Harding Chapter 59 Alz/Dementia Evolve.Elsevier

When caring for a patient with Alzheimer's disease, which task could be delegated to the LPN/VN on the team? Administer enteral feedings via a gastrostomy tube.

Rationale: Administering enteral feedings via a gastrostomy tube is within the scope of practice for the LPN/VN. The RN will be responsible for individualized teaching and patient referrals. The UAP will be able to use bed alarms and frequently monitor the patient.

The home care nurse is visiting patients in the community. Which patient is exhibiting an early warning sign of Alzheimer's disease (AD)? A 72-yr-old female patient is unable to locate the address where she has lived for 10 years.

Rationale: An early warning sign of AD is disorientation to time and place such as geographic disorientation. Occasionally misplacing items and joking about memory loss are examples of normal forgetfulness. Impaired ability to recognize family and close friends is a manifestation of middle or moderate dementia (or AD). Incontinence and inability to perform self-care activities occur with severe or late dementia (or AD).

The patient is having some increased memory and language problems. What diagnostic tests will be done before this patient is diagnosed with Alzheimer's disease? (Select all that apply.) Urinalysis MRI of the head Liver function tests Neuropsychologic testing Blood urea nitrogen and serum creatinine

Rationale: Because there is no definitive diagnostic test for Alzheimer's disease, and many conditions can cause manifestations of dementia, testing must be done to eliminate any other causes of cognitive impairment. These include urinalysis to eliminate a urinary tract infection, an MRI to eliminate brain tumors, liver function tests to eliminate encephalopathy, BUN and serum creatinine to rule out renal dysfunction, and neuropsychologic testing to assess cognitive function. A chest x-ray examination is not used to investigate an alternate cause of memory or language problems.

Benzodiazepines are indicated in the treatment of delirium caused by which condition? Alcohol withdrawal

Rationale: Benzodiazepines can be used to treat delirium associated with sedative and alcohol withdrawal. However, these drugs may worsen delirium caused by other factors and must be used cautiously. Polypharmacy, cerebral hypoxia, and electrolyte imbalances are not treated with benzodiazepines.

When providing community health care teaching about the early warning signs of Alzheimer's disease (AD), which signs should the nurse ask family members to report? (Select all that apply.) Losing sense of time Difficulty performing familiar tasks Problems with performing basic calculations Becoming lost in a usually familiar environment

Rationale: Difficulty performing familiar tasks, problems with performing basic calculations, losing sense of time, and becoming lost in a usually familiar environment are all part of the early warning signs of AD. Misplacing car keys and momentarily forgetting a name is a normal frustrating event for many people.

The nurse in the long-term care facility cares for a 70-yr-old man with late-stage dementia who is undernourished and has problems chewing and swallowing. What should the nurse include in the plan of care for this patient? Provide thickened fluids and moist foods in bite-size pieces.

Rationale: If patients with dementia have problems chewing or swallowing, pureed foods, thickened liquids, and nutritional supplements should be provided. Foods that are easy to swallow are moist and should be in bite-size pieces. Distractions at mealtimes, including the television, should be avoided. Fluids should not be limited but offered frequently; fluids should be thickened. Patients with late-stage dementia have difficulty understanding words and would not have the cognitive ability to select menu choices.

Which patient should receive a depression assessment first? A patient in the early stages of Alzheimer's disease

Rationale: Patients in the early stages of Alzheimer's disease are particularly susceptible to depression because they are acutely aware of their cognitive changes and the expected disease trajectory. Delirium is typically a short-term health problem that does not typically pose a heightened risk of depression.

Which patient has the greatest risk of developing delirium? An older patient who takes multiple medications to treat various health problems.

Rationale: Polypharmacy is implicated in many cases of delirium, and this phenomenon is especially common among older adults. Brain atrophy, if associated with cognitive changes, is indicative of dementia. Alterations in sleep and environment, as well as pain, may cause delirium, but this is less of a risk than in an older adult who takes multiple medications.

The nurse has administered a dose of risperidone (Risperdal) to a patient with delirium. What finding demonstrates the intended effect of the medication? Lying quietly in bed

Rationale: Risperidone is an antipsychotic drug that reduces agitation and produces a restful state in patients with delirium. However, it should be used with caution. Antidepressant medications treat depression, and antihypertensive medications treat hypertension. However, there are no medications that will cause confusion to disappear in a patient with delirium.

Unlicensed assistive personnel (UAP) working for a home care agency report a change in the alertness and language of an 82-yr-old female patient. The home care nurse plans a visit to evaluate the patient's cognitive function. Which assessment would be most appropriate? Mini-Mental State Examination (MMSE)

Rationale: The MMSE is often used to assess cognitive function. Cognitive testing is focused on evaluating memory, ability to calculate, language, visual-spatial skills, and degree of alertness. The CAM is used to assess for delirium. The GCS is used to assess the degree of impaired consciousness. The NIHSS is a neurologic examination stroke scale used to evaluate the effect of acute cerebral infarction on the levels of consciousness, language, neglect, visual field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss.

A 78-yr-old woman was transferred to the intensive care unit after emergency abdominal surgery. The nurse notes the patient is disoriented and confused, has incoherent speech, is restless, and agitated. Which action by the nurse is most appropriate? Reorient the patient.

Rationale: The patient has manifestations of delirium. Care of the patient with delirium is focused on eliminating precipitating factors and protecting the patient from harm. Give priority to creating a calm and safe environment. The nurse should stay at the bedside and provide reassurance and reorienting information as to place, time, and procedures. The nurse should reduce environmental stimuli, including noise and light levels. Avoid the use of chemical and physical restraints if possible.

A patient is diagnosed with the mild cognitive impairment stage of Alzheimer's disease. What nursing intervention is most appropriate for the nurse use with the patient? Use a calendar and family pictures as memory aids.

Rationale: The patient with mild cognitive impairment will have problems with memory, language, or another essential cognitive function that is severe enough to be noticeable to others but does not interfere with activities of daily living. A calendar and family pictures for memory aids will help this patient. This patient should not yet have disruptive behavior or get lost easily. Using a writing board will not help this patient with communication.

Which statement by the wife of a patient with Alzheimer's disease demonstrates an accurate understanding of her husband's medication regimen? "I'm really hoping his medications will slow down his mental losses."

Rationale: There is presently no cure for AD, and drug therapy aims at improving or controlling decline in cognition. Medications do not directly address the physical manifestations of AD.

A 59-yr-old female patient with a frontotemporal lobar dementia has difficulty with verbal expression. While her husband was at work, she walked to the gas station for a soda but did not understand the request for payment. What can the nurse suggest to keep the patient safe? Adult day care

Rationale: To keep the patient safe during the day while the husband is at work, an adult day care facility would be the best choice. This patient would not need assisted living. Advance directives are important but are not related to her safety. Monitoring for behavioral changes will not keep her safe during the day.

Which nursing intervention is most appropriate when caring for patients with dementia? Give simple directions, focusing on one thing at a time.

Rationale: When dealing with patients with dementia, tasks should be simplified, giving directions using gestures or pictures and focusing on one thing at a time. It is best to treat these patients as adults, with respect and dignity, even when their behavior is childlike. The nurse should use gentle touch and direct eye contact. Calling the patient "honey" or "sweetie" can be condescending and does not show respect.