Caring for Clients With Dementia and Thought Disorders

Drug Therapy for Alzheimer Disease

Cholinesterase Inhibitors

• Common Generic Drugs:

  • Donepezil (Aricept)

  • Galantamine (Razadyne)

  • Rivastigmine (Exelon)

• Intended Use:

  • Increases acetylcholine by blocking cholinesterase in mild to severe dementia due to Alzheimer's Disease (AD);

  • Memory improvement in dementia due to stroke, vascular disease, or multiple sclerosis.

• Common Side Effects:

  • Headache, nausea, diarrhea, insomnia, muscle cramps;

  • Bradycardia, exacerbations of asthma, chronic obstructive pulmonary disease;

  • Dyspepsia, anorexia, abdominal pain, weight loss.

• Safety Warnings for Nurses:

  • Do not use to treat acute delirium;

  • Benefit is absent 6 weeks after discontinuation;

  • Monitor for potential GI bleeding;

  • Report heart rate < 60 beats/min;

  • If using transdermal patches, rotate sites and ensure old patches are removed.

N-methyl-D-aspartate (NMDA) Receptor Antagonists

• Common Generic Drug:

  • Memantine (Namenda)

• Intended Use:

  • Provides nerve cell protection from excessive glutamate in moderate to severe AD dementia.

• Common Side Effects:

  • Dizziness, headache, confusion.

• Combination Drug:

  • Memantine/donepezil (Namzaric)

• Safety Warnings for Nurses:

  • Avoid in renal disease;

  • Administer with a full glass of water.

Drug Therapy for Schizophrenia

First-Generation Antipsychotics (Conventional)

• Common Generic Drugs:

  • Chlorpromazine (Thorazine)

  • Fluphenazine (Prolixin)

  • Haloperidol (Haldol)

  • Loxapine (Adasuve)

  • Perphenazine (Trilafon)

  • Prochlorperazine (Compazine)

  • Thioridazine (Mellaril)

  • Thiothixene (Navane)

  • Trifluoperazine (Stelazine)

• Intended Use:

  • Block neurotransmission in psychotic disorders to relieve positive symptoms.

• Common Side Effects:

  • Hypotension, drowsiness, nasal congestion, dry mouth, agranulocytosis, dystonia, behavioral changes, photosensitivity.

Second-Generation Antipsychotics (Atypical)

• Common Generic Drugs:

  • Cariprazine (Vraylar)

  • Clozapine (Clozaril, FazaClo)

  • Lurasidone (Latuda)

  • Olanzapine (Zyprexa)

  • Paliperidone (Invega)

  • Quetiapine (Seroquel)

  • Risperidone (Risperdal)

  • Ziprasidone (Geodon)

• Intended Use:

  • Act on serotonin and dopamine receptor sites for schizophrenia and manic phases of bipolar disorder.

• Common Side Effects:

  • Agitation, akathisia, anxiety, drowsiness, headache, constipation, dry mouth, nausea, weight gain, agranulocytosis.

Nursing Safety Warnings for Antipsychotics

• Monitor for extrapyramidal symptoms (EPSs).

• Instruct on sun protection.

• Monitor for tardive dyskinesia (TD) and neuroleptic malignant syndrome.

• Track weight and labs for elevated cholesterol, triglycerides, and blood sugar.

Nursing Care Plan for Clients with Dementia

Assessment

• Interview both client and family for history regarding memory, moods, sleep patterns, and self-care activities.

• Assess cognitive status (orientation, memory, emotional state).

• Perform complete physical examination, focusing on muscular strength and mobility.

Common Nursing Diagnoses and Outcomes

• ADL Deficit

  • Expected Outcome: Client to perform hygiene with assistance.

  • Interventions:

    • Observe client's hygiene habits and establish a consistent routine.

• Impaired Home Maintenance

  • Expected Outcome: Surrogate will manage household responsibilities.

  • Interventions:

    • Identify support systems and plan household task sharing.

• Memory Impairment

  • Expected Outcome: Reorientation in personal and life experiences.

  • Interventions:

    • Frequent orientation reminders; use clocks and calendars for environmental cues.

• Impaired Verbal Communication

  • Expected Outcome: Improved communication with caregivers.

  • Interventions:

    • Simplify communication, engage in reminiscence, and encourage social interactions.

Caregiver Support

• Fatigue Risk

  • Expected Outcome: Caregiver experiences decreased anxiety and increased knowledge.

  • Interventions:

    • Suggest respite care options and provide information about social services.

Safety Interventions

• Injury Risk

• Sleep Deprivation

  • Place environmental clues for orientation.

  • Ensure safety through supportive footwear, environmental adjustments, and monitoring for wandering.

• Expected Outcomes for Sleep:

  • Maintain an uninterrupted sleep cycle with appropriate environment adjustments like dim lights.

This structured and detailed set of notes covers drug therapy for Alzheimer’s disease and schizophrenia, including nursing care strategies for clients with dementia. It provides essential information on pharmacological treatments and effective nursing interventions aimed at improving patient quality of life.