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Beta-amyloid
Tau protein
Rationale
Beta-amyloid and tau proteins are associated with Alzheimer's disease. Development of plaques in the brain tissue is a part of aging; however, in clients with Alzheimer's disease, these plaques are seen in specific parts of the brain. These plaques are made up of clusters of insoluble deposits of a protein called beta-amyloid, other proteins, remnants of neurons, nonnerve cells such as microglia,
and other cells such as astrocytes. Tau proteins, through the microtubules, provide support to the intracellular structures in the central nervous system. In Alzheimer's disease, the tau protein is altered, which in turn causes the microtubules to twist together in a helical fashion. This twisting of microtubules results in formation of neurofibrillary tangles, a characteristic finding in the neurons of persons with Alzheimer's disease. Prion proteins are related to Creutzfeldt-Jakob disease,
which is a rare and fatal brain disorder. Pick bodies are associated with frontotemporal lobar degeneration, which is a clinical syndrome associated with shrinking of the frontal and temporal anterior lobes of the brain. Alpha-synuclein is a protein associated with dementia with Lewy bodies in the brainstem and cortex. Lewy bodies are abnormal deposits of alpha-synuclein.
Agitation
Increased vocalization
Withdrawal
Rationale
Because of
difficulties with oral and written language, clients with Alzheimer's disease may have difficulty expressing physical complaints, including pain. Pain can result in an alteration in the client's behaviour, such as increased vocalization, agitation, withdrawal, or changes in functioning. Wandering may be related to loss of memory or to the side effects of medications, or it may be an expression of a physical or emotional need, restlessness, curiosity, or stimuli that trigger memories of earlier
routines. Sundowning is a specific type of agitation in which the client becomes more confused and agitated in the late afternoon or evening. The cause of sundowning is unclear, but several theories propose that it is due to a disruption in circadian rhythm. Other possible causes include fatigue, being in an unfamiliar environment, noise, medications, reduced lighting, and sleep fragmentation.
Behavioral problems occur in most patients with AD. These problems include repetitiveness, delusions, hallucinations, agitation, aggression, altered sleeping patterns, wandering, and resisting care. What are nursing strategies to address difficult behavior in AD?
A. redirection, distraction, reassurance
B. continuation, explanation, discourage
B, D, E
B. An 86-year-old male hospitalized with
pneumonia is agitated and trying to get out of bed, stating he is "crawling with bugs."
Later manifestations may include agitation and hallucinations, as displayed by this 86-year-old male in this patient scenario.
D. An 82-year-old female admitted for emergency post-stroke treatment has been in the ICU for five days, seeing and talking to people not visible.
This 82-year-old female on assessment is manifesting the late clinical signs of delirium, which can include agitation,
misperception, misinterpretation, and hallucinations.
E. An 80-year-old hospitalized man is easily excited about the change to his daily routine, and is yelling and screaming at the hospital staff.
Agitation is a late clinical sign of delirium.