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Management and Nursing Care Plan for Dementia


Definition of Dementia

Dementia can be defined as cognitive and memory disorders that can affect daily activities. People with dementia often show some disturbances and changes in daily behavior (behavioral symptoms) that interfere with (disruptive) or do not disturb (non-disruptive) (Volicer, L., Hurley, AC, Mahoney, E. 1998). Grayson (2004) states that dementia is not just ordinary disease, but rather a collection of symptoms caused by multiple diseases or conditions resulting in changes in personality and behavior.


Causes of Dementia


Causes of dementia according to Nugroho (2008) can be classified into 3 major categories:

1. Syndrome dementia with disease essentially unknown etiology, often not found in this class of cerebral atrophy, abnormalities may be present in sub-cellular or biochemical level on enzyme systems, or on the metabolism such as those found in Alzheimer's disease and senile dementia.

2. Syndrome dementia with known etiology but can not be treated,
The main cause in this class include:
  • Spinocerebellar degeneration disease.
  • Subacute sclerosing leukoencephalitis (van Bogaert).
  • Huntington's chorea.
  • Creutzfeldt-Jakob disease, etc.
3. Syndrome dementia by etiology of the disease that can be treated, in this class include:
Cerebrovascular disease.
  • Metabolic diseases.
  • Nutrition disorder.
  • Due to chronic intoxication.
  • Communicating hydrocephalus.
Dementia (senility) is a severe cognitive decline such that it interferes with activities of daily living and social activities. Cognitive decline in dementia usually begins with the deterioration of memory or memory (forgetful). Dementia mainly caused by Alzheimer's disease is closely related to old age. Alzheimer's disease causes 60% of senility or dementia and is expected to continue.

The classic symptoms of Alzheimer's disease dementia is memory loss happens gradually, including difficulty finding the right word or mention, is not able to recognize the object, forgetting how to use plain and simple objects, such as pencils, forgot to turn off the stove, close the window or close the door, the mood and personality may change, agitation, trouble with memory, and made ​​a bad decision can lead to unusual behavior.

These symptoms are very varied and individual. Gradually the symptoms of Alzheimer's disease may occur in a different time, could be faster or slower. The symptoms are not always an Alzheimer's disease, but if the symptoms lasted more frequent and real, to consider the possibility of Alzheimer's disease (Nugroho, 2008).



Signs and Symptoms of Dementia

In general, signs and symptoms of dementia are as follows:
  1. Decline in memory that continues to happen. In patients with dementia, "forget" become a part of daily life that can not be separated.
  2. Impaired orientation of time and place, for example: forget the day, week, month, year, where people with dementia are.
  3. The decline and inability to arrange words into correct sentences, using words that are not appropriate for a condition, repeat the word or the same story many times.
  4. Excessive expression, for example, excessive crying when she saw a television drama, furious at small mistakes committed by others, fear and nervousness that is not grounded. People with dementia often do not understand why these feelings arise.
  5. The change of behavior, such as: indifferent, withdrawn and anxious.
  6. The whole range of cognitive function is damaged.
  7. Originally impaired short-term memory.
  8. Personality and behavioral disorders, mood swings.
  9. Motors and focal neurologic deficits.
  10. Irritability, hostility, agitation and seizures.
  11. Psychotic Disorders: hallucinations, illusions, delusions and paranoia.
  12. Aphasia, apraxia, agnosia and.
  13. ADL (Activities of Daily Living) difficult.
  14. Difficult to regulate the use of finances.
  15. Not be able to go home when traveling.
  16. Forgot to put the important stuff.


Patient Examination

1. Patients routine laboratory examination.
Laboratory tests are only done once a clinical diagnosis of dementia is made to help search the etiology of dementia, especially in reversible dementia, although 50% of people with dementia is Alzheimer's dementia with normal laboratory results, laboratory tests should be performed routinely. Laboratory tests are routinely done include: complete blood count, urinalysis, serum electrolytes, blood calcium, urea, liver function, thyroid hormone, folic acid levels.

2. Imaging
Computed Tomography (CT) scan and MRI (magnetic resonance imaging) has become a routine examination in the examination even if the results are still questionable dementia.

3. Examination of EEG
Electroencephalogram (EEG) does not provide specific features and in most EEG was normal. In the advanced stages of Alzheimer's can illustrate diffuse slowing, and periodic complexes.

4. Examination of cerebrospinal fluid
Lumbar puncture is indicated when clinically encountered acute onset dementia, persons with immunosuppressants, meninges and heat stimuli encountered, atypical presentations of dementia, normotensive hydrocephalus, syphilis test (+), meningeal stinger on CT scans.


Management for Dementia

Psychosocial therapy

Deterioration in mental status has a significant meaning in patients with dementia. The desire to continue living depends on the memory. Short-term memory is lost before the loss of long-term memory in most cases of dementia, and many patients typically experience distress as a result of thinking about how they use more memory function in addition to thinking about the disease being experienced. The identity of the patient has faded over the course of the disease, and they can only use a little bit and getting his memory. Emotional reactions ranging from severe depression to kecemasanyang and catastrophic terrorism is rooted in the realization that understanding itself (sense of self) disappeared.

Patients usually will benefit from supportive psychotherapy and educational so that they can understand the journey and the nature of the illness. They can also get support in her grief and acceptance of worsening disability and attention to the problems of self-esteem. Many functions are still intact can be maximized by helping patients identify activities that can still be doing. A psychodynamic approach to the defect in the function of the ego and the limitations of cognitive function can also be beneficial. The doctor can help the patient to find a way of "peace" with defects ego functions, such as saving a calendar for a patient with a problem orientation, create a schedule to help organize the structure of their activities, and make notes to memory problems.

Psychodynamic interventions involving the patient's family can be very helpful. It helps patients to fight feelings of guilt, sadness, anger, and despair as he slowly felt shunned by the family.

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