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Client with Alzheimer’s Disease Form of dementia characterized by progressive, irreversible deterioration of general intellectual functioning • Begins with

memory loss, initially subtle until progresses to being more noticeable; course includes deteriorating cognition and judgment with eventual physical decline and total inability to perform ADL Risk factors • older age • female • family history • Exact cause is unknown; theories include loss of transmitter stimulation, genetic defects, viral and autoimmune cases • Warning signs include • Memory loss affecting ability to function in job • Difficulty with familiar tasks • Problems with language, abstract thinking • Disorientation, changes in mood and personality Types and Changes in brain • Familial (follows inheritance pattern) and sporadic • Early-onset (<65) • Older-onset (>65) • Loss of nerve cells and presence of neurofibrillary tangles and amyloid plaques • Progressive brain atrophy Manifestations : Stage I • Appears healthy and alert • Cognitive deficits are undetected • Subtle memory lapses, personality changes • Seems restless, forgetful, uncoordinated Stage II • • • • • • • • Memory deficits more apparent Less able to behave spontaneously Wandering behavior, deterioration in orientation to time and place Changes in sleeping patterns, agitation, stress Trouble with simple decisions Sundowning: increased agitation, wandering, disorientation in afternoon and evening hours Echolalia, scanning speech, total aphasia at times, apraxia, astereognosis, inability to write Becomes frustrated and depressed

Stage III • Increasing dependence with inability to communicate, loss of continence • Progressive loss of cognitive abilities, falls, delusion, paranoid reactions • Average life expectancy is 7 years from diagnosis to death, often from pneumonia, secondary to aspiration Collaborative Care • No cure • Supportive care for client and family Diagnostic Tests • Diagnosis by ruling out other conditions including depression, hypothyroidism, infection, stroke • EEG shows slow pattern in later stages of disease • MRI and CT scan: shrinkage of hippocanthus • Positron emission tomography (PET):visualizes brain activity and interactions • Folstein Mini-Mental Status: instrument reflecting loss of memory and cognitive skills Medications • Cholinesterase inhibitors used to treat mild to moderate dementia • Tacrine hydrochloride (Cognex) • Donepezil hydrochloride (Aricept) • Rivastigmine (Exelon) • Medications to treat depressions • Tranquilizers for severe agitation

music. spastic paresis. brain stem. optic nerve destroyed in patches called plaques • Demyelination slows and distorts nerve conduction resulting in absence of impulse transmission • Neurons in spinal cord. dysarthria (scanning speech). haziness • Brain stem involvement: nystagmus. pregnancy. ataxia. cognitive dysfunctions. ginko biloba. careful history Lumbar puncture with CSF analysis: increased number of T lymphocytes. cerebrum. and these also can trigger relapses Manifestations • Fatigue • Optic nerve involvement: blurred vision. dance Nursing Care &Health Promotion • Intensive. and optic nerve affected • Recurrent demyelination and plaque formation result in scarring of glia and degeneration of axons • Disease follows different courses. spinal optic nerve MRI: shows multifocal lesions CT scan of brain: changes . deafness • Weakness. anti-inflammatory agents. limiting disability Diagnostic Tests • • • • Neurological exam. cerebellum. elevated level of immunoglobulin G (IgG) Cerebral. Coenzyme Q10 • Art therapy. brain. hyptonia • Blindness Collaborative Care Focus is on retaining optimum functioning. supportive nursing interventions directed at physical and psychosocial responses to illness • Maintain functional abilities • Maintain safety of client and caregiver Nursing Diagnoses • Impaired Memory • Include written or verbal reminders • Use cues to deal with memory loss • Chronic Confusion • Anxiety • Hopelessness • Caregiver Role Strain Client with Multiple Sclerosis Description • Chronic demyelinating disease of CNS associated with abnormal immune response to environmental factor • Initial onset followed by total remission making diagnosis difficult • Most persons have disease with periods of exacerbations and remissions • Progression of disease with increasing loss of function • Incidence is highest in young adults (20 – 40). vertigo. most common is the relapsing-remitting type • Stressors trigger MS: febrile states. physical exertion and fatigue. bladder and bowel dysfunction • Cerebellar: nystagmus.• Thioridazine (Mellaril) • Haloperidol (Haldol) • Antioxidants: vitamin E. estrogen replacement therapy in women Complementary Therapy • Massage. onset between 20 – 50 • Affects females more than males • More common in temperate climates • Occurs mainly in Caucasians Pathophysiology • Autoimmune response to prior viral infection • Inflammation destroys myelin leading to axon dysfunction • Myelin sheaths of white matter of spinal cord. numbness in leg(s). herbs.

auditory.• PET: measures brain activity • Evoked response testing of visual. exacerbations • Prevention of respiratory and urinary tract infections Nursing Diagnoses • Fatigue • Self care deficits Home Care • Education • Referral to support group and resources • Referral to home health agencies when condition requires Bell’s Palsy Description • Disorder of seventh cranial nerve and causes unilateral facial paralysis • Occurs between age of 20 – 60 equally in males and females • Cause unknown. appears as if a stroke Prognosis • Majority of person recover fully in few weeks to months • Some persons have residual paralysis Diagnosis based on physical examination Collaborative Care • Corticosteroids are prescribed in some cases but use has been questioned • Treatment is supportive Nursing Care • Teaching client self-care: prevent injury and maintain nutrition • Use of artificial tears. but thought to be related to herpes virus Manifestations • Numbness. wearing eye patch or taping eye shut at night. unable to close eye. somatosensory impulses show delayed conduction Medications • ACTH • Glucocorticosteroids • Immunosuppressants: azathioprine (Imuran). stiffness noticed first • Later face appears asymmetric: side of face droops. small frequent meals . wrinkle forehead or pucker lips on one side • Lower facial muscles are pulled to one side. wearing sunglasses • Soft diet that can be chewed easily. cyclophosphamide (Cytoxan) • Cychophosphamide • Antispasmodics to treat muscle spasms • Medications to deal with bladder problems: anticholinergics or cholinergics depending on problem experienced by client Rehabilitation • Physical therapy to maintain abilities and deal with spasticity Nursing Care Education and support of client dealing with chronic disease with unpredictable course Health Promotion • Client needs to develop strategies to deal with fatigue.