PSYCHO EDUCATION

ON DEMENTIA
SUBMITTED TO SUBMITTED BY

R.ILAKKIYA

I YEAR MSC NURSING

NNC

SUBMITTED ON
NAME OF THE STUDENT TEACHER : R.ILAKKIYA

TOPIC: DEMENTIA

SUBJECT : MENTAL HEALTH NURSING

EVALUATOR:

CLASS OF GROUP : III YEAR

NUMBER OF STUDENTS: 47

DATE AND TIME :

VENUE:

AV AIDS : FLASH CARDS

METHOD OF TEACHING : PSYCHO EDUCATION

S.NO SPECIFIC TIME CONTENT TEACHER’S LEARNER’S AV EVALUATION
OBJECTIVES ACTIVITY ACTIVITY AIDS
1 DEMENTIA Teaching listening Black

INTRODUCTION board

Dementia is a syndrome – usually of a chronic or

progressive nature – in which there is deterioration in
cognitive function (i.e. the ability to process thought)
beyond what might be expected from normal ageing. It
affects memory, thinking, orientation, comprehension,
calculation, learning capacity, language, and judgement.
Consciousness is not affected. The impairment in
cognitive function is commonly accompanied, and
occasionally preceded, by deterioration in emotional
control, social behaviour, or motivation.
2 EPIDEMIOLOGY
Dementia occur more commonly in the elderly than the
middle age. It increases the age from 0.1% in those
below 60 years of age to 15-20% in those who are 80
years of age .With aging population the prevalence of
dementia rising; the prevalence of moderate to severe
dementia in different population groups is approximately
5% in the general population older than 65 years of age,
20-40% in the general population older than 85 years of
age, 15-20% in out patient general medical practices and
 50% in chronic care facilities
3 Define dementia DEFINITION Teaching listening Roller

Dementia is a chronic organic mental disorder, board

characterized by impairment of intellectual functions

,Impairment of memory (predominantly of recent
memory, especially in early stages), Deterioration of
personality with lack of personal care .

4 List down the Causes of dementia teaching listening chart

causes of the Dementia is caused by damage to or loss of nerve cells
dementia and their connections in the brain.
The most common causes of dementia include:
 Degenerative neurological diseases. These
include Alzheimer's disease, Parkinson's
disease, Huntington's disease, and some types of
multiple sclerosis. These diseases get worse over
time.
 Vascular disorders. These are disorders that affect
the blood circulation in your brain.
 Traumatic brain injuries caused by car accidents,
falls, concussions, etc.
 Infections of the central nervous system. These
 include meningitis, HIV, and Creutzfeldt-Jakob
disease.
 Long-time alcohol or drug use
 Certain types of hydrocephalus, a buildup of fluid
in the brain

5 List down the Types of Dementia teaching listening ppd

types of Dementia can be split into two groups based on which
dementia part of the brain is affected.
 Cortical dementias happen because of problems in the
cerebral cortex, the outer layer of the brain. They play a
critical role in memory and language. People with
these types of dementia usually have severe memory
loss and can't remember words or understand
language. Alzheimer's and Creutzfeldt-Jakob disease are
two forms of cortical dementia.
 Sub cortical dementias happen because of problems in
the parts of the brain beneath the cortex. People with sub
cortical dementias tend to show changes in their speed of
thinking and ability to start activities. Usually, people
with sub cortical dementia don't have forgetfulness
and language problems. Parkinson's disease,
Huntington's disease, and HIV can cause these types of
dementia.
Some types of dementia affect both parts of the brain.
 Progressive dementia
Dementia that gets over time, gradually interfering with
more and more cognitive abilities.
Primary dementia
Dementia such as Alzheimer’s disease that does not
result from any other disease.
Secondary disease
Dementia that occurs as a result of physical disease or
injury.

6 List down the Signs and symptoms Teaching listening

sign and Dementia affects each person in a different way,
symptom of depending upon the impact of the disease and the
dementia person’s personality before becoming ill. The signs and
symptoms linked to dementia can be understood in three
stages.
Early stage: the early stage of dementia is often
overlooked, because the onset is gradual. Common
symptoms include:
 forgetfulness
 losing track of the time
 becoming lost in familiar places.
Middle stage: as dementia progresses to the middle
stage, the signs and symptoms become clearer and more
 restricting. These include:
 becoming forgetful of recent events and people's
names
 becoming lost at home
 having increasing difficulty with communication
 needing help with personal care
 experiencing behaviour changes, including
wandering and repeated questioning.
Late stage: the late stage of dementia is one of near total
dependence and inactivity. Memory disturbances are
serious and the physical signs and symptoms become
more obvious. Symptoms include:
 becoming unaware of the time and place
 having difficulty recognizing relatives and friends
 having an increasing need for assisted self-care
 having difficulty walking
 experiencing behaviour changes that may escalate
and include aggression.

Diagnosis
7 Explain the
Medical history. Typical questions about a person's
diagnostic
medical and family history might include asking about
evaluation of
whether dementia runs in the family, how and when
dementia
symptoms began, changes in behavior and personality,
 and if the person is taking certain medications that might
cause or worsen symptoms.

Physical exam. Measuring blood pressure and other vital

signs may help physicians detect conditions that might
cause or occur with dementia. Some conditions may be
treatable.

Cognitive and neuropsychological tests

Doctors will evaluate thinking (cognitive) function. A
number of tests measure thinking skills, such as
memory, orientation, reasoning and judgment, language
skills, and attention.
Neurological evaluation
Doctors evaluate memory, language, visual perception,
attention, problem-solving, movement, senses, balance,
reflexes and other areas.
Brain scans
 CT or MRI. These scans can check for evidence of
stroke or bleeding or tumor or hydrocephalus.
 PET scans. These can show patterns of brain activity and
whether the amyloid protein, a hallmark of Alzheimer's
disease, has been deposited in the brain.
Laboratory tests
Simple blood tests can detect physical problems that can
 affect brain function, such as vitamin B-12 deficiency or
an underactive thyroid gland. Sometimes the spinal fluid
is examined for infection, inflammation or markers of
some degenerative diseases.
Psychiatric evaluation
A mental health professional can determine whether
depression or another mental health condition is
contributing to symptoms.

8 Explain the PSYCHOPHARMACOLOGY Teaching explaining ppd

therapies of
The following are used to temporarily improve dementia
dementia
symptoms.
 Cholinesterase inhibitors. These medications —
including donepezil (Aricept), rivastigmine (Exelon) and
galantamine (Razadyne) — work by boosting levels of a
chemical messenger involved in memory and judgment.
Although primarily used to treat Alzheimer's disease,
these medications might also be prescribed for other
dementias, including vascular dementia, Parkinson's
disease dementia and Lewy body dementia.
Side effects can include nausea, vomiting and diarrhea.
Other possible side effects include slowed heart rate,
fainting and sleep disturbances.
  Memantine. Memantine (Namenda) works by
regulating the activity of glutamate, another chemical
messenger involved in brain functions, such as learning
and memory. In some cases, memantine is prescribed
with a cholinesterase inhibitor.
A common side effect of memantine is dizziness.
 Other medications. Your doctor might prescribe
medications to treat other symptoms or conditions, such
as depression, sleep disturbances, hallucinations,
vaparkinsonism or agitation.

9 Enlist the psycho PSYCHOTHERAPIES teaching listening Ppd
therapy for Several dementia symptoms and behavior problems
dementia might be treated initially using nondrug approaches,
such as:
 Occupational therapy. An occupational therapist can
show you how to make your home safer and teach coping
behaviors. The purpose is to prevent accidents, such as
falls; manage behavior; and prepare you for the dementia
progression.
 Modifying the environment. Reducing clutter and noise
can make it easier for someone with dementia to focus
and function. You might need to hide objects that can
threaten safety, such as knives and car keys. Monitoring
 systems can alert you if the person with dementia
wanders.
 Simplifying tasks. Break tasks into easier steps and
focus on success, not failure. Structure and routine also
help reduce confusion in people with dementia.

10 LIFESTYLE AND HOME REMEDIES teaching listening Ppd

Dementia symptoms and behavior problems will

progress over time. Caregivers might try the following
suggestions:
 Enhance communication. When talking with your loved
one, maintain eye contact. Speak slowly in simple
sentences, and don't rush the response. Present one idea or
instruction at a time. Use gestures and cues, such as
pointing to objects.
 Encourage exercise. The main benefits of exercise in
people with dementia include improved strength,
balance and cardiovascular health. Exercise may also be
helpful in managing symptoms such as restlessness.
There is growing evidence that exercise also protects the
brain from dementia, especially when combined with a
healthy diet and treatment for risk factors for
cardiovascular disease.
Some research also shows that physical activity might
slow the progression of impaired thinking in people with
 Alzheimer's disease, and it can lessen symptoms of
depression.
 Engage in activity. Plan activities the person with
dementia enjoys and can do. Dancing, painting,
gardening, cooking, singing and other activities can be
fun, can help you connect with your loved one, and can
help your loved one focus on what he or she can still do.
 Establish a nighttime ritual. Behavior is often worse at
night. Try to establish going-to-bed rituals that are
calming and away from the noise of television, meal
cleanup and active family members. Leave night lights
on in the bedroom, hall and bathroom to prevent
disorientation.
Limiting caffeine, discouraging napping and offering
opportunities for exercise during the day might ease
nighttime restlessness.
 Keep a calendar. A calendar might help your loved one
remember upcoming events, daily activities and
medication schedules. Consider sharing a calendar with
your loved one.
 Plan for the future. Develop a plan with your loved one
while he or she is able to participate that identifies goals
for future care. Support groups, legal advisers, family
members and others might be able to help.
You'll need to consider financial and legal issues, safety
and daily living concerns, and long-term care options.
Alternative medicine
Several dietary supplements, herbal remedies and
therapies have been studied for people with dementia.
But at this time there is no convincing evidence for any
of these.
Use caution when considering taking dietary
supplements, vitamins or herbal remedies, especially if
you're taking other medications. These remedies aren't
regulated, and claims about their benefits aren't always
based on scientific research.
While some studies suggest that vitamin E supplements
may be helpful for Alzheimer's disease, the evidence is
not convincing and large doses may pose risks. Vitamin
E supplementation is not currently recommended, but
including vitamin E in the diet through foods such as
nuts is suggested to promote brain health.
Other therapies
The following techniques may help reduce agitation and
promote relaxation in people with dementia.
 Music therapy, which involves listening to
soothing music
 Light exercise
 Watching videos of family members
 Pet therapy, which involves use of animals, such
 as visits from dogs, to promote improved moods
and behaviors in people with dementia
 Aromatherapy, which uses fragrant plant oils
 Massage therapy
 Art therapy, which involves creating art, focusing
on the process rather than the outcome
 Coping and support
 Receiving a diagnosis of dementia can be
devastating. Many details need to be considered
to ensure that you and those around you are as
prepared as possible for dealing with a condition
that's unpredictable and progressive.
Care and support for the person with the disease
Here are some suggestions you can try to help yourself
cope with the disease:
 Learn as much as you can about memory loss,
dementia and Alzheimer's disease.
 Write about your feelings in a journal.
 Join a local support group.
 Get individual or family counseling.
 Talk to a member of your spiritual community or
another person who can help you with your
spiritual needs.
 Stay active and involved, volunteer, exercise, and
participate in activities for people with memory
 loss.
 Spend time with friends and family.
 Participate in an online community of people who
are having similar experiences.
 Find new ways to express yourself, such as
through painting, singing or writing.
 Delegate help with decision-making to someone
you trust.

10 List down the NURSING INTERVENTIONS teaching listening Ppd

nursing
The nursing interventions for a dementia client are:
intervention
 Orient client. Frequently orient client to reality and
surroundings. Allow client to have familiar objects
around him or her; use other items, such as a clock, a
calendar, and daily schedules, to assist in maintaining
reality orientation.
 Encourage caregivers about patient
reorientation. Teach prospective caregivers how to
orient client to time, person, place, and circumstances, as
required. These caregivers will be responsible for client
safety after discharge from the hospital.
 Enforce with positive feedback. Give positive feedback
when thinking and behavior are appropriate, or when
 client verbalizes that certain ideas expressed are not based
in reality. Positive feedback increases self-esteem and
enhances desire to repeat appropriate behavior.
 Explain simply. Use simple explanations and
face-to-face interaction when communicating with client.
Do not shout message into client’s ear. Speaking slowly
and in a face-to-face position is most effective when
communicating with an elderly individual experiencing
a hearing loss.
 Discourage suspiciousness of others. Express
reasonable doubt if client relays suspicious beliefs in
response to delusional thinking. Discuss with the client
the potential personal negative effects of continued
suspiciousness of others.
 Avoid cultivation of false ideas. Do not permit
rumination of false ideas. When this begins, talk to client
about real people and real events.
 Observe client closely. Close observation of client’s
behavior is indicated if delusional thinking reveals an
intention for violence. Client safety is a nursing priority.

11 Explain the Nursing diagnosis teaching listening ppd

nursing 1. Disturbed Thought Process related to change in
diagnosis of cognitive ability
dementia 2. Chronic Confusion
3. Impaired Verbal Communication related to
psychological barrier
4. Self-Care Deficit: Bathing/Hygiene related to
cognitive impairment
5. Impaired Physical Mobility related to cognitive
impairment
6. Disturbed Sleep Pattern related to confusion or
environmental stimuli
7. Disturbed Sensory Perception related to altered
sensory reception/inability to communicate,
understand, speak or respond
8. Social Isolation related to mental illness
9. Compromised Family Coping related to
progressive dependence of the patient on the
family
10. Risk for Injury related to unable to recognize
hazards in the environment

NURSING MANAGEMENT
The nursing management of a client with dementia
include the following:
NURSING ASSESSMENT
Assessment of a client with dementia include the
following:
 Psychiatric interview. The psychiatric
interview must contain a description of the
client’s mental status with a thorough
description of behavior, flow of thought and
speech, affect, thought processes and mental
content, sensorium and intellectual resources,
cognitive status, insight, and judgment.
 Serial assessment. Serial assessment of
psychiatric status is necessary for determining
fluctuating course and acute changes in
mental status, interviews with family
members should be included and can be
crucial in the treatment of infants and young
children with cognitive disorders.
NURSING DIAGNOSIS
Nursing diagnoses that can use for developing nursing
care plans for patients with dementia include:
 Risk for trauma related to disorientation
or confusion.
 Risk for self-directed or other-directed
violence related to delusional thinking.
 Chronic confusion related to alteration in
 structure/function of brain tissue.
 Self-care deficit related to cognitive
impairment.
 Risk for falls related to cognitive impairment.
NURSING CARE PLANNING AND GOALS
The major nursing care planning goals for dementia are:
 Client will accept explanations of inaccurate
interpretation within the environment.
 With assistance from caregiver, client will be
able to interrupt non-reality-based thinking.
INTERVENTION
 Speak slowly and use short, simple words and
phrases.
 Consistently identify yourself, and address the
person by name at each meeting.
 Focus on one piece of information at a time.
Review what has been discussed with patient.
 If patient has vision or hearing disturbances, have
him wear prescription eyeglasses and/or a hearing
device.
 Keep environment well lit.
 Use clocks, calendars, and familiar personal
effects in the patient’s view.
 If patient becomes verbally aggressive, identify
and acknowledge feelings.
 If patient becomes aggressive, shift the topic to a
safer, more familiar one.
 If patient becomes delusional, acknowledge
feelings and reinforce reality. Do not attempt to
challenge the content of the delusion.
 Discuss restriction of driving when
recommended.
 Assess patient’s home for safety: remove throw
rugs, label rooms, and keep the house well lit.
 Assess community for safety.
 Alert neighbors about the patient’s wandering
behavior.
 Alert police and have current pictures taken.
 Provide patient with a MedicAlert bracelet.
 Install complex safety locks on doors to outside or
basement.
 Install safety bars in bathroom.
 Closely observe patient while he is smoking.
 Encourage physical activity during the daytime.
 Give patient a card with simple instructions
(address and phone number) should the patient get
lost.
 Use night-lights.
 Install alarm and sensor devices on doors.
EVALUATION
The outcome criteria for a patient with dementia include:

 With assistance from caregiver, client is able

to distinguish between reality-based and
non-reality based thinking.

 Prospective caregivers are able to verbalize

ways in which to orient client to reality, as
needed.

DOCUMENTATION GUIDELINES

Documentation needed for a client with dementia

include the following:

 Individual findings, including factors

affecting, interactions, nature of social
exchanges, specifics of individual behavior.

 Cultural and religious beliefs, and

expectations.

 Plan of care.

 Teaching plan.

 Responses to interventions, teaching, and

 actions performed.

 Attainment or progress toward the desired

outcome.
CONCLUSION
still now we have seen about the causes, types, signs and symptoms, management, nursing responsibilities and psychotherapy of dementia.
BIBLIOGRAPHY

 R.Sreevani ―a guide to mental health and psychiatric nursing‖,3rd edition ; jaypee brothers medical publishers 2010,pg no (123 to 127)
 Niraj ahuja ― A short text book of psychiatry‖,7th edition ; jaypee brothers medical publishers 2011 ,pg no (142 to 145)
 Mary C Townsend ―psychiatric mental health nursing‖,6th edition; F.Adavis company 2009,pg no (647 to 662)