10 hours ago Patient-related challenges to pain management were universal across care settings; nurse- and organisation-related barriers differed between settings. A need for interactive learning and practice development, particularly in pharmacology, was identified. Conclusions: Achieving pain management in practice was highly challenging. A number of barriers were identified; however, … >> Go To The Portal
• Monitor knowledge use – monitor the number of times the nurses use the PAINAD pain scale to assess pain in dementia patients and by selecting and providing appropriate interventions for pain relief 14
Participants in the DNP project were asked to complete a survey to determine knowledge and beliefs about pain in elderly patients with dementia. A copy of the survey is included in Appendix A. Zwakhalen, Hamers, Peijnenburg, and Berger (2007) developed the tool to discover gaps in knowledge based
nurses on the aging process and the progression of dementia, bridging the research- practice gap by providing education for the assessment and management of pain in the cognitively impaired older adult, and the utilization of an observational pain assessment tool. This section also discusses Knowles (1981, 2005) adult learning theory.
The nurse is assessing a diabetic patient who also has dementia. The nurse finds that the patient did not take a prescribed oral antidiabetic drug in the morning and now has elevated blood sugar levels. What is the possible reason for the patient not taking the drug in the morning?
Cholinisterase Inhibitors are the most commonly prescribed medications for dementia. There are 3 cholinisterase inhibitors, which include, Donepezil, Galantamine and Rivastigmine.
The PAINAD scale consists of five items: breathing, negative vocalizations, facial expression, body language, and consolability. Each element of the scale is scored, and the possible total scores of 0 (no pain) to 10 (severe pain) are comparable to the traditional 0-to-10 pain scale.
Because there is currently no cure for dementia, patients rely on the care management provided by nurses in both clinical and home-based settings. Nurses provide direct care to patients, helping to relieve the burden placed on family members and other caregivers.
In the early stages of Alzheimer's, the person with dementia may need help remembering to take medications. As a caregiver, you may find it helpful to: Use a pill box organizer. Using a pill box or keeping a daily list or calendar can help ensure medication is taken as prescribed.
The Pain Assessment in Advanced Dementia Scale (PAINAD) is a reliable assessment tool for dementia patients. It can be used in both nonverbal and verbal patients.
Purpose: The ePAT is a multimodal pain scale designed to assist clinicians and health care workers assess pain in people with moderate to severe dementia at the point of care.
They provide treatment, care and support for people with mental health problems and dementia. They might assess you at home, and they advise you and your carers on ways of improving your health and quality of life.
The nursing interventions for a dementia client are:Orient client. Frequently orient client to reality and surroundings. ... Encourage caregivers about patient reorientation. ... Enforce with positive feedback. ... Explain simply. ... Discourage suspiciousness of others. ... Avoid cultivation of false ideas. ... Observe client closely.
Their role involves taking a detailed admission history about the patient, their family, background, and their likes and dislikes; this is known as the personal history, and understanding the patients background can improve the patients journey in whichever care setting they are in.
Medication management is a strategy for engaging with patients and caregivers to create a complete and accurate medication list using the brown bag method. A complete and accurate medication list is the foundation for addressing medication reconciliation and medication management issues.
Making the decision to stop medication Medication should be reviewed regularly, and continued for as long as the benefits are greater than any side effects. If the person with dementia decides to stop taking a drug, they should speak to the doctor first if possible, or as soon as they can after stopping treatment.
The 7 stages of DementiaNormal Behaviour. ... Forgetfulness. ... Mild Decline. ... Moderate Decline. ... Moderately Severe Decline. ... Severe Decline. ... Very Severe Decline.
The goals of therapy are to decrease pain while increasing function and enhancing quality of life. Because chronic non-cancer pain can be reduced but not eliminated, ongoing pain reporting is common in patients with dementia.
Muscle relaxants should be avoided in individuals older than 65 because of intolerance to side effects . Opioid analgesics are the mainstay for the treatment of moderate to severe pain in patients with advanced illness. Long-acting or sustained-release analgesic preparations should be used for continuous pain.
Pain in the elderly patient may be more difficult to assess because of the patient’s cognitive and physical impairments. Traditional approaches to pain management may need to be modified because of a sometimes-elusive diagnosis, altered patient physiology, ...
Rule out other potential infectious, metabolic, medication-related, and social-situation changes as possible causes for acute decline. Prescribe a trial of scheduled medications (be cautious with scheduled NSAIDs). Use a stepwise approach. Start low, go slow, be aware of possible under treatment.
In those with advanced dementia who may be unable to communicate verbally about their pain, you may need to evaluate their condition (and their response to treatment) by facial expressions, verbalizations, body movements, changes in interpersonal interactions, activity patterns and routines such as sleep disruption and appetite suppression . Multiple questionnaires have been developed with variable success rates in eliciting pain levels in persons with dementia, with no general consensus on which one is superior.38
Cognitive impairment resulting from delirium, dementia, or other mental health conditions may make both the assessment and management of symptoms more difficult. In a patient with complicated emotional issues, they may describe the pain in imprecise, inconsistent terms. Poly-pharmacy is common.
Elderly are more sensitive to the effects of the opioids, due to age-related physiologic changes (e.g., decreased renal or hepatic function and altered body-fat distribution) as well as comorbid medical conditions.
Kriebel-Gasparro emphasizes that nurses who have training in dementia and Alzheimer's disease with gerontological patients can provide quality medical care to help track and manage symptoms. Early detection of dementia and treatment of other health issues can help people maintain their independence longer and slow the progression of symptoms.
Ann Kriebel-Gasparro, a faculty member in Walden University's master of science in nursing program, describes dementia as a group of symptoms rather than a particular disease. This term encompasses a variety of conditions that affect memory, problem-solving, and decision-making. The loss of cognitive functions associated with dementia symptoms interferes with the ability to carry out everyday activities such as driving, paying bills, or living alone. Alzheimer's, the most common type of dementia, affects 60-80% of all patients diagnosed with dementia.
Creating a nursing care plan helps to reduce restlessness, anxiety, and other challenging behaviors.
As dementia progresses, Kriebel-Gasparro reminds nurses not to make assumptions about a patient's ability to communicate and comprehend. The symptoms of dementia and Alzheimer's disease affect each person differently from the early to moderate states. Patients need to be treated with kindness and support, using these communication techniques:
The best care plans include activities that help patients stay connected to their pre-dementia lives , such as watching a favorite TV show or movie. As the disease progresses, nurses should make sure the activities fit their patients' ability levels.
As their patients progress through the disease, nurses may experience a range of emotions---anxiety, sadness, guilt, anger, and depression.
Over 55 million people across the globe live with dementia. According to the World Health Organization, dementia, which includes the diagnosis of Alzheimer's disease, is one of the leading causes of disability for the world's elderly population and ranks as the seventh leading cause of death among all diseases. The demand for nurses with the training and sensitivity to care for dementia and Alzheimer's patients has never been greater.
Drug excretion is slow in older adults because of a decrease in renal blood flow.
The patient is at risk for nonadherence to the drug regimen because he or she may be unable to afford the medication costs. The patient is not confused; therefore, it is unlikely that the patient will fail to understand the drug's purpose. The patient may be able to afford dietary expenses and other necessities, but may not be willing to spend money on medication; therefore, lack of adequate nutrition would not necessarily be a concern. The use of herbal preparations is a practice that does not necessarily apply to all patients who lack health insurance.
While assessing the renal function in an elderly patient, a nurse learns that the patient has reduced renal blood flow. What is the impact of this age-related change on drug action?
Most drugs get metabolized in the liver. The decreased liver function will lead to reduced metabolism of drugs. As a result, drugs may not be available for therapeutics effect or excretion may be reduced, causing drug toxicity. Reduced liver function does not cause increased drug excretion, as drug excretion take place through kidneys. Liver impairment does not affect absorption, as it is a function of the stomach and intestines. Impaired liver function may decrease first pass metabolism.
4) The patient has an increase in hepatic enzyme production. The patient is experiencing the adverse effects of taking multiple medications. Confusion, malnutrition, and falls are common effects of polypharmacy, or multiple drug use. The patient may experience a change in dietary patterns due to the effects of taking multiple drugs.
Because drug absorption is slowed in the older adult, drugs with a longer half-life may increase the potential for toxicity. The nurse should assess the patient, and the dose may need to be decreased. An alternative drug should not be needed. The time of administration will not affect the half-life. The medication should not be halved; this will not affect the half-life.
Impaired memory of the patient. Patients with dementia have an impaired memory status, which presents a barrier for effective management of illness. These patients may forget to take medicines on time. This problem can be resolved by obtaining the assistance of family members, caregivers, or health care professionals.