Questions and Answers
What is the main function of a medical alert bracelet?
To assist if the patient leaves home.
Goals of care for an older adult patient diagnosed with delirium caused by fever and dehydration will focus on:
Which intervention should the nurse suggest to the family of an older adult with moderately severe dementia who forgets where the bathroom is?
What is the nurse's best reply to a family asking how long it will be before their member with severe dementia recognizes them?
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Which alternative could the nurse suggest to the family members of a patient with severe dementia who becomes anxious and agitated when reoriented?
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What is the priority need for a patient with late-stage dementia?
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What is the most likely reason for the patients change in mental status after starting new medications?
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What is the priority outcome for both a patient with delirium and a patient with dementia?
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What should the nurse tell the family regarding the recovery of a patient with delirium secondary to a urinary tract infection?
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What is the most important assessment information for a patient diagnosed with delirium?
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What problem common to stage 3, mild cognitive decline Alzheimer's disease should the nurse address?
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Which interventions should be included in the plan of care for a patient diagnosed with moderately severe Alzheimer's disease with a self-care deficit of dressing and grooming? Select all that apply.
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Which assessment findings would the nurse expect in a patient experiencing delirium? Select all that apply.
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Which nursing diagnoses are most applicable for a patient diagnosed with severe Alzheimer's disease? Select all that apply.
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An older adult patient takes multiple medications daily. Over 2 days, the patient developed confusion, slurred speech, an unsteady gait, and fluctuating levels of orientation. These findings are most characteristic of:
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A patient with fluctuating levels of awareness, confusion, and disturbed orientation shouts, 'Bugs are crawling on my legs. Get them off!' Which problem is the patient experiencing?
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A patient with fluctuating levels of consciousness, disturbed orientation, and perceptual alteration begs, 'Someone get these bugs off me.' What is the nurse's best response?
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What is the priority nursing diagnosis for a patient with fluctuating levels of consciousness, disturbed orientation, and visual and tactile hallucinations?
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What is the priority intervention for a patient diagnosed with delirium who has fluctuating levels of consciousness, disturbed orientation, and perceptual alterations?
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A patient diagnosed with delirium is experiencing perceptual alterations. Which environmental adjustment should the nurse make for this patient?
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Which assessment finding would be likely for a patient experiencing a hallucination? The patient:
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Consider these health problems: Lewy body disease, frontal-temporal lobar degeneration, and Huntington's disease. Which term unifies these problems?
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Which medication prescribed to patients diagnosed with Alzheimer's disease antagonizes N-Methyl-D-Aspartate (NMDA) channels rather than cholinesterase?
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An older adult was stopped by police for driving through a red light. When asked for a driver's license, the adult hands the police officer a pair of sunglasses. What sign of dementia is evident?
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An older adult drove to a nearby store but was unable to remember how to get home or state an address. When police intervened, they found that this adult was wearing a heavy coat and hat, even though it was July. Which stage of Alzheimer's disease is evident?
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Consider these diagnostic findings: apolipoprotein E (apoE) malfunction, neurofibrillary tangles, neuronal degeneration in the hippocampus, and brain atrophy. Which health problem corresponds to these diagnostic findings?
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A patient with stage 3 Alzheimer's disease tires easily and prefers to stay home rather than attend social activities. The spouse does the grocery shopping because the patient cannot remember what to buy. Which nursing diagnosis applies at this time?
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A patient has progressive memory deficits associated with dementia. Which nursing intervention would best help the individual function in the environment?
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Two patients in a residential care facility have dementia. One shouts to the other, 'Move along, you're blocking the road.' The other patient turns, shakes a fist, and shouts, 'You're trying to steal my car.' What is the nurse's best action?
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An older adult patient in the intensive care unit has visual and auditory illusions. Which intervention will be most helpful?
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A patient diagnosed with Alzheimer's disease calls the fire department saying, 'My smoke detectors are going off.' Firefighters investigate and discover that the patient misinterpreted the telephone ringing. Which problem is this patient experiencing?
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During morning care, a nurse asks a patient diagnosed with dementia, 'How was your night?' The patient replies, 'It was lovely. I went out to dinner and a movie with my friend.' Which term applies to the patient's response?
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A nurse counsels the family of a patient diagnosed with Alzheimer's disease who lives at home and wanders at night. Which action is most important for the nurse to recommend to enhance safety?
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Study Notes
Delirium vs. Dementia
- Delirium is marked by abrupt onset, fluctuating awareness, and perceptual disturbances, while dementia develops insidiously.
- Amnestic syndrome involves memory issues without additional cognitive deficits.
Hallucinations
- Tactile hallucinations involve perceiving sensations such as bugs crawling on the skin without a real external stimulus.
- When responding to a patient experiencing hallucinations, acknowledging their feelings and providing reassurance is crucial for emotional support.
Prioritizing Care
- The highest priority nursing diagnosis for patients with altered consciousness and misperception is the risk for injury due to environmental misinterpretation.
- For patients with delirium, careful observation and supervision are essential interventions.
Environmental Considerations
- A well-lit, quiet room with no glare or shadows helps reduce sensory distortions for patients with cognitive impairments.
- Use of glasses and hearing aids can clarify sensory perceptions and diminish illusions.
Types of Dementia
- Lewy body disease, frontal-temporal lobar degeneration, and Huntington's disease are all classified under dementia.
- Alzheimer's disease is linked with specific diagnostic findings such as neurofibrillary tangles and brain atrophy.
Alzheimer’s Disease Medications
- Memantine (Namenda) acts on NMDA channels, differing from cholinesterase inhibitors like Donepezil, Rivastigmine, and Galantamine, which increase acetylcholine in mild-to-moderate cases.
Cognitive Decline Stages
- Moderately severe cognitive decline encompasses severe memory loss, impacting daily tasks and decision-making.
- Agnosia is the loss of the ability to recognize familiar objects.
Patient Interventions
- Simple, step-by-step directions assist patients with dementia in managing their tasks.
- For wandering patients, suggesting locks at the top of doors enhances safety by reducing the risk of them exiting unsupervised.
Family Education
- Family members of patients with Alzheimer’s should be taught strategies to enhance safety and functioning, such as labeling specific areas to assist with memory.
- Encourage maintaining routines and familiar environments to better the quality of life for individuals with cognitive impairments.
Confabulation and Illusions
- Confabulation involves the creation of false memories or stories by patients due to memory deficits, serving as a defense mechanism.
- Illusions arise from misperceptions of real stimuli, contrasting hallucinations which involve nonexistent stimuli.
Coping with Disturbances
- Addressing agitation by separating and distracting patients can prevent escalation of conflicts caused by cognitive impairments.
Goals of Care
- In patients with delirium, the primary goal is to facilitate a return to premorbid functional levels and manage the underlying causes like fever or dehydration.### Urinary Care and Dementia
- Regular toileting on a 2-hour schedule may be beneficial for patients.
- Disposable briefs may be more appropriate in later stages of dementia.
- Severely limiting oral fluid intake increases the risk of urinary tract infections.
Family Communication Regarding Dementia
- An older patient with severe dementia may not recognize family members, leading to family concerns.
- Nurses should use therapeutic communication to help families cope with the irreversibility of dementia.
- It is disappointing when a loved one does not recognize family, acknowledging this helps address emotional challenges.
Managing Anxiety in Dementia Patients
- Family should focus interactions on familiar topics with patients, rather than attempting reorientation which can cause anxiety.
- Techniques like validating patient feelings provide meaningful connections.
Priorities in Late-Stage Dementia Care
- The primary need for patients in late-stage dementia is maintenance of nutrition and hydration.
- Typically, patients lose the ability to eat, chew, and swallow, necessitating careful nutritional support.
Confusion in Elderly Patients
- Confusion in elderly patients caused by drug actions and interactions is common, with delirium characterized by abrupt changes in awareness and perception.
- Regularly monitoring medications is crucial, as they’re often linked with delirium episodes.
Safety Concerns for Patients with Dementia and Delirium
- The highest priority for patients experiencing delirium or dementia is to ensure safety in their environment.
- Other outcomes, such as verbal communication and participation in self-care, can be considered lower priorities.
Recovery from Delirium
- Recovery from delirium caused by infections, such as urinary tract infections, often occurs as the underlying cause is treated.
- Clear communication about expected recovery helps manage family expectations.
Assessing Delirium in Patients
- Gathering a list of all medications is essential when assessing a patient with delirium as medication interactions are common causes.
- Exploring recent life changes or personality changes may also provide context but is secondary to medication history.
Alzheimer's Disease and Cognitive Decline
- In patients with mild cognitive decline from Alzheimer's, expect communication deficits as a primary issue.
- Understanding that patients may struggle to engage in lengthy conversations is important for family members.
Self-Care Deficits in Alzheimer’s Patients
- Appropriate interventions include providing clothing that is easy to manipulate and labeling clothing to assist with identity.
- Utilizing distraction techniques can help if the patient initially resists dressing.
Signs of Delirium
- Patients may exhibit impaired consciousness, disorientation to time and place, and wandering attention as signs of delirium.
- Recognition of hallucinations and illusions is also noted, while agnosia is more indicative of dementia.
Applicable Nursing Diagnoses for Severe Alzheimer's Disease
- Common nursing diagnoses include urinary incontinence, disturbed sleep pattern, and risk for caregiver role strain.
- Acute confusion is not applicable due to chronic nature of dementia, and the cognitive abilities for grieving may not be present.
Studying That Suits You
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Description
Test your understanding of neurocognitive disorders with this flashcard quiz based on Varcarolis Chapter 23. Dive deep into conditions like delirium, dementia, and Alzheimer's disease, and solidify your knowledge with practical definitions and scenarios.
