Alzheimers

Question 1

What is Alzheimer’s Disease

Answer 1

A non-reversible type of dementia that progressively develops over many years

Question 2

What is dementia

Answer 2

multiple cognitive deficits that impair memory and can affect language, motor skills, and/or abstract thinking

Question 3

What are risk factors of Alzheimer’s Disease (AD)

Answer 3

Age (generally occur in 60s/70s), sex (female), chemical imbalances, previous head injury, genetics (apolipoprotein E)/family history of AD, ethnicity (African American and Hispanics are at increase risk), environmental agents (herpes virus/metal/toxic waste)

Question 4

Characteristics of AD

Answer 4

memory loss, problems with judgment, and changes in personality.
as disease progresses, severe physical decline accompanies deteriorating cognitive functions

Question 5

What are the stages of AD

Answer 5

Early stage, middle stage, late stage

Question 6

Characteristics of Mild Alzheimer’s (early stage)

Answer 6

memory lapses, losing or misplacing items, difficulty concentrating and organizing, unable to remember material just read, still able to perform ADLs, short-term memory loss noticeable to close relations, trouble remembering names when introduced to new people, greater difficulty performing tasks when in a worse setting, can get lost driving (basically short term memory problems and issues with new things)

Question 7

Characteristics of Moderate Alzheimer’s (middle stage)

Answer 7

forgetting events of your own history, difficulty performing tasks that require planning and organizing (finances), difficulty with complex mental arithmetic, personality and behavioral changes (withdrawn/subdued/compulsive/repetitive actions), changes in sleep patterns, can wander and get lost, can be incontinent, clinical findings are noticeable to others (basically harder to do more complex things and starting to lose autonomy)

Question 8

Characteristics of Severe Alzheimer’s (late stage)

Answer 8

Losing ability to converse with others, assistance required for ADLs, incontinence, losing awareness of one’s environment, progressing difficulty with physical abilities, progressing difficulty with physical abilities (ex: walking, sitting, eventually swallowing), eventually loses ability to move (can develop stupor and coma), death frequently related to choking or infection, vulnerable to infection (especially pneumonia) which may become lethal (basically, more life threatening symptoms)

Question 9

What assessments can be used to detect/measure AD?

Answer 9

Mini Mental State Examination (MMSE), set test using FACT, Short Blessed Test, or Clock Drawing Test

Question 10

Low levels of what protein precursor supports the diagnosis of AD?

Answer 10

Soluble beta protein precursor (sBPP) in the cerebral spinal fluid when taken from a puncture in the lumbar region
-Beta amyloid protein normally assists in growth and protection of nerve cells

Question 11

What are nursing interventions for AD?

Answer 11

Assess cognitive status/memory judgment/personality changes; help with ADLs when necessary; encourage client and family to participate in a AD support group; provide a safe environment (monitor, keep client from stairs/elevators/exits, remove dangerous equipment); provide frequent walks; provide cognitive stimulation; provide memory training; use of routines

Question 12

What is pharmacotherapeutics based on?

Answer 12

The theory that AD is a result of depleted levels of the enzyme acetyltransferase

Question 13

What prevents the breakdown of acetylcholine (ACh) and what is the effect?

Answer 13

Donepezil, increased nerve impulses at the nerve sites

Question 14

What blocks nerve cell damage caused by excess glutamate and therefore shows reduction of deterioration in clients?

Answer 14

Memantine

Question 15

What drugs help slow the process of AD?

Answer 15

Cholinesterase inhibitors, memantine, and donepezil

Question 16

What should nurses observe for when clients are on AD medication?

Answer 16

Observe for frequent stools or upset stomach, monitor for dizziness/headache/unsteady gait, use caution when administering medication tothose who have asthma or COPD (lung problems can worsen)

Question 17

What are some alternative therapies for AD and their effects?

Answer 17

estrogen therapy for females (can prevent AD but not useful in treating effects of existing dementia)
ginkgo biloba (an herbal product taken to increase memory and blood circulation) can cause a variety of adverse effects and medication interactions, if client is doing this it must be shared with provider

Question 18

A charge nurse in a long term care facility is preparing a program for assistive personnel about caring for a client who has AD. What should be included in the program? Describe 3 nursing interventions for each of the following: providing cognitive stimulation, providing memory training

Answer 18

cognitive stimulation: offer varied environmental stimulations (walks, music, and craft activities); keep a structured environment/introduce change slowly; use a calendar ti assist with orientation; use short directions when explaining care; be consistent and repetitive; use therapeutic touch (ex: mas

memory training: reminisce about the past; help the client make lists and rehearse; repeat the client’s last statement to stimulate memory

Question 19

A nurse is providing teaching to the partner of a client who as AD and has a new prescription for donepezil. Which of the following statements by the partner indicates the teaching is effective?
A. This medication should increase my husband’s appetite
B. This medication should help my husband sleep better
C. This medication should help my husband’s daily function
D. This medication should increase my husband’s energy level

Answer 19

C; Donepezil helps slow the progression of AD and can help improve behavior and daily functions

Question 20

A nurse working in a long-term care facility is planning care for a client who has moderate AD. Which of the following interventions should be included in the plan of care?
A. Use a gait belt for ambulation
B. Thicken all liquids
C. Provide protective undergarments
D. Reorient the client to self and current events

Answer 20

D; A client who has moderate AD can require reorientation to self and current events as cognitive function declines

Question 21

A nurse is making a home visit to a client who has AD. The client’s partner states that the client is often disoriented to time and place, is unsteady, and has a history of wandering. Which of the following safety measures should the nurse review with the partner? Select all that apply.
A. Remove floor rugs
B. Have door locks that can be easily opened
C. Provide increased lighting in stairwells
D. Install handrails in the bathroom
E. Place the mattress on the floor

Answer 21

A, C, D, E; all can reduce the risk of falling

Question 22

A nurse is caring for a client who has AD and falls frequently. Which of the following actions should the nurse take first to keep the client safe?
A. Keep the call light near the client
B. Place the client in a room close to the nurses’ station
C. Encourage the client to ask for assistance
D. Remind the client to walk with someone for support

Answer 22

B; allows for close observation of the client for nurses

Question 23

A nurse is caring for a client who has AD. A family member of the client asks the nurse about risk factors for the disease. Which of the following should be included in the nurse's response? Select all that apply.
A. Exposure to metal waste products
B. Long-term estrogen therapy
C. Sustained use of vitamin E
D. Previous head injury
E. History of herpes infection

Answer 23

A, D, E