Dementia Nursing: A Guide to Practice
Not applicable: The guideline was not adapted from another source. This is the current release of the guideline.
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Eating and feeding issues in older adults with dementia: part II: interventions. Brief evaluation of executive dysfunction: an essential refinement in the assessment of cognitive impairment. How to Try This video. Administering and interpreting the Mini-Cog. Dementia, including: Progressive dementia Alzheimer's disease Vascular dementia Dementia with Lewy bodies.
Recommendations Major Recommendations. Parameters of Assessment No formal recommendations for cognitive screening are indicated in asymptomatic individuals. Cognitive Parameters Orientation: person, place, time Memory: ability to register, retain, recall information Attention: ability to attend and concentrate on stimuli Thinking: ability to organize and communicate ideas Language: ability to receive and express a message Praxis: ability to direct and coordinate movements Executive function: ability to abstract, plan, sequence, and use feedback to guide performance Mental Status Screening Tools Folstein Mini-Mental State Examination MMSE is the most commonly used test to assess serial cognitive change.
Clock Drawing Test CDT is a useful measure of cognitive function that correlates with executive-control functions. They are also useful in monitoring the progression of functional decline.
Guide to antipsychotic drug use in dementia care | Dementia Partnerships
The severity of disease progression in dementia can be demonstrated by performance decline in activity of daily living ADL and instrumental ADL IADL tasks and is closely correlated with mental-status scores. Behavioral Assessment Assess and monitor for behavioral changes; in particular, the presence of agitation, aggression, anxiety, disinhibitions, delusions, and hallucinations. Evaluate for depression because it commonly coexists in individuals with dementia.
A thorough evaluation of all prescribed, over-the-counter, homeopathic, herbal, and nutritional products taken is done to determine the potential impact on cognitive status.
Laboratory tests are valuable in differentiating irreversible from reversible forms of dementia. Structural neuroimaging with noncontrast computed tomography CT or magnetic resonance imaging MRI scans are appropriate in the routine initial evaluation of patients with dementia. Elicit the caregiver perspective of patient function and the level of support provided.
Evaluate the impact that the patient's cognitive impairment and problem behaviors have on the caregiver mastery, satisfaction, and burden.
Evaluate the caregiver's experience and patient—caregiver relationship. Monitor the effectiveness and potential side effects of medications given to improve cognitive function or delay cognitive decline. Provide appropriate cognitive-enhancement techniques and social engagement. Ensure adequate rest, sleep, fluid, nutrition, elimination, pain control, and comfort measures. Avoid the use of physical and pharmacologic restraints. Maximize functional capacity: maintain mobility and encourage independence as long as possible; provide graded assistance as needed with ADLs and IADLs; provide scheduled toileting and prompted voiding to reduce urinary incontinence; encourage an exercise routine that expends energy and promotes fatigue at bedtime; and establish bedtime routine and rituals.
Address behavioral issues: identify environmental triggers, medical conditions, caregiver—patient conflict that may be causing the behavior; define the target symptom i. Ensure a therapeutic and safe environment: provide an environment that is modestly stimulating, avoiding overstimulation that can cause agitation and increase confusion and understimulation that can cause sensory deprivation and withdrawal.
Utilize patient identifiers name tags , medic alert systems and bracelets, locks, and wander guard. Eliminate any environmental hazards and modify the environment to enhance safety. Provide environmental cues or sensory aids that facilitate cognition, and maintain consistency in caregivers and approaches. Encourage and support advance-care planning: explain trajectory of progressive dementia, treatment options, and advance directives.
Integrate community resources into the plan of care to meet the needs for patient and caregiver information; identify and facilitate both formal e. Follow-up to Monitor Condition Follow-up appointments are regularly scheduled; frequency depends on the patient's physical, mental, and emotional status and caregiver needs. Identify and treat any underlying or contributing conditions.
And yet this vital nursing speciality within a field of growing importance is often neglected and undervalued.
- Excellence in Dementia Care: Research into Practice : Murna Downs : .
- Connect With NursingCenter.
- Beginning XQuery.
- Philosophy and Biodiversity.
- Sharing knowledge and learning across the Well Pathway for Dementia.
Dementia Nursing: A Guide to Practice addresses this need by empowering nurses and other health professionals with the latest knowledge and the best clinical practice in dementia care -- presented within a holistic philosophy of person-centred care. This book encourages nurses to go beyond the technical aspects of nursing practice to hear the deeply human needs of the people in their care.
The purpose of the book is not only to identify physical problems and clinical needs, but also to capture the lived experience of those with dementia, and to encourage all carers to respond with creativity and imagination. The breadth and depth of this definitive textbook are impressive, with evidence-based chapters on all major subjects within the field of dementia nursing.
DEMENTIA NURSING: A GUIDE TO PRACTICE
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