Presentation on theme: "ALZHEIMER’S DISEASE: A Study of Alzheimer’s Disease Pathology and Nursing Management of Unmet Needs By Jennifer Krueger, RN, BSN Alverno College,"— Presentation transcript:
1 ALZHEIMER’S DISEASE:A Study of Alzheimer’s Disease Pathology and Nursing Management of Unmet NeedsBy Jennifer Krueger, RN, BSN Alverno College, MSN 621April 29, 2010
2 tutorial Instructions To navigate throughout this tutorial:Click on the icon in the lower left corner of each slide to return to the Table of Contents page at any time.Tableof ContentsOnly use the left or right arrows locatedin the upper right hand corner of eachslide, to progress to the next slide or returnto the previous slide.BackForward(Unless specifically indicated, images were obtained from Microsoft Clipart, 2011)
3 CASE STUDY--RosieMeet, Rosie! Rosie is 84 years old and lives with her daughter, son-in-law, and two grandchildren. She moved in with her daughter six months ago, after her husband passed away. While Rosie is in excellent physical health, her family has noticed some changes in her personality and decision-making skills.Throughout this tutorial, you will answer questions about Rosie as they relate to each section. When you come to a slide with Rosie’s picture, answer the question. Then click the forward arrow in the upper right corner of the slide to continue.
4 LEARNING OBJECTIVES:Explain the basic pathology of Alzheimer’s Disease including the influence of stress, inflammation, aging and genetics.Recognize challenging behavior as communication of unmet needs.Identify nursing interventions that will influence/reduce challenging behaviors in patients with Alzheimer’s Disease.
5 Nursing Management of Unmet Needs TABLE OF CONTENTSClick on a box to find out more about each topic…Just the FactsPathophysiologyImmuneandStress ResponseGenetically SpeakingWhat are ChallengingBehaviors?Nursing Management of Unmet NeedsReferences
6 JUST THE FACTS Did You Know? Alzheimer’s Disease is the most common cause of dementia in older adults;60-80% of all cases. (Omnicare, 2010)Approximately 13% of all persons older than 65 years old have Alzheimer’sDisease. (Omnicare, 2010)In million people were affected by Alzheimer’s Disease. (Omnicare, 2010)The risk of developing the disease increases with age, and approximately 50% ofall people over the age 85 have Alzheimer’s Disease. (Porth and Maftin, 2009)Currently, there are no specific diagnostic tests to diagnose Alzheimer’s Disease;diagnosis is made by excluding other possible causes of dementia symptoms.(Porth and Maftin, 2009)
7 JUST THE FACTS Did You Know? There are normal a changes in the brain, associated with aging…Weight of brain decreases.Neuron loss, mostly in the cortex in the superior temporal area.Neurons atrophy with changes in neurotransmission.Despite changes, cognitive abilities remain intact.Changes in personality or cognitive deficits are considered not normal in the older adult.Many times, plaques and tangles associated with Alzheimer’s Disease are found in older adults with no cognitive impairment.(Porth and Maftin, 2009)
8 JUST THE FACTS What Is Alzheimer’s Disease? A disease involving neuropathic and neurotransmitter changes.A disease causing cortical atrophy with loss of neurons particularly in the parietal and temporal lobes of the brain.A progressive disease leading to death within 8 to 10 years after diagnosis.Ranges in stages of very mild cognitive decline to very severe cognitive decline.Click here to see a normal brain…Click here to see a brain affected by Alzheimer’s Disease(Porth and Maftin, 2009)(Alzheimer’s Association, 2011)(Image credit : Jannis Productions, Stacy Jannis. Picture used with permission from the Alzheimer’s Association)
9 JUST THE FACTS Stages Of Alzheimer’s Disease Click on each stage to learn more…. (Stages are as defined by the Alzheimer’s Association)Stage 1No Impairment. Person does not show any signs and symptoms to a medical professional or family members.Very Mild Cognitive Decline. Patient may feel like they have memory lapses, forgetting familiar words or objects. Family, friends and medical professionals do not detect any signs or symptoms.Stage 2Mild Cognitive Decline (Early-stage). Family and friends may start noticing problems with name-finding, planning or organizing. A medical professional may detect problems with memory or concentration.Stage 3Moderate Cognitive Decline (Mild or early-stage). A careful medical interview should be able to detect problems in several areas including, knowledge of current events, impaired ability to perform challenging mental arithmetic (counting backward from 75 by 7s), managing finances, memory of personal history, may be moody and withdrawn.Stage 4(Alzheimer’s Association, 2011)(Porth and Maftin, 2009)
10 JUST THE FACTS Stages Of Alzheimer’s Disease Click on each stage to learn more….(Stages are as stated by the Alzheimer’s Association)Moderately Severe Cognitive Decline (Moderate or mid-stage). Major gaps in memory and cognitive function. Will need some assistance with day to day activities. Will not remember address or phone numbers. Able to remember significant details about self and is usually able to use the toilet and feed self.Stage 5Severe Cognitive Decline (Moderately severe or mid-stage). Memory continues to worsen. Significant changes in personality may emerge. Will need help with dressing, toileting; may be incontinent. Tends to wander or get lost.Stage 6Stage 7Very Severe Cognitive Decline (Severe or late-stage). Final stage of disease. Loses all ability to respond to their environment, including the ability to speak and control movement.(Alzheimer’s Association, 2011)(Porth and Maftin, 2009)
11 JUST THE FACTS Let’s Review! Two years ago, Rosie started to feel like she was forgettingsimple things; birthdays, phone numbers and names of friends.Since moving in with her daughter, Rosie has been choosinginappropriate clothing for the season and is refusing to participatein her normal social activities. She seems moody at times and hasbeen forgetting to take her daily medications.Rosie is most likely in what stage of Alzheimer’s Disease:Click on the correct shape below!Stage 1Stage 4Stage 5Stage 7Sorry, try again!Rosie’s cognitiveability is affected.Stage 1, is “No,Impairment”.You’re Correct!Rosie is most likelyin the early stages ofAlzheimer’s Disease.Sorry, try again!Rosie’s impairment is notas severe as Stage 5.Sorry, try again! Rosie’simpairment is not as severeas Stage 7.
12 PATHOPHYSIOLOGY Anatomy 101: The Brain What area does what?ParietalLobeOccipitalLobeFrontalLobeTemporalLobe(Image credit: Alzheimer’s Disease Education and Referral Center, NIA. Picture used with permission from the Alzheimer’s Association)Roll Over Each Lobe To Find Out!(Porth and Maftin, 2009)
13 PATHOPHYSIOLOGY Anatomy 101: A Brain Cell Neuron: A brain cell affected by Alzheimer’s DiseaseClick on a box to labelthe parts of a neuron!Schwann cells surrounds axonNissl BodiesCell BodyAxon TerminalsDendriteAxonNucleusThe three main parts of a neuron:Axon: The extension from the neuron cell body that takes information away from the cell body.Cell Body (S0ma): The part of the cell that contains the nucleus.Dendrite: Extensions from the neuron cell body that takes information to the cellbody.(Porth and Maftin , 2009)
14 PATHOPHYSIOLOGY Pathological Aspects The major pathological features of Alzheimer’s Disease are the presence ofneuritic plaques, neurofibrillary tangles, and amyloid angiopathy .NEUROFIBRILLARYTANGLESAMYLOIDPROCESSINGNEURITIC PLAQUESClick on a box to learn about each feature contributing to the progressionof Alzheimer’s Disease.(Porth and Maftin, 2009)
15 PATHOPHYSIOLOGY Pathological Aspects NEURITIC PLAQUESNeuritic plaques are clusters of protein fragments, arranged around a central amyloid core.The most common type of deposits have fragment residues of amino acids in length.Plaques are associated with degeneration of neurons at the synaptic junction,affecting cell to cell communication.As Alzheimer’s Disease progresses, plaque formationincreases.Synaptic Junction(Porth and Maftin, 2009)(Wippolid, Carins, Vo, Holtzmann and Morris, 2007)
16 PATHOPHYSIOLOGY Pathological Aspects NEUROFIBRILLARYTANGLESAre primarily composed of a protein called Tau wound around each other in a helical fashion.They are resistant to chemical or enzymatic breakdown and remain in brain tissue after theneuron dies.Tangles destroy cell transport systems leading to neuron death.Tangles have also been identified in other forms of dementia, although usually withoutplaque formation, as found in Alzheimer’s Disease.The relationship between tangles and plaques is not completelyunderstood.Click on the picture tolearn moreabout Tau…(Alzheimer’s Association, 2011)(Lippens, Sillen, Landrieu, Amniai, Sibille, Babier, Leroy, Hanoulle & Wiersuzeski, 2007)(Wippolid, Garins, Vo, Holtzmann andMorris, 2007)(Porth and Maftin, 2009)Here
17 PATHOPHYSIOLOGY What About Tau? Tau protein is important in the structural stabilization of nerve cells, allowing transport ofnecessary proteins and enzyme-containing vesicles essential for cell maintenanceand function.Tau is only present in neurons.Too much or too little Tau leads to neuronal dysfunction.If Tau collapses, as it does in Alzheimer’s Disease, it twists into helical strands becomingneruofibillary tangles.When tangles form, cells begin to die.(Alzheimer’s Association, 2011)(Lippens et al, 2007)(Wippolid et al, 2007)
18 Protofibrils and fibrils PATHOPHYSIOLOGY Pathological AspectsAMYLOIDPROCESSINGThere are many types of amyloid proteins present in the body; B-amyloid is unique to the brain.B-amyloid is a protein fragment that is snipped from a larger protein called Amyloid Precursor Protein (APP) which is associated with the cell membrane.APP processing can follow two pathways, benign and harmful. As the harmful pathway progresses, B-amyloid protein fragments start sticking together forming oligomers.Oligomers start to grow larger becoming protofibrils and fibrils; eventually other proteins and material are added forming neuritic plaques.Click on each arrow below to progress the amyloid pathway to neuron death!Neuron deathAPPB-amyloid fragmentsOligomersProtofibrils and fibrilsNeuritic plaques(Menon and Lutsep, 2010)(Porth and Maftin, 2010)
19 PATHOPHYSIOLOGY Pathological Aspects Click on the video to learn more !"(Retrieved from YouTube, 2011 and embedded with permission of the Alzheimer's Disease Education and Referral Center, a service of the National Institute on Aging, 2008).
20 PATHOPHYSIOLOGY Pathological Aspects What does this all mean?As plaques and tangles accumulate, neurons die. The cortex of the brain atrophies, initially damaging areas involved in thinking, planning and remembering.As the disease progresses, the parietal and temporal lobes of the brain are particularly affected; these areas are related to communication and interpretation of sensory input.Eventually, plaques and tangles spread to large portions of the brain causing severe atrophyand cortical damage .(Alzheimer’s Association, 2011)(Porth and Maftin, 2009)Click hereTangle and plaque involvement are represented by shaded blue areas.Images credit: Alzheimer’s Disease Education and Referral Center, NIA. Picture used with permission from the Alzheimer’s Association.)
21 PATHOPHYSIOLOGY Let’s Review! Rosie has Stage 4 Alzheimer’s Disease. What three major factorscontribute to the progression of her symptoms?Neurofibrillary tangles, confusion and dehydration.B. Neuritic plaques, neuron repair and synapse junctions.Neuritic plaques, neurofibrillary tangles andamyloid processing.D. Amyloid angiopathy, neuritic plaques and a history of falling.A.B.C.D.Sorry, try again!Confusion is a symptomof AD. Dehydration is nota major factorcontributing to theprogression of AD.Sorry, try again!Of these three,only neuritic plaquesis a factorcontributing to AD.You’re Correct!Neuritic plaques, neurofibrillarytangles and amyloid processingare the 3 major factors contributingto Alzheimer’s Disease.Sorry, try again!Falling is not a majorfactor contributingto the progressionof a AD.
22 may form oligomers that PATHOPHYSIOLOGY Let’s Review!Inside Rosie’s brain, neurofibillary tangles are forming. Whichprotein fragment may be snipped from the larger APP,eventually leading to the formation of oligomers?Neuritic plaquesAmyloid Precursor ProteinC. A-amyloidD. B-amyloidA.B.C.D.Sorry, try again!Neuritic plaques areformed from clustersof protein fragments.Sorry, try again! AmyloidPrecursor Protein is APP.Sorry, try again!Alpha amyloid isNot correct.You’re Correct!B-amyloid fragmentsmay form oligomers thateventually formneuritic plaques, inpeople with AD.
23 IMMUNE AND STRESS RESPONSE Alzheimer’s Disease and the IMMUNE RESPONSE…What is the IMMUNE RESPONSE?“The collective response of cells and molecules of the Immune System” (Porth and Maftin, 2009).The Immune System includes:1. Innate and Adaptive immunity (barriers to microbes/antigen recognition).2. Cells ( Leukocytes, Lymphocytes, and Dendritic Cells).3. Cytokines (Proteins that stimulate cells of the immune system to respond).The Immune ResponseCellsImmunityCytokines(Porth and Maftin, 2009)
24 IMMUNE AND STRESS RESPONSE Alzheimer’s Disease and the IMMUNE RESPONSEAn activated IMMUNE RESPONSE will begin the INFLAMMATORY PROCESS.There are two types of inflammatory process:Acute: Short in duration. Characterized by exudate seeping into tissues, heat,swelling, pain.Chronic : Long in duration, lasting days to years. Presence of WBC’s, fibrosis andtissue necrosis.Redness,Swelling HeatPain,Systemic ResponseInflammatory Response(Porth and Maftin, 2009)
25 IMMUNE AND STRESS RESPONSE Alzheimer’s Disease and the IMMUNE RESPONSE….The exact role the IMMUNE RESPONSE plays in AD is still uncertain; however it has been attracting attention in research in four ways:As a first responder to initial pathological AD events.2. Assisting in clearing of the toxic by-products of APP processing.3. Provider of protection to neurons.4. As a possible target for treatment strategies.Click here four times!(Cohen, 2009)
26 IMMUNE AND STRESS RESPONSE Alzheimer’s Disease and the IMMUNE RESPONSEFacts about “Microglia”; the first responders to initial Central Nervous Systemdamage….Microglia are immune cells of the Central Nervous System (CNS). They are considered to be in a “resting state” until activated.Upon CNS injury, microglia are triggered from thesubstances released from the damaged tissue.Activated microglia release growth factors,anti-inflammatory factors, and protectivesubstances (cytokines) to restoredamaged tissue.Click on thepictureto learnmore aboutMicroglia and AD.Here(University of Washington, 2008)
27 IMMUNE AND STRESS RESPONSE Alzheimer’s Disease and the IMMUNE RESPONSEMicroglia and Alzheimer’s Disease…Microglia immune response contributes to the progression of Alzheimer’s Disease, although exact contributions are not really known.In people with Alzheimer’s disease microgliaare found in close association with B-amyloid.Microglia respond to abnormal APPprocessing by assisting in the clearing of toxicby-products.Their role in the CNS may be far more complexthan previously appreciated.(Cohen, 2009)(Mandrekar-Colucci and Landreth, 2010)
28 IMMUNE AND STRESS RESPONSE Alzheimer’s Disease and the STRESS RESPONSEWhat is the STRESS RESPONSE?Stress is a state of symptoms arising from the “coordinated activation of theneuroendocrine and immune system”(Porth and Maftin, 2009). It was first described by Hans Selye, anendocrinologist in the 1930’s. He called it the General Adaptation Syndrome (GAS).(Porth and Maftin, 2009)StressorsStressorsActivationofGASHormones and Neurotrans-mittersReleasesActivating the GAS releases hormones and neurotransmitters alerting the bodyto stressors. Adaptations are made within the body to return it to abalanced state.(Porth and Maftin, 2009)
29 IMMUNE AND STRESS RESPONSE Let’s Review! Which type of cell inside Rosie’s Central Nervous System clear toxic by-products of APP processing?A. NeuronsB-amyloidC. MonocyteD. MicrogliaA.B.C.D.Sorry, try again!Neurons are braincells.Sorry, try again!B-amyloid is aprotein fragment.Sorry, try again!Monocytes are whiteblood cells related toMicroglia.You’re Correct!Microglia cleartoxic by-products ofAPP processing.
30 IMMUNE AND STRESS RESPONSE Let’s Review! Inside Rosie two complementary systems are triggered in thepathology of AD. Which two systems are involved?Immune and StressDigestive and ImmuneC. Skeletal and StressD. Neurological and RespiratoryA.B.C.D.You’re Correct!Although how, isnot exactly known!Sorry, try again!This is not correct.Sorry, try again!This is not correct.Sorry, try again!This is not correct.
31 GENETICALLY SPEAKING Alzheimer’s and Genetics Late-Onset Early-Onset There are two types of Alzheimer’s Disease, early-onset and late onset; both have genetic links:Late-OnsetEarly-OnsetRare; only 5% of all people who have AD.Develops in people ages years old.Some cases of early-onset AD are inherited; they are called Familial AD (FAD).FAD is caused by gene mutations on specific chromosomes 21, 14, and 1.These mutations form abnormal amyloid precursor protein (APP), causing increased amounts of B- amyloid.If a person inherits either chromosomes, 21,14, or 1 they will almost always develop AD.Most cases of AD are Late-Onset.Develops after age 60.Gene mutations found in early-onset are not found in late-onset.A specific gene for late-onset has not been identified.A pre-disposing genetic risk does exist related to, apolipoprotein E (APOE) gene, found on chromosome 19.(National Institute of Aging, 2008)
32 GENETICALLY SPEAKING Genetic Research and Alzheimer’s Disease Research in AD genetics has intensified regarding questions related to “What makesthe disease process begin?” and “What role do AD risk-factor genes interacting with othergenes, lifestyle and/or environmental factors affect the risk of developing AD?”Focuses on prevention and treatments.Scientist believe four to seven more AD risk-factor genes exist and are working to discoverthem.A major goal is to develop accurate reliable screening tests; however they may never beable to predict with 100% accuracy.(National Institute of Aging, 2008)
33 risk factor gene related GENETICALLY SPEAKING Let’s Review!Rosie has late-onset Alzheimer’s Disease. What predisposing riskfactor gene may have interacted with lifestyle and environmental factorsincreasing Rosie’s chances of developing Alzheimer’s Disease?Chromosome 21.B. APOE gene.Amyloid Precursor Protein (APP).D. Chromosome 1.A.B.C.D.Sorry, try again!Chromosome 21 isrelated to early-onsetAD.You’re Correct!APOE gene hasbeen identified as arisk factor gene relatedto late-onset AD.Sorry, try again!APP is related to theformation of tanglesfound in both late &early-onset AD.Sorry, try again!Chromosome 1 is related to early-onset AD.
34 WHAT ARE CHALLENGING BEHAVIORS? “People only see what they are prepared to see….” (Ralph Waldo EmersonThinkExist.com, 2011)Rosie’s has progressed to Stage 6 of Alzheimer’s Disease. She started to wanderfrom home and became very verbally abusive. Her family was no longer able to care forher at home and placed her in a long-term care facility. Nursing staff has reported Rosieto be verbally abusive, fearful, and combative with bathing. She also continually calls out“ I want to go home!”.Click HereClick HereProblemBehaviorsChallengingBehaviorsRosieWhat Do You See?
35 Combative Aggressive Behavior Repetitive Behavior/Repetitive Questions WHAT ARE CHALLENGING BEHAVIORS?What are typical CHALLENGING BEHAVIORS exhibited by peoplewho have Alzheimer’s Disease?AgitationSuspicious BehaviorVerbal AbuseCombative Aggressive BehaviorYellingDepressionFear and AnxietyWanderingRepetitive Behavior/Repetitive QuestionsClick Here!(Alzheimer’s Association,2011)
36 WHAT ARE CHALLENGING BEHAVIORS? In long-term care settings CHALLENGING BEHAVIORS might be exhibited…At change of shift.With bathing/showering.In the evening.With different or new caregivers.With nursing treatments.During the night.After being contradicted.After being given complicated instructions.After a day out with family.When frustrated with simple tasks.Click Here!(Alzheimer’s Association,2011)
37 WHAT ARE CHALLENGING BEHAVIORS? Why do CHALLENGING BEHAVIORS occur?May be related to deterioration of brain due to disease pathology in areas that regulateimpulse control, emotions and sensory processing.May be related to pain that can be felt, but not articulated or specifically identified.May be related to an underlying medical condition, like a urinary tract infection or pneumonia.May be related to side effects of medications.May be triggered by environmental conditions, for example lighting, noise or agitatedbehaviors of others.Click on the picture to find out!(Alzheimer’s Challenging Behavior Task Force, 2010)
38 WHAT ARE CHALLENGING BEHAVIORS? Whatever the source, a caregiver’s response may improve or make the behavior worse. In this way, “behaviors are best seen as a dynamic interaction between the person with dementia, the caregiver and the specific environment.”(Alzheimer’s Challenging Behavior Task Force, 2010)Stressors in EnvironmentResponse of CaregiverChallenging BehaviorInfluencesRosie(Alzheimer’s Challenging Behavior Task Force, 2010)
39 WHAT ARE CHALLENGING BEHAVIORS? Let’s Review!Since moving into the long-term care facility, Rosie’s challenging behaviorof yelling and resisting bathing has worsened. What factors may beaffecting her behavior?Caregiver’s response to the bathing experience.Progression of AD affecting Rosie’s Parietal and Temporal lobes of her brain.Environment of shower room, including lighting, sounds and temperature.D. All of the above.A.B.C.D.Sorry, try again!This could be acontributing factor.Sorry, try again! This could be a contributing factor.Sorry, try again!This could be a contributing factor.You’re Correct! All of these factors could be influencing Rosie’s behavior.
40 Stressors in Environment NURSING MANAGEMENT OF UNMET NEEDSWhat are unmet needs?Physical Needs: Pain, illness, hunger, thirst, constipation, fatigue, response toincontinence, side effects related to medications, impaired vision or hearing.Affective Needs: Intolerance of environmental stressors (overstimulation fromnoise, lighting, etc.), boredom, loneliness, balance of sensory-stimulating versessensory-calming activities, meaningful human interaction.Stressors in Environment(Alzheimer’s Association, 2011)(Alzheimer’s Challenging Behaviors Task Force, 2010)(Kovach, C., Logan, B., Noonan, P., Schlidt, A.,Smierz, J., Simpson, M., & Wells, T., 2006)Rosie“When behavioral symptoms are unnoticed, dismissed or not understood as symptoms ofunmet needs, the needs of the older person with dementia are missed…” (Kovach et al, 2006).
41 NURSING MANAGEMENT OF UNMET NEEDS What is YOUR response?Do you CONSISTENTLY DO A COMPLETE PHYSICAL ASSESSSMENT with anyoneexperiencing behavioral problems, especially when symptoms appear suddenly?Do you DISMISS BEHAVIOR SYMPTOMS, as “typical or normal behavior” for that person?Do you CONSIDER ENVIRONMENTAL STRESSORS OR PHYSICAL NEEDS WITH anyoneexperiencing behavior problems?Do you CONSIDER PERSONAL PREFERENCES with every activity? (What did the personenjoy/like prior to be moved to the facility?Response of Caregiver(Alzheimer’s ChallengingBehavior Task Force, 2010)(Alzheimer’s Association, 2011)(Kovach et al, 2006)Rosie“….failure to recognize behavior as symptoms leads to the under treatment of many needs.” (Kovach et al, 2006).
42 NURSING MANAGEMENT OF UNMET NEEDS Possible BARRIERS….TimeDisengaged StaffFloat StaffLack of KnowledgeResponse of CaregiverBarriersRosie(Alzheimer’s Challenging Behavior Task Force, 2010)(Simpson, Stevens, & Kovach, 2007)
43 NURSING MANAGEMENT OF UNMET NEEDS To manage a CHALLENGING BEHAVIOR….Assess for physical needs and intervene as necessary:PainThirstPhysical illnessHungerConstipationIncontinenceVisionHearing(Kovach et al, 2006)“It takes an average of 23 minutes to manage disruptive behaviors. Agitatedbehaviors are contagious, so it is advantageous to get them under control as soon aspossible” (Alzheimer’s Challenging Behavior Task Force, 2010).
44 NURSING MANAGEMENT OF UNMET NEEDS To manage a CHALLENGING BEHAVIOR….Assess for affective needs and intervene as necessary:Environment (lighting, noise level, movement)Overstimulation/UnderstimulationBoredomLonelinessNeed for human contactFearNew or different staff(Kovach et al, 2006)“It takes an average of 23 minutes to manage disruptive behaviors. Agitatedbehaviors are contagious, so it is advantageous to get them under control as soon aspossible” (Alzheimer’s Challenging Behavior Task Force, 2010).
45 NURSING MANAGEMENT OF UNMET NEEDS To manage a CHALLENGING BEHAVIOR….adapt YOUR response:Stop the activity that could be contributing to the behavior.Try to distract with something enjoyable.Stay calm.Don’t argue.Respond to the emotions underlying the behavioral need.Ask yourself, “If safety is not an issue, can the behavior be accepted?”StopDistractStay CalmRespondIs it OK?“It takes an average of 23 minutes to manage disruptive behaviors. Agitatedbehaviors are contagious, so it is advantageous to get them under control as soon aspossible” (Alzheimer’s Challenging Behavior Task Force, 2010).(Alzheimer’s Association, 2011)(Kovach et al, 2006)
46 NURSING MANAGEMENT OF UNMET NEEDS To manage a CHALLENGING BEHAVIOR….Person-Centered Care:“Care provided according the residents’ needs, desires and preferences”(Alzheimer’s Challenging Behaviors Task Force, 2010).Adapting the environment by encouraging “a continuous process of listening, trying new things, seeing how they work and changing in an effort to individualize care”(Alzheimer’s Challenging Behaviors Task Force, 2010).“Person-Centered care seeks to maximize choice and autonomy, and thus canreduce the presence of challenging behaviors”(Alzheimer’s Challenging Behaviors Task Force, 2010).Rosie’s Choices:Click on Rosie for her choices!Likes to go to bed 22:30pm.Prefers waking up at 9:30.Does not like showers, baths only.Coffee, black, 2 sugars.Likes gardening, and quilting.Rosie
47 NURSING MANAGEMENT OF UNMET NEEDS Let’s Review!The next time Rosie becomes verbally abusive at her care-givers whilebeing given a shower, the nurse should…Ensure Rosie’s showering routine is designed around her preferences.Assess Rosie for physical needs, specifically pain.Stop the shower and stay calm.D. All of the above.A.B.C.D.Sorry, try again!Sorry, try again!Sorry, try again!You’re Correct!Assessing for pain,stopping the shower, staying calm and being person-centered may meet Rosie’s unmet needs.
48 behavior may be related to an unmet need, like pain. NURSING MANAGEMENT OF UNMET NEEDSLet’s Review!As Rosie’s nurse, what can you do to affect Rosie’s possibility ofexhibiting future, challenging behaviors?Call Rosie’s physician and ask them to increase the dosage of Rosie’sscheduled anti-psychotic.Plan to dismiss Rosie’s behavior as normal.Identify Rosie’s challenging behavior as an unmet need and be prepared to assess both physical and affective stressors.D. Insist with Rosie she needs to stop behaving this way.A.B.C.D.Sorry, try again!This should not be yourfirst choice.Sorry, try again!By dismissing Rosie’sbehavior as normal, youmay miss an unmetneed.You’re Correct!Rosie’s challengingbehavior may be related to an unmet need, like pain.Sorry, try again!Arguing with Rosie may make the situation worse.
49 REFERENCESAlzheimer’s Association. (2011). The challenging behaviors of Alzheimer’s disease. Portland, OR:Author.Alzheimer’s Association. (2011). Stages of Alzheimer’s disease. Retrieved fromAlzheimer’s Association. (2011). Inside the brain: An interactive tour. Retrieved fromAlzheimer’s Challenging Behaviors Task Force (2010). Handcuffed. Milwaukee, WI: Author.Cohen, R. (2009). The role of the immune system in Alzheimer’s disease. Focus, The Journal ofLifelong Learning in Psychiatry, 7 (1),Kovach, C., Logan, B., Noonan, P., Schlidt, A., Smierz, J., Simpson, M., & Wells, T., (2006).Effects of the serial trial intervention on discomfort and behavior of nursinghome residents with dementia. American Journal of Alzheimer’s Disease andOther Dementias, 21 (3),Lippens, G., Sillen, A., Landreau, I., Amniai, L., Sibille, N., Barbier, P., Leroy, A., Hanoulle, X.,& Wieruszeski, J., ( 2007). Tau aggregation in Alzheimer’s disease. Prion, 1 (1),Mandrekar-Colucci, S., Landreth, G., (2010). Microglia and inflammation in Alzheimer’sdisease. CNS & Neurological Disorders Drug Targets, 9. Retrieved from/ html
50 REFERENCESMenon, R. and Lutsep, H. (2011). Cerebral amyloid angiopathy. Retrieved fromemedicine.medscape.com/article/ overview.National Institute on Aging. (2008). Alzheimer’s disease genetics fact sheet (NIH PublicationNo ). Washington, DC: U.S. Government Printing Office.National Institute on Aging. (2008). Inside the brain: Unraveling the mystery ofAlzheimer’s disease. Retrieved fromOmnicare. (2010). Geriatric pharmaceutical care guidelines. Covington, KY: Omnicare, Inc.Porth, C. and Matfin, G. (2009). Pathophysiology: Concepts of altered health states.Philadelphia, PA: Wolters Kluwer Health/ Lippencott Williams & Wilkins.Simpson, M., Stevens, P. & Kovach, C. (2007). Nurses’ experience with the clinicalApplication of a research-based nursing protocol in a long-term care setting.Journal of Clinical Nursing, 16,Think Exist. (2011). Ralph Waldo Emerson. Think Exist.com. Retrieved fromto see/14514.htmlUniversity of Washington. (2008). Microglia. Retrieved from Washington.edu/moeller/microglia.shtml
51 REFERENCESWippolid, F., Carins, N., Vo, K., Holtzmann, D., & Morris, J., (2007). Neuropathology for theneuroradiologist: Plaques and tangles. American Journal of Neuroradiology 29 (1),18-22.
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