21 COGNITIVEDISORDERS 527
clients lose that awareness of self, which gradually
deteriorates until they can look in a mirror and fail
to recognize their own reflections.
ROLES AND RELATIONSHIPS
Dementia profoundly affects the client’s roles and
relationships. If the client is still employed, work per-
formance suffers even in the mild stage of dementia
to the point that work is no longer possible given the
memory and cognitive deficits. Roles as spouse, part-
ner, or parent deteriorate as clients lose the ability
to perform even routine tasks or recognize familiar
people. Eventually clients cannot meet even the most
basic needs.
Inability to participate in meaningful conversa-
tion or social events severely limits relationships.
Clients quickly become confined to the house or apart-
ment as they are unable to venture outside unassisted.
Close family members often begin to assume the role
of caregiver; this can change previously established
relationships. Grown children of clients with demen-
tia experience role reversal; that is, they care for par-
ents who once cared for them. Spouses or partners
may feel as if they have lost the previous relationship
and now are in the role of custodian.
PHYSIOLOGIC AND SELF-CARE
CONSIDERATIONS
Clients with dementia often experience disturbed
sleep–wake cycles; they nap during the day and wan-
der at night. Some clients ignore internal cues such
as hunger or thirst; others have little difficulty with
eating and drinking until dementia is severe. Clients
may experience bladder and even bowel incontinence
or have difficulty cleaning themselves after elimina-
tion. They frequently neglect bathing and grooming.
Eventually clients are likely to require complete care
from someone else to meet these basic physiologic
needs.
Data Analysis
Many nursing diagnoses can be appropriate because
the effects of dementia on clients are profound; the dis-
ease touches virtually every part of their lives. Com-
monly used nursing diagnoses include the following:
- Risk for Injury
- Disturbed Sleep Pattern
- Risk for Deficient Fluid Volume
- Risk for Imbalanced Nutrition: Less Than
Body Requirements - Chronic Confusion
- Impaired Environmental Interpretation
Syndrome- Impaired Memory
- Impaired Social Interaction
- Impaired Verbal Communication
- Ineffective Role Performance
In addition, the nursing diagnoses of Disturbed
Thought Processes and Disturbed Sensory Percep-
tion would be appropriate for a client with psychotic
symptoms. Multiple nursing diagnoses related to phys-
iologicstatus also may be indicated based on the
nurse’s assessment such as alterations in nutrition,
hydration, elimination, physical mobility, and activ-
ity tolerance.
Outcome Identification
Treatment outcomes for clients with progressive de-
mentia do not involve regaining or maintaining abil-
ities to function. In fact, the nurse must reassess
overall health status and revise treatment outcomes
periodically as the client’s condition changes. Out-
comes and nursing care that focus on the client’s
medical condition or deficits are common. Current
literature proposes a focus on psychosocial care that
maximizes the client’s strengths and abilities for as
long as possible. Psychosocial care involves main-
taining the client’s independence as long as possible,
validating the client’s feelings, keeping the client
involved in the environment, and dealing with behav-
ioral disruptions respectfully (Allen-Burge, Stevens
& Burgio, 1999; Boyd, 2001; Engelman, Matthews
& Altus, 2002; Finnema, Droes, Ribbe & Van Tilburg,
2000).
Treatment outcomes for a client with dementia
may include the following:- The client will be free of injury.
- The client will maintain an adequate balance
of activity and rest, nutrition, hydration, and
elimination. - The client will function as independently as
possible given his or her limitations. - The client will feel respected and supported.
- The client will remain involved in his or her
surroundings. - The client will interact with others in the en-
vironment.
Intervention
Psychosocial models for care of clients with dementia
are based on the approach that each client is a unique
person and remains so, even as the disease’s progres-
sion blocks the client’s ability to demonstrate those
unique characteristics. Interventions are rooted in
the belief that clients with dementia have personal
strengths. They focus on demonstrating caring, keep-
ing clients involved by relating to the environment