Chapter 23

You are preparing Genevieve, an 86 year old patient diagnosed with Alzheimer's disease, for discharge and giving discharge education to Genevieve's family, who will be caring for her. Which of the following interventions would be beneficial to teach Genevieve's family? (select all that apply) A. Recommend switching to hospital type gowns to facilitate bathing, dressing, and other physical care of patients B. Discourage wandering by installing complex locks or locks placed at the tops of doors where the patient cannot readily reach them C. For situations in which the patient becomes upset, teach loved one to listen briefly, providing support, and then change the topic. D. Recognize that the pt. can no longer successfully interact with others; provide a darkened, quite room for her to spend her time E. Encourage caregivers to care for themselves, as well as the patient via use of support resources such as adult day care or respite care F. If the patient is prone to wandering away, encourage family to notify police and neighbors of the patient's condition wandering behavior and description.

A. Recommend switching to hospital type gowns to facilitate bathing, dressing, and other physical care of patients B. Discourage wandering by installing complex locks or locks placed at the tops of doors where the patient cannot readily reach them C. For situations in which the patient becomes upset, teach loved one to listen briefly, providing support, and then change the topic. E. Encourage caregivers to care for themselves, as well as the patient via use of support resources such as adult day care or respite care F. If the patient is prone to wandering away, encourage family to notify police and neighbors of the patient's condition wandering behavior and description.

Intervention(s) appropriate for Evelyn and other hospitalization patients experiencing delirium include which of the following? (select all that apply) A. Immediately place the pt. in restraints if she begins hallucinate or act irrationally or unsafely B. Ensure that a clock and a sign indicating the day and date are displayed where the patient can see them easily C. Being prepared for possible hostile responses to efforts to take vital signs or provide directed physical care D. Prevent sensory deprivation by placing the pt. near the nurses station and leaving the television and multiple lights on24 hours a day E. Speaking with the patients frequently for short periods of time for reassurance, assisting the patient in remaining oriented and ensuring the patient safety. F. Anticipating that the patient may try to leave if agitated and providing for continuous direct observation to prevent wandering.

B. Ensure that a clock and a sign indicating the day and date are displayed where the patient can see them easily C. Being prepared for possible hostile responses to efforts to take vital signs or provide directed physical care E. Speaking with the patients frequently for short periods of time for reassurance, assisting the patient in remaining oriented and ensuring the patient safety. F. Anticipating that the patient may try to leave if agitated and providing for continuous direct observation to prevent wandering.

Evelyn, a 73-year old woman with pneumonia becomes agitated after being admitted to the intensive care unit through the emergency department. Her vital signs are erratic, and her thinking seems disorganized. During her first 24 hours in ICU, the patient varies from somnolent to agitated and from laughing to angry shouting. Her daughter reports that the patient "was never like this at home." What is the most likely explanation for the situation? A. Pneumonia has worsened the patient's early-stage of dementia B. The pt. is experiencing delirium secondary to pneumonia C. The pt is sundowning due to decrease stimulation of the intensive care unit D. The pt. doesn't want to be in the hospital and is angry that the staff will not let her leave

B. The pt. is experiencing delirium secondary to pneumonia

Mrs. Smith dies at the age of 82. In the 2 months following her death, her husband, aged 84 and in good health, has begun to pay less attention to his hygiene and seems less alert to his surroundings. He complains of difficulty concentrating and sleeping and reports that he lacks energy. His family sometimes has to remind and encourage him to shower, take his medications, and eat, all of which he then does. Which response is most appropriate? A. Reorient Mr. Smith by pointing out the day and date each time you have occasion to interact with him B. Meet with family and support persons to help them accept, anticipate, and prepare for the progression of his stage II dementia C. Avoid touch and proximity; these are likely to be uncomfortable for Mr. Smith and may provoke aggression when he is disoriented D.

D. Arrange for an appointment with a therapist for evaluation and treatment of suspected depression.

Which statement about dementia is accurate? A. The majority of people over the age of 85 are affected by dementia B. Disorientation is the dominant and most disruptive symptom of dementia C. People with early dementia do not tend to be distressed by symptoms D. Hypertension, diminished activity levels, and head injury increase the risk of dementia.

D. Hypertension, diminished activity levels, and head injury increase the risk of dementia.