Alzheimer's disease: Patient Care

Reality orientation is helpful for patients in Stage I of the disease. Validation therapy is most appropriate for patients in Stage I or III. These patients are unable to be reoriented and need reassurance and affirmation of their feelings and thoughts. Validation therapy is a form of communication in which the patient's feelings are valued and supported by all members of the health care team, rather than refuted.

In collaboration with the physical and occupational therapists, the nurse assesses the patient's need for assistance with activities of daily living. Self-care, exercise, and other activities are encouraged  to the fullest extent possible. If sleep disturbances occur, the patient should rest between daytime activities, but sleeping during daytime hours is discouraged. Neurological function, including mental and emotional states and motor capabilities, is monitored for further deterioration. Vital signs and respiratory status are assessed for signs and symptoms of pneumonia and other infections. The patient is evaluated for indications of gastrointestinal or urinary problems (anorexia, dysphagia, and urinary or fecal incontinence), and fluid and food intake is monitored to detect imbalances. The nurse or assisting  nursing personnel takes the patient to the bathroom or bedside commode before and after meals and every 2 hours in between. Skin is inspected for evidence of trauma, such as bruises, abrasions, or other breakdown. The occupational therapist, home health nurse, or case manager assesses the patient's living environment to eliminate hazards, and teaches the family to monitor the patient's ability to perform tasks. Because the patient may misperceive the environment, health professionals should speak softly and calmly and allow sufficient time for answers, given the patient's slowed througt processes and impaired ability to communicate verbally. The case manager or nurse evaluates the caregiver's ability to manage the patient at home and makes the appropriate referrals to available local resources such as counseling, support groups, and respite care as indicated.

The local chapter of the Alzheimer's Disease and Related Disorders Association (ADRDA), sometimes simply referred to as the Alzheimer's Association, is an excellent resource. A list of local chapters can be found through their website at www.alz.org.