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Dennis is an 81 years old man who has Alzheimer’s Disease and is in residential care, his wife, Jill, died five years ago. He has two children (David and Alyson) and eight grandchildren, although contact with them has steadily decreased as his condition deteriorated. Concerns were raised when Dennis was found wandering quite a distance from the care home in the early hours of the morning. He was unable to find his way back and was dressed only in his pyjamas and slippers.


Dennis had previously worked as a vet, his passion for animals evident in the range of pets (dogs and cats) that he and Jill had kept at their house. After his retirement, he had been keen on outdoor pursuits and had with his wife been a member of a rambling club. He enjoyed meeting other people and had a very active social life. When not engaged in these activities he would content himself with word puzzles and crosswords.


Dennis has fluctuating periods of lucidity and confusion, becoming extremely distressed when he is more aware of his deteriorating cognition (on one occasion he was found by healthcare staff screaming and shouting obscenities). He rarely gets involved with activities and poor concentration and confused thinking have made crosswords and word puzzles very difficult. His mobility is poor and he has fallen on a number of occasions. Dennis is also periodically incontinent (often doubly), his poor orientation and levels of confusion causing problems. He rarely leaves the residential home and seldom has visits from his family, as they are often a distressing and confusing experience for all concerned.


Recently, he has become increasingly confused and disorientated, usually when carers asked him to do something. On one occasion when he was asked to come to the table for his meal, Dennis became very confused, crying out and asking for his mother. Using a reality orientation approach, the carer explained to Dennis that his mother, father and wife are dead, at which point he walked away looking very upset and confused.
 

Causes of Alzheimer's Disease

Alzheimer’s diseases can be defined as neurological disorders that affect people usually over 65 years of age. This disorder is characterized by death of the cells in the brain. This disorder results in loss of memory as well as decline in cognitive abilities (Prince et al. 2016). The assignment will mainly portray the causes, sign, symptoms, and recovery interventions of the disorder. This will be done by linking the case study of Dennis with the different aspects of the disorders and how care can be planned for him for his effective treatment.

Alzheimer’s disease is mainly observed in aging individuals, mainly those who have crossed 65 years of age. This is mainly a neurodegenerative disorder where there is progressive death of brain cells over a course of time. The total size of the brain shrinks gradually until a condition reaches where the brain tissue possesses progressively fewer number of nerve cells and connections. In such conditions, the brain is seen to have plaques. Plaques are usually found between the dying cells of the brain (Koivisto et al. 2016).  A build up of protein called beta-amyloid takes place which result in the formation of plaques that lay between the brain cells. Another protein also disintegrates called the tau that results in formation of tangles among the brain neurons. These interfere with the ability of the neurons to communicate with each other that in turn results in destruction of the nerve cells. Overtime, it spreads to grey matter affecting neural functions and cognitive abilities (Olsen et al. 2016). Age is seen to be the greatest factor in the development of this disorder. With the aging of Dennis, he was gradually being affected by the disorders. With the passing of days, more neuronal destruction had taken place in his brain due to plaque and tangle formation. All these had resulted him in reaching an advanced stage of Alzheimer is where most of the cognitive abilities had been lost.

Several signs and symptoms had been noticed in the case of Dennis that shows that he was suffering from Alzheimer disorder. The first symptom of Dennis that shows that he was suffering from Alzheimer’s disorder is his loss of memory that is disrupting his daily life. In case of Dennis, it is seen that he has forgotten his identity and has started crying for her mother. He had forgotten that his mother and wife had passed away and could never come back. This loss of memory ensured that he was suffering from the disease. Patients with such disorder also face challenges in planning as well as in solving problems (Mace and Rabens 2017). The same had been seen in case of Dennis where he had not been able to properly solve his puzzles. He used to love solving puzzles and crosswords when he was young. However, as he had got older and had been affected by the disorder, his capability to solve puzzles and crosswords had diminished and he feels confused now. Moreover, another symptom of the disorder is that patients tend to confuse time and place. A similar scenario was observed where once, he had been found wandering on the road and could not come back to his residential home. Another issue that patients in this disorder also experience is withdrawal from work and social activities (Chen et al. 2016). Once, Dennis used to have a very active social life with his wife but onset of this disorder had made him unsocial. In most of the times, he remains in a state of confusion and lucidity. He is also seen to shout and scream obscenities that are never done by socially active people as it is against social norms. Another symptom is that people suffering from this disorder also have frequent changes in mood and personality (Dewing and Djik 2016). Dennis is also seen to show different sort of reactions where sometimes he starts crying when he is called for food or he becomes upset for his condition and become morose. Sometimes he gets disappointed and starts shouting and screaming. All these symptoms ensure that Dennis was suffering from advanced stage of Alzheimer disease. 

Signs and Symptoms of Alzheimer's Disease


The nursing interventions provided for Dennis should be person centered. The interventions should be provided depending upon the different requirement of the patients. Moreover, they should maintain the dignity of the patients and should respect Dennis in every ways. Dennis has impaired functioning and faces challenge while doing complex tasks. Therefore, he has gradually withdrawn himself from a number of activities. In such situations, nurses should avoid occurrence of any stressful situations in front of Dennis. The nurses should never force the patient more than he could perform. Dennis has lost his memory and therefore he might face issues in recalling events in his life. Therefore, the caregiver should utilize reminders in the form of notes, cues, single-day calendars and many others (Wubker et al. 2015). She should establish a communication process with the patients so that he cannot entirely withdraw himself from the social life. As his family members visit him too less and he cannot socialize with others properly, there is a high chance of him becoming socially excluded. Therefore, the nurses should communicate with him on daily basis and at the same time make him remember different events. Moreover, he has a tendency to get lost whenever he is walking alone and therefore the caregiver should accompany him on walks and ensure that his working area is safe and secure. Moreover, Dennis is showing inconsistency in different types of ordinary tasks in daily living. This is understood from the way he reacted when he was called for the meal. Therefore, the nurses should help Dennis in maintaining consistencies by keeping needed items in his views, assisting him with daily activities and behaving compassionately with him. His increased forgetfulness in meals can be handled by keeping food near him and handing him medications as required. He is still living in the past that became obvious from the way he was calling for his mother. Therefore, the caregiver should arrange social meetings with others and maintain all his physical, mental and work activities (Muller et al. 2017).  Dennis also has poor balance and uncoordinated motor skills for which he had suffered falls. Therefore, handrails, bed rails, grab bars, non skid slippers should be provided and excessively loose garments should be avoided. Environment of his room should be bright and clutters from his room should be cleared. Important amenities should be kept near his reach.

From the entire discussion, it is known that Dennis is suffering from Alzheimer disease. Plaques and tangled had been formed in his brain which had interfered with the neuronal functioning resulting in neuronal death. Therefore, different signs and symptoms are observed like loss of memory, forgetting ways back home, increased confusion, and inability to do complex tasks, falls and many. Therefore, nursing interventions should be provided like assisting him while he is talking walk, arranging for his social meetings, keeping his necessities in front of him, altering his living environment and many others. These would ensure a better quality life for Dennis. 

References:

Chen, L.L., Li, H., Lin, R., Zheng, J.H., Wei, Y.P., Li, J., Chen, P. and Chen, H.Y., 2016. Effects of a feeding intervention in patients with Alzheimer's disease and dysphagia. Journal of clinical nursing, 25(5-6), pp.699-707.

Dewing, J. and Dijk, S., 2016. What is the current state of care for older people with dementia in general hospitals? A literature review. Dementia, 15(1), pp.106-124.

Koivisto, A.M., Hallikainen, I., Välimäki, T., Hongisto, K., Hiltunen, A., Karppi, P., Sivenius, J., Soininen, H. and Martikainen, J., 2016. Early psychosocial intervention does not delay institutionalization in persons with mild Alzheimer disease and has impact on neither disease progression nor caregivers' well?being: ALSOVA 3?year follow?up. International journal of geriatric psychiatry, 31(3), pp.273-283.

Mace, N.L. and Rabins, P.V., 2017. The 36-hour Day: A Family Guide to Caring for People who Have Alzheimer Disease, Other Dementias, and Memory Loss. JHU Press.

Müller, C., Lautenschläger, S., Meyer, G. and Stephan, A., 2017. Interventions to support people with dementia and their caregivers during the transition from home care to nursing home care: A systematic review. International journal of nursing studies, 71, pp.139-152.

Olsen, C., Pedersen, I., Bergland, A., Enders?Slegers, M.J., Patil, G. and Ihlebæk, C., 2016. Effect of animal?assisted interventions on depression, agitation and quality of life in nursing home residents suffering from cognitive impairment or dementia: a cluster randomized controlled trial. International journal of geriatric psychiatry, 31(12), pp.1312-1321.

Prince, M., Comas-Herrera, A., Knapp, M., Guerchet, M. and Karagiannidou, M., 2016. World Alzheimer report 2016: improving healthcare for people living with dementia: coverage, quality and costs now and in the future.

Wübker, A., Zwakhalen, S.M., Challis, D., Suhonen, R., Karlsson, S., Zabalegui, A., Soto, M., Saks, K. and Sauerland, D., 2015. Costs of care for people with dementia just before and after nursing home placement: primary data from eight European countries. The European Journal of Health Economics, 16(7), pp.689-707.

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