Introduction
Patient Description
The patient described in this paper is a family member of mine who has experienced Alzheimer’s for the last three years. It is a 69-year-old man suffering from memory, language, comprehension, and reasoning impairment, which makes him vulnerable during interactions with the outer world. The laboratory test results include an MRI scan demonstrating how brain regions are shrinking due to Alzheimer’s disease.
Rationale for Selection
This patient is selected because his case justifies the importance of highly sensitive and empathetic nurses who help patients remain independent regardless of their medical conditions.
Assessment Data Clustering and Problem Framing
Subjective Data
Alzheimer’s disease is associated with dementia symptoms and cognitive disability. Two-thirds of people with dementia develop Alzheimer’s at age 65 or older (Kumar et al., 2022). This patient also started developing symptoms such as poor judgment, out-of-character behavior, and disorganization when he was 66. In a year, the patient experienced selective short-term memory loss and confusion with recognizing dates and places. These signs of Alzheimer’s are subjective data since they are collected from the patient and their family members’ observations.
When nurses interact with the patients, they also facilitate subjective assessment to evaluate the disease progression and development of other conditions. Although nursing professionals are not responsible for a mental status examination, they can observe and draw conclusions after asking clients to concentrate on specific tasks or memorize some visuals. In my experience with this patient, he demonstrates quick attention shifts and problems with multitasking, such as watching television and talking simultaneously. Although the person does not show neuropsychiatric symptoms such as psychosis, apathy, and agitation, he should avoid environmental triggers and complicated tasks (Kumar et al., 2022). This subjective data about a person’s cognitive task problems proves that nurses should help patients with Alzheimer’s to deal with their activities and avoid injuries.
Objective Data
Regarding the objective data obtained from laboratory and diagnostic results, it helps monitor the changes in brain functions. Initially, the patient passed complete blood tests to detect any other illnesses. The results proved that the patient had no accompanying diseases except cognitive decline. However, later, physicians used volumetric MRI to verify the shrinkage of the temporal lobe (Kumar et al., 2022).
Since phosphorylated tau proteins and beta-amyloid play crucial roles in differential diagnosis, they are also included in the objective measurement. During this examination, the presence of beta-amyloid 42 proved the existence of plaque in the brain that interferes with neuron functions. These data help to differentiate the diagnosis from many other cognitive health impairments and dementia forms.
Prioritization of Patient Problems and NANDA-I Nursing Diagnoses
Short-Term Memory Loss
Nursing diagnosis is the most vital part of clinical judgment, guaranteeing that a patient receives appropriate treatment and clinical interventions. While medical diagnosis deals directly with pathology, nursing diagnosis requires an accurate assessment of the patient’s physical and mental response to their health condition, involving their family and community (Matt, 2023). Regarding this patient, he experiences selective short-term memory loss, thus, forcing me to select the risk for long-term memory loss or dementia as the most acute nursing diagnosis.
Classification approved by NANDA-1 recognizes the instances when risk diagnosis might be the highest priority for a medical condition. If the patient already demonstrates confusion with dates and places, he is at risk of forgetting information necessary for survival. Since the patient’s core skills and behaviors can disappear with long-term memory loss, the risk for dementia, as evidenced by impaired memory, is a critical nursing diagnosis.
Disturbed Thought Processes
Another nursing diagnosis recognized during interactions with the patient is disturbed thought processes related to a decreased level of consciousness, as evidenced by confusion, multitasking, and problem-solving. It applies to problem-centered diagnosis as classified by NANDA-1 and recognizes the most important symptoms and signs of Alzheimer’s (Matt, 2023). Disturbed thought processes interfere with the patient’s daily life, forcing him to experience attention shifts and mood swings. As the disease progresses, impaired cognition results in difficulties with verbal communication, which deteriorates the patient’s mental state. Therefore, the disturbed thought process should be controlled by nurses as it can cause injuries and social isolation.
Evidence-Based Nursing Interventions
The evidence-based intervention to relieve short-term memory loss and address the risk for dementia is reminiscence group therapy. During this therapy, the patient recalls his life events vocally and discusses his past experiences with other group members (Lök et al., 2018). It meets the social and psychological needs of the patient, empowering him as a self-confident and valuable individual with persistent human dignity. Avoiding sharing traumatizing experiences ensures that negative emotions do not trigger the patient. Nevertheless, reminiscence group therapy is a necessary nursing intervention that helps patients recall events from their childhood and capture them for as long as possible.
Meanwhile, the patient’s disturbed thought process requires a more gentle and comprehensive approach. The evidence-based intervention for this nursing diagnosis is sensory stimulation therapy and affective practice, implemented during the early stages of dementia (Lök et al., 2018). Since this patient does not develop dementia, this technique mildly helps him navigate his thoughts and feelings in the present. The patient frequently confuses places and times, so he needs the nurses’ help to relieve the psychological tension and calm his emotions.
Among all sensory stimulation therapies, music therapy is chosen as the most suitable one since the patient enjoys listening to the Mozart symphony. During this therapy, the patient listens to the sounds, such as rainfall, to relax his mind. It is helpful for his cognition as it connects the person to the world around them through the five senses (Lök et al., 2018). Additionally, it is associated with high levels of anxiety relief and reduced unwanted behaviors. During the therapy, the patient is asked about his feelings, facilitating mutual understanding between the nurse and the patient.
Expected Patient Outcomes
Reducing Short-Term Memory Loss
The third nursing process step, identifying expected outcomes, sets measurable goals for a specific time. Regarding the risk for dementia or the patient’s current selective loss of short-term memory, the patient is expected to remember his childhood experiences, critical historical terms, and memorable events from his past at any time when given the trigger, such as photographs, music, or foods (Lök et al., 2018). Thus, the patient will describe these memories during every reminiscence therapy session to train his short-term and long-term memory.
As the expected outcome is connected to the patient’s cognitive abilities to memorize and verbalize, it is limited to the three months of the sessions. Moreover, the patient is expected to remain socially active after interacting with other group members, improving his emotional and mental state by building meaningful relationships (Lök et al., 2018). While reminiscing about the events that happened yesterday with emotions, the patient provides information to the nurses about any environmental triggers. It is an additional help to health care since reminiscence therapies encourage patients to share their feelings. Hence, the patient will recall his past events to ensure his brain functions as actively as possible.
Addressing Disturbed Thought Processes
The expected outcome for the disturbed thought process is that the patient will demonstrate a normal reality orientation after a month of the music sessions. Although it might seem like a short time, it is enough for the patient with Alzheimer’s to maintain cognition appropriate for his disease stage. Since reminiscence therapy already targets memory skills, music therapy targets the emotions that result from disturbed cognition. The patient will communicate his feelings and cooperate with the staff to ensure that music sessions help him adjust to his surroundings.
Conclusion
To conclude, patients with Alzheimer’s need constant monitoring and assistance from nurses to relieve negative emotions and physical disorientation. As this patient loses the skills necessary for survival, the nursing staff should ensure his dignity remains protected for a longer time. The risk for dementia and disturbed thought processes is identified as a critical nursing diagnosis, requiring reminiscence therapies and music sessions. As a result of these nursing interventions, the patient is expected to maintain his current memory skills and cognitive processes to diminish the risk of dementia.
References
Kumar, A., Sidhu, K., Goyal, A., Tsao, J. W., & Doerr, C. (2022). Alzheimer disease (nursing). In StatPearls. StatPearls Publishing. Web.
Lök, N., Bademli, K., & Selçuk‐Tosun, A. (2018). The effect of reminiscence therapy on cognitive functions, depression, and quality of life in Alzheimer patients: Randomized controlled trial. International Journal of Geriatric Psychiatry, 34(1), 47– 53. Web.
Matt, V. (2023). Nursing diagnosis guide and list: All you need to know to master diagnosing. Nurses Labs. Web.