Nursing Care of Clients with Cognitive Disorders

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-mild neurocognitive disorders
-short term and reversible
-acute cognitive disturbance
-cardinal symptoms: alteration in level of consciousness, altered
awareness and inability to direct, focus, sustain, and shift atten-
tion, periods of lucidity, disorganized, thinking, and poor executive
functioning
-others: disorientation to time and place, anxiety, agitation, rest-
lessness, poor memory recall, delusional thinking, hallucinations
(visual) or tactile and illusions
-sudden change I reality with a sense that they are dreaming while
*Explain Delirium? awake
-experience dramatic scenes that engender strong feelings of fear,
panic, and anger
-considered medical emergency requires immediate attention to
prevent serious damage
-in pts with pretexting cognitive impairment (dementia) there is
an acceleration of cognitive decline (can have long term conse-
quences)
-depression can be found post delirium
*early detection of delirium is crucial
-disorientation and confusion are usually worse at night and during
early morning
What is the most common complication of hospitalization in older
delirium
patients?
age, lower education, sensory impairment, decreased functional
*What are predisposing factors for delirium?
status, comorbid medical conditions, malnutrition, and depression
1. acute onset and fluctuating course
2. reduced ability to direct, focus, shift, and sustain attention
3. disorganized thinking
*What are the 4 cardinal features of delirium? 4. disturbance of consciousness
(suspect delirium when the pt abruptly develops a disturbance in
consciousness and he ability to focus, sustain, or shift attention is
impaired)
-mistake folds in the bedclothes for white rats or the cord of a
window blind for a snake
Explain illusions? -misinterprets an object of the pt's projected fear
-illusions unlike delusions hallucinations can be explained and
clarified
*What type of hallucinations are common in delirium? visual and tactile. Illusions are also common
- may try t0 go home
-wandering, pulling out IV lines and catheters, and falling out of
bed are common dangers
-difficulty processing the environment
-the environment should be made simple and clear
-objects such as clocks and calendars can maximize orientation
to time
-glasses, hearing aids, and adequate lighting without glare can
*Explain Physical Needs for the pt with delirium?
maximize the person's ability to interpret what is going on
-short periods of social interaction can help decrease anxiety
-LOC alternates from lethargy to stupor or from semi-coma to
hypervigilance (pts are extremely alert, eyes constantly scan the
room, difficulty falling asleep or agitated throughout the night)

-Autonomic signs present in delirium: tachycardia, sweating,

flushed face, dilated pupils, elevated BP
*What should always be suspected as a potential cause of delir-
medications
ium?

*What are Moods and Physical Behaviors of delirium?

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-pt may alternate between agitation and appear calm and settled
-agitation delirium: hyperactive
-no agitation: delirium is hypoactive
-pt may cry, call for help, strike out
-pt may have euphoria, or depression, and apathy
-behaviors and emotions are erratic and fluctuating
-pts can recall sometimes their confused state after delirium sub-
sides
-anxiety and fear can remain with them for months after delirium
has gone away
*pts with acute delirium should never be left alone (family mem-
bered can help stay with the pt if the nurse cannot)
-assess for acute onset and fluctuating levels of awareness
-asses pts ability to attend to immediate environment
-establish pts normal LOC
-asses for pts cognitive impairment such as existing dementia dx
What are Assessment guidelines when caring for the pt with
-asses potential for injury such falls and wandering
delirium?
*remember that if the underlying cause of delirium is not treated,
permanent brain damage may occur
(antipsychotics and antianxiety meds may help control behavioral
symptoms)
-make sure environment is safe
-reduce or eliminate factors causing delirium
-use physical restraints are needed
-provide positive regard
-administer meds for anxiety or agitation as needed
-provide pt with info about what is happening and what can be
expected
-limit need for decision making, if pt is frustrated or confused
*Explain Interventions for Delirium Management?
-inform pt of person, place, and time as needed
-approach pt slowly and from the front and address pt by name
-reorient pt by using sings, pictures, clocks, calendars, and color
coding of environment to provide stimulation of memory, and
promote appropriate behavior
-provide low stimulation environment
-encourage use of aids that increase sensory input such as glass-
es, hearing aids, and dentures
-progressive deterioration of cognitive functioning with no change
in consciousness
-collection of symptoms that are due to an underlying brain disor-
der
-mild forms d not interfere with activities of daily living
-dementia affects memory, problem solving and complex attention
-Alzheimer's disease is the most common type
-dementia is marked by progressive deterioration in cognitive
functioning and the ability to solve problems and learn new skills
*Explain Dementia? and by a decline in the ability to perform activities of daily living
-pts with dementia can have anxiety, mood lability and depression,
as well as hallucinations and delusions
-classified as mild or major (substantial decline that curtails the pts
independence and functioning)

signs: poor judgment and decision making, inability to manage a

budget, losing track of the date or the season, difficulty having a
conversation, misplacing things and being unable to retrace steps
to find them
-dementia is associated with AD, frontotemporal lobar degener-
ation, Lewy bodies, vascular issues, traumatic brain injury, HIV
*What are the several types of dementia?
infection, Prion disease, Parkinson's disease, and Huntington's
disease

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poor judgment and decision making, inability to manage a budget,
*What are signs of dementia? losing track of the date or the season, difficulty having a conver-
sation, misplacing
-cardiovascular disease, obesity, sedentary lifestyle, inactivity, di-
What are risk factors for Alzheimer's disease? abetes, inactivity, high cholesterol, brain injury and trauma (boxers
and football players)
-type of dementia
-progressive deterioration of cognitive functioning
-initial deterioration may be so subtle that others may not notice
-in early phases some pts are able to hide severe deficits in
memory
-pt may have defense mechanisms including denial, confabulation
(creation of stories or answers in place of actual memories to
*Explain Alzheimer's disease? maintain self esteem), perseveration (repeating of phrases or
behavior), and avoidance of questions
Ex of Confabulation: when asked how was your weekend, pt might
say, "S pent the weekend with my daughter or I discussed politics
with the president." It is an unconscious attempt to maintain self
esteem
Ex of Perseveration: repetition of phrases or behavior which is
eventually seen and is often intensified under stress
-memory impairments: initially pt has difficulty remembering re-
cent events
-disturbances in executive functioning: (planning, organizing, ab-
stract thinking)
-Aphasia (loss of language ability): initially pt has problem finding
correct word, then is reduced to a few words, and finally reduced
to babbling or mutism
-Apraxia (loss of purposeful movement in the absence of motor
*What are symptoms observed in AD?
or sensory impairment): unable to perform purposeful tasks. Ex:
apraxia of dressing, pt is unable to put clothes on properly (arms
in trousers or put a jacket on upside down).
-Agnosia (loss of sensory ability to recognize object): pt may lose
ability to recognize familiar sounds (auditory agnosia), such as
the ring ot the phone. Loss of this ability extends to the inability
to recognize familiar objects (visual or tactile agnosia) such as a
glass, magazine, pencil, or toothbrush
A patient with dementia is unable to name ordinary objects. In- B. agnosia.
stead, he describes the function, for example, "the thing you cut Rationale: Agnosia is the failure to identify objects despite intact
æ
meat with." The nurse should assess this as: sensory function. 1. Apraxia is the inability to carry out purposeful,
A. apraxia. complex movements and use objects properly. 3. Aphasia refers
B. agnosia. to inability to speak (expressive) or inability to comprehend what
C. aphasia. is said or written (receptive). 4. Amnesia is inability to remember
D. amnesia a significant block of information.
Which of the following descriptions of patient experience and
behavior can be assessed as an illusion? A patient
A. states, "I keep hearing a man's voice telling me to run away."
B. looks at the shadows on a wall and tells the nurse she sees
B. looks at the shadows on a wall and tells the nurse she sees
frightening faces on the wall.
frightening faces on the wall.
C. becomes anxious whenever the nurse leaves her bedside.
D. tries to hit the nurse when vital signs are being taken.
Which of the following would the nurse assess as an example of
B. Inability to name a familiar object
cognitive impairment?
Rationale: Inability to name an object is called agnosia. Naming an
A. Crying when the occasion calls for laughter
object requires a high level of cortical functioning. Agnosia is an
B. Inability to name a familiar object
example of cognitive impairment.
C. Incontinence
An illusion is a misinterpreted sensory perception.
D. Agitation
An action the nurse can advise a family to take in the home setting
to enhance safety for the family member with Alzheimer's disease
is
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A. placing throw rugs on tile or wooden floors.
B. instructing patient on cooking safety.
D. having patient wear an identification bracelet with name, ad-
C. allowing patient to smoke unattended.
dress, and telephone number
D. having patient wear an identification bracelet with name, ad-
dress, and telephone number
With respect to evaluation of outcomes and goals for the patient
A. changing expectations for the patient as patient abilities dete-
with Alzheimer's disease, the nurse should be aware of the need
riorate.
for
Rationale: A patient whose course of illness is predictably down-
A. changing expectations for the patient as patient abilities dete-
ward will need to have goals and outcomes correspondingly ad-
riorate.
justed to lower levels. This is true of a patient with Alzheimer's
B. identifying stressors that impact negatively on the patient.
disease. Option 1 is the only one that deals with goal and outcome
C. simplifying the environment to reduce sensory perceptual
planning. Option 2 deals with assessment, and options 3 and 4
alterations.
deal with interventions.
D. changing interventions when goals are unmet.
Which of the following is an appropriate nursing intervention for a
patient with dementia who develops a catastrophic reaction?
A. Employ negative responses to the behavior.
C. Eliminate or reduce environmental stimulation.
B. Use touch to communicate.
C. Eliminate or reduce environmental stimulation.
D.Maintain close personal boundaries.
The husband of a patient with moderately advanced Alzheimer's
disease tells the nurse his wife becomes greatly distressed sev-
eral times a week as she tells him she sees strangers walking
around in the house. She thinks these strangers are taking her
things. The nurse should advise the husband to:
A. try to talk his wife out of these ideas by using logic. B. try diverting her by suggesting an activity.
B. try diverting her by suggesting an activity.
C. search the house with her and show her that no strangers are
there.
D. put locks on doors and windows to increase her sense of
security.
D. disturbed sleep-wake cycle
An objective sign that frequently accompanies the subjective
D. disturbed sleep-wake cycle
symptoms of delirium is:
Rationale: Patients with delirium often demonstrate day-night
A. reduced awareness.
sleep reversal. Regarding option 1, awareness fluctuates. Regard-
B. disorganized thinking.
ing option 2, thinking matches level of awareness, with logical al-
C. psychomotor retardation.
ternating with illogical. Regarding option 3, psychomotor agitation
D. disturbed sleep-wake cycle
is often seen as plucking at the bed sheets or nightgown.
Which of the following nursing techniques are appropriate for
successful interaction with a patient who has been diagnosed with
C. Encouraging communication and maintaining a calm demeanor
Alzheimer's disease
Rationale: These interventions will create a positive emotional
A. Giving all directions at one time to increase understanding
climate and preserve patient self esteem. 1. Directions should be
B. Correcting errors made by the patient by speaking to him in a
given in step-by-step fashion. 2. Activities should not be judged,
loud, clear voice
and the patient should be addressed in a well-modulated voice. 4.
C. Encouraging communication and maintaining a calm de-
Patients with dementia usually need increased time to perform a
meanor
task, and direction should not be rephrased, only repeated.
D. Setting strict time limits and repeatedly rephrasing misunder-
stood questions
The nurse notes that an elderly patient has fluctuating levels of
awareness. She seems anxious. She tells the nurse she saw her
granddaughter standing at the foot of the bed during the night.
Later the nurse sees her moving her hands as though picking
things out of the air. The nurse should suspect: A. delirium.
A. delirium.
B. dementia.
C. bipolar disorder.
D. schizophrenia
When the nurse gives anticipatory guidance to the family of a
C. Inability to carry on an in-depth conversation
patient with early Alzheimer's disease, which behavioral problem
Rationale: Families should be made aware that the patient will
common to that stage of the disease should be mentioned?
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A. Violent outbursts
have difficulty concentrating and following or carrying on in-depth
B. Emotional disinhibition
or lengthy conversations. The other symptoms are usually seen at
C. Inability to carry on an in-depth conversation
later stages of the disease.
D. Inability to eat and drink enough to meet body requirements
Which of the following patients is at highest risk of developing
A 78-year old patient with dementia
dehydration?
A 75-year-old patient who has vision and hearing problems has a
history of striking out at caregivers. Which of the following is the Get the patient's attention and consent before starting care.
most appropriate nursing intervention?
To evaluate thoroughly an older patient's memory, it is helpful to
Stimulate memory chain through associations.
use reminiscence strategies because they:
Aricept (donepezil) is an Alzheimer's medication and is expected
to do what? æ-
Acetylcholine
enhance the concentration of ___ in the brain, thus improve æ-
cognitive functioning
________ ______.
What is it called when the loss of the ability to recognize or identify
Agnosia
familiar objects?
What is it when you're unable to perform previously known motor
Apraxia
activities?
What types of drugs should be avoided in persons with dementia,
as it can interfere with learning & might decrease cognitive abilities Benzodiazepines (ie. Valium)
further?
-onset is sudden
-can be caused by hypoglycemia, fever, dehydration, hypotension,
infection, adverse drug reaction, head injury, change in environ-
ment (hospital), pain, stress
-cognitive impaired memory, judgment, attention span can fluctu-
ate throughout the day
-LOC is altered
*Briefly describe some important factors about Delirium?
-activity is increased or reduced, restlessness, worse in evening
(sundowning), sleep/wake cycle may be reversed
-pt has rapid emotional swings, fearful, anxious, suspicious, ag-
gressive, hallucinations, or delusions
-speech and language is rapid, inappropriate, incoherent, ram-
bling
-prognosis can be reversible with proper and timely treatment
-onset is slow, over months
-caused by Alzheimer's disease, HIV infection, neurological dis-
ease, chronic alcoholism, head trauma
-cognition is impaired memory, judgment, attention pan, abstract
thinking, agnosia
-LOC not altered
*Briefly explain important factors about Dementia?
-activity level not altered, behaviors may worse in evening (sun-
downing)
-emotional state is flat; agitation
-speech and language is incoherent, slow (effort to find right word),
inappropriate, rambling, repetitious
-prognosis is not reversible and progressive

-onset may be gradual, with exacerbation during crisis or stress

-causes include lifelong hx, losses, loneliness, crises, declining
health, medical conditions
-cognition in that pt has difficulty concentration, forgetfulness,
inattention
*Briefly explain important factors about Depression?
-LOC not altered
-activity level is usually decreased, lethargic, fatigue, lack of mo-
tivation, may sleep poorly and awaken in early morning
-emotional state includes extreme sadness, apathy, irritability,
anxiety, paranoid ideation

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-speech is slow, flat, low
-prognosis can be reversible with proper and timely treatment
-pt loses energy, drive, and initiative and has difficulty learning new
things
-depression ma occur early in the disease
-as AD progresses pt is often unable to identify familiar objects or
people, even spouse (agnosia)
Explain Mild cognitive impairment due to Alzheimer's disease? -pt needs repeated instructions and directions to perform the
simplest tasks (apraxia)
-when AD progresses to the point that the person cannot take care
of themselves they can become agitated, violent, paranoid, and
delusional because the world is frightening
-wandering behavior also occurs
-agraphia (inability to read and write)
-hyperorality (need to taste, chew, and put everything in one's
mouth)
Explain what behaviors occur late in Alzheimer's disease?
-blunting of emotions
-visual agnosia (loss of ability to recognize familiar objects)
-hypermetamorphosis (touching everything in site)
Stage 1: no impairment. No memory problems

Stage 2: very mild cognitive decline (may be age-related or due

*Explain stage 1 and Stage 2 of Alzheimer's disease?
to dementia). Pts forget familiar words or location of everyday
objects. No s/s of dementia can be detected during a medical
exam or by friends, or family
Stage 3: mild cognitive decline (early-stage Alzheimer's can be
diagnosed in some with s/s). Other begin to notice. Problems
coming up with right word or name. Trouble remembering names
when introduced to people. Difficulties performing tasks in social
or at work. Forgetting material one has just read. Losing or mis-
placing an object. Increasing trouble with placing or organizing.
Forgetfulness of recent events
*Explain stage 3 and Stage 4 of Alzheimer's disease?
Stage 4: moderate cognitive decline (mild or early-stage
Alzheimer's disease). Impaired ability to perform challenging
mental arithmetic. Difficulty performing complex tasks such as
planning inner, paying bills, or managing finances. Pt becomes
moody or withdrawn especially in social or mentally challenging
situations
Difficulty paying bills or managing finances occurs in which stage
Sage 4
of Alzheimer's disease?

Stage 5: moderately severe cognitive decline (moderate or mid-

stage Alzheimer's disease). Gaps in memory and thinking are
noticeable, and pts begin to need help with day-today activities. A
this stage, pts may be unable to recall their own address or tele-
phone numbers or the high schools or colleges from which they
graduated. They become confused about where they are or what
day it is. Have trouble with less challenging mental arithmetic, need
help choosing proper clothing for the season or the occasion. Still
remember significant details about themselves and their families.
*Explain stage 5 and Stage 6 of Alzheimer's disease? Still require no assistance with eating or using the toilet.

Stage 6: severe cognitive decline (moderately severe or midstage

Alzheimer's disease). Personality changes may take place, and
suffers may need hel with daily activities. At this stage pts may lose
awareness of recent experiences as well as their surroundings,
remember their own names but have difficult with their personal
histories. Distinguish familiar and unfamiliar faces but have trouble
remembering the name of a spouse or caregiver. Need help dress-
ing properly and may make mistakes such as putting pajamas over
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daytime clothes or shoes on the wrong feet. Experience major
changes in sleep patterns (sleeping during the day, restlessness
at night). Need help with toileting, have trouble controlling their
bladder or bowels, experience behavioral changes such as suspi-
ciousness and delusions or compulsive repetitive behavior. Tend
to wander or become lost
At which stage of Alzheimer's disease do pts become confused
about where they are or what day it is, need help with choosing
Stage 5 (can still eat and use toilet on their own)
proper clothing to wear, but still remember significant details about
themselves and their families?
At which stage of Alzheimer's disease does the pt need help
with toileting, accidently place the wrong clothes or shoes on,
tends to wander, may remember own name and may be able
Stage 6
to distinguish familiar and familiar faces, but does not remember
names of others including spouses, and loses awareness of their
own surroundings?
Stage 7: very severe cognitive decline (severe or late-stage
Alzheimer's disease). Pts lose the ability to respond to their en-
vironment, to carry on a conversation, and eventually to control
movement. May still say words or phrases. Pts need help with
*Explain stage 7 of Alzheimer's disease?
much of their daily personal care, including earing and using the
toilet. They may also lose the ability to smile, sit without support,
and hold their heads up. Reflexes become abnormal, muscle grow
rigid, swallowing is impaired
-evaluate current level of cognitive and daily functioning
-identity the needs of the family for teaching and guidance on
how to mange catastrophic reaction, lability of mood, aggressive
What are assessment guidelines for dementia? behaviors, and nocturnal delirium and increased confusion and
agitation at night (sundowning)
-safety is the most important concern when caring for these indi-
viduals
-provide rest periods
-monitor nutrition and weight
-place identification bracelet on pt
-address pt by name and speak slowly
-give one simple direction at a time
-use distraction to manage behavior
-provide consistent caregivers, physical environment, and daily
routine
-provide a low-stimulation environment with adequate lighting
*Explain some nursing interventions for the pt with Dementia?
-provides cues such as current events, seasons, location, and
names to assist orientation
-eta pt at small table in groups of three to five for meals
-provide finger foods
-limit number of choices pt has to make so as not to cause anxiety
-place pts name in large block letters in room and on clothing as
needed
-use symbols rather than written signs to assist pt in locating
groom, bathroom or other area

-speak slowly
-use short, simple words and phrases
-maintain face to ace eye contact
-be near person when talking
-focus on one piece of information at a time
*Guidelines for communication with pts with dementia? -talk with pt about familiar and meaningful things
-encourage reminiscing about happy times in life
-acknowledge pts delusions and reinforce reality. Do not argue
-if pt gets into argument, stop argument and temporally separate
those involved. After short while (5 min), explain to each pt matte
of factly why you had to intervene
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-when pt becomes verbally aggressive, acknowledge pts feelings
and shift the topic to more familiar ground ("I know this is upsetting
for you because you always cared for others. Tell me about your
children.")
-have pt wear glasses or hearing aids
-keep room well lit
-have clicks, calendars, and personal items in clear view while he
or she is in bed
-reinforce pictures, calendars to anchor pt in reality
Dressing and Bathing: always have pt wear own clothes even if
in hospital, use clothing with elastic and substitute fastening tape
(velcro0 for buttons and zippers, give step by step instructions, if pt
is resistant to performing self-care, come back later and ask again

Nutrition: monitor food and fluid intake, offer finger food that the
pt can take away from the dinner table, weigh pt regularly once
a week, during periods of hyperorality (make sure they don't eat
Explain pt and family teaching guidelines for the pt with dementia?
nonfood items)

Bowel and Bladder Function: begin bowel and bladder program

early, start with bladder control, label bathroom door

Sleep: keep area well lit at night, maintain calm atmosphere during
the day, if meds are indicated, consider neuroleptics with sedative
properties (Haldol), avoid use of restraints
-Donepezil (Aricept) drug of choice for AD because its once per
day dosing and few side effects

-Cholinesterase Inhibitors: used to improve cognition, behavior

function. Slows progression
Donepezil (Acricept)
Galantamine (Razadyne)

-Antipsychotics: used for paranoid thinking, hallucination, agitation

Zyprexa
Risperdal

-Anticonvulsants: for agitated and aggressive behavior and emo-

Explain Pharmacological Interventions for AD?
tional lability
Carbamazepine (Tegretol)
Divalproex (Depakote)

-Antianxiety: treats anxiety restlessness, verbally disruptive be-

havior, and resistance
Lorazepam (Ativan)
Oxazepam (Serax)

-Galantamine (Razadyne) is prescribed in the first and second

stages of AD)
-Memantine (Namenda) is prescribed for symptoms found in mod-
erate to severe stages of the disorder
-if pt wanders at night, keep mattress on floor (prevents falls)
-have pt were a medical alert bracelet that cannot be removed.
Provide police department with recent pictures
What are some interventions for wandering for the pt with demen- -if pt is in the hospital, have them wear brightly colored best with
tia? name, unit, and phone number printed on the back, put complex
locks on door, and place locks at top of door (ability to look up and
reach upward is lost in moderate and late AD), encourage physical
activity during the day, install sensory devices

delirium

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Which disorder is always secondary to an underlying condition
and is therefore temporary, transient, and may last from hours to
days once the underlying cause is treated?
irreversible
Primary dementia is what?
Ex: AD
What is the most dominant and most disruptive symptoms of
disorientation
dementia?
-Benzodiazepine drugs like Valium (diazepam) should be avoided
Which drugs should be avoided in the patient with dementia? -These drugs can interfere with learning, and might decrease
cognitive abilities further
Which medication can be given to help decrease the confusion
and agitation that occurs at night (sundowning) in pts with de- Haldol (haloperidol)
mentia?
Inability to move voluntarily, weight loss, vacant stare, and lan-
end stage
guage impairment all reflect which stage of dementia?
When someone copes with a stressful situation by analyzing
intellectualization
the situation and "being strong," the defense mechanism of
(avoid painful emotions associated with a disturbing situation)
___________ is being used.
Difficulty remembering names when introduced to people, diffi-
culties performing tasks in social or at work.
Forgetting material one has just read (forgetting recent events) Stage 3
characterizes what stage of
AD?
Difficulty performing complex tasks such as planning inner, paying
bills, or managing finances characterizes which stage of Stage 4
AD?
Mild or early-stage Alzheimer's disease with moderate cognitive
Stage 4
decline is what stage?
Early-stage Alzheimer's disease with mild cognitive decline is
Stage 3
what stage?
At what stage of AD is it when the pt tends to wander and has
suspiciousness and delusions or compulsive Stage 6
repetitive behavior?
At what stage of AD is it when the pt needs help with toileting? Stage 6
What stage of AD is it when the pt needs help dressing properly
and may make mistakes such as putting pajamas over daytime
Stage 6
clothes or shoes on the wrong feet. Experience major changes
in sleep patterns (sleeping during the day, restlessness at night)?
Moderately severe or midstage Alzheimer's disease is what
Stage 6
stage?
Moderate or midstage Alzheimer's disease is what stage? Stage 5
"Spent the weekend with my daughter or I discussed politics with Confabulation
the president." Is an example of what? It is an unconscious attempt to maintain self esteem
Mild or early stage Alzheimer's disease? stage 4
Early-stage Alzheimer's is which stage? stage 3
1. Which of the following interventions should the nurse incor-
porate in the care plan of a patient with dementia to support A. Daily activity schedule
short-term memory? Rationale: A daily activity schedule helps remind the patient of
æ
A. Daily activity schedule what to do and when to do it. A written schedule helps support
B. Activities using large muscles recent memory. Options 2, 3, and 4 are appropriate activities but
C. Simple word games do not directly address the support of recent memory.
D. A discussion group
A 45-year-old male has been admitted with a diagnosis of delirium
of unknown etiology. The nurse would expect to assess:
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A. fluctuating level of consciousness. A. fluctuating level of consciousness.
B. gait abnormalities. Rationale: Disturbances of consciousness that tend to fluctuate
æ
C. apathetic affect. during the course of the day are a primary symptom of delirium.
D. negative thought content. The other options are not expected in delirium.
A patient with dementia is unable to name ordinary objects. In- B. agnosia.
stead, he describes the function, for example, "the thing you cut Rationale: Agnosia is the failure to identify objects despite intact
æ
meat with." The nurse should assess this as: sensory function. 1. Apraxia is the inability to carry out purposeful,
A. apraxia. complex movements and use objects properly. 3. Aphasia refers
B. agnosia. to inability to speak (expressive) or inability to comprehend what
C. aphasia. is said or written (receptive). 4. Amnesia is inability to remember
D. amnesia a significant block of information.
Which of the following descriptions of patient experience and
behavior can be assessed as an illusion? A patient
A. states, "I keep hearing a man's voice telling me to run away." B. looks at the shadows on a wall and tells the nurse she sees
B. looks at the shadows on a wall and tells the nurse she sees frightening faces on the wall.
frightening faces on the wall. Rationale: An illusion is a misinterpreted sensory perception.
æ
C. becomes anxious whenever the nurse leaves her bedside.
D. tries to hit the nurse when vital signs are being taken.
Which of the following is an appropriate nursing intervention for a C. Eliminate or reduce environmental stimulation.
patient with dementia who develops a catastrophic reaction? Rationale: Reducing stimulation is calming and will allow the
æ
A. Employ negative responses to the behavior. patient to focus his or her limited intellectual skills on regaining
B. Use touch to communicate. control. 1. Behavioral responses to the patient should be positive.
C. Eliminate or reduce environmental stimulation. 2. Touch can easily be misinterpreted as a threat. 4. Patients need
D. Maintain close personal boundaries. increased personal space during catastrophic reactions.
Which of the following nursing techniques are appropriate for
successful interaction with a patient who has been diagnosed with
C. Encouraging communication and maintaining a calm demeanor
Alzheimer's disease
Rationale: These interventions will create a positive emotional
æ
A. Giving all directions at one time to increase understanding
climate and preserve patient self esteem. 1. Directions should be
B. Correcting errors made by the patient by speaking to him in a
given in step-by-step fashion. 2. Activities should not be judged,
loud, clear voice
and the patient should be addressed in a well-modulated voice. 4.
C. Encouraging communication and maintaining a calm de-
Patients with dementia usually need increased time to perform a
meanor
task, and direction should not be rephrased, only repeated.
D. Setting strict time limits and repeatedly rephrasing misunder-
stood questions
A patient with severe dementia no longer recognizes family mem-
bers and becomes anxious and agitated when they attempt reori-
Focus interaction on familiar topics
entation. Which alternative could the nurse suggest to the family
members?
An elderly patient is admitted with delirium secondary to a urinary
tract infection. The family asks whether the patient will ever recov- "The confusion will probably get better as we treat the infection."
er. Select the nurse's best response.
An elderly person presents with symptoms of delirium. The family
reports, "Everything was fine until yesterday." What is the most A list of all medications the person currently takes
important assessment information for the nurse to gather?
a a
A patient with severe dementia no longer recognizes family mem-
bers and becomes anxious and agitated when they attempt reori-
entation. Which alternative could the nurse suggest to the family
members?
b. Focus interaction on familiar topics.
a. Wear large name tags.
b. Focus interaction on familiar topics.
c. Frequently repeat the reorientation strategies.
d. Place large clocks and calendars strategically.
An 89-year-old man with Alzheimer's disease wanders around the
unit disturbing other patients. Which of the following actions by the
nurse would be MOST appropriate? 3) CORRECT— keeps patient active and independent, structures
his environment, promotes socialization, orients him and pre-
1. Call the physician for an order for a tranquilizer.
2. Place the patient in a geri chair with a clipboard to complete a
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 Nursing Care of Clients with Cognitive Disorders
Study online at https://quizlet.com/_1orora
puzzle.
serves his dignity; does not block his wandering behaviors but
3. Allow the patient to assist the staff to sort the linen.
uses them constructively; it also protects others from intrusion
4. Explain to the patient that he may not leave his room.
The psychiatric home health nurse visits the home of a patient
diagnosed with middle-stage Alzheimer's disease. The patient
lives with his daughter and son-in-law, who both insist he stay with
them for as long as possible. Which of the following observations
(3.) CORRECT—the dryer itself could be hazardous to this patient
MOST concerns the nurse?
in terms of misperceptions of what it is—e.g., a gun—or in terms
of improper use causing burns or other injuries; also, having it
1. There are extension cords on the floors behind furniture.
in bathroom can increase potential for electric shock by patient
having contact with water while holding the device when it is turned
2. There is a bowl of artificial fruit on a glass coffee table.
on
3. There is a blow-dryer on a hook on the bathroom wall.

4. The door locks are at the tops of the doors

The nurse admits a 75-year-old client diagnosed in the early stage
of Alzheimer's disease. The nurse should assess for which of the
following symptoms?

1. Increased muscle tone and rigidity. 2) CORRECT— symptoms of early-stage Alzheimer's include
recent memory loss and changes in motor activity, such as con-
2. Restlessness and pacing. tinuous pacing, wandering, and agitation

3. Extension of the head and neck.

4. Shuffling gait.
You are caring for Maggie, a 78-year-old with Alzheimer's disease
and Stage III breast cancer who can no longer communicate The Pain Assessment in Advanced Dementia scale
verbally. What is the appropriate way to assess Maggie's pain?
You are caring for Miguel, age 76, who is experiencing delirium.
"Once we know the underlying medical cause of the delirium, we
Which nursing response is appropriate when the patient's daugh-
can begin treatment to attempt to reverse the process."
ter asks, "Will he ever stop acting like this?"
Marco, age 83, has dementia and has difficulty feeding himself
despite the fact that there is nothing wrong with his motor func- Apraxia
tions. Which term should the nurse use to document this finding?
A nurse suspects a client is experiencing delirium. Which specific A decreased level of consciousness with intermittent hypervigi-
assessment information would support this suspicion? lance
Explain agraphia? inability to read and write
A 69-year-old patient has been admitted to an adult psychiatric
B) Difficulty performing familiar tasks, such as placing a telephone
unit because his wife thinks he is getting more and more confused.
call
He laughs when he is found to be forgetful, saying "I'm just getting
C) Misplacing items, such as putting dish soap in the refrigerator
old!" After the nurse completes a thorough neurologic assess-
E) Rapid mood swings, from calm to tears, for no apparent reason
ment, which findings would be indicative of Alzheimer's disease?
F) Getting lost in one's own neighborhood
Select all that apply.

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