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Delirium and DementiasPsychiatric Nursing: Contemporary Practice

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What causes the deficiences of serotonin associated with AD?
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Loss of neurons in the raphi nuclei
What condition is associated with consistent development of neurofibrillary tangles and beta-amyloid plaques, pointing to a chromosomal mutation link?
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Down Syndrome (trisomy 21)
What medication has been linked to a decreased risk of developing AD and why?
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NSAIDS-they reduce inflammation. Inflammation of the brain is one of the early hallmarks of AD.
What are the three main objectives of the initial assessment of a patient suspected of having AD?
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Confirmation of the dx, establishing a baseline of cognitive function, and developing a therapeutic relationship with the patient and primary caregiver.
What is the current focus of AD treatment?
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Managing the cognitive symptoms, delaying cognitive decline, treating noncognitive symptoms like agitation, psychosis and mood disorders, and supporting the caregivers.
Priority care of AD changes throughout the course of the disease. What are the priorities intially?
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Delaying cognitive decline and supporting family members. Support, education and cognitive interventions for depression.
Priority care of AD changes throughout the course of the disease. What are the priorities with moderate AD?
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Protecting the patient from injury because of lack of judgment.
Priority care of AD changes throughout the course of the disease. What are the priorities with late stage AD?
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Meeting the physical needs of the patient.
What are the two symptoms that often result in nursing home placement of a patient with AD?
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Incontinence and behavioral problems like wandering or aggression.
What are the most common health problems associated with the caregivers of people with AD?
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Lack of energy & sleep, stress and/or panic attacks, pain/aching, and depression.
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What stage of AD do symptoms like gait disturbances, seizures and tremors typically occur?
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During any of them
What stage of AD do symptoms like flexion contractures and primitive reflexes develop?
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During the late stages these are the prominent features of the disorder
What is thought to be the cause of sleep-wake disturbances in people with AD?
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Neurotransmitter dysregulation of melatonin in the pineal gland.
What is one of the earliest symptoms of AD?
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Withdrawal from normal activities
How can nutrition be impacted by AD?
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Some patients with AD are bulemic, hyperoral (eating or chewing almost everything possible and sometimes with an insatiable appetite) and some experience anorexia and have no appetite.
In the end stages of AD, patients can become hypersensitive to _______, making it important to objectively assess the patient's comfort level.
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Touch
What are possible signs of pain in a non-verbal patient with AD?
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Changes in nonverbal communication, hypervocalizations, restlessness or agitation that is increased from baseline.
For patients with AD, ________ is a high-risk time for agression and agitation.
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Bath time
The ___________ approach focuses on personalizing care to meet resident's needs, accommodating resident's preferences, attending to the relationship and interaction with the resident, using effective communication and interpersonal skills, and adapting the physical environment and bathing procedure to decrease stress and discomfort....useful for patients with AD.
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Person-centered
What nutritional interventions are useful for a hyperactive AD patient?
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Providing high protein, high calorie foods, preferably in the form of finger foods. Providing a fanny pack with an assortment of nutritious foods can be useful.
What nutritional interventions are useful for an AD patient who has difficulty swallowing?
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Provide thick liquids or semisoft foods, make the dining environment calm and the food presentation appealing. One-dish meals like a casserole are ideal.
  
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