Dementia In The Older Adult
Which dementia is both the most common type of dementia and also a leading cause of death? Vascular dementia Alzheimer's disease Frontotemporal dementia Dementia with Lewy bodies
Alzheimer's disease Alzheimer's disease is the most common type of dementia and with over 5 million affected; it is the sixth leading cause of death in the US.
A student nurse is caring for a client who appears to be disoriented, confused, and seems restless with mood swings. Upon questioning the family, the nurse learns that the patient has been unable to balance their checkbook, pay bills, and gets their medications "mixed-up". Which of the following types of dementia should the nurse assess in this patient? Vascular dementia Alzheimer's disease Unknown dementia Lewy body dementia
Alzheimer's disease Patients with Alzheimer's disease experience many disturbances across various cognitive and physical functions including disorientation, memory loss, language deficits, visual disturbances, and confusion with restlessness and mood swings.
The family of a confused patient who has been exhibiting inappropriate behavior, memory loss, and inability to retain information is questioning why the physician is ordering an EEG. Which is the best explanation that should be used? An EEG is useful in the diagnosis of VaD. An EEG can provide the best information about the patient's current mental status. An EEG is useful in detecting pathologic conditions such as space-occupying lesions. An EEG is a noninvasive technique that allows assessment of regional glucose use and oxygen consumption.
An EEG can provide the best information about the patient's current mental status. An EEG is useful in determining the current mental status of a patient.
A nurse is encouraging a family who cares for their parent who has been diagnosed with early stage Alzheimer's disease regarding non-pharmacologic interventions; which interventions does she offer? Select all that apply. Assist with meals Provide liquids in thin forms Develop and maintain routines Use a firm voice to communicate Modify factors that contribute to behavior issues
Assist with meals It is important to ensure meals are soft, cut into small pieces, and have some slight consistency to liquids; also, it is crucial to serve meals at the same time each day for consistency. Develop and maintain routines Developing and maintaining routines, as well as the use of clocks and calendars, can help the patient with dementia maintain independence in self-help skills and activities of daily living. Modify factors that contribute to behavior issues When behavior issues occur, it is best not to try and change the patient but to modify the factors causing the behavior and the behavior itself.
Which is the only definitive way to diagnose dementia? MRI CT Scan Autopsy Cerebrospinal Fluid
Autopsy Autopsy is the only definitive way to determine dementia type, although diagnostic testing is quickly becoming more reliable.
When assessing a patient for dementia, in addition to the physical exam, the nurse will anticipate which of the following to be ordered? Select all that apply. Blood work Patient history Genetic testing Diagnostic testing Neurological examination
Blood work Blood work is important in completely assessing the patient for any pathological conditions that may be mimicking dementia symptoms. Patient history Obtaining a complete patient history can help the physician in determining any pre-disposition or risk factors that may contribute to dementia. Diagnostic testing Diagnostic testing such as CT scans, MRIs, EEGs, and PET scans can help determine which type of dementia the patient may be experiencing. Neurological examination A neurological exam often includes functional and cognitive tests that can help the physician determine mental status and capabilities.
The student nurse is responsible for educating a newly diagnosed dementia patient's family on interventions and care for their family member. Which interventions and information should be included? Select all that apply. Fluid intake Commitment Antipsychotics Communication Cholinesterase inhibitors Maintenance of motor skills
Commitment One of the best interventions for patients with dementia is commitment of the family and support system to work continually on maintaining an environment that reduces stress and encourages self-help and activities. Communication Communication is instrumental in caring for the dementia patient as tone, eye contact, and tender touch can help calm the patient and facilitate their autonomy and self-reliance. Maintenance of motor skills Maintenance of motor skills and functional behaviors helps facilitate self-help skills and independence.
A patient who has been deemed unable to make appropriate decisions regarding health care by their provider does not have health care proxy in place. In which direction should the nurse guide the patient's family? Have the patient sign a living will. Refer the family to the medical provider for advice. Have the patient execute a Durable Power of Attorney Health Care Direct the family to an attorney or social worker to help facilitate obtaining legal guardianship.
Direct the family to an attorney or social worker to help facilitate obtaining legal guardianship. An attorney or social worker can help facilitate a court-appointed guardianship for the patient in order to make health care decisions.
Compared to a living will, which is the advantage of a Durable Power of Attorney-Healthcare (DPAHC)? The patient can participate in the decision-making process. The DPAHC speaks for the patient when the patient has no voice. Designated agents are allowed to ask questions and gather information in order to make a decision based on patient's wishes. Any person can be designated as an agent to make health care decisions at a time in the future when the patient may be rendered incompetent.
Designated agents are allowed to ask questions and gather information in order to make a decision based on patient's wishes. Unlike a living will, designated agents in a DPAHC are allowed to ask questions, assess the situation, and gather information in order to make decisions based on the patient's wishes.
Which are symptoms considered the "triad" that appear together in normal pressure hydrocephalus (NPH)? Select all that apply. Altered arousal Gait disturbances Urinary incontinence Cognitive disturbances Progressive language decline
Gait disturbances Gait disturbances, such as ataxia, are seen in patients with NPH. Urinary incontinence Urinary incontinence is seen in conjunction with other disturbances and altered functions in NPH. Cognitive disturbances Changes in cognitive function, especially when advanced prior to gait disturbances, typically have poorer outcomes in patients with NPH.
Which risk factors for dementia should the nurse assess for in a patient as they approach the age of 65? Select all that apply. Hypertension Hyponatremia Hypercholesterolemia Poor nutritional status Decrease in folate levels Peripheral vascular disease
Hypertension High blood pressure, or hypertension, increases the risk factor for dementia as the patient gets older. Hypercholesterolemia High cholesterol levels can inhibit proper vascular activity to the brain which can attribute to dementia. Poor nutritional status Poor dietary intake and nutritional status is considered a risk factor for dementia and can lead to early signs of impaired cognitive status. Decrease in folate levels A decreased folate level has been attributed to an increase in dementia in the older patient.
When educating a patient on the risk factors for vascular dementia, the nurse should include information on which of the following? Select all that apply. Hypertension Hyponatremia Arteriosclerosis Blood dyscrasias Diabetes mellitus Metabolic disorders
Hypertension Hypertension is a common risk factor that can contribute to vascular dementia. Arteriosclerosis Arteriosclerosis, hardening of the arteries, is a contributing risk factor in the development of vascular dementia. Blood dyscrasias Blood dyscrasia (hemophilia, anemia, etc.) are considered a risk factor for the development of vascular dementia. Diabetes mellitus Diabetes mellitus is a contributing factor to increased heart disease, thus increasing the risk for vascular dementia.
A patient has just been diagnosed with Alzheimer's disease, but is still in the early stage. Which information should the nurse provide the patient and their family when asked about a Durable Power of Attorney for Health Care (DPAHC)? Select all that apply. It may be executed by any competent adult. It is important for financial matters and health care decisions. It allows patients to still participate in the decision making process. It allows the patient to designate a surrogate of their choice to make their wishes known. It states that withholding care in compliance with the document does not constitute suicide. It enables the designated surrogate to ask questions and assess the situation to make decisions.cs
It is important for financial matters and health care decisions. DPAHC is a legal document that can cover financial matters as well as health care proxy which can be set up while a patient is still competent. It allows patients to still participate in the decision making process. Patients can still participate in the decision making process while they are still competent and can designate an agent of choice. It allows the patient to designate a surrogate of their choice to make their wishes known. A DPAHC is a legal document that allows the patient to designate a surrogate of choice that they feel will ensure that wishes will be carried out for them when they can no longer do so. It enables the designated surrogate to ask questions and assess the situation to make decisions. Unlike a living will, the designated surrogate has the ability to consider all options and ask questions so the situation can be thoroughly assessed to make decisions.
In order for nurses to stay abreast of changes in laws pertaining to health care proxies, which work environment resources are able to provide updates within each state? Select all that apply. Physicians Legal counsel Risk management Head nursing staff Facility administration
Legal counsel Attorneys and legal representatives are excellent resources for inquiring about the legalities of health care proxy. Risk management Risk management staff is responsible for identifying and preventing possible risks for liability and would be a resource for information regarding the legalities of health care proxy. Facility administration Facility administration work closely with attorneys and state legislators and would be a viable resource for information on health care proxy.
Which type of diagnostic tests can be useful in diagnosing dementia? Select all that apply. MRI CT scans Genetic testing Laboratory testing Cerebrospinal fluid testing
MRI MRI is useful in diagnosing vascular dementia. CT scans CT is useful in detecting pathologic conditions such as space-occupying lesions when diagnosing dementia. Laboratory testing Laboratory testing such as blood and urine testing can be useful in ruling out other pathological conditions that mimic dementia. Cerebrospinal fluid testing Cerebrospinal fluid testing is useful in determining causes of reversible dementia.
A patient's family is concerned that their loved one may be developing Alzheimer's disease as it runs in the family. Which manifestations and symptoms should the nurse confirm with the family? Select all that apply. Memory loss Easily agitated Alteration in mood Fluctuations in cognition Altered periods of arousal Prolonged sadness with anxiety
Memory loss Alzheimer's disease results in short-term memory loss, with inability to remember people and daily experiences. Easily agitated Patients with Alzheimer's disease are easily agitated due to confusion and sudden fluctuations in cognition. Alteration in mood Due to constant changes in dopamine and fluctuations in cognition, alteration in mood can be expected in patients with Alzheimer's disease. Fluctuations in cognition Fluctuation in cognition is common in those experiencing Alzheimer's disease; and often, patients appear to be very cognizant, but then do not understand what is being said.
Which test of mental function may be used to aid in the diagnosis of dementia? IQ test CT scans Mini-Cog test Laboratory tests
Mini-Cog test The "Mini-Cog" test is used to test mental status and cognition which can help with determining dementia.
A new patient has been admitted with shortness of breath and atrial fibrillation. The family states that the patient has been increasingly agitated and their memory has become worse over the course of the past few months. Which is the first step the nurse should take while beginning the assessment process for dementia? Interview the family Obtain blood and urine Obtain a thorough history Call the physician for orders
Obtain a thorough history Obtaining a thorough history will allow the nurse to determine which steps should be taken in planning and interventions and will give information regarding any further testing needed for diagnosing dementia.
Which would best explain the purpose of a living will? Allows family members to make decisions to withhold treatment if they so choose. Enables the physician to diagnose incompetence and incapability of making decisions. Provides written expression of patient's wishes regarding use of medical interventions in the event of terminal conditions. Releases medical providers of liability regarding decisions to withhold treatment and death which results from such decisions.
Provides written expression of patient's wishes regarding use of medical interventions in the event of terminal conditions. A living will is intended to provide written instructions or expression of a patient's wishes regarding any medical interventions upon terminal illness in which they can no longer make these decisions themselves.
Hyponatremia, alcohol intoxication, vitamin B12 deficiency, and thyroid disorders can all contribute to which type of dementia? Vascular dementia Alzheimer's disease Parkinson's disease Reversible dementia
Reversible dementia Reversible dementia is a phenomenon that resembles dementia due to pathologic etiologies such as metabolic disorders, thyroid disease, hyponatremia, and alcohol intoxication or withdrawal.
A nurse is working with a patient whose family has a Durable Power of Attorney-Health Care that was executed in another state. To ensure that the DPAHC is carried out legally and appropriately, which representative should the nurse consult? Legal Guardian Surrogate Proxy Nursing Supervisor Risk Management Staff
Risk Management Staff Risk Management staff would be the appropriate representative to seek counsel regarding the legalities of another state's DPAHC and how it relates to the current state's legal obligations.
Which elements of a patient history are important in assessing for dementia? Select all that apply. Sex Race Risk factors Medications Social history Family history
Risk factors Risk factors such as hypertension and diabetes should be assessed as these increase the risk for dementia. Medications Certain medications may cause signs of dementia and should be assessed. Social history Habits such as smoking (tobacco use) are contributing factors, which increase the risk of developing dementia. Family history Family history of dementia should be assessed to determine any familial link to predisposition of dementia.
A patient who is recovering from a stroke is experiencing impaired ability to retain new information, reasoning ability, and has impaired spatial orientation and language. Which disorder is indicative of these clinical manifestations? Vascular dementia Alzheimer's disease Reversible dementia Frontotemporal dementia
Vascular dementia Loss of cognitive function in vascular dementia occurs due to ischemia, hypoperfusion, or hemorrhagic brain lesions resulting from cerebrovascular disease or cardiovascular pathologic conditions; and the loss involves gradual or sudden changes in mental ability that interfere with social and work functioning.
Which are considered the common types of dementia? Select all that apply. Vascular dementia Parkinson's disease Alzheimer's disease Reversible dementia Frontotemporal dementia Dementia with Lewy bodies
Vascular dementia Vascular dementia (VaD) is a common type of dementia typically associated with CVA, hypertension, and peripheral vascular disease and is the second most common type of dementia. Alzheimer's disease Alzheimer's disease is the most common type of dementia effecting 60-80% of older adults. Frontotemporal dementia While the risk factors for frontotemporal dementia are poorly understood, it is still one of the most common types of dementia. Dementia with Lewy bodies Dementia with Lewy bodies (DLB) is the third most common form of dementia and is commonly seen in patients with Parkinson's disease.
Which describes the instance when legal guardianship is sought in health care representation? When family members deem it necessary for the care of their loved one. When there is a lack of agreement among family members involving care. When the individual is no longer capable of making decisions for himself or herself. When a surrogate is needed to act as a mediator and intervene to make decisions for the patient.
When the individual is no longer capable of making decisions for himself or herself. Legal guardianship should be sought when a patient is no longer capable of making decisions regarding their healthcare and a surrogate agent is needed.
Which information about living wills is important to convey to a patient when dementia has been diagnosed early? A court-appointed conservator oversees the decision-making process. A surrogate can be designated to handle financial and medical decisions in the event the patient cannot. In the event of disagreements within the family, a guardian is assigned to mediate and make final decisions regarding care. Wishes regarding the use of medical treatments in the event of a terminal illness or condition can be expressed while still competent.
Wishes regarding the use of medical treatments in the event of a terminal illness or condition can be expressed while still competent. It is important for patients and their families to understand that medical decisions regarding treatment can be made early while the patient is still cognizant.
