A patient receiving a cholinesterase inhibitor may be treated in the hospital, nursing home, or in an outpatient setting. The patient's cognitive ability and functional ability are assessed before and during therapy. The baseline or initial assessment depends on the stage of AD. The nurse assesses the patient for confusion, agitation, and impulsive behavior. Speech, ability to perform activities of daily living, and self-care ability also are assessed. These assessments will be used by the nurse in the ongoing assessment in monitoring the patient's improvement (if any) after taking the cholinesterase inhibitors. These drugs may slow the progression of the disease but are not a cure for AD.
Before starting therapy for the hospitalized patient, the nurse obtains a complete psychiatric and medical history. With AD, patients often are unable to give a reliable history of their illness. A family member or primary caregiver will be able to verify or give information needed for an accurate assessment. During the time the history is taken, the nurse observes the patient for any behavior patterns that appear to be deviations from normal. Examples of deviations include poor eye contact, failure to answer questions completely, inappropriate answers to questions, a monotone speech pattern, and inappropriate laughter, sadness, or crying. These patients are in varying stages of decline. Display 33-1 identifies the stages of AD and the associated clinical manifestations. The nurse documents the patient's cognitive ability using Display 33-1 as a guide.
Late dementia or the final phase of AD may last from a few months to several years while the patient becomes increasingly immobile and dysfunctional.
Physical assessments include obtaining blood pressure measurements on both arms with the patients in a sitting position, pulse, respiratory rate, and weight. The functional ability of the patient is also important.
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