Mental Health Exam 6
End of life care interventions
-Practice being present with the family and the patient -Provide palliative symptom management -Assess for any spiritual issues
Delirium: nursing interventions
-assess potential for injury (falls/wandering) -encourage family to come in and sit with patient -restraining older adults worsens confusion, try using distraction
How should you communicate with a patient with dementia?
-be respectful, treat them like an adult not a child -when giving directions do it step by step and be concrete
Severe Alzheimer's
-cannot have a conversation -requires full time care -may forget how to walk/swallow
What are some important communication points after the death of a family member?
-empathize -don't give advice -talk about the patient who died
Moderate Alzheimer's
-frustration and anger -forgets/refuses hygiene -forgets memories -disoriented to time/season -change in sleep patterns -problems controlling bladder/bowels -risk for wandering -suspicion
Which stage of the grieving cycle is hardest for the family?
Acceptance -family members feel as if the patient is giving up
Tourette's: medications
Antipsychotics -haldol & abilify
Which of the following will Nurse Dory use when communicating with a client who has cognitive impairment?
Short words and simple terms
Memantine
not for early alzheimer's -added to regimen later in disease process
Nurse Isabelle enters the room of a client with a cognitive impairment disorder and asks what day of the week it is; what the date, month, and year are; and where the client is. The nurse is attempting to assess?
orientation
In which neurocognitive disorder is consciousness altered?
Delirium
Which neurocognitive disorder experiences "sundowning" more commonly?
Delirium
If an elderly patient with dementia is ordered benzodiazepines, what should you do?
Do not give the whole dose
Mrs. Mendoza is a 75-year-old client who has dementia of the Alzheimer's type and confabulates. The nurse understands that this client:
Fills in memory gaps with fantasy
How can you promote independence in a patient with dementia?
allow patient to dress themselves if able
How is ADHD diagnosed?
must be present in 2+ settings
Delirium: treatment
treat underlying cause
aphasia
impairment of language
apraxia
inability to perform particular purposive actions
Donepezil
indicated for all 3 stages of alzheimers
Hospice care
indicated within 6 months to live -cannot continue life-saving treatments
Rosana is in the second stage of Alzheimer's disease who appears to be in pain. Which question by Nurse Jenny would best elicit information about the pain?
"Do you hurt?" pause "Do you hurt?"
Mrs. Jordan is an elderly client diagnosed with Alzheimer's disease. She becomes agitated and combative when a nurse approaches to help with morning care. The most appropriate nursing intervention in this situation would be to:
Remain calm and talk quietly to the client.
82-year-old Mr. Robeson together with his daughter arrived at the medical-surgical unit for diagnostic confirmation and management of probable delirium. Which statement by the client's daughter best supports the diagnosis?
"The changes in his behavior came on so quickly! I wasn't sure what was happening."
What not to say when helping family cope with loss
-"I know how you feel." - "When my mother died, I cried for months and could hardly eat... [and proceed with long story." - After a sudden and unexpected death: "At least he didn't suffer." -"She is with God now." -"You can be grateful for the time you had together."
Dementia: nursing interventions
-Do not give patient choices, tell them what you are going to do -Avoid quizzing the patient with questions -Provide cues such as seasons, location, names -Provide low-stimulation environment
ADHD may appear as
-impulsivity -not being able to take turns -talkativeness -poor school performance
Mild Alzheimer's
-less energy and motivation to do things -maintain personality and social activities -start to develop problems remembering words/names
How can you help orient a patient with delirium?
-place a calendar/clock -keep curtains open -encourage family to visit -make sure hearing aids/glasses are used -keep lights off at night, well-lit during the day
Autism: Interventions
-provide structure and consistency -keep the same routine -use rewards/consequences
Autism Spectrum Disorder may appear as
-resistance to touch, hugs -overstimulation triggering anger -over adherence to routines
Which neurocognitive disorder has a reversed sleep-wake cycle?
delirium
How is immediate recall affected in neurocognitive disorders?
delirium: impaired dementia: normal
Dementia: treatment
donepezil and memantine
What should you teach a family member who is anticipatory grieving?
educate & encourage them to continue to be present with the patient during the end of their life
How must you know a patient is experiencing delirium?
establish the patient's normal LOC by interviewing family/caregivers
Palliative Care
Early symptom management -aimed at chronic illness
s/sx of delirium
illusions, hallucinations, autonomic symptoms (sweating, tachycardia, flushed face, elevated BP)
Dementia: s/sx
memory impairment* disrupts daily life, confusion with time & place, difficulty completing familiar tasks, confabulation, perseveration, aphasia, apraxia, agnosia
Delirium orientation
pt is usually oriented to person, but not place & time
Dementia
slowly progressive and irreversible -does not change LOC -difficulty with memory, thinking, and comprehension
ADHD: medications
stimulants and non-stimulants
In clients with a cognitive impairment disorder, the phenomenon of increased confusion in the early evening hours is called:
sundowning
Delirium
temporary medical emergency -has an abrupt onset
agnosia
the inability to recognize familiar objects
considerations with stimulants
these drugs work quickly -monitor eating/sleeping (insomnia)
considerations with nonstimulants
used for patients with ADHD who also have tourette's or anxiety