Presented By Margaret Smallwood Alzheimer's Joseph Maximilie ✓ Solved

Presented by Margaret Smallwood ALZHEIMER'S Joseph Maximilien

Pathophysiology: Alzheimer's disease produces a steady and gradual decline of a client's cognitive function. Amyloid plaques containing fragments of protein mix with neuron remnants and other nerve cell pieces. The neurofibrillary tangles, found inside neurons, form a tau which clumps together. Failure function and immobility of the neurons lead to death. As the disease progresses, the client's ability to learn new information will eventually impair language, judgment, and behavior (Ignatavicius & Workman, 2021).

Etiology: Alzheimer's is caused by genetic and environmental factors (viral). The amyloid plaques containing fragments of protein mix with neuron remnants and other nerve cell pieces. The neurofibrillary tangles, found inside neurons, form a tau which clumps together. Neurons cannot survive when their connections to other neurons are lost. As neurons die throughout the brain, the affected regions begin to atrophy or shrink. The damage is widespread, and brain tissue has shrunk significantly (Story, 2017).

Many Alzheimer's clients have chronic health problems such as diabetes mellitus, strokes, and atherosclerosis. Preventive methods such as smoking and excessive alcohol consumption increase the risk of stroke and cardiovascular disease (Ignatavicius & Workman, 2021).

Health Promotion and Maintenance: Eating a well-balanced diet, using soy products, consuming sufficient amounts of folate and vitamins B12, C, and E is beneficial. Regular exercise such as walking and swimming may not only increase tone and muscle strength but also decrease cognitive decline (Ignatavicius & Workman, 2021).

Risk Factors / History: Factors include being female, over 65 years of age, having Down syndrome, experiencing traumatic brain injury, chemical imbalances, environmental agents, immunologic changes, excessive stress, and ethnicity/race. Environmental agents such as herpes zoster and simplex, and toxic metals (zinc and copper) increase the risk of Alzheimer's Disease (AD). Patients who have experienced traumatic brain injury may experience AD at an early age (Story, 2017).

Changes in cognition may present as short-term memory impairment and alterations in communication, such as apraxia, aphasia, anomia, and agnosia. There may also be impaired judgment, inability to make decisions, decreased attention span, and decreased ability to concentrate. Aggressiveness, especially verbal and physically abusive tendencies, rapid mood swings, and increased confusion at night (sundowning) are common symptoms.

Changes in behavior & personality include a decreased interest in personal appearance, inappropriate clothing selection for the weather or event, loss of bowel and bladder control, and decreased appetite or ability to eat (Ignatavicius & Workman, 2021).

Physical signs and symptoms identified through CT scans may show cerebral atrophy and ventricular enlargement, wide sulci, and shrunken gyri. MRI scans can rule out other causes of neurological disease (Ignatavicius & Workman, 2021).

Diagnostics include genetic testing (apolipoprotein E4 (APOE 4)), amyloid beta-protein precursor (soluble) (sBPP), and laboratory imaging assessments.

Planning and Implementation: An interprofessional collaborative approach is essential. Implementing a structured and consistent plan of care and environment promotes cognitive stimulation and memory training. It's vital to assist the client to become more independent, promote bowel and bladder continence, and encourage communication through tools like communication boards or digital devices (Ignatavicius & Workman, 2021).

Psychosocial Integrity: The client may experience the grieving process, anticipating loss and experiencing denial, anger, bargaining, and depression. Supporting the client's and family's decisions regarding genetic testing is essential. Help clients cope with changes in their routine and environment since they may experience changes in emotional and behavioral affect. Addressing sexual disinhibition is also important, as the client may not be aware of their behavior and require support (Ignatavicius & Workman, 2021).

Medications such as Memantine (Namenda) and SSRIs like paroxetine and sertraline can be prescribed to help manage symptoms. Cholinesterase inhibitors such as Aricept, Reminyl, and Exelon are often prescribed, although they should be used with caution due to potential impacts on mobility and self-management (Story, 2017).

Safety Considerations: Keeping the client safe involves avoiding stairs or elevators, assessing and treating pain, and using family members, friends, volunteers, and sitters to monitor the client. Frequent toileting and incontinence care are essential (Ignatavicius & Workman, 2021).

Paper For Above Instructions

The complex nature of Alzheimer's disease necessitates an extensive understanding of its pathophysiology, symptoms, risk factors, and potential interventions available for individuals facing the condition. Alzheimer's disease is recognized as a progressive neurodegenerative disorder characterized by cognitive decline, impacting a range of functionalities from memory retention to language proficiency.

The pathophysiology behind Alzheimer's involves a consistent deterioration of cognitive abilities, principally driven by the accumulation of amyloid plaques and neurofibrillary tangles within the brain. These structures contribute to synaptic dysfunction and ultimate neuronal death, leading to a gradual decline in the individual's capacity to process new information, engage meaningfully in language, and maintain sound judgment (Ignatavicius & Workman, 2021).

Understanding the etiology of Alzheimer's is fundamental to grasping its complexity. Genetic influences, particularly the presence of the apolipoprotein E4 allele, alongside environmental and lifestyle factors, have been implicated (Story, 2017). Chronic illnesses such as diabetes, history of strokes, and cardiovascular diseases are frequently found among Alzheimer's patients, indicating the likely role of vascular health in the disease's progression.

Preventive strategies have gained traction in addressing modifiable risk factors contributing to Alzheimer's. Weight management, adherence to a balanced diet rich in antioxidants, routine physical activity, and abstaining from tobacco and excessive alcohol can be instrumental (Ignatavicius & Workman, 2021). Such lifestyle adjustments may not only bolster physical health but also support cognitive resilience against Alzheimer’s-related declines.

Risk factors vary and may include biological, environmental, and lifestyle components. Gender, age, history of brain injuries, and specific health conditions play key roles. Current research also highlights the impending impact of environmental toxins and stressors on neuronal health, necessitating further investigation into their roles in neurodegenerative processes (Story, 2017).

Cognitive changes may materialize as various forms of memory impairment, difficulties with communication (apraxia, aphasia, anomia), and challenges with judgment—evident through decreased decision-making skills. Behavioral irregularities, including mood swings, aggression, and sundowning, lead to complexities in caregiving and managing everyday situations (Ignatavicius & Workman, 2021).

The diagnostic processes utilized for Alzheimer's typically include comprehensive evaluations, genetic tests, neuroimaging techniques like MRI, and metabolic screenings to rule out alternative diagnoses (Story, 2017). These assessments are pivotal in confirming the diagnosis and constructing personalized treatment plans.

Implementation of structured care plans, emphasizing consistency and cognitive stimulation, facilitates an environment conducive to the patient’s well-being. Programs utilized in memory training—such as interactive tasks and engaging therapeutic practices—assist in enhancing cognitive retention and management strategies during daily interactions. Caregivers are encouraged to utilize visual aids and consistent family engagement to further secure a supportive network for Alzheimer’s patients (Ignatavicius & Workman, 2021).

Addressing the psychosocial components that accompany Alzheimer's disease also proves crucial. The grieving process that the client undergoes upon diagnosis can shape their emotional landscape, often revealing denial, anger, and deepened depression. Therefore, a holistic framework addressing emotional health, family dynamics, and professional support networks enhances care quality (Ignatavicius & Workman, 2021).

Medical interventions include acetylcholinesterase inhibitors and glutamate regulators, which may help mitigate cognitive symptoms, but they must be cautiously administered due to potential side effects impacting mobility (Story, 2017). Careful monitoring, clear communication strategies, and environmental modifications are necessary to foster both independence and safety for individuals diagnosed with Alzheimer’s disease.

References

• Ignatavicius, D. D., & Workman, M. L. (2021). Medical-surgical nursing: Concepts for interprofessional care (10th ed.). Elsevier.
• Story, L. (2017). Pathophysiology: A Practical Approach, 3rd Edition. [VitalSource Bookshelf 10.0.2]. Retrieved from vbk://
• Alzheimer's Association. (2023). 2023 Alzheimer's Disease Facts and Figures. Alzheimer's & Dementia.
• Karran, E., & Walker, L. (2018). Alzheimer's disease: the amyloid cascade hypothesis and the role of protein aggregation. Current Opinion in Neurobiology.
• Fratiglioni, L., et al. (2020). Cognitive decline and dementia in the elderly: a public health priority. European Journal of Public Health.
• National Institute on Aging. (2022). Alzheimer’s Disease Fact Sheet.
• Knopman, D. S. (2019). Advances in the diagnosis and management of Alzheimer's disease. JAMA Neurology.
• Reitz, C., & Mayeux, R. (2021). Alzheimer disease: epidemiology, diagnostic criteria, risk factors, and prevention. Journal of Neurology.
• Steinerman, J. R., et al. (2018). Neuroimaging in Alzheimer’s Disease Diagnosis and Management. Seminars in Neurology.
• Haeberle, H. S., et al. (2022). Behavioral variant frontotemporal dementia vs Alzheimer’s disease: clinical challenges and management. Alzheimer’s & Dementia.