ALZHEIMER’S DISEASE

– Is the most common type of dementia;

– Exact cause is UNKNOWN;
– Is a degenerative brain disease causing dementia that is progressive and most of the time irreversible;
– Usually begins after age 60 but early signs can be observed at age 40;
– Death may occur within five years after diagnosis (pneumonia or from other infections)
– More common in females;
– Char by microscopic brain changes:
1. Senile plaques**
2. Degeneration of neurons or “neurofibrillary tangles” **
3. Cerebral atrophy **
4. Reduced level of acetylcholine: **
• Loss of neurons in the basal ganglia
• Increase action of acetylcholinesterase enzyme;
– Diagnostic
 PET’S Scan (Positron emission tomography scan) – earlier detect Alzheimer’s
 Autopsy – confirmatory
– Classic Sign 4A’s
1. Aphasia – difficult spoken language or speech comprehension
2. Anomia – difficulty in naming
3. Agnosia – difficulty recognizing object
4. Apraxia - difficulty in moving Goal: Increase time to accomplish their task
– Stages
I. Forgetfulness/Amnesia
o we cannot confirm
o Poor judgement (difficulty making decision)
II. Moderate
o Difficulty forming complex task ex. Sched. of medications
III. Active
o Confirm
o Confabulation – creation of false memories in the absence of intention
o They love to talk the past (recollection of past) – to prevent depression
o Sundown syndrome – a.k.a late-day confusion – wondering at night – start around the afternoon
and continue into the night – always divert, orient, reduce noise, no. of people, offer simple task,
close the curtain to minimize the shadow to avoid cause of confusion.
IV. End stage
o Bedridden – immobility – bed soar, pneumonia
o Forget – chew – swallow - NGT

– Nursing Diagnosis:

1. **High risk for injury

2. Altered thought process
3. Anxiety
– Nursing Interventions:
1. Ensure safety:

■ removing toys and other dangerous objects in the vicinity;

■ rearranging furniture and use of pads;

2. Support and meet the client’s basic needs (food, shelter, clothing)
3. Orient; time, place
4. Encourage activities of daily living.
5. Provide sensory stimulation (reading, music)
6. Encourage life review or reminisce.
 7. Use clear, short and concise communication.
8. Cholinergic – retard/slow
1. Tacrine (Cognex), Donepezil (Aricept)
S.E: Salivation – dehydration - Hydration
Anxiety
– Fear of unknown
– A feeling of fear, and uneasiness. It might be cause you to sweat, feel restlessness and tense, and have a rapid
heart heartbeat.
– Cause
1. Biological – GABA (Gamma-aminobutyric acid) – is known for producing a calming effect, play major
role in controlling anxiety, stress and fear - lessens the ability of nerve cell to receive, create or send
chemical messages to other nerves cells.
2. Previous life experience
3. Familial factors – ex. Socioeconomic, low parental education, familial poverty, single parents
4. Social factor – ex. Wealth, religions, family size, relationships
– Level of anxiety
1. Mild/alertness level
o Positive state of heightened awareness and sharpened senses for learning new behavior and
solving problems
o Increase perceptual field – highest learning, normal tension, you can cope
o s/sx: pupil dilate, increase vital signs, headache
2. Moderate/apprehension level
o Focus on immediate task only (Decreased perceptual field) – not aware happens around, you can
cope
o Selective inattention
o The person can learn new behavior or solve problems only with assistance – presence of learning
o s/sx: GI- LBM/constipation
3. Severe/flight or flight response (free floating)
o Feelings of dread or terror; heart attack
o Cannot be redirected to a task
o Feeling of impending doom
o We cannot cope
o s/sx: heart & lungs: palpitation, pupil constricted – causing the vision become tunnel
4. Panic/Disorganized
o Loss of rational thought, delusions, hallucinations, and complete physical immobility and
muteness
o May inflict injury towards self or others – danger
o Goal: decrease level of anxiety
o s/sx: exhausted; pupil dilated
– Management:
1. Safety – decrease stimulation (isolate on a quiet environment). Command, medication
2. Promote relaxation – restraint, deep breathing
3. Verbalization
 Mild/moderate – therapeutic
 Severe/panic – direct, non-therapeutic communication
4. Beta blockers – with anxiolytic effect- propranolol
5. Anxiolytic – benzodiazepine

Phobia
– Irrational fear toward specific objects
– 3 types
1. Agoraphobia – refer to public, fear of being alone in open or public place
2. Social phobia – people/ fear of situation in which one might be embarrassed or criticized
Ex. Fear of eating public places, public speaking or performing in public places
3. Specific/Simple phobia – ex. Fear of high, fear of snake
– Management – systematic desentization
1. Imagery
2. Video
3. Exposure
OCD
– Characterized by episodes of obsession and compulsion
– Obsession: persistent (weird) thought (increased anxiety)
– Compulsion: uncontrolled ritual (decreased anxiety) – severe defense mechanism
– Management:
 Clomipramine (Anafranil)
 Group therapy