movement will disrupt the images, much like a
camera trying to take a picture of a moving object. Loud clanging noises will come from the
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scanner. This is perfectly normal. Depending on the images, at times it may be necessary for
the person to hold their breath.

If the patient feels uncomfortable during the procedure, they can speak to the MRI technician via
the intercom and request that the scan be stopped.

After an MRI scan

After the scan, the radiologist will examine the images to check whether any more are required.
If the radiologist is satisfied, the patient can go home.

The radiologist will prepare a report for the requesting doctor. Patients are usually asked to
make an appointment with their doctor to discuss the results.
• Make sure the scanner can accommodate the patient’s weight and abdominal
girth.
• Inform the patient that skeletal MRI evaluates both bone and soft tissue. Inform him of
who will conduct the test and where it will take place.
• Explain that the test takes 30 to 90 minutes.
• Explain to the patient that, although MRI is painless and involves no radiation exposure
from the scanner, a contrast medium may be required depending on the type of tissue being
examined.
• If the patient is claustrophobic or if the scanning will take a long time, inform him that a
light sedative may be given to relieve anxiety. Open scanners have been designed for use on
patients suffering from extreme claustrophobia or morbid obesity, but tests using such machine
take longer.
• An anesthesiologist may need to be present to monitor a heavily sedated patient.
• Tell the patient that he must lie flat, and describe the test procedure.
• Explain to the patient that he’ll hear the scanner clicking, whirring, and thumping as it
moves inside its housing.
• Reassure the patient that he’ll be able to communicate with the technician at all times.
• Instruct the patient to remove all metallic objects, including jewelry, hairpins, or watches.
• Stop I.V. infusion pumps, feeding tubes with metal tips, pulmonary artery catheters, and
similar devices before the test.
• Ask whether the patient has any surgically implanted joints, pins, clips, valves, pumps, or
pacemakers containing metal that could be attracted to strong MRI magnet. If he does, he won’t
be able to have the test.
• Make sure that the patient or a responsible family member has signed an informed
consent form, if required.

• Provide patient with comfort measures as needed.

• Tell the patient to resume his normal diet and activities unless otherwise indicated.
• Monitor vital signs.
• Monitor the patient for orthostatic hypotension.
Dementia Blood Test Panel A Dementia Blood Test Panel is commonly ordered tests used to
differentiate between Alzheimer's and other forms of Dementia. Includes CBC, Electrolytes, TSH,
T4 total, Vitamin B12, CRP, and Sedimentation Rate. Fasting for 12 hours is required.
Refrain from taking vitamin C supplements and fruits 24 hours before the collection and biotin for
at least 72 hours prior to the collection. Must draw before Schilling test, transfusions or B12
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therapy is started. Test results usually take 3-5 days but may take longer based on weather,
holiday, or lab delays Many blood tests don't require any special preparations. For some, you
may need to fast (not eat any food) for 8 to 12 hours before the test. Your doctor will let you know
how to prepare for blood tests.
Genetic Test Apolipoprotein (Apo) E is one of the five major types of blood lipoproteins and is
synthesized under the control of the APOE gene (A-E). This test examines a person's DNA to
identify which APOE forms (genotype) are present. The APOE gene has three variants (alleles)
– e2, e3, and e4 – with e3 being the most abundant allele, occurring in 60% of the general
population. Everyone inherits a pair of APOE genes that is some combination of these three.
In symptomatic adults, APOE genotyping is occasionally used as an additional test to aid
in the diagnosis of likely late-onset Alzheimer dementia (AD). However, the link of the e4 allele
with late-onset AD does not imply that it causes AD; rather, it indicates that more people with late-
onset AD have e4 alleles than similar aged peers who do not have late-onset AD. As a result,
APOE genotyping is referred to as susceptibility or risk factor testing because it indicates whether
there is an elevated risk of Alzheimer's disease but is not precisely diagnostic of Alzheimer's
disease. For example, if a person develops dementia, the presence of APOE e4 may raise the
possibility that the dementia is caused by Alzheimer's disease (AD), but it does not prove it.
nurses assist individuals in making decisions about DNA studies, ensure that consent is
informed before genetic testing, and help clients cope with genetic information after test results
are known. Nurses with advanced education in genetics identify and counsel people who are
candidates for DNA testing and individuals and families experiencing or is a candidate for genetic
test in identifying Alzheimer’s Disease

Medical management
Donepezil hydrochloride
Donepezil is used to treat confusion (dementia) related to Alzheimer's disease. It does not cure
Alzheimer's disease, but it may improve memory, awareness, and the ability to function. This
medication is an enzyme blocker that works by restoring the balance of natural substances
(neurotransmitters) in the brain.
Memantine
Memantine is used to treat the symptoms of Alzheimer's disease (AD; a brain disease that
slowly destroys the memory and the ability to think, learn, communicate and handle daily
activities). Memantine is in a class of medications called NMDA receptor antagonists. It works
by decreasing abnormal activity in the brain.

Nursing management
After a diagnosis of Alzheimer's disease is made and a treatment plan implemented, patients
should return for evaluation on a regular basis. Both cognitive and behavioral symptoms of
dementia tend to change as the disease progresses, so regular visits allow adaptation of
treatment strategies to current needs. Patients with dementia may not be a reliable resource for
history-taking, so encourage a family member, friend or caregiver to accompany the patient to
all visits.
1. Establish an effective communication system with the patient and his family to help them
adjust to the patient’s altered cognitive abilities.
2. Provide emotional support to the patient and his family.
3. Administer ordered medications and note their effects. If the patient has trouble
swallowing, crush tablets and open capsules and mix them with a semi soft food.
4. Protect the patient from injury by providing a safe, structured environment.
5. Provide rest periods between activities because the patient tires easily.
6. Encourage the patient to exercise as ordered to help maintain mobility.
7. Encourage patient independence and allow ample time for him to perform tasks.
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8. Encourage sufficient fluid intake and adequate nutrition.

9. Take the patient to the bathroom at least every 2 hours and make sure he knows the
location of the bathroom.
10. Assist the patient with hygiene and dressing as necessary.
11. Frequently check the patient’s vital signs.
12. Monitor the patient’s fluid and food intake to detect imbalances.
13. Inspect the patient’s skin for evidence of trauma, such as bruises or skin breakdown.
14. Encourage the family to allow the patient as much independence as possible while
ensuring safety to the patient and others.
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ANATOMY AND PHYSIOLOGY

Nervous System

The nervous system is a complex network of nerves and cells that carry messages to and from
the brain and spinal cord to various parts of the body. The nervous system includes both the
Central nervous system and Peripheral nervous system. The central nervous system is made up
of the brain and spinal cord, and the peripheral nervous system is made up of the Somatic and
the Autonomic nervous systems.

Functions of the Nervous System

1. Gathers information from both inside and outside the body - Sensory Function

2. Transmits information to the processing areas of the brain and spine

3. Processes the information in the brain and spine – Integration Function

4. Sends information to the muscles, glands, and organs so they can respond appropriately –
Motor Function

It controls and coordinates all essential functions of the body including all other body systems
allowing the body to maintain homeostasis or its delicate balance.

The Nervous System is divided into Two Main Divisions: Central Nervous System (CNS) and
the Peripheral Nervous System (PNS)
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Basic Cells of the Nervous System

Neuron

Neurons, also known as nerve cells, send and receive

signals from your brain. While neurons have a lot in
common with other types of cells, they’re structurally and
functionally unique special
projections called axons allow neurons to transmit electrical
and chemical signals to other cells. Neurons can also
receive these signals via root like extensions known as
dendrites.

At birth, the human brain consists of an estimated 100

billion neurons trusted Source. Unlike other cells, neurons
don’t reproduce or regenerate. They aren’t replaced once
they die the
creation of new nerve cells is called neurogenesis. While
this process isn’t well understood, it may occur in some
parts of the brain after birth.

• Basic functional cell of nervous system

• Transmits impulses (up to 250 mph)

Parts of a Neuron

• Dendrite – Nerve cells (neurons) have extensive

processes called dendrites. These occupy a large surface
area of a neuron. They receive many signals from other
neurons and contain specialized proteins that receive,
process, and transfer these to the cell body. Dendrites also
possess organelles that enable them to alter protein
density in response to changes in frequency of neuronal
inputs.

• Cell Body - Also

known as a soma, the cell
body is the neuron’s core.
The cell body carries
genetic information,
maintains the neuron’s
structure, and provides energy to drive activities. Like other
cell bodies, a neuron’s soma contains a nucleus and
specialized organelles.

• Axon – An axon is a long, tail-like structure which

joins the cell body at a specialized junction called the axon
hillock. Many axons are insulated with a fatty substance
called myelin.

• Schwann Cells- Derived from the neural crest and

play crucial roles in the maintenance and regeneration of
the motor and sensory neurons of the peripheral nervous
system (PNS). They are mainly required for insulating
(myelinating) and supplying nutrients to individual nerve fibers (axons) of the PNS
neurons.

• Myelin sheath – Are sleeves of fatty tissue that protect the nerve cells. These
cells are part of the central nervous system, which carries messages back and forth
between the brain and the rest of the body
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• Node of Ranvier – Is the conical projection of the neuron that connects the cell
body or soma with the axon. In other words, the region where the axon is connected to
the soma is at the axon hillock.

• Impulses travel from dendrite to cell body to axon

Three types of Neurons

o Sensory neurons – bring messages to CNS

o Motor neurons - carry messages from CNS

o Interneurons – between sensory & motor neurons in the CNS

Impulses

• A stimulus is a change in the environment with sufficient strength to initiate a

response.

• Excitability is the ability of a neuron to respond to the stimulus and convert it into
a nerve impulse

• All of Nothing Rule – The stimulus is either strong enough to start and impulse or
nothing happens

• Impulses are always the same strength along a given neuron and they are self-
propagation – once it starts it continues to the end of the neuron in only one direction-
from dendrite to cell body to axon

• The nerve impulse causes a movement of ions across the cell membrane of the
nerve cell.

Synapse

 Synapse - small gap or space between the axon of one neuron and the dendrite of
another - the neurons do not actually tough at the synapse

 It is junction between neurons which uses neurotransmitters to start the impulse in

the second neuron or an effector (muscle or gland) the synapse insures one-way
transmission of impulses
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Neurotransmitters

Neurotransmitters – Chemicals in the junction which allow impulses to be started in the

second neuron

Central Nervous System

A. Brain

1. The largest organ in the nervous

system; composed of about 100 billion
neurons (interestingly, although the
neurons contain DNA, there is no DNA
replication or mitosis in the brain, as a
result the number of neurons
decreases as a person ages).

2. Divided into 3 main regions: Cerebrum,

Cerebellum, and the Brain Stem.

3. Contains spaces called ventricles

where choroid plexuses of Pia mater
produce cerebrospinal fluid (CSF), and
these ventricles allow CSF to circulate
around the brain and into the spinal
cord (through the central canal).

• Brain stem – medulla, pons,

midbrain
• Diencephalon – thalamus &
hypothalamus
• Cerebellum
• Cerebrum

B. Spine

• Spinal Cord

Meninges

Meninges are the three coverings

around the brain & spine and help
cushion, protect, and nourish the
brain and spinal cord.

• Dura mater is the most outer

layer, very tough

• Arachnoid mater is the

middle layer and adheres to the
Dura mater and has web like
attachments to the innermost
layer, the Pia mater

• Pia mater is very thin,

transparent, but tough, and covers
the entire brain, following it into all
its crevices (sulci) and spinal cord

• Cerebrospinal fluid, which buffers, nourishes, and detoxifies the brain and spinal
cord, flows through the subarachnoid space, between the arachnoid mater and the
Pia mater
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Brain

The brain is a complex organ that controls thought,

memory, emotion, touch, motor skills, vision,
breathing, temperature, hunger and every process
that regulates our body. Together, the brain and
spinal cord that extends from it make up the central
nervous system, or CNS.

Regions of the Brain

Cerebellum – Coordination of movement and

aspects of motor learning. The cerebellum
(“little brain”) is a structure that is located at the
back of the brain, underlying the occipital and
temporal lobes of the cerebral cortex. Although the
cerebellum accounts for approximately 10% of the
brain’s volume, it contains over 50% of the total
number of neurons in the brain.

Cerebrum – The largest part of the brain. It is

divided into two hemispheres, or halves, called the
cerebral hemispheres. Areas within the cerebrum
control muscle functions and also control speech,
thought, emotions, reading, writing, and learning.
Mainly on conscious activity including perception,
emotion, thought, and planning

Thalamus – Brain’s switchboard –filters and then

relays information to various brain regions. The
thalamus is a paired gray matter structure of the
diencephalon located near the center of the brain.
It is above the midbrain or mesencephalon,
allowing for nerve fiber connections to the cerebral
cortex in all directions each thalamus connects to
the other via the interthalamic adhesion

Medulla – Vital reflexes as heart beat and

respiration. At the bottom of the brainstem, the
medulla is where the brain meets the spinal cord.
The medulla is essential to survival. Functions of
the medulla regulate many bodily activities,
including heart rhythm, breathing, and blood flow,
and oxygen and carbon dioxide levels.

Brainstem – The brainstem is the structure that

connects the cerebrum of the brain to the spinal
cord and cerebellum. It is composed of four
sections in descending order: the diencephalon,
midbrain, pons, and medulla oblongata. Medulla,
pons, and midbrain (Involuntary responses) and
relays information from spine to upper brain

Hypothalamus– Involved in regulating activities

internal organs, monitoring information from the
Autonomic nervous system, controlling the
pituitary gland and its hormones, and regulating
sleep and appetite

Cerebrum

• Is the largest portion of the brain encompasses about two-thirds of the brain mass

• It consists of two hemispheres divided by a fissure – corpus callosum

• It includes the cerebral cortex, the medullary body, and basal ganglia
 17

• Cerebral cortex is the layer of the brain often referred to as gray matter because
it has cell bodies and synapses but no myelin

a. The cortex (thin layer of tissue) is gray because nerves in this area lack the
insulation or white fatty myelin sheath that makes most other parts of the brain
appear to be white.

b. The cortex covers the outer portion (1.5mm to 5mm) of the

cerebrum and cerebellum o The cortex consists of folded bulges
called gyri that create deep furrows or fissures called sulci

c. The folds in the brain add to its surface area which increases the
amount of gray matter and the quantity of information that can be
processed

• Medullary body – is the white matter of the cerebrum and consists of myelinated
axons

a. Commisural fibers – conduct impulses between the hemispheres and form corpus
callosum

b. Projection fibers – conduct impulse in and out of the cerebral

hemispheres

c. Association fibers – conduct impulses within the hemispheres

Basal ganglia – masses of gray matter in each hemisphere which are

involved in the control of voluntary muscle movements

Lobes of the Cerebrum

d. Frontal – Motor area

involved in movement
and in planning &
coordinating behavior

e. Parietal – Sensory
processing, attention,
and language

f. Temporal – Auditory
perception, speech,
and complex visual
perceptions

g. Occipital – Visual
center plays a role in
processing visual
information

Special regions

a. Broca’s area – located in the frontal lobe – important in the production of

speech

b. Wernicke’s area – comprehension of language and the production of meaningful

speech

c. Limbic System – a group of brain structures (aamygdala, hippocampus, septum,

basal ganglia, and others) that help regulate the expression of emotions and
emotional memory
 18

Peripheral Nervous System

The peripheral nervous system refers to parts of

the nervous system outside the brain and spinal
cord. It includes the cranial nerves, spinal nerves
and their roots and branches, peripheral nerves,
and neuromuscular junctions. In the peripheral
nervous system, bundles of nerve fibers or axons
conduct information to and from the central
nervous system. The autonomic nervous system
is the part of the nervous system concerned with
the innervation of involuntary structures, such as
the heart, smooth muscle, and glands within the
body. It is distributed throughout the central and
peripheral nervous systems.

Cranial nerves

• 12 pair
• Attached to under surface of brain

Spinal nerves

• 31 pair
• Attached to spinal cord

Somatic Nervous System (voluntary)

• Relays information from skin, sense

organs & skeletal muscles to CNS

• Brings responses back to skeletal

muscles for voluntary responses

Autonomic Nervous System (involuntary)

• Regulates bodies involuntary

responses
• Relays information to internal organs
• Two divisions
o Sympathetic nervous system – in times
of stress

 Emergency response
 Fight or flight
 Parasympathetic nervous system, when
body is at rest or with normal functions
 Normal everyday conditions
 19

PATHOPHYSIOLOGY
Etiology Modifiable Risk Factors
● Probable Senile Dementia of the  Sedentary Lifestyle
Alzheimer Type (SDAT): 50%  Social Isolation
● Multi-infarct: 15%  Cardiovascular
● Alcohol: 8% disease
● Neoplasms: 5%
● Trauma: 4% Unmodifiable Risk Factors
● Hydrocephalus: 3% ● Age
● All others, including Huntington’s ● Family History
chorea, metabolic causes, etc.: ● Down’s Syndrome
15%

Neurodegeneration due to
Alzheimer’s Disease

Neural damage primarily in the

cerebral cortex

Formation of neuritic plates Tangled masses of non-

(deposits of amyloid protein) functioning neurons
(neurofibrillary tangles)

Decrease in brain size

Alteration of the normalcy of

activities of neurotransmitters

Decreased production of Decreased production of

acetylcholine dopamine

Decreased
production of Emotional Impaired
acetylcholine and functional
attention ability
deficit
 20

Signs and Symptoms Signs and

 Forgetfulness Symptoms
Signs and
 Disorientation  Depression
Symptoms
 Anxiety and
 Inability to
agitation
perform
 Decreased
ADLs
attention
 Immobility
span
 21

DRUG STUDY

Drug Doctor’s Order Mechanism of Indications Contraindications Effects Nursing

Action Considerations
Generic Name: Dosage: Hydroxyurea is a WBC is Hypersensitivity, Side effects:
Hydroxyurea 200 mg potent RR inhibitor decreased. severe anemia and Nausea and - Review the
Brand Name: Route: that reduces bone marrow vomiting status of
Hydrea Oral intracellular depression. Rash and itching kidney, liver,
Frequency: deoxynucleotide Diarrhea and bone
Feeling drowsy
PO q day triphosphate pools marrow
Time: and acts as an S- function before
Classification: Adverse Effects:
Bedtime phase-specific Leukemia
and
Antimetabolites Form: agent with periodically
Date Given: Anemia
Capsule inhibition of DNA Myelosuppression during therapy;
October 1, 2021 synthesis and monitor
Date eventual cellular Therapeutic hemoglobin,
Discontinued: cytotoxicity. Effects: WBC, platelet
October 2,2021 Helps to lower counts at least
high WBC once weekly.
- Discontinue
the therapy if
WBC drops to
4.5-
14.5x10^9/L

Hydroxyurea: Generic, Uses, Side Effects, Dosages, Interactions, Warnings. (2021, September 1). RxList. https://www.rxlist.com/consumer_hydroxyurea_hydrea/drugs-
condition.htm
 22

Drug Doctor’s Order Mechanism of Indications Contraindications Effects Nursing

Action Considerations
Generic Name: Dosage: Donepezil binds Cognition and Hypersensitivity to Side effects:
Donepezil 5 mg (for 4-6 reversely to Activities of daily donepezil Nausea - Educate the
hydrochloride weeks) acetylcholinesterase living, are hydrochloride or Diarrhea family and
Brand Name: 10-23 mg and inhibits the improved. piperidine Vomiting caregivers that
Aricept (increase after) hydrolysis of derivatives. donepezil does
Classification: acetylcholine, thus Adverse not alter the
Acetylcholinesterase increasing the Effects: progression of
Inhibitor Route: availability of Bradycardia Alzheimer
Date Given: Oral acetylcholine at the Heart Block disease.
October 1, 2021 Frequency: synapses, Hypertension - Assess
Od enhancing Edema cognitive and
Date Discontinued: Time: cholinergic Therapeutic behavior to
October 4, 2021 Bed time transmission. Effects: assess
Form: Helps to treatment
Tablet improve efficacy.
cognitive and
behavior.
Donepezil: Generic, Uses, Side Effects, Dosages, Interaction, Warnings. (2021, September 13). RxList. https://www.rxlist.com/consumer_donepezil_aricept_aricept_odt/drugs-condition.htm

Uses, Side Effects, Dosages, In

 23

Drug Doctor’s Order Mechanism of Indications Contraindications Effects Nursing

Action Considerations
Generic Name: Dosage: Memantine is an Memory, Side effects: - Educate the
Memantine 5 mg NMDA receptor awareness and Hypersensitivity to Dizziness family and the
Brand Name: Route: antagonist, it ability to perform product or Headache caregiver the
Namenda Oral works by daily functions, are components Confusion proper
Frequency: Od decreasing improved constipation administration
Time: abnormal activity of the
Classification: Bedtime in the brain. Adverse medicine;
NMDA Receptor Form: Effects:  do not
021, Antagonist Tablet Hepatitis divide September
Date Given: Pancreatitis the
13
October 1, 2021 Congestive dose
heart failure  if
Date Therapeutic missed
Discontinued: Effects: a
October 4, 2021 It helps improve dose,
the memory, do not
awareness and double
ability to the
perform daily next
functions. dose
- assess
dizziness and
drowsiness
that might
affect gait,
balance and
other
functional
activities.
 24

Memantine: Generic, Uses, Side Effects, Dosages, Interactions, Warnings. (2021, August 19). RxList. https://www.rxlist.com/consumer_memantine_namenda/drugs-condition.htm

Drug Doctor’s Order Mechanism of Indications Contraindications Effects Nursing

Action Considerations
Generic Name: Dosage: 1g (15 Paracetamol has Fever, pain, and Hypersensitivity to Side effects: - Must check
Paracetamol mcg/mL) central analgesics headache, are paracetamol. Drowsiness the patient is
Brand Name: Route: IV effect that is treated. Severe Fatigue not taking
Ifimol IV Frequency: if mediated through hepatocellular drugs
Classification: needed activation of insufficiency. Adverse containing
Non-opioid Time: descending Effects: paracetamol.
Analgesic Q 4-6 hourly serotonergic Hepatocellular - Evaluate the
Date Given: Form: pathways. necrosis or less effectiveness
October 2, 2021 Vial frequently renal of the drug.
tubular
necrosis.
Date Therapeutic
Discontinued: Effects:
October It treated fever,
pain, and
headache.

Ifimol IV Full Prescribing Information, Dosage & Side Effects | MIMS Philippines. (n.d.). N. Retrieved October 11, 2021, from https://www.mims.com/philippines/drug/info/ifimol%20iv?type=full
 25

LABORATORY RESULTS AND DIAGNOSTIC STUDIES

Name: Mr. B Admitting Physician: Dr. Z Sex: Male

Address: Zamora st., Don Admitting Hospital: Age: 70

Domingo Maddela, Bayombong
, Nueva Vizcaya
Date: October 1, 2021

A. MRI Brain Scan

Laboratory Report Analysis at
Region II Trauma Medical Center
(RIITMC)
Result Implications

When a patient develops

Alzheimer’s disease, their brain
begins to atrophy. MRIs use
magnets and radio sound waves
to produce an image of the
patient’s brain, shows a more
brain anatomy than PET. This
scan can help doctors find atrophy
in the brain and track its
deterioration by comparing the
scans of an Alzheimer’s patient
with a healthy brain scan.

The MRI result of Mr. B reveal brain

shrinkage, and shows widening of
the grooves and fissures of the
cerebral cortex that indicate
progressively severe brain atrophy
or the loss or damage of brain cells
result from having Alzheimer's
disease.

B. Blood Chemistry
Legend:
Laboratory Report Analysis at Blue- Below the normal range
Olivarez General Hospital Red- Above the normal range
Dr. A. Santos Ave. Paranaque Black- within the normal range
City, Metro Manila
DEMENTIA BLOOD TEST Normal Values Result
PANEL
WBC 4.5-14.5 x10^9 /L 15 x10^9 /L
RBC 4.2-5.9 x10^9 /L 4 x10^9 /L
Hemoglobin 12-18/dL 11g/L
Hematocrit 37-50% 36.5 %
MCV 78.1-99.2 fL 101 fL
MCH 25.7-33.8 pg 24.3 pg
MCHC 32.0-35.3 g/dL 31.1 g/dL
RDW 11.8-15.3 % 16.2 %
Platelets 150K-450K/mcL 480K/ mcL
Neutrophils 39.7%-77.3% 79.5%
Lymphocytes 17.8%-51.8% 15%
Monocytes 0-12% 15%
Eosinophils 0-6% 6.9%
 26

Basophiles 0-2% 1%
Immature Granulocytes 1.5 – 8.5 x 10^9/L 9.1 x 10^9/L

Electrolytes
Sodium 135-145 mEq/L 130 mEq/L
Potassium 3.5-5 mEq/L 2.9 mEq/L
Chloride 95-105 mEq/L 90 meq/L
Carbon dioxide 22 to 29 mEq/L 30.1 mEq/ L
Calcium 8.5-10.5 mg/dl 11 mg/dL

TSH 4-6 mIU/L 3 mIU/L

T4 total 5-11.0 mcg/dl 4.1 mcg/dL
Vitamin B12 300 to 350 pg/mL 150 pg/mL
C-Reactive Protein 1.0-3.0 mg/L 5.0 mg/L
Sedimentation Rate 0 to 22 mm/hr 23 mm/hr

DEMENTIA BLOOD Normal Values Result PATHOPHYSIOLOGICAL

TEST PANEL BASIS
Complete Blood
Count
WBC 4.5-14.5 x10^9 /L 15 x10^9 /L Indication: Above the
normal range

Significance: A blood cell

that helps protect the body
from infection. Increased
WBC count may indicate an
infection or other stress to
the body that deals.

Implication: Mr. B has an

elevated level of WBC which
thought to carry amyloid-ß
peptide in Alzheimer
patients.
RBC 4.2-5.9 x10^9 /L 4 x10^9 /L Indication: Below the
normal range

Significance: A blood cell

that carries oxygen around
the body through the blood
stream

Implication: Mr. B has low

RBC wherein it is include in
the characterization of
progressive deterioration in
cognitive abilities including
memory impairment,
typically in the elderly.
Hemoglobin 12-18/dL 11g/L Indication: Below the
normal range

Significance: Hemoglobin
is a protein in the red blood
cells that carries oxygen to
the body's organs and
tissues and transports
carbon dioxide from organs
and tissues back to the
lungs.
 27

Implication: Mr. B has a

low hemoglobin count that
may indicate abnormalities
of hemoglobin levels or
structure that can a cause of
anemia deficiency is
associated with an
increased risk of developing
dementia
Hematocrit 37-50% 36.5 % Indication: Below the
normal range

Significance: The volume

or percentage of red blood
cells in the blood sample
indicates that the blood has
enough red blood cells to
carry oxygen to the cells.

Implication: Mr. B has low

level of hematocrit that can
indicate an insufficient
supply of healthy red blood
cells that may lead to
anemia deficiency is
associated with an
increased risk of developing
dementia
Mean 78.1-99.2 fL 101 fL Indication: Above the
Corpuscular normal range
Volume
(MCV) Significance: An MCV
blood test is often part of a
complete blood count
(CBC), a routine screening
test that measures many
different components of the
blood including red blood
cells it may also be used to
diagnose or monitor certain
blood disorders.

Implication: Mr. B has high

level MCV which indicates
that the red blood cells are
larger than the average
larger MCV reduces the
amount of RBC reaching the
brain size, and also indicate
vitamin B12 deficiency.
Mean Corpuscular 25.7-33.8 pg 24.3 pg Indication: Lower the
Hemoglobin normal range
(MCH)
Significance: The MCH is
the average amount in each
of red blood cells of a
protein called hemoglobin,
which carries oxygen
around the body

Implication: Mr. B has low

level MCH which indicate
anemia deficiency is
associated with an
 28

increased risk of developing

dementia
MCHC 32.0-35.3 g/dL 31.1 g/dL Indication: Below the
normal range

Significance: The average

quantity of hemoglobin in a
set of red blood cells is
measured by MCHC.

Implication: Mr. B has low

mean corpuscular
hemoglobin concentration
(MCHC) which indicates that
the hemoglobin in a
person's red blood cells is
insufficient. Anemia can be
caused by a shortage of
hemoglobin, an iron-rich
protein.
RDW 11.8-15.3 % 16.2 % Indication: Above the
normal range

Significance: The red cell

distribution width (RDW)
blood test measures the
amount of red blood cell
variation in volume and size.
(Gonzalez, 2019)
Implication: This might
indicate a nutritional
deficiency, such as an iron,
folate, or vitamin B-12
insufficiency. These findings
might potentially indicate
macrocytic anemia, which
occurs when your body
does not create enough
normal red blood cells and
those that do are bigger
than normal.
Platelets 150K-450K/mcL 145K/ mcL Indication: Below the
normal range

Significance: Blood cells

that help blood clot and
avoid excess bleeding.

Implication: Mr. B has

slightly decrease platelet
which considered to be a
biomarker for early
diagnosis of AD.
Neutrophils 39.7%-77.3% 79.5% Indication: Above the
normal range

Significance: If neutrophil
counts are high, it can mean
an infection or are under a
lot of stress. While without
enough neutrophils, body
can't fight off bacteria.

Implication: Elevated NLR

levels are usually
 29

considered as an
inflammatory marker
inflammation plays a
significant role in the
pathophysiology of
Alzheimer's disease (AD)
Lymphocytes 17.8%-51.8% 15% Indication: Below the
normal range

Significance: A type of
WBC that plays a key role in
immunity and helps protect
the body from infection

Implication: A low
lymphocyte count specifies
that the body's resistance to
fight infection is substantially
reduced
Monocytes 0-12% 15% Indication: Above the
normal range

Significance: Monocyte is
part of the innate immune
system and can effectively
remove dead cells and
debris.

Implication: a high level of

indicate inflammatory
signals where they
proliferate and differentiate
into macrophages as
response.
Basophiles 0-2% 1% Indication: Below the
normal range

Significance: Basophils
plays key role in activation in
certain kidney diseases
analyzed in minimal-change
disease and focal
segmental
glomerulosclerosis

Implication: Low basophil

levels indicates their over
utilization due to chronic
inflammatory condition
wherein basophils have
recently been shown to be
important in causing the
body to produce the
antibody called
immunoglobulin E (IgE).

Electrolytes
Sodium 135-145 mEq/L 130 mEq/L Indication: Below the
normal range

Significance: Sodium is an
electrolyte as well as a
mineral. It aids in
 30

maintaining the body's water

and electrolyte balance (the
quantity of fluid within and
outside the cells). Sodium is
also necessary for the
proper functioning of
neurons and muscles.
Implication: Several
studies reported that chronic
hyponatremia resulted in
mild cognition impairment
which in turn was
associated with increased
risk of progression to
dementia
Potassium 3.5-5 mEq/L 2.9 mEq/L Indication: Below the
normal range

Significance: It aids the

operation of your nerves
and the contraction of your
muscles. It helps in the
maintenance of a normal
pulse. It also assists in the
transport of nutrients and
waste materials into and out
of cells.

Implication: A biochemical
hallmark of Alzheimer's
disease is the loss of
intracellular
compartmentalization of
potassium, which indicates
a loss of membrane integrity
and mitochondrial
malfunction.
Carbon dioxide 22 to 29 mEq/L 30.1 mEq/ L Indication: Above the
normal range

Implication: CO poisoning
is associated with a risk of
toxicity of the central
nervous system and heart.
Increased level of CO2 in
the blood decreases the
cerebral metabolism of
oxygen.
Calcium 8.5-10.5 mg/dl 11 mg/dL Indication: Above the
normal range

Implication: excessive
levels might lead to cell
death, which provides a key
target for the calcium
channel blockers might be
used as the neuroprotective
agents in Alzheimer's

Thyroid Stimulating 4-6 mIU/L 3 mIU/L Indication: Below the

Hormone normal range
(TSH)
Significance: Both low and
high TSH levels were
associated with an
 31

increased risk of developing

incident AD
Implication: Thyroid
hormones have been linked
to cognitive decline and
Alzheimer's disease in the
past.
Thyroxine 5-11.0 mcg/dl 4.1 mcg/dL Indication: Below the
(T4 total) normal range

Significance: Dementia,
and its most frequent
subtype which is
Alzheimer's disease, has
been associated with thyroid
status
Vitamin B12 300 to 350 pg/mL 150 pg/mL Indication: Below the
normal range

Significance: Vitamin B12

is a nutrient that aids in the
health of your body's blood
and nerve cells, as well as
the production of DNA,
which is the genetic material
found in all of your cells.
Vitamin B12 also aids in the
prevention of megaloblastic
anemia, a blood disorder
that causes fatigue and
weakness. High levels of
vitamin B12 in the blood are
already known to help
reduce levels of
homocysteine, which has
been linked to an increased
risk of Alzheimer's disease,
memory loss, and stroke.

Implication: Low B12 levels

with both the symptoms of
Alzheimer's and actual
atrophy (shrinkage) of the
brain
C-Reactive Protein 1.0-3.0 mg/L 5.0 mg/L Indication: Above the
normal range

Significance: C-reactive
protein (CRP) is a
nonspecific marker of
inflammation that is
increased in the brain and
serum of patients with
Alzheimer's disease (AD),
and has been associated
with increased risk of
developing dementia.
Sedimentation Rate 0 to 22 mm/hr 23 mm/hr Indication: Above the
normal range

Significance: A blood test

to determine whether or not
your body is inflamed. It's
one sign to your doctor that
you could be suffering from
an illness.
 32

Implication: elevated ESR

occurs with inflammation but
also with anemia, infection

C. Genetic Test
Laboratory Report Analysis at
Olivarez General Hospital
Dr. A. Santos Ave. Paranaque City, Metro Manila
Test Result Implications
APOE genotyping is
referred to as
APOE genotyping Positive for APOE e4 alleles susceptibility or risk factor
testing and is sometimes
used as an added test to
help in the diagnosis of
probable late onset
Alzheimer disease (AD) in
symptomatic adults.

Mr. B have more than one

copy of APOE e4, wherein
The e4 version of the
APOE gene increases an
individual's risk for
developing late-onset
Alzheimer disease.
The major effect of apoE
isoforms on the risk of
developing AD is via its
effect on Aβ aggregation
and clearance, influencing
the onset of Aβ deposition.
 33

COMPREHENSIVE GERIATRIC ASSESSMENT

COMPREHENSIVE GERIATRIC ASSESSMENT FORM

Date of Assessment: October 1, 2021

Time of Assessment: 9:00 am

A. PERSONAL DATA ASSESSMENT

Name: Mr. B
Address: Bayombong, Nueva Vizcaya
Age: 70 years old
Gender: Male
Civil Status: Married
Date and Time of Assessment: October 1, 2021
Advanced Health Directive Planning
DNR Directive: None
Living Will: None
Medical Power of Attorney: None
Financial Health Planning
Primary source of healthcare:
 Region II Trauma and Medical Center (R2TMC)

Financial resources related to illness:

 Philhealth
 Mr. B’s son

B. MEDICAL ASSESSMENT Justification/ Pathophysiological basis

Vital Signs
Temperature
Rate: 36.5
Route: Axilliary
Peripheral pulse
Rate: 76 beats per minute
Rhythm: Regular
Location: Radial Artery
Pulse amplitude: Normal
Apical pulse
Rate: 80 beats per minute
Rhythm: Regular
Murmurs: (-)
Respirations
Rate: 18 beats per minute
Rhythm: Regular
Use of accessory muscles: None
Lung sounds: Bronchovesicular
General appearance: According to Lakhan (2021), patients
The patient was observed physically. with Alzheimer disease most
Furthermore, the patient appeared disoriented, can’t commonly present with insidiously
remember things and struggling to organize thoughts. progressive memory loss, to which
He also was having difficulty in communicating and other spheres of cognition are
understanding instructions. impaired over several years. In
addition, according to an article, it is
usually because the person is losing
neurons in parts of the brain.
Allergic reactions on
Medication: None
Food: None
Environment: None
Vaccinations:
1. Influenza Vaccine
 34

Health promotion activities:

1. Morning Stroll
2. Fishing on a river

Long term conditions:

1. None
Regular clinics and therapies:
1. None
2. None
3. None
Surgical history:
1. None
2. None
3. None
Eyes/ Vision As we age, our sensory modalities
Eyes: Blurry Vision (including vision) show gradual
Pupil: The pupils are equally round and deterioration and most of the major eye
reactive to light and accommodation. diseases are age-related. The
Use of glasses: The patient is not using prevalence of these sight-threatening
glasses diseases dramatically increases above
75 years of age. (Physiopedia, 2021)
Ears/ Hearing Hearing loss is a natural consequence
Hearing: Normal of getting older. As you get older, the
Hearing aid: Patient does not use hearing aid hair cells in your inner ear begin to die
and when more and more hair cells die
our hearing gets worse and worse.
Skin integrity According to Mayoclinic, age spots are
The patient has no scars, wounds and surgical caused by overactive pigment cells.
incisions but has a presence of black spots on the Age spots appear when melanin
skin. becomes clumped in the skin or is
produced in high concentrations
Mucous membranes:
Nasal mucosa and oral mucosa are moist and
intact.

Airway clearance
Mr. B is able to sniff each nostril and no occlusion
noted. There is no blockages or obstruction noted.
The patient has normal breath sound. And there is no
sticky or thick mucus.

Color According to Hovan (2018), the skin is

Skin: The patient’s skin is fair and dry.
Nails: Pink tones is seen in the nails.
Lips: The patient’s lips is moist and no
lesions.
Capillary refill: Capillary refill is 2-3 seconds
Oxygen therapy: None
dry combined with age-related
changes in the makeup of the skin
itself (loss of collagen, oil glands, and
elasticity) and dryness related to
changes in climate.

Braden Scale (Pressure Ulcer Risk) Score Justification/

Pathophysiological basis
Sensory Perception 3 It is slightly limited. The patient
responds to verbal commands,
but cannot always
communicate discomfort or the
need to be turned.
Moisture 3 Skin is usually dry; linen only
requires changing at routine
intervals.
Activity 2 Ability to walk is severely
limited or nonexistent. Cannot
bear their own weight and/or
must be assisted into chair or
wheelchair.
 35

Mobility 2 Makes occasional slight

changes in body or extremity
position but unable to make
frequent or significant changes
independently.
Nutrition 2 Rarely eats a complete meal
and generally eats only about
half of any food offered. Protein
intake includes only 3 servings
of meat or dairy products per
day. Occasionally will take a
dairy supplement
Friction 1 Requires moderate to
maximum assistance in
moving. Complete lifting
without sliding against sheets is
impossible. Frequently slides
down in bed or chair, requiring
frequent repositioning with
maximum assistance.
Spasticity, contractures, or
agitation leads to almost
constant friction.
Total 13
Interpretation Moderate Risk

C. PHYSICAL AND FUNCTIONAL ASSESSMENT Justification/ Pathophysiological basis

Current Activity:
The patient needs assistance when going to the
comfort room, dressing, washing or in doing other
activities. There is a limited activity.
Sleep:
The patient used to have fewer than 5 hours of
sleep. He is also experiencing sleep disturbances.
Body Frame: Ectomorph
Height: 173 cm or 68 inches
Weight: 65 kg
BMI: 21.7 kg/m2 = Normal
According to PubMed, the etiologies of
sleep disruptions in AD are multi-
faceted. Degradation of neuronal
pathways that initiate and maintain
sleep, changes in the hypothalamic
suprachiasmatic nucleus (the
circadian “pacemaker” of the body),
and other modifications in brainstem
regions and pathways that regulate
sleep-wake cycles have been
implicated in the sleep disturbances
observed in AD patients.
Ectomorph are long and lean, with
little body fat, and little muscle.

Coordination: According to Weatherspoon, 2019, as

Mr. B arise from sitting position assisted. we age, the neuromuscular
communication in our body isn't as
strong as it was earlier in life. In
addition, a recent study found
evidence that age-related changes
coordination.
Muscle Strength As we get older and become less
Right upper extremity: 4 active, our body will undergo muscle
Left upper extremity: 4 loss. Studies show that adults age 50
Right lower extremity: 4 and older lose 15% of their muscle
Left lower extremity: 4 strength each decade as they age.
This can reduce your endurance to the
point that you feel weaker in your legs.
(Actegy Health, 2021)
 36

Motor
Fine: The patient can pick a ballpen
Gross: The patient can stand or sit
Range of Motion According to Healthline, range of
Abduction: 4/5 motion naturally declines as we age.
Adduction: 4/5
Flexion: 4/5
Extension: 4/5
Pain:
Provocation: N/A
Palliation: N/A
Quality: N/A
Region: N/A
Radiation: N/A
Severity scale: N/A
Time onset/ timing: N/A

Morse Scale (Falls Risk) Score Justification/

Pathophysiological basis
Age 3 The patient is 70 years old
Fall History 0 The patient did not fall during
the admission or any fall
history.
Mobility 0 Ambulates and transfers with
assistance or assistive devices
Elimination 5 Incontinence. Incontinence
develops because messages
between the brain and the
bladder or bowel don't work
properly.
Medications 3 There is one present
Patient care equipment (IV, Feeding 0 There is no present patient care
Tubes, Indwelling Catheters, etc.) equipment.
Total 13
Interpretation High Risk

Basic Activities of the Daily Living

Activity Score Justification/
Pathophysiological basis
1. Bathing 0 Needs help with bathing more
than one part of the body,
getting in or out of the bathtub
or shower; requires total
bathing
2. Dressing 0 Needs help with dressing self or
needs to be completely
dressed
3. Toileting 0 Needs help transferring to the
toilet and cleaning self
4. Transferring 0 Needs help in moving from bed
to chair
5. Continence 0 Is partially or totally incontinent
of bowel or bladder
6. Feeding 0 Needs partial or total help with
feeding or requires parenteral
feeding
Total 0
Interpretation The patient is very
dependent

Instrumental Activities of the Daily Living

Activity Score Justification/
Pathophysiological basis
 37

1. Telephone 0 Mr. B is avoiding the discussion

about the phone. He also
doesn’t remember the last time
he used it and can’t tell her
phone number. He needs
assistance in dialing the phone
number.
2. Traveling 1 The patient was able to travel
but not alone. He is with his
sone whenever they go outside
3. Shopping 0 Mr. is completely unable to
shop. His son is the who often
shops for groceries or going to
the store.
4. Preparing meals 0 The patient needs to have
prepared meals and served. He
is not able to cook
5. Housework 0 Mr. B does not participate in
any housekeeping. According
to his son, Mr. B is struggling in
doing and accomplishing tasks
or even turning on the stove.
6. Medication 0 The patient is not capable in
dispensing own medication.
7. Money 0 Mr., B is incapable in handling
money
8. Laundry 0 All laundry must be done by
others.
Total 1
Interpretation The patient is
dependent in his
Instrumental
Activities of the
Daily Living
Assessment

Tinetti Balance Test

Activity Score Justification/
Pathophysiological basis
1. Sitting balance 0 Leans or slides in chair
2. Arising 1 Able, uses arms to help up
3. Attempt to arise 1 Able, requires > 1 attempt
4. Immediate standing balance (first 5 1 Steady but uses walker or
seconds) other support
5. Standing balance 1 Steady but wide stance (heels
4 inches
apart) and uses cane or other
support
6. Nudging 0 Begins to fall
7. Eyes closed 0 Unsteady
8. Turning 360 degrees 0 Unsteady (grabs, swaggers)
9. Sitting down 2 Safe, smooth motion
Total 6
Interpretation

Tinetti Gait Test

Activity Score Justification/
Pathophysiological basis
1. Initiation of gait 0 There is any hesitancy or
multiple attempts to start
2. Step length and height 1 RIGHT foot passes left stance
foot
3. Step symmetry 1 RIGHT AND LEFT step appear
equal
 38

4. Step continuity 0 Stopping or discontinuity

between steps
5. Path 2 Straight without walking aid
6. Trunk 1 No sway – but flexion of knees
or back, or spreads arms out
while walking
7. Walk stance 1 Heels almost touching while
walking
Gait Total 6
Balance Total 6
BALANCE and GAIT total 12
Interpretation High Risk for Falls

D. NUTRITIONAL ASSESSMENT Justification/ Pathophysiological basis

Diet Restriction: None
Fluid Intake:
The patient drinks 6-8 glasses of water
Height: 173 cm or 68 inches
Weight: 65 kg
BMI: 21.7 kg/m2
Interpretation: Normal
Skin turgor: With age, your skin loses elasticity,
Mr. B’s skin may take 20 seconds to return to normal causing poor skin turgor.
Gag reflex: Normal response
Swallow:
The patient is able to
swallow
Appetite:
Mr. B has a good appetite
Food likes:
 Leafy vegetables
 Fruits
 Fish
 Whole grains
Food dislikes:
 Potatoes
 Sodas
Elimination- bowel:
Stool
Frequency: 3 times a week
Consistency: Soft and pass easily
Color: Brown in color
Elimination- bladder:
Urine
Frequency: 4 times in 24-hour period
Color: Pale yellow
Amount: 500 ml
Transparency: Clear and no presence of
cloudiness
Abdomen
Contour: Flat
Bowel Sounds Normal sounds are a result of
Right lower: Borborygmi, 20 bowel sounds/minute peristaltic activity and consist of clicks
Right upper: Borborygmi, 20 bowel sounds/minute and gurgles
Right upper: Borborygmi, 20 bowel sounds/minute
Left lower: Borborygmi, 20 bowel sounds/minute

Mini Nutritional Assessment- Screening

Screening Score Justification/
Pathophysiological basis
1. Has food intake declined over the 1 According to his son, there is no
past 3 months due to loss of appetite, loss of appetite seen in the
patient.
 39

digestive problems, chewing or

swallowing difficulties?
2. Weight loss during last 3 months 3 No weight loss
3. Mobility 2 Goes out
4. Has suffered psychological stress or 0 Yes
acute disease in the past 3 months
5. Neuropsychological problems 1 Mr. B was diagnosed with mild
to severe Alzheimer’s disease.
6. Body mass index (BMI) 3 BMI 21 to less than 23
-OR- Height: 173 cm or 68 inches
Calf circumference (CC) in cm Weight: 65 kg
BMI: 21.7 kg/m2 = Normal
Total 10
Interpretation A score of 8-11
points is at risk
of malnutrition

Mini Nutritional Assessment

Assessment Score Justification/
Pathophysiological basis
1. Lives independently (not in a 0 The patient lives with his son
nursing home)?
2. Takes more than 3 prescription 0 The patient is not taking any
drugs per day medications/maintenance
drug
3. Pressure sores or skin ulcers 0 There is no presence of skin
ulcers during the
assessment
4. How many full meals does the 2 The patient eats thrice a day
patient eat daily?
5. Selected consumption markers for 1 The patient drinks milk every
protein intake breakfast and eats some
 At least one serving of dairy portions of leafy vegetables
products (milk, cheese, yogurt) and meat.
per day?
 Two or more servings of
legumes or eggs per week?
 Meat, fish or poultry every day?
6. Consumes two or more servings of 1 The patient eats fruits.
fruit or vegetables per day?
7. How much fluid is consumed per 1 The patient drinks more than
day? 5 glass of water in a daily
basis.
8. Mode of feeding 0 Mr. B was unable to eat
without assistance
9. Self- view of nutritional status 1 The patient is uncertain of
nutritional state
N: Do you view yourself as
having no nutritional
problem?
P: I don’t know
10. In comparison with other people of 0.5 Does not know
the same age, how does the patient
consider his/ her health status?
11. Mid- arm circumference (MAC) 0.5 22
12. Calf circumference (CC) 1 The CC of Mr. B is 31,
anthropometric parameter
that is closely related to
whole body muscle mass
and is known to be
associated with the nutrition
status of the elderly
population.
Total 8
 40

Total Score of MNA-Screening 18

and Assessment
Interpretation At risk of
malnutrition

E. PSYCHOLOGICAL/ PSYCHIATRIC Justification/ Pathophysiological basis

ASSESSMENT
Level of Consciousness The patient’s eyes open in response to
Eyes: 3 the sound of the voice. Also, the
Verbal: 4 patient is able to reply, but his
Motor: 4 responses don’t seem quite right. And
the patient tries to pull their arm away
from you when applying a painful
stimulus to their fingertip.,
Orientation The patient is disoriented to person,
place and time
Person:
Questioned asked: “Sino pong kasama niyo sa
bahay?”
Answer: “Kapatid ko”

Place:
Questioned asked: “Nasaan po kayo ngayon?”
Answer: “Di ko alam”

Time:
Question asked: “Anong oras na po ngayon?”
Questioned asked: “Alas syete”
Memory

Immediate:
Question asked: “Nagumagahan na po ba kayo?”
Patient: “ Di ko maalala”

Recent: The patient was unable to remember the

food that he ate last night.
Question asked: “Ano pong kinain niyo kagabi?”
Patient: Di ko alam

Remote: The patient was able to answer but

answered it wrong.
Question asked: “Kailan po birthday niyo?
Patient: “February 8, 1951”

Health attitude: Positive The patient does not drink alcohol or

smoke
Nonverbal Behaviors: Presence of facial expressions
and vocal sounds.

Mini Mental State Examination

Questions Score Justification/
Pathophysiological basis
“What is the year? Season? Date? 1 P: Rainy day
Day? Month?”
“Where are we now? State? County? 2 P: Philippines, Bayombong
Town/city? Hospital? Floor?”
The examiner names three unrelated 2 P: Pen, Handkerchief
objects clearly and slowly, then the
instructor asks the patient to name all
three of them. The patient’s response is
used for scoring. The examiner repeats
them until patient learns all of them, if
possible.

“I would like you to count backward from
100 by sevens.”
Alternative: “Spell WORLD backwards.”
“Earlier I told you the names of three
things. Can you tell me what those
were?”
Show the patient two simple objects,
such as a wristwatch and a pencil, and
ask the patient to name them.
“Repeat the phrase: ‘No ifs, ands, or
buts.’”
“Take the paper in your right hand, fold
it in half, and put it on the floor.”
“Please read this and do what it says.”
“Make up and write a sentence about
anything.”
“Please copy this picture.”
Total
Interpretation
Geriatric Depression Scale
Question
1. Are you basically satisfied with your
life?
2. Have you dropped many of your
activities and interests?
3. Do You feel that your life is empty?
4. Do you often get bored?
5. Are you hopeful about the future?
6. Are You bothered by thoughts you
can't get out of your head?
41
2 P: R-L-D-O-W
1 P: The patient pinpointed the
pen except the other two
things.
0 P: The patient can’t remember
the name of the two objects.
1 P: ‘No ifs, ands, or buts.’”
1 N: Gives the patient a piece of
blank paper
P: Take the paper in his left
hand, fold it in half, and put it
on the table
0 N: Written instruction is “Close
your eyes.”
P: Reads slowly the written
instruction and did not close
his eyes
0 P: “Eat pleas”
0 P:
10
The degree of
impairment is
moderate
Score Justification/
Pathophysiological basis
1 The patient responded no
N: Kuntento kaba sa iyong
buhay?
P: hindi, simula nung namatay
aswa ko
0 The patient responded no
N: Madami po ba kayong
interest at aktibidad na hindi na
ginagawa?
P: Wala
0 The patient responded No
N: Nararamdaman mo bang
“empty” ang iyong buhay?
P: Hindi
0 The patient responded no
N: Madalas po ba kayong
mainip?
P: Hindi
0 The patient responded yes
N: May nakikitang po ba
kayong pag-asa sa
kinabukasan?
P: Oo naman
0 The patient responded no

7. Are you in good spirits most of the
time?
8. Are you afraid that something bad is
going to happen to you?
9. Do you feel happy most of the time?
10. Do you often feel helpless?
11. Do you often get restless and
fidgety?
12. Do you prefer to stay at home rather
than go out and do things?
13. Do you frequently worry about the
future?
14. Do you feel you have more problems
with memory than most?
15. Do you think it is wonderful to be
alive now?
16. Do you feel downhearted and blue?
17. Do you feel worthless the way you
are now?
18. Do you worry a lot about the past?
19. Do you find life very exciting?
42
N: May gumugulo po ba sa
inyong isipan na hindi ninyo
maalis?
P: Wala di ko alam
0 The patient responded yes
N: Madalas ka bang in “good
spirits”
P: Oo minsan
0 The patient responded no
N: Takot po ba kayo na baka
may masamang mangyayari po
sainyo?
P: Hindi ako takot, kasi pag
oras ko na, oras ko na.
0 The patient responded yes
N: Madalas po ba kayong
masaya?
P: (nods his head)
1 The patient responded yes
N: Pakiramdam niyo ba wala na
kayong magawa sa inyong
kalagayan?
P: Oo
1 The patient responded yes
N: Madalas po ba kayong hindi
mapakali?
P: Oo
0 The patient responded no
N: Mas gusto mo bang manatili
sa bahay kaysa lumabas at
gumawa ng mga kung ano
anong bagay?
P: Hindi, gusto rin lumabas
0 The patient responded no
N: Madalas po ba kayo nag
aaalala sa kinabukas
P: Hindi
1 The patient responded yes
N: Sa palagay niyo po ba mas
marami kayong problema sa
memorya kaysa sa karamihan?
P: Oo, nakaklimut ako
0 The patient responded yes
N: Sa palagay niyo po ba na
magandang mabuhay ngayon.
P: Oo naman
0 The patient responded no
N: Madalas po ba kayong
namanghihinaan ng loob at
malungkot.
P: Hindi
1 The patient responded yes
N: Nawawalan po ba kayo ng
halag sa inyong sarili ngayon
P: Oo
0 The patient responded no
N: Madalas niyo po bang isipin
ang inyong nakaraan?
P: Hindi, wala na akong
masaydong maalala sa
nakaraan.
0 The patient responded yes
N: Sa tingin mo ba “very
exciting” ang buhay?
P: Oo, bakit naman hindi?

20. Is it hard for you to get started on
new projects?
21. Do you feel full of energy?
22. Do you feel that your situation is
hopeless?
23. Do you think that most people are
better off than you are?
24. Do you frequently get upset over
little things?
25. Do you frequently feel like crying?
26. Do you have trouble concentrating?
27. Do you enjoy getting up in the
morning?
28. Do you prefer to avoid social
occasions?
29. Is it easy for you to make decisions?
30. Is your mind as clear as it used to
be?
Total
Interpretation
F. SOCIAL- ENVIRONMENT ASSESSMENT
Name of Caregiver: Mr. V
Caregiver relationship: Son
Caregiver stress: Having frequent headaches and
bodily pain
Significant others: Son
Social engagement
Occupation: Teacher
Current activities indoor: Watching TV
Current activities outdoor: Jogging
Pets: Dogs
Personal safety concerns: None
Home safety concerns: None
43
1 The patient responded yes
N: Nahihirapan po ba kayong
magsimula ng mga bagong
gawain?
P: Oo, sobra
0 The patient responded yes
N: Pakiramdam mo ba puno ng
lakas o energy?
P: Oo
0 The patient responded No
N: Sa palagay mo ba wala nang
pag-asa ang iyong sitwasyon?
P: Hindi naman po
0 The patient responded no
N: Sa tiningin niyo po may mas
magaling kaysa sa inyo?
P: hindi, wala naman
1 The patient responded yes
N: Parati ba kayong nagagalit
kahit sa maliliit na bagay lang?
P: Madalasa ko mairita
0 The patient responded no
N: Nararamdaman niyo po ba
na gusto niyong umiyak?
P: hindi
1 The patient responded yes
N: Nahihirapan po ba kayong
mag concentrate”
P: Oo, lalo na sa mg abagay
na gusto kong gawin
0 The patient responded yes
N: Sa umaga po ba,
ginaganahan po ba kayong
bumangon?
P: Oo
0 The patient responded no
N: Mas gusto niyo bang
umiywas sa mga okasyon o
pagtitipon?
P: Hindi
1 The patient responded no
P: Madali lang po bas a inyo
na gumawa ng isang
desisyon?
N: Nahihirapn ako, hindi
1 The patient responded no
P: Malinaw ba ang pag-isip mo
tulad ng dati?
N: Hindi
10
Normal
Justification/ Pathophysiological basis
 44

History of Abuse
Emotional: None
Sexual: None
Physical: None
Smoking Habit
Age started: None
Age stopped: None
Number of cigars a day: None
Alcohol Abuse
Type: None
Frequency: None
Hobbies and Favorite Activities: Walking

COMPREHENSIVE GERIATRIC ASSESSMENT FORM

Date of Post-assessment: October 4, 2021
Time of Post-assessment: 10:00 am
A. PERSONAL DATA ASSESSMENT
Advanced Health Directive Planning
DNR Directive: None
Living Will: Present
Medical Power of Attorney: None
Financial Health Planning
Primary source of healthcare:
 Region II Trauma and Medical Center
(R2TMC)
Financial resources related to illness:
 Philhealth
 Pension
 Mr. B’s son
Justification/ Pathophysiological basis
A living will is a legal document that
specifies which medical procedures
you would and would not want to be
used to keep you alive, as well as your
preferences for other medical issues
like pain management and organ
donation. In relation to our patient,
when he found out his illness, Mr. B
decided to made a living will.
Mr. B is a retired teacher and has a
pension for working 40 years in his
previous school and also his son is a
private school teacher in which these
are the sources of their living.

B. MEDICAL ASSESSMENT Justification/ Pathophysiological basis

Vital Signs
Temperature
Rate: 36.8 C
Route: Axillary
Peripheral pulse
Rate: 3+
Rhythm: Regular
Location: Radial
Pulse amplitude: Normal
Apical pulse
Rate: 85 bpm
Rhythm: Regular
Murmurs: (-)
Respirations
Rate: 16 cpm
Rhythm: Regular
Use of accessory muscles: None
Lung sounds: Bronchovesicular
General appearance: Patient with moderate to severe
 The patient was observed physically, he also Alzheimer’s disease experiences
experiences hallucination, forgetting things that moodiness or withdrawal, particularly
happen recently, mood swings. in social situations or when anything
necessitates too much contemplation.
They often forget things and begins to
 45

doubt their loved ones, their own minds

and even fabric of their reality.
Allergic reactions on
Medication: None
Food: None
Environment: None
Vaccinations: The patient receive influenza vaccine
1. Influenza Vaccine to help protect against flu.
Health promotion activities: He likes to have mornings stroll with
1. Morning Stroll his grandson together with his son.
According to several studies, taking
frequent, short walks can help with
memory and physical ability.
Long term conditions:
1. None
Regular clinics and therapies:
1. None
Surgical history:
1. None
2. None
3. None
Eyes/ Vision Peripheral vision loss is prevalent in
Eyes: Blurred vision. Decrease peripheral patients suffering from dementia. For
vision persons with Alzheimer's disease,
Use of glasses: None reduced side vision can provide a
range of issues.
Ears/ Hearing
Hearing: Normal because hearing loss is a
natural consequence of getting older.
Hearing aid: Does not use hearing aid
Skin integrity
Scar/s: None
Wound/s: None
Surgical incision/s: None
Mucous membranes: moist Which means that the patient is
hydrated. Mucous membrane is the
body’s protection from harmful
external agents.
Airway clearance Mr. B is able to sniff and no occlusion
Mouth: Clear of any obstructions noted. There is no blockage or
Nose: Clear of any obstructions obstruction noted. There is no sticky
or thick mucus.
Skin: Brown color, dry and hang loosely skin The skin gets less elastic and more
with the appearance of wrinkles delicate over time. Natural oil
production declines, causing the skin
to become dry and wrinkled. The fat in
the deeper layers of the skin starts to
go. This results in drooping, loose skin
with more visible wrinkles and cracks.

Nails: Pink tones

Lips: moist and no lesions

Capillary refill: go back in 2 seconds
Oxygen therapy: None
Normal membranes are pink with
capillary refill of less than 2 seconds.
Membrane pallor suggest poor
perfusion. Delayed and prolonged
capillary refill time greater than 2
seconds indicated dehydration.
 46

Braden Scale (Pressure Ulcer Risk)

Score Pathophysiological Basis/Justification
Sensory Perception 3 SLIGHTLY LIMITED- patient responds to verbal
commands, but cannot always communicate discomfort
or the need to be turned.
Moisture 1 CONSTANTLY MOIST- skin is kept moist almost
constantly
Activity 3 WALK OCCASIONALY- walks occasionally during day,
but for very short distances, with or without assistance.
Spends majority of each shift in bed or chair.
Mobility 2 VERY LIMITED- Makes occasional slight changes in
body or extremity position but unable to make frequent
or significant changes independently.
Nutrition 2 VERY POOR- Rarely eats a complete meal and
generally eats only about half of any food offered. Protein
intake includes only 3 servings of meat or dairy products
per day. Occasionally will take a dairy supplement
Friction 1 FREQUENT SLIDING- Requires moderate to maximum
assistance in moving. Complete lifting without sliding
against sheets is impossible. Frequently slides down in
bed or chair, requiring frequent repositioning with
maximum assistance. Spasticity, contractures, or
agitation leads to almost constant friction.
Total 12
Interpretation High Risk Nursing Interventions
(10-12) 1. Consider a protocol that increases the
frequency of turning
2. supplements turning with small shifts in position
3. facilitates maximal remobilization
4. manages moisture, nutrition, and friction and
shear

C. PHYSICAL AND FUNCTIONAL ASSESSMENT Justification/ Pathophysiological basis

Current Activity: Moderate activity due to Alzheimer’s the integration of exercise training into
disease, mood swings
Sleep: 5 hours of sleep
Body Frame: Ectomorph
Gait: slower walking speed, reduced step length and This gait adaptation is more apparent
increased variability in step timing
Coordination: Mr. B arise from sitting position
assisted.
Balance: Balanced when standing and absence of Elders lose balance function as they
postural instability with minimal assistance
Muscle Strength
Right upper extremity: Grade 4
Left upper extremity: Grade 4
Right lower extremity: Grade 4
Left lower extremity: Grade 4
Motor
the care of persons with AD is both
needed and feasible
on irregular than level surfaces and
may be a mechanism to increase head
and pelvis stability in older adults.
(Osaba et al, 2019)
Age-related changes are caused by
the loss of function to multiple areas of
the brain. As we age, the
neuromuscular communication in our
body isn’t as strong as it was earlier in
life. (Weatherspoon, 2019)
age due to sensory loss, the inability to
integrate information and give motor
orders, and musculoskeletal function
loss.
Muscle weakness in the elderly is due
to decreased physical activity.
Inactivity and aging cause a marked
relative increase in the endo- and
perimysia connective tissue, which
result in changes in the mechanical
properties of the skeletal muscle.
(Siparsky, 2014)
 47

Fine: Can pick a pencil in the table

Gross: Can sit and stand
Range of Motion As they age, most people lose some
Abduction: 4/5 range of motion. Tight muscles, injury,
Adduction: 4/5 pain, arthritis, and a lack of activity are
Flexion: 4/5 some of the causes. Many elderly
Extension: 4/5 persons are unaware of how much
range of motion they have lost until it
Full range of motion with against gravity with becomes difficult to walk, shower,
minimal resistance. dress, or cook. (Arizona Center on
Aging)
Pain:
Provocation: N/A
Palliation: N/A
Quality: N/A
Region: N/A
Radiation: N/A
Severity scale: N/A
Time onset/ timing: N/A

Morse Scale (Falls Risk) Score Pathophysiological Basis

Age 2 70 years old
Fall History 0 No fall history
Mobility 2 Requires assistance or supervision for
mobility, transfer and ambulation
Elimination 5 INCONTINENCE- Incontinence
develops because messages between
the brain and the bladder or bowel don't
work properly.
Medications 5 There are 2 or more medication
Patient care equipment (IV, Feeding 1 One present (IV)
Tubes, Indwelling Catheters, etc.)
Total 15
Interpretation High Risk/ Refer
Justification The older adult's 'ability to perform a task’ is likely
to be lower than that experienced pre‐morbidly,
owing to their ‘health’ (illness, injury or surgery
which led to the hospitalization). This creates the
need for the older adult to have ‘awareness of
self and ability’ and their reduced level of
capacity. (Haines et al, 2015)

Basic Activities of the Daily Living

Activity Score Justification/ Pathophysiological basis
1. Bathing 0/1 The patient needs help from his son with bathing due to
lack of energy
2. Dressing 1/1 Gets clothes from closets and drawers and puts on
clothes and outer garments with fasteners
3. Toileting 1/1 The patient don’t need help in transferring to the toilet
4. Transferring 1/1 The patient don’t need help from his son in moving from
bed to chair
5. Continence 0/1 Partially or totally incontinent of bowel or bladder
6. Feeding 1/1 The patient don’t need help with feeding.
Total 4/6
Interpretation Dependent

Instrumental Activities of the Daily Living

Activity Score Justification/ Pathophysiological basis
 48

1. Telephone 0/2 Mr. B doesn’t remember the last time he used it and can’t
tell his phone number. He needs assistance in dialing the
phone number.
2. Traveling 1/2 Able to travel but not alone. He is with his son or grandson
every time they will go outside.
3. Shopping 0/2 Mr. B is unable to shop. He just stay at their house.
4. Preparing meals 0/2 Unable to prepare meals
5. Housework 1/2 He was able to do some housework like cleaning the
house and dishwashing.
6. Medication 1/2 Able to take medications but needs to remind him every
time or needs someone to prepare
7. Money 1/2 Able to give money because he is a retired teacher but his
son is the one who manages the money.
Total 4/14
Interpretation The patient is dependent in his Instrumental activities of the Daily
Living

D. NUTRITIONAL ASSESSMENT Justification/ Pathophysiological basis

Fluid Intake: 6-7 glasses of water per day
Height: 173 cm or 68 inches
Weight: 65 kg
BMI: 21.7 kg/m2
Interpretation: Normal
Skin turgor: brings back within 2 seconds

Gag reflex: Normal response

Swallow: Able
Appetite: Good appetite Mr. B eats 3 times a day
Food likes:
 Leafy vegetables
 Fruits
 Fish
 Whole grains
Food dislikes:
 Potatoes
 Sodas
Elimination- bowel: Normal stool consistency can range
Stool from type 3 to 5, with type 4 being ideal
 Frequency: 3 times a week bowel movement. Adults should aim
 Consistency: Soft and pass easily for 25-35 grams daily from fruits,
 Color: Brown in color vegetables, beans and legumes, nuts
and whole grains.
Elimination- bladder: Amber Yellow Urine is a normal color
Urine of urine. The result of a pigmented
Frequency: 4 times in 24-hour period called urochrome and how diluted or
Color: Pale yellow concentrated the urine is pigments and
Amount: 500 ml other compounds in certain foods and
Transparency: Clear and no presence of medications can change your urine
cloudiness color.
Abdomen
Contour: Flat
Bowel Sounds When the stomach is empty, you're
Right lower: Growling, 6 bowel sounds/minute more likely to hear loud sounds
Right upper: Growling, 6 bowel sounds/minute because there's nothing in it to quiet
Left upper: Growling, 6 bowel sounds/ minute the noise. Also, the force and rate of
Left lower: Growling, 6 bowel sounds/ minute contractions in the stomach and small
intestines increase after the organs
have been empty for about 2 hours.
Sounds associated with hunger
usually echo like a growl

Decreased or absent bowel sounds

often indicate constipation

Mini Nutritional Assessment- Screening
Screening
1. Has food intake declined over the
past 3 months due to loss of
appetite, digestive problems,
chewing or swallowing difficulties?
2. Weight loss during last 3 months
3. Mobility
4. Has suffered psychological stress
or acute disease in the past 3
months
5. Neuropsychological problems
6. Body mass index (BMI)
Total 10/14
Interpretation At risk of malnutrition
Mini Nutritional Assessment
Assessment
1. Lives independently (not in a
nursing home)?
2. Takes more than 3 prescription
drugs per day
3. Pressure sores or skin ulcers
4. How many full meals does the
patient eat daily?
5. Selected consumption markers
for protein intake
 At least one serving of dairy
products (milk, cheese,
yoghurt) per day (NO)
 Two or more servings of
legumes or eggs per week
(YES)
 Meat, fish or poultry every day
(YES)
6. Consumes two or more servings
of fruit or vegetables per day?
7. How much fluid is consumed per
day?
8. Mode of feeding
9. Self- view of nutritional status
10. In comparison with other people
of the same age, how does the
patient consider his/ her health
status?
11. Mid- arm circumference (MAC)
12. Calf circumference (CC)
49
Score Justification/ Pathophysiological basis
2/2 According to his son, there is no loss of
appetite seen in the patient.
3/3 No weight loss
1/2 The patient is able to get out of
bed/chair but does not often goes out
1/2 For the past 3 months he began to
doubts his loved ones, his own mind
and even the fabric of his reality.
0/2 Mr. B was diagnosed with mild to
severe Alzheimer’s disease.
3/3 BMI 21 to less than 23
Height: 173 cm or 68 inches
Weight: 65 kg
BMI: 21.7 kg/m2 = Normal
Score Justification/ Pathophysiological basis
0/1 The patient lives with his son.
0/1 The patient is not taking any medication
0/1 There is no presence of skin ulcers during
the assessment
2/2 The patient eats three times a day
1/1 According to his son, the patient drinks
milk every breakfast and eats some
portions of leafy vegetables and meat.
1/1 According to his son, the patients eats
vegetables and fruits every day.
1/1 The patient drinks more than 5 glass of
water in a daily basis.
1/2 Unassisted-independent
0/2 The patient is uncertain of nutritional state
0/2 Does not know- Health perceptions can
predict perceived control and use of
control-enhancing strategies in dealing
with age-related challenges.
0.5/1 The MAC of the client is 22, wherein MAC
is a measurement that allows health
workers to quickly determine if a patient is
acutely malnourished.
1/1 The CC of Mr. B is 31, anthropometric
parameter that is closely related to whole
body muscle mass and is known to be
associated with the nutrition status of the
elderly population.
 50

Total 7.5/16
Total Score of MNA-Screening 17.5
and Assessment
Interpretation At risk for malnutrition

E. PSYCHOLOGICAL/ PSYCHIATRIC Justification/ Pathophysiological basis

ASSESSMENT
Level of Consciousness

Eye opening response: to speech

Score: 3
Verbal: Confused
Score: 4
Motor: Flexion withdrawal from pain
Score: 4

Total Scores: 11 Best response

Orientation The patient is disoriented to person,

The patient is oriented to: place and time
Person:
Questioned asked: “Sino po kasama niyo sa
bahay?”
Answer: “Yung anak ko”

Place:
Questioned asked: “Saan po kayo nakatira?”
Answer: “Sa..Di ko ko na maalala”

Time:
Questioned asked: “Anong oras na po?”
Answer: “hindi ko alam”
Memory The patient does not remember the
Immediate: things that happen to him
Questioned asked: “Kumain na po ba kayo?”
Answer: “Di ko na maalala”

Recent:
Questioned Asked: “Sino po yung Doktor na
bumisita po sa inyo?”
Answer: “Di ko kilala”

Remote:
Questioned Asked: “Kailan po birthday niyo?”
 51

Answer: “Hindi ko na maalala”

Health attitude: Positive The patient does not drink alcohol or

smoke
Nonverbal Behaviors: Presence of facial expressions
and vocal sounds.

Mini Mental State Examination

Questions Score Justification/ Pathophysiological basis
“What is the year? Season? Date? 1/5 P: “Rainy”
Day? Month?”
“Where are we now? State? County? 2/5 P: “Hospital, Bayombong”
Town/city? Hospital? Floor?”
The examiner names three unrelated 2/3 P: “Pencil, Notebook”
objects clearly and slowly (pen,
handkerchief, and stapler) then the
instructor asks the patient to name all
three of them. The patient’s response
is used for scoring. The examiner
repeats them until patient learns all of
them, if possible.
“I would like you to count backward 2/5 P: “P.O.D.L.R”
from 100 by sevens.”
Alternative: “Spell WORLD
backwards.”
“Earlier I told you the names of three 2/3 P: The patient pointed pencil and
things. Can you tell me what those notebook but not the other thing.
were?”
Show the patient two simple objects, 0/2 P: The patient can’t remember the
such as a wristwatch and a pencil, name of the two objects.
and ask the patient to name them.
“Repeat the phrase: ‘No ifs, ands, or 0/1 P: The patient can’t remember what is
buts.’” said by the nurse
“Take the paper in your right hand, 0/3 N: Give the paper to Mr. B
fold it in half, and put it on the floor.” P: Can’t follow what the nurse said
“Please read this and do what it says.” 0/1 N: N: Written instruction is “Close your
eyes.”
P: Reads slowly the written instruction
and did not close his eyes
“Make up and write a sentence about 1/1 P: “Are we going home?”
anything.”
“Please copy this picture.” 0/1 N: The nurse gives the patient a blank
piece of paper and asks him/her to
draw the symbol below

P:

The patient wasn’t able to draw the

symbol
Total 10/30
Interpretation Moderate
 52

Geriatric Depression Scale

Question Score Justification/ Pathophysiological
basis
1. Are you basically satisfied with 0/1 The patient said yes.
your life? N: “Kuntento po ba kayo sa buhay
niyo?”
P: “Oo, kuntento na ako”
2. Have you dropped many of your 1/1 The patient stated yes.
activities and interests? N: “Marami ka po bang aktibidades na
hindi na ginagawa?”
P: “Oo, may edad na rin kasi ako”
3. Do You feel that your life is 0/0 The patient said no.
empty? N: “Nararamdaman mob a na may
kulang pa sa buhay mo?”
P: “Hindi”
4. Do you often get bored? 1/1 The patient answered yes
N: “Madalas po ba kayong mainip?”
P: “Oo”
5. Are you hopeful about the future? 0/1 The patient responded yes
N: “May nakikitang po ba kayong pag-
asa sa kinabukasan?”
P: “Oo naman”
6. Are You bothered by thoughts you 1/1 The patient responded yes
can't get out of your head? N: “May gumugulo po ba sa inyong
isipan na hindi ninyo maalis?”
P: “Meron”
7. Are you in good spirits most of the 1/1 The patient responded no
time? N: “madalas ka bang in “good spirits””
P: “no”
8. Are you afraid that something bad 0/1 The patient responded no
is going to happen to you? N: “Takot po ba kayo na baka may
masamang mangyayari po sainyo?”
P: “Hindi ako takot, kasi pag oras ko
na, oras ko na.”
9. Do you feel happy most of the 1/1 The patient said no
time? N: “Madalas po ba kayong masaya?”
P: “hindi kasi nagging makakalimutin
na ako eh”
10. Do you often feel helpless? 1/1 The patient responded yes
N: “Pakiramdam niyo ba wala na
kayong magawa sa inyong
kalagayan?”
P: “Oo”
11. Do you often get restless and 1/1 The patient responded yes
fidgety? N: “Madalas po ba kayong hindi
mapakali?”
P: “Oo”
12. Do you prefer to stay at home 0/1 The patient responded no
rather than go out and do things? N: “Mas gusto mo po bang manatili sa
bahay kaysa lumabas at gumawa ng
mga kung ano anong bagay?”
P: “Hindi, gusto rin lumabas”
13. Do you frequently worry about the 0/1 The patient responded no
future? N: “Madalas po ba kayo nag aaalala
sa kinabukas”
P: “Hindi”
14. Do you feel you have more 1/1 The patient responded yes
problems with memory than N: “Sa palagay niyo po ba mas
most? marami kayong problema sa
memorya kaysa sa karamihan?”
P: “Oo, nakakalimutin ako “
 53

15. Do you think it is wonderful to be 0/1 The patient responded yes

alive now? N: “Sa palagay niyo po ba na
magandang mabuhay ngayon.”
P: “Oo naman, gusto ko pang
makasama ng matagal ang apo ko”
16. Do you feel downhearted and 0/1 The patient responded no
blue? N: “Madalas po ba kayong
namanghihinaan ng loob at
malungkot?”
P: “Hindi”
17. Do you feel worthless the way you 1/1 The patient responded yes
are now? N: “Nawawalan po ba kayo ng halaga
sa inyong sarili ngayon’
P: “Oo kasi dagdag ako sa inaalala ng
anak ko”
18. Do you worry a lot about the past? 0/1 The patient responded no
N: “Madalas niyo po bang isipin ang
inyong nakaraan?”
P: “Hindi, wala na akong masaydong
maalala sa nakaraan.”
19. Do you find life very exciting? 0/1 The patient responded yes
N: “Sa tingin mo ba “very exciting” ang
buhay?”
P: “Oo, bakit naman hindi?”
20. Is it hard for you to get started on 1/1 The patient responded yes
new projects? N: “Nahihirapan po ba kayong
magsimula ng mga bagong gawain?”
P: “Oo, sobra”
21. Do you feel full of energy? 0/1 The patient responded yes
N: “Pakiramdam mo ba puno ng lakas
o energy?”
P: “Oo”
22. Do you feel that your situation is 0/1 The patient responded No
hopeless? N: “Sa palagay mo ba wala nang pag-
asa ang iyong sitwasyon?”
P: “Hindi naman po”
23. Do you think that most people are 0/1 The patient responded no
better off than you are? N: “Sa tiningin niyo po may mas
magaling kaysa sa inyo?”
P: “hindi, wala naman”
24. Do you frequently get upset over 1/1 The patient responded yes
little things? N: “Parati ba kayong nagagalit kahit
sa maliliit na bagay lang?”
P: “Madalasa ko mairita lalo na kapag
di ko mahanap yung mga gamit ko”
25. Do you frequently feel like crying? 1/1 The patient responded yes
N: “Nararamdaman niyo po ba na
gusto niyong umiyak?”
P: “Oo”
26. Do you have trouble 1/1 The patient responded yes
concentrating? N: “Nahihirapan po ba kayong mag
concentrate”
P: “Oo, lalo na kapag sobrang dami
ng gagawin”
27. Do you enjoy getting up in the 0/1 The patient responded yes
morning? N: “Sa umaga po ba, ginaganahan
po ba kayong bumangon?”
P: “Oo”
28. Do you prefer to avoid social 0/1 The patient responded no
occasions? N: “Mas gusto niyo bang umywas sa
mga okasyon o pagtitipon?”
P: “Hindi”
29. Is it easy for you to make 1/1 The patient responded no
decisions? P: “Madali lang po ba sa inyo na
gumawa ng isang desisyon?”
N: “Nahihirapn ako, hindi”
 54

30. Is your mind as clear as it used to 1/1 The patient responded no

be? P: “Malinaw ba ang pag-isip mo tulad
ng dati?”
N: “Hindi”
Total 15/30
Interpretation Moderate Depression

Geriatric Depression Scale Reference:

Welison Evenston G Ty, Roger D Davis, Maria Isabel E Melgar, et al. Filipino Geriatric Depression

Scale (GDS) using Rasch Analysis. Int J Psychliatr Res. 2019; 2(7): 1-6.

Diagnosis: Moderate Alzheimer’s Disease

NURSING INTERVENTIONS Rationale

Before
1. Review if there is a past record of the To have a brief background about the patient’s
patient. behavior.
2. Orient client Orient client to reality and surroundings on a
regular basis. Allow the client to have familiar
objects about him or her; use other items to
aid in keeping reality orientation, such as a
clock, a calendar, and daily schedules.
During
1. Establish therapeutic relationship with the To win the trust of the patient.
patient.
2. Explain Simply When communicating with clients, use basic
explanations and face-to-face interaction. Do
not yell a message into the ear of a client.
When interacting with an elderly person who
has a hearing loss, speaking slowly and in a
face-to-face stance is most beneficial.
3. When approaching the patient, use a Being overly cheerful may indicate to the
moderate-level of tone of voice. Avoid being patient that being cheerful is the goal and that
overly cheerful. other feelings are not acceptable.
4. Use silence and active listening when The patient may not communicate if the nurse
interacting with the patient. Let the patient is too much. The nurse’s presence and use of
know that you are concerned and you consider active listening will communicate the interest
the patient a worthwhile person. and concern.
5. Encourage the patient to ventilate feelings Expressing feelings may help relieve despair,
in whatever way is comfortable-verbal or non- hopelessness, and so forth. Feelings are not
verbal. Let the patient know that you will listen inherently good or bad. The nurse must
and accept what is being expressed. remain nonjudgmental about the patient’s
feelings and express this to the patient.
6. Discourage suspiciousness of others If a client expresses questionable ideas in
reaction to delusional thinking, express
reasonable doubt. Discuss with the client the
personal consequences of continuing to be
suspicious of others.
7. Avoid cultivation of false ideas Allowing incorrect thoughts to ruminate is not
a good idea. Talk to the client about actual
people and genuine occurrences when this
starts.
8. Observe client closely If delusional thinking indicates a desire for
violence, close observation of the client's
 55

conduct is recommended. The safety of the

client is a top priority for nurses.
After
1. Provide positive feedback at the end of Giving favorable feedback at the end of the
interview. interview will increase the patient's chances of
success and confidence. Also, it can boost the
self-esteem of the elderly.

F. SOCIAL- ENVIRONMENT ASSESSMENT Justification/ Pathophysiological basis

Name of Caregiver: Mr. V Mr. V took all the responsibility in
Caregiver relationship: Son taking care of his father.
Caregiver stress: None
Significant others: Son, Grandson
Social engagement
Occupation: Retired Teacher
Current activities indoor: Watching TV,
staying in their home
Current activities outdoor: Walking
Current social support: Son, Grandson
Pets: Dogs
Personal safety concerns: None

Home safety concerns: None

Signs of neglect or abuse: None

Hobbies and favorite activities: Due to the loss of his memory
Upon waking up in walking and fishing with his son
and grandson. He often forgets things that he was
doing. However, a week prior to admission the patient
reduced his productivity wherein he just stayed at their
house in the morning, he often got irritated easily, he
is experiencing hallucination, he begins to doubt his
family, his own mind and even the fabric of his reality.

COURSE IN THE WARD

Date and Time Doctor’s Order
October 01, 2020 PLS admit patient B to the
8:00 am medical ward under the service
of Dr. Z
-pls secure consent for
admission and management
-Pls insert Ivf nd hook D5LRS
1L x 8 20ggts
-Request laboratory for blood
chem MRI , genetic test
- Pls monitor the ptient
every 4 hrs
Medications:
Nurse Order
D- admitted a male , 70 years
old, with chief complain of
memory loss , hallucination and
distinct images
A-VS
Temperature- 36.5 C
PR: 80bpm
RR: 18bpm
BP: 140/90
A- consent for hospitalization
secured, kept monitored
A-Endorsed to the medical
ward
A – laboratory request
forwarded
A- insert IVF aseptically
R-Patient is cooperating

9:00 am D- Transferred to the medical

Pls- checked the laboratory ward
result A- Place in a comfortable
position
 56

A- inform the patient and

significant other NPO for 24 hrs
for dementia blood test panel
A
12:00 pm A- Get patients VS
Temperature- 36.8 C
PR: 85bpm
RR: 18bpm
BP: 120/90
A-Monitors the patient
1:00 pm D- Significant others reported
patient
A- Check the patient
A- Told the patient that he will
be staying here for a while
A- Told the significant others
that incase of emergency just
notify
4:00 pm A-Check VS of the patient
A- Assess the patient
5:00 pm D- Significant others reported
patient shouting
A- Check the patient
A-Told the patient that he is in
the hospital and nothing to
worry
8:00 pm -pls give Hydroxyurea 20-30 mg, A-Check the patients VS
Donepezil hydrochloride 5mg A- Told the patient to take a
and Memantine 5mg via IV rest already
every bedtime A-Gave Hydroxyurea 20-30 mg
A-Gave Donpezil hydrochloride
5mg via iv
A-Gave Memantine 5mg
A- Inform family member incase
of emergency notify the nurse
October 2, 2020 Doctors Visitation D-Check the patients condition
8:00 am A-assess VS of the patient
Temperature- 37.4 C
PR: 89bpm
RR: 17bpm
BP: 140/90
A- Assist the significant other to
sponge bath the patient
A-teach proper way in doing
A- Make sure the patient is ok

8:40 am Doctors Visitation

9:00 am -inform the laboratory for D- Laboratory for dementia
dementia blood test blood test
A- Inform the med lab
A- Assist the patient
A- inform the significant others
that she may now eat
12:00 pm -pls give paracetamol for head D- Significant other reported
ache 15mcg/ml that patient is in pain
A- assess the vs
Temperature- 36.8 C
PR: 92bpm
RR: 18bpm
BP: 110/90
A- Told the Doctor
A- gave paracetamol
 57

A-Monitor if the patient already

have his meal
4:00 pm -Monitor patient every 4 hrs A- Assess the patient and VS
Temperature- 36.2C
PR: 87bpm
RR: 17bpm
BP: 140/90
A-Make sure the patient is ok
A- Talk to the patient in a
moderate voice
A-Monitor if the patient
defacate already
R- patient response that she
wants to go home
8:00 pm A- asses VS
-pls give Hydroxyurea 20-30 mg, Temperature- 36.5 C
Donepezil hydrochloride 5mg PR: 84bpm
and Memantine 5mg via IV RR: 19bpm
every bedtime BP: 120/90
A-Make sure that the patient
take his dinner
A- allow him to take a rest
A-Gave Hydroxyurea 20-30 mg
A-Gave Donepezil hydrochloride
5mg
A-Gave Memantine 5mg
October 3 2020 D-Check the patient’s condition
8:00 am A- Assess the Vital Sign
Temperature- 37,2 C
PR: 92bpm
RR: 17bpm
BP: 140/90
A- Check the patient if he
already take his breakfast
A- Assist the significant other
for his bath
R-Cooperated
9:00 am D-Check the patients output
A-Ask the significant others
about his output
A- Educate the significant other
that they should not argue or
try to reason with the patient

12:00 pm Check the VS of the patient

Temperature- 36.2 C
PR: 87bpm
RR: 18bpm
BP: 110/95
A- Told the patient that he will
be alright
A- Comfort the patient
4:00 pm Check the VS of the patient
Temperature- 36.5 C
PR: 90bpm
RR: 17bpm
BP: 100/80
A- check if the patient is ok
A- Allow the patient to verbalize
his concern
8:00 pm -pls give Hydroxyurea 20-30 mg, A- asses VS
Donepezil hydrochloride 5mg Temperature- 36.9 C
 58

and Memantine 5mg via IV PR: 90bpm

every bedtime RR: 18bpm
BP: 130/100
A-Make sure that the patient
take his dinner
A- allow him to take a rest
A-Gave Hydroxyurea 20-30 mg
A-Gave Donepezil hydrochloride
5mg
A-Gave Memantine 5mg
October 4, 2020 Ready for Discharge D-Billing
8:00 am A-VS
Temperature- 36.8 C
PR: 85bpm
RR: 16bpm
BP: 120/90

A-Told the significant others

that can now settle their
account, before going home,
settled their hospital bills.
R-Cooperative
9:30 am D-Discharge health teaching

A- Educate the significant

other about the medicine of
our patient

A- Educate them on how to

properly handle their ffather

A-Advice them just incase of

emergency notify the doctor

R-Cooperative
10:00 am DISCHARGE
 59

NURSING CARE PLANS

ASSESSMENT NURSING SCIENTIFC GOAL NURSING RATIONALE EVALUATION

DIANOSIS EXPLANATION INTERVENTION
Subjective Data Alzheimer’s Short-term: Independent: Short-term
“Nagiging Disturb Thought Disease After 2 days of nursing
makakalimutin na po Process related to interventions, the 1. Assessed attention 1. To determine ability to After 2 days of nursing
siya at paulit-ulit po impaired memory patient will be able to: span/distractibility and participate in planning interventions, the goal was
ang tanong niya” as secondary to Multiple Cognitive ability to make decisions and executing care. met as evidenced by:
verbalized by the son. Alzheimer’s deficits & Memory - Maintain usual reality or solve problems.
Disease as Impairments orientation The patient was able to:
Objective Data evidenced by 2. Provided safety
- Memory Loss memory loss -Identify ways to measures such as side 2. To prevent further -Identified ways to
-Patient struggles to Deterioration ofcompensate for rails, padding as deterioration. compensate for cognitive
comprehend selective mentalcognitive impairment necessary and close impairment and memory
information and functions and memory deficits supervision as indicated. deficits (including SO).
organize thoughts (including SO)
-Difficulty in 3. Scheduled structured -Demonstrated behaviors
communicating and Disturb Thought -Demonstrate activity and rest periods. to minimize changes in
understanding Process behaviors to minimize 3. To provide stimulation mentation.
directions changes in mentation 4. Maintained a while reducing fatigue.
-Respond late to pleasant, quiet - Maintained usual reality
queries -Family members will environment and 4. Client may respond orientation.
-Patient became be able to exhibit approach patient in a with anxious or
forgetful understanding of slow calm manner. aggressive behaviour if -Family members was able
-Patient lost required care and will startled or to exhibit understanding of
perceptual and demonstrate overstimulated. required care and will
linguistic abilities appropriate coping 5. Gave simple demonstrate appropriate
-Patient easily gets skills. directions, using short 5. May aid in reducing coping skills.
upset and agitated words and simple confusion and increases
- Disoriented to -Patients will have sentences. Used low possibility that -Patients behavioural
person, place and behavioural problems voice and spoke slowly communications will be problems were identified
time. to the patient. and controlled.
 60

identified and understood and

controlled. remembered.

6. To convey interest
6. Listened with regard. and worth to individual.
Maintained eye contact.
7. To assist patient in
7. Allowed ample time developing coping
for patient to respond to strategies.
questions and
comments and make
simple decisions.
8. Provides clues to aid
in recognition of reality.
8. Maintained reality
oriented relationship and
environment (clocks,
calendar, personal
items, and daily
schedule of activities).
9. Sleep deprivation may
9. Promoted adequate further impair cognitive
rest and undisturbed abilities.
periods of sleep.

10. Comments from the

patients may involve
10. Instructed family reliving experiences
methods to use with from previous years and
communication with may be totally
patient. appropriate within that
context.
 61

To decrease abnormal
activity in the brain and
improve memory
awareness and ability to
perform daily functions.
Dependent:

Administered receptor Enhances intake and

antagonist, as ordered general wellbeing.
by the physician.

Collaborative:
Coordinated with other
members of the health
care team to provide
nutritionally well balance
diet, incorporating
patient’s preferences as
able.

ASSESSMENT NURSING SCIENTIFC GOAL NURSING RATIONALE EVALUATION

DIANOSIS EXPLANATION INTERVENTION
Subjective Data Alzheimer’s Short-term: 1. Established rapport 1. Trust is the main key After 2 weeks of nursing
“Hindi na po niya Self-Care Deficit: Disease After 2 weeks of nursing through a calm, point in establishing interventions, the goal was
kayang maligo, (Bathing/Hygiene interventions, the supportive, caring relationship with the met as evidenced by:
maghugas at tumae and Toileting) patient will be able to: approach in interaction. patient. - The patient was able to
mag-isa” as verbalized related to Memory Functional maintain physical care with
by the son. Loss Impairments 2. Organized a less assistance.
structured, routine
 62

Objective Data AEB by inability to - Patient will be able to schedule of activities in2. To help patient -Patient’s family was able
- Memory Loss wash body parts Decline in ability to maintain physical care bathing considering resume his ADLs without to carry out self-care
- Impaired ability to do and carry out perform ADLs with less assistance. patient’s abilities whileoverstimulation, foster program on a daily basis.
activities of daily living toileting routine maximizing hisindependence and
such as bathing, -Patient’s family will be independence. promote self-care and Long Term:
washing and toileting Self-Care Deficit able to carry out self- recall as long as After 1 month of nursing
-Patient becomes care program on a daily 3. Established a possible. interventions, the goal was
forgetful basis. scheduled toileting and met as evidenced by:
-Patient struggles to habit training program. -Patient was able to
comprehend Long Term: Take the patient to the 3. Helps establish participate in activities that
information After 1 month of nursing bathroom every 2 hours, toileting routines. would promote her level of
- Disoriented to interventions: run the water, and place functioning and learn and
person, place and -Patient will be able to the patient’s hands in recall previous capabilities.
time. participate in activities warm water, or pour
that would promote her warm water over the
level of functioning and genitalia.
learn and recall
previous capabilities.
4. Instructed patient in
activity with short step-
by-step method by not
rushing the patient.

4. Promotes self-esteem
and feelings of
5. Assisted patient with accomplishment;
toileting as necessary. rushing patient causes
frustration.

6. Monitored patient for 5. Allows patient to

sudden changes in perform independently
urinary status. for as long as possible.
 63

6. May indicate the

presence of infection,
prostatic hyperplasia,
urethral sphincter failure,
bladder irritation, or
certain medication
7. Taught and instructed effects.
significant others
-bathing technique &
what to observe for 7. Provides knowledge
during the bath. and facilitates continuity
-regarding toileting of care to promote
program, times to take bathing and toileting.
patient to the bathroom.

Dependent:

Administered receptor
antagonist, as ordered
by the physician. To decrease abnormal
activity in the brain and
improve memory
awareness and ability to
perform daily functions.
 64

ASSESSMENT NURSING SCINTIFC GOAL NURSING RATIONALE EVALUATION

DIANOSIS EXPLANATION INTERVENTION
Subjective Data: Risk for Injury Alzheimer’s Short-term: Independent: Short-term
“Hindi na po siya related to Disease After 2 days of
makakita ng Alzheimer’s nursing 1. Assessed 1. AD decreases After 2 days of nursing interventions, the goals were
husto” as Disease AEB interventions, the patient’s awareness of met as evidenced by patient was able to:
verbalized by the hallucinations Changes in the patient will be surroundings for potential dangers,
son. brain able to: hazards and and disease -Remained safe from environmental hazards
removed them. progression resulting from cognitive impairment.
Patient will coupled with
Objective Data: Memory Loss and remain safe from hazardous -Family ensured safety precautions are instituted
- Blurry Visions Cognitive defects environmental environment that and followed.
-Forgetfulness hazards resulting could lead to
and Memory Loss from cognitive accidents.
-Patient Hallucinations impairment. 2. Provided After 2 weeks of nursing interventions, the goal was
experiences adequate lighting met as evidenced by:
hallucinations Family will ensure and clear 2. Allows patient
- Cannot bear safety pathways, to be able to see -Patient was able to demonstrate behaviors that
own weight precautions are reduced patient’s things and find helped him protect self from injury and had reality
and/or must be instituted and bed to lower way around room orientation necessary in learning/retaining essential
assisted into chair followed. position. without danger of aspects in daily living.
or wheelchair. tripping or falling
-Easily agitated and prevents
-Patient lost After 2 weeks of injury.
perceptual and nursing
linguistic abilities interventions, the 3. Prevent risk of
patient will be falls.
able to:
-Demonstrate
behaviors that 3. Instructed
helps him protect family to keep
self from injury pathways clear,
and will have move furniture
reality orientation against the wall,
necessary in remove throw
 65

learning/retaining rugs, remove

essential aspects wheels on beds
in daily living. and chairs or set 4. Noise, crowds
lock them in and etc. are
place. usually the
excessive
4. Maintain a sensory neurons
nice, quiet and can increase
environment interference.
(neighbourhood
for SO). 5. To convey
interest and so
that patient will be
able to recognize
you.
5. Talked to
patient face-to-
face and stood 6. Promotes
where he can see positive
you. atmosphere and
increase
possibility of
6. Adapted understanding.
communication to
the level of
patient and used
a low tone of
voice and spoke 7. Provides clues
slowly to the to aid in
patient. recognition of
reality.

7. Maintained
reality oriented
relationship and
 66

environment
(clocks, calendar,
personal items,
and daily 8. Providing
schedule of health teachings
activities). could assist SO in
understanding the
patient’s condition
8. Educated SO: and would aid
-about patient’s them cope and
condition. take care the
-how to patient.
communicate,
deal and care the
patient.
-to identify the
risk of hazards
that may arise
and instruct them
to remove it.