Alzheimer's PrepU with Rationale

A family of a patient with Alzheimer's disease asks the nurse what causes this condition? Which response by the nurse would be most appropriate?

"Evidence shows that there are changes in nerve cells and brain chemicals." rationale: Specific neuropathologic and biochemical changes are found in patients with Alzheimer's disease. These include neurofibrillary tangles and neuritic plaques as well as altered neurotransmitter function, specifically acetylcholine. Vascular dementia is associated with a subclinical stroke. Although genetics is being studied as an underlying mechanism for Alzheimer's disease, no specific gene or genetic marker has been identified. Delirium is often the result of the interaction or use of multiple drugs.

A client with Alzheimer's disease is prescribed donepezil hydrochloride. When teaching the client and family about this drug, which of the following would the nurse include?

"The drug helps to control the symptoms of the disease." rationale: Donepezil hydrochloride is a cholinesterase inhibitor used to control symptoms of Alzheimer's disease. It does not cure or slow progression. Typically cognitive ability improves within 6 to 12 months of therapy, but if stopped, cognitive progression occurs. It is recommended that treatment continue at least through the moderate stage of the illness. However, it usually is not prescribed as life-long therapy.

A nurse is caring for a client with dementia. A family member of the client asks what the most common cause of dementia is. Which response by the nurse is most appropriate?

"The most common cause of dementia in the elderly is Alzheimer's disease." rationale: The nurse should inform the family member that Alzheimer's disease is the most common cause of dementia in elderly clients. Dementia is a clinical manifestation, not a disease process. Although drug interactions and overmedication are causes of dementia, these causes aren't as common as Alzheimer's disease. Depression is common in elderly clients, but it doesn't cause dementia.

A client was found wandering in a local park, unable to state who or where the client is or where the client lives. The client is brought to the emergency department, where an identification is eventually made. The client's spouse states that client was diagnosed with Alzheimer's disease 3 years earlier and has experienced increasing memory loss. The spouse reports worry about how to continue to care for the client. Which response by the nurse is most helpful?

"What aspect of caring for your spouse is causing you the greatest concern?" rationale: The nurse should determine the specific concerns of the client's spouse. Jumping to conclusions regarding the client's need for a nursing home or other care placement options would be inappropriate. The nurse must tailor care to the client and the family, focusing on their needs. Although support groups, children, and friends may prove helpful to the client's spouse, the nurse must establish a plan for continued care that addresses the spouse's specific concerns.

A nurse is assessing a client diagnosed with Alzheimer's disease. As part of the assessment, the nurse asks the client to identify common objects. The nurse is assessing for what?

Agnosia rationale: Agnosia is the failure to recognize or identify objects despite intact sensory function. Aphasia is alterations in language ability. Apraxia is the impaired ability to execute motor activities despite intact motor functioning. Executive functioning is the ability to think abstractly, plan, initiate, sequence, monitor, and stop complex behavior.

A client with stage II Alzheimer's disease is admitted to the short stay unit after cardiac catheterization that involved a femoral puncture. The client is reminded to keep their leg straight. A knee immobilizer is applied, but the client repeatedly attempts to remove it. The nurse is responsible for three other clients who underwent cardiac catheterization. What's the best step the nurse can take?

Ask the staffing coordinator to assign a nursing assistant to sit with the client. rationale: The nurse should ask the staffing coordinator to assign a nursing assistant to sit with the client. This action promotes client safety while avoiding restraint use. Applying wrist restraints doesn't prevent injury to the lower leg. Also, restraints should be applied only after other less restrictive measures have been attempted. A client with stage II Alzheimer's disease has memory impairment that impedes their ability to remember repeated instruction. Sedation isn't indicated for this client.

The family of an older adult reports increasing inability to perform basic activities of daily living. After evaluation, the client is diagnosed with Alzheimer's disease. What intervention will be implemented to slow cognitive decline?

Cholinesterase inhibitors rationale: Cognitive function in Alzheimer's disease can be enhanced by the use of medications to slow progression and improve depression, agitation, or sleep disorders. The cholinesterase inhibitors have been shown to be effective in slowing the progression of the disease by potentiating the action of available ACh and inhibiting acetylcholinesterase. There has been no demonstrated improvement of cognitive function with use of lipid-lowering statins or antioxidant nutritional supplement therapy. Psychotherapy is appropriate for depression.

A client has recently brought her elderly mother home to live with her family. The client states that her mother has moderate Alzheimer's disease and asks about appropriate activities for her mother. The nurse tells the client to

Ensure that the mother does not have access to car keys or drive an automobile. rationale: A person with Alzheimer's disease needs to be provided with a safe environment. Driving is prohibited. Cooking and cleaning may be too much stimulation and place the client in danger. Daily activities must be simplified, short, and achievable. Smoking is allowed only with supervision. The person needs adequate lighting, and nightlights are helpful, particularly if the person has increased confusion at night.

An elderly client is becoming progressively confused due to Alzheimer's disease. The family can no longer manage the client at home due to wandering. Which of the following living arrangements could the nurse recommend?

Extended-care facility rationale: If the older adult is cognitively impaired, family caregivers face the need for daily care giving, such as that which is provided in an extended-care facility. Respite care is temporary housing and NORCs enable the client to remain at home. Accessory apartments are separate apartments constructed, in part, out of an existing house and do not have any health care services.

A client with moderate Alzheimer's disease has been eating poorly, losing weight, and playing with food at meals. The nurse best intervenes by

Placing one food at a time in front of the client during meals rationale: Tasks should be simplified for the client with Alzheimer's disease. All options are steps the nurse can take to promote eating for the client with Alzheimer's disease. Offering one food at a time, however, helps to prevent the client from playing with food.

The client is 42 years old, married, and has two children, ages 16 and 18. The client is also caring for the client's parent, who is in the late stages of Alzheimer's disease. The nurse would want to assess the client for what?

Signs of stress rationale: Nurses must assess family members, especially caregivers, for signs of stress or burnout. Although this issue might not be pertinent during early stages of dementia, it becomes paramount as clients progressively degenerate and demands for physical care mount.

To encourage adequate nutritional intake for a client with Alzheimer's disease, a nurse should

stay with the client and encourage them to eat. rationale: Staying with the client and encouraging them to feed themself will ensure adequate food intake. A client with Alzheimer's disease can forget how to eat. Allowing privacy during meals, filling out the menu, or helping the client to complete the menu doesn't ensure adequate nutritional intake.

A nurse is educating a client's family on Alzheimer's disease. Which statement by the nurse would cause the charge nurse to intervene?

"Routine administration of donepezil at the same time every day can cure the disease." rationale: Alzheimer's is a degenerative and irreversible disorder of the cerebral cortex. Medications should be administered as ordered, but there is no cure for this disease. Labeling items and using large-numbered clocks and calendars help promote memory and recall. Clients with Alzheimer's are at high risk for injury because they have impaired memory and poor judgment. Maintaining a safe environment is important. Alzheimer's disease places clients at risk for metabolic complications such as dehydration and malnutrition. Offering finger foods and fluids can prevent these complications.

The nurse at a long-term care facility is assessing each of the residents. Which resident most likely faces the greatest risk for aspiration?

A resident who suffered a severe stroke several weeks ago Rationale: Aspiration may occur if the patient cannot adequately coordinate protective glottic, laryngeal, and cough reflexes. These reflexes are often affected by stroke. A patient with mid-stage Alzheimer's disease does not likely have the voluntary muscle problems that occur later in the disease. Clients that need help with ADLs or have severe arthritis should not have difficulty swallowing unless it exists secondary to another problem.