NU 160 CH. 17 Cognitive Impairment, Alzheimer's & Dementia

An elderly female client on the mental unit suddenly becomes upset because she can’t remember where she is. She says, “I can’t think straight.” The staff has never witnessed this behavior in the client, and this type of complaint is not documented in the nursing history. What is the client most likely experiencing?

• Hallucinations

• Dementia

• Delusions

• Delirium

Answer explanation

Delirium is characterized by a sudden onset of signs and/or symptoms such as disorientation, disorganized thinking, and decreased attention span. Delirium has various causes, such as medical conditions, drug reactions or interactions, and electrolyte imbalances. If the cause is determined early in the process, delirium is reversible. Hallucinations refer to perceptual alterations of the senses, dementia is a chronic condition of confusion related to disease, and delusions are irrational thoughts or beliefs that cannot be changed by rational explanations.

A 91-year-old female patient with dementia is being seen by the home health nurse. She no longer recognizes her husband or children. She also has forgotten how to eat and dress and she wanders through the house both day and night. The nurse notes that the caregiver is noticeably tired, yet he is adamant that he wants his wife to be in her home. What should be the priority focus of the nurse’s communication with the husband?

• Inform the husband that the wife’s care is too hard for him and he must place her in a nursing home as soon as possible

• Discuss how the husband plans to meet his own needs for health and well-being

• Give the husband the names of agencies that will do in-home care

• Suggest to the husband that he install locks on his wife’s bedroom so that he can sleep at night and get rest

Answer explanation

The husband’s wife is in the middle to late stages of Alzheimer’s disease and requires constant monitoring. The patient has lost all sense of time and place and may display such behaviors as agitation, uncooperativeness, and wandering. It is important for the nurse to discuss with the husband how he is planning to get the rest he needs and take care of his own health. Telling the husband to move his wife to a nursing home would not be feasible because the husband has already decided he wants to keep his wife at home. Giving the husband the names of agencies would be a possible intervention but would not occur until after the nurse has discussed the husband’s needs. Locking the patient in the bedroom at night is not a safe intervention and would not help the husband.

The early stage of Alzheimer’s disease is characterized by:

• Loss of recent memory

• Loss of remote memory

• Withdrawal from family

• Apraxia

Answer explanation

Loss of recent memory is the most characteristic sign in the early stage of the disease. Loss of remote memory occurs during the intermediate stage along with loss of recent memory; withdrawal from family and apraxia occur in the intermediate stage.

The nurse is aware, when developing a care plan, that the three major goals of care for the client in whom Alzheimer’s disease has been diagnosed include providing for the client’s safety and well-being, therapeutically managing the client’s behaviors, and:

• Supporting the client during curative care

• Providing support for family, relatives, and caregivers

• Arranging for nursing home placement

• Tracking the progress of medical, legal, and financial records

Answer explanation

This disease is devastating not only to the client, but also to significant others as well. A major component of the care plan is for the care of the client’s loved ones. Supporting the client during curative care is incorrect because there is no cure for Alzheimer’s disease; nursing home placement is not going to be the plan of action for all clients with the disease; and tracking medical, legal, and financial records is a responsibility of the family.

Most individuals with Alzheimer’s disease are cared for in:

• Nursing homes

• Their own homes

• Long-term care facilities specifically set up for clients with Alzheimer’s

• All of the above

Answer explanation

Most clients are cared for in their homes by family and friends with the support of home care agencies.