Nursing Management of Dementia

Sreeja V, RN, RPN*, Jyoti Beck, RN, RPN**

* staff Nurse, Central Institute of Psychiatry, Ranchi, India

** Dep. Nur. Superintendent. Central Institute of Psychiatry, Ranchi, India

	Introduction
	Prevalence & Epidemiology
	Etiology
	Signs & Symptoms
	Types of dementia
	Assessment & Management
	Nursing management
	Nursing care plan
	Problems of the carer
	Conclusion
	Bibliography

IX. NURSING CARE PLAN FOR PATIENTS WITH DEMENTIA

 

Nursing Needs	Goals	Planning	Implementation	Evaluation
Therapeutic Needs	1. To reduce any types of infection 2. To recover from any infection 3. Help him to develop sense of security.	All types of illness may be treated symptomatically	1. Give medicines as prescribed. 2. Help the patient to express his physical complaints. 3. Give assurance that medicine will be provided in time.

 

Nursing Needs	Goals	Planning	Implementation	Evaluation
Physical needs   Prevent from injuries	1. To help to avoid repeated injuries 2. To feel confident that environment is safe.	1. Plan safe and decreased conge-sted environment . 2. Plan to keep few activities, not injuries to patient	1. Provide adequate furniture in the room. 2. Check no wires, tubes etc. are spread in room. 3. Electricity connections should be covered 4. Provide the same physical setup. 5. Any change in the room should inform the patient. 6. Provide a bell. 7. Adequate light. 8. Pleasant and quite environment.	Moves in the room with confidence.
Promote Communication	1.To enhance self concept. 2. Develop sense of satisfaction of interacting with others. 3. Feel accepted	1. Spend time with patients.   2.Selective Communication	1. Approach in a slow calm manner. 2. Observe non-verbal cues. 3. face the patient 4. Talk gently 5. Give simple clear message him to talk   6. Listen with respect 7.Repeat instruction frequently	Express happiness that, he is able to convey message clearly
Nursing Needs	Goals	Planning	Implementation	Evaluation
Reduce disorientation	1. To help him feel comfortable and decreased confusion 2. To help in regular activities 3. To feel secure and decreased restless.	1. Re-orientation   2. Clear communication	1. Orient him to time, place of persons with help of a clock calendar and physical setup. 2.  Call him by his name. 3. Repeat the routine activity 4. Avoid argument 5. Speak slowly, clearly  in simple sentence. 6. Convey warmth and concern. 7. Touch him to provide a sense of security. 8. Respond to his question 9. Encourage him to  speak clearly, not to mumble words 10. created comfortable environment without stress or hurry	1. He looks less confused   2. Feels comfortable in the setting
Help in personal hygiene	1. To help patient to feel fresh 2. Develop sense of well being 3. Habit of cleanliness 4. Prevent infection 5. Feel accepted	1. Setup a routine plan  out activities for regular bowel and bladder habits	1. Help him to brush and take bath 2.  Help him to clean his back 3.  Give message at the back to prevent bed sore. 4. Change position 5. Observe skin for injuries, bruising or abrasion 6. If in continence change the dress put deodorant to prevent odor 7. If constipation provide laxatives 8.   Step by step directions to be given 9. Don’t be in hurry 10. Encourage to comb, shave etc.	Patient brush his teeth, take bath, combs hair trice to tries to be self sufficient.

 

Nursing Needs	Goals	Planning	Implementation	Evaluation
Help to adjust with perceptual change	1. To reduce anxiety 2. To adjust perceptual deprivation 3. To improve in his sensation 4. To decreased irritability	1. Patients are very confused and had anxiety. 2. Not able to recognize places 3. Help to reduce anxiety and confusion 4. Patient will be disturbed with hallucination. Help him to cop up	1. Re-orient the place and allow him to touch and feel familiarity . 2.Allow him to smell his old perfume 3. Prevent him from burns. Lack of sensitivity may cause burn. 4. Speak very clearly to patient. 5. Help the relatives to understand that changes is due to disease.	Patients feel less restless.
Help to adjust in alteration in memory of attention	1. Help the patient to increased attention span. 2.  To adjust memory changes.	1. Patients get irritated unable to recall, recent events. 2. Feels inadequate in front of relative and friends.	1. Make them to understand change is due to disease. 2. Tell the relatives not to get irritated if he were forget to inform important messages. 3. Switch an old songs  or show old photographs to stimulated memory. 4. Provide activities of his own choice 5. Give appreciation for complete work 6. Provide opportunity to do the tasks, which he had been doing for many years	1. The patients shows concentration and efficiency in his works   2. Feels comfortable with old things.

 

Nursing Needs	Goals	Planning	Implementation	Evaluation
Nutritional need	1. To build general health 2. To make him to take regular meals. 3. Build up health	1. May take small quantity for fear of in continence   2.. Soft, easily digestible food.	1. Ask his likes and dislikes. 2. Soft and frequent meals. 3. Don’t scoled him, if he has messed up 4. don’t make him to hurry up 5. Provide roughage and green leafy vegetable.	Patient enjoys soft meals.
Improve sleep	1. To reduce loneliness and depression at height 2. To feel fresh 3. Participate in day activities. 4. Get reduce fatigued	1. Planning sleep schedule. 2. A calm and quite environment	1. Discourage day time sleep. 2. Keep him busy with activities 3. Encourage warm water bath at night 4. Keep the room calm. 5. Give bath massage 6. Allow him to read books in he interested 7. Provide warm milk	Sleep for long hours at night

 

Nursing Needs	Goals	Planning	Implementation	Evaluation
Psychological needs	1. To reducing the feelings of isolation. 2. To develop sense of belongingness 3. Enhance self concept	1. Feels alien among his own 2. Likes to participate in activities 3. Provide an attitude of concern	1. Call him by his name. 2.Tell the relatives to visit 3. Encourage activities 4. Actively listen to his past experience 5.Listen him with respect 6.Encourage visit by children	Feel satisfied Talking to others

 

Nursing Needs	Goals	Planning	Implementation	Evaluation
Recreational needs	1. To decrease social isolation 2. To spend time productively 3.To enjoy life 4. Feel useful for family members	1. Help in diverting patients mind 2. Hobbies of his own, in which some productive outcome is possible	1. Tell children to pay with patients, simple games. 2. Provide knitting which she enjoys. 3. Read story for children. 4. TV. program of his choice. 5. Encourage to interact with his own group	Patients enjoys life and feels he is useful for family members.

E.

Nursing Needs	Goals	Planning	Implementation	Evaluation
Spiritual needs	1. To help him to follow his routine 2. To reduce distress and despair.	1. Help him to maintain their rituals 2. Help them to adjust	1. Allow the patient to attend his regular prayers. 2. Don’t get irritated with extra time spent by patient. 3. Graduals help him to reduce the time. 4. Provide religious books. Videos and cassettes.	The patient says “ Now I am not able to pray for long because I get tired”.

 

Nursing Needs	Goals	Planning	Implementation	Evaluation
Discharge plan	1. To help him to be self sufficient.   2. To cope with changes due to illness	1. Depends on family support. 2. Discuss with family 3. To develop realistic goal towards patients recovery	1. Encourage family to talk about problems they have to face at home. 2. discuss the plan of care at home. 3. Explain the needs to make physical and social adjustment 4. Educate patient’s relatives for after care help from various agencies. 5. Importance of follow-up care	Relative of patients get prepared to adjust at home.