Alzheimer's Disease, Dementia, and Delirium

A nurse is caring for a patient who becomes agitated in the evening. What nursing interventions are most helpful? Select all that apply.

Creating a calm environment reduces agitation in the patient; restraining or threatening the patient can worsen the problem. Caffeine is a stimulant, so limiting caffeine intake would help in reducing agitation. Healthcare providers should be consulted if antianxiety drugs or sedatives need to be prescribed. Do not allow the patient to sleep for long hours at night, and limit daytime naps. Maximize the exposure to daylight rather than isolating the patient.

The nurse is providing care to several patients on a medical-surgical unit. Which patient's dementia is caused by a neurodegenerative disorder?

Alzheimer disease is a major cause of neurodegenerative dementia. About 60% to 80% of patients with dementia are diagnosed with Alzheimer disease. Dementia associated with alcoholism is caused by toxic, metabolic, or nutritional diseases. Dementia associated with multiple sclerosis is caused by an immunologic disease. Dementia associated with uremic encephalopathy is caused by a systemic disease.

The nurse is caring for a 70-year-old patient. What are the symptoms of dementia that the nurse should be observant for? Select all that apply.

In dementia, there is progressive neurodegeneration, and vascular changes lead to cognitive impairment. The cognitive impairment manifests as abrupt changes in behavior, memory loss, and cognitive dysfunction, which are all symptoms of dementia. Other symptoms include dysfunction or loss of orientation, attention, language, judgment, and reasoning. Presence of seizures indicates other neurologic problems. Dyspnea is a manifestation of impaired respiratory function.

For which patient should the nurse prioritize an assessment for depression?

Patients in the early stages of Alzheimer's disease are particularly susceptible to depression, because the patient is acutely aware of his or her cognitive changes and the expected disease trajectory. Delirium is typically a shorter-term health problem that does not typically pose a heightened risk of depression.

A patient seeks medical attention because of cognitive impairment. The patient is diagnosed with Alzheimer's disease. Which finding forms the basis for the diagnosis?

The diagnosis of Alzheimer's disease is made after a thorough neurological examination reveals cognitive impairment. Testing is done to rule out all possible known causes. If no cause is found for the change in mental status, the diagnosis of Alzheimer's disease is made based on exclusion. Brain atrophy is found with aging and may be present with normal cognitive functioning. The ApoE-4 found upon genetic testing is only a risk factor gene for late onset Alzheimer's disease (after age 60). Vascular brain lesions such as infarcts of the brain occur with vascular dementia.

A nurse is assessing an older adult patient with memory loss. What symptoms are found in the patient with Alzheimer's disease, separate from normal forgetfulness? Select all that apply.

The manifestations of Alzheimer's disease include a change in cognitive functioning and memory loss such as forgetting what an item is used for, a loss of sense of time, and, in later stages, having little or no awareness of cognitive problems. Momentarily forgetting an acquaintance's name is normal. Joking about memory loss may indicate mild cognitive impairment and ample awareness of one's cognitive problems.

A spouse of a patient, just diagnosed with Alzheimer's disease in the mild stage, asks the nurse how to plan for the future and make treatment decisions. Select the correct information the nurse should give the spouse.

The nurse should assist the spouse and patient to look at the future realistically and make health care decisions while the patient has the capacity to participate in the process. Progression of Alzheimer's disease varies with the individual. Offering the spouse a possible cure is false reassurance. The patient may not achieve a comfort level with the diagnosis.

Select the appropriate manner to interact with a patient aged 75 who recently became confused and agitated in the intensive care unit. Select all that apply.

The patient has developed delirium, which is common among elderly patients in intensive care units. A calm, reassuring approach enhances feeling of security. Wearing eye glasses and hearing aids assists the patient in communication. Reorientation verbally with reinforcement visuals such as a clock is helpful. Correcting all misstatements interferes with patient trust. The environment should not be overstimulating, so the television should be off.

Which statement by the wife of a male patient with Alzheimer's disease (AD) demonstrates an accurate understanding of her husband's medication regimen?

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