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Delirium and DementiasPsychiatric Nursing: Contemporary Practice

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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.
What interventions are useful for patients with middle stages of AD who are experiencing urinary or bowel incontinence due to disorientation?
Show Answer
Orientation to the location of the toilet with signs and active training
What interventions are useful for patients with middle stages of AD who are experiencing urinary or bowel incontinence due to the patient not recognizing their bladder is full?
Show Answer
Increasing fluid intake can help to fill the bladder sufficiently to give a clear message of the need to urinate.
How can you assess a patient's orientation in a hospital environment without asking, Where are you?
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Ask them if they know who their surgeon is and what surgery they had.
What interventions are useful for patients with middle stages of AD who are experiencing urinary or bowel incontinence due to the patient not being able to get to the toilet in time?
Show Answer
Position them near the toilet or place a portable toilet nearby. Provide modified clothing (easy to open fasteners in place of zippers or buttons), limit the amount of fluid consumed after the evening meal.
Why are indwelling catheters contraindicated in patients with AD?
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They are not well tolerated requiring the use of restraints and they foster the develop of UTIs.
What are some subtle signs in patients with AD that they may be constipated?
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Lethargy, reduced appetite, and abdominal distention
How can constipation be prevented or treated in patients with AD?
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Provide fiber rich diets, encourage at least 1500-2000 mL of fluids a day, and use a gentle laxative like milk of magnesia.
What should be avoided when treating AD patients for constipation?
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Enemas and harsher chemical cathartics, they increase pain and discomfort leading to more distress.
Why are sedative-hypnotics prescribed with caution to treat patients with AD for sleep problems?
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The may cause a paradoxical reaction of agitation and insomnia (especially in elderly patients).
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________ naps are suggested for patients with AD who have sleep problems to produce REM sleep patterns and can help patients who are restless.
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Morning
_________ naps are suggester for patients with AD who have sleep problems to produce deep sleep and are useful to due reduce restlessness associated with fatigue.
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Afternoon
___________ may help eliminate late-day confusion (sundowning) and night time awakenings in patients with AD.
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Morning and Afternoon
How can you assess whether a patient with AD is experiencing relief from pain medications?
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Decreased restlessness, agitation or hypervocalizations.
What is the general rule for administering medications in elderly patients?
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Start low (dose) and go slow (titration)
What can be one of the biggest nursing challenges regarding medicating an AD patient?
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Convincing the patient to take the medication.
What intervention can be useful for getting an AD patient who is suspicious of taking the medication you are providing because they think it's poison?
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Identify the conditions under which the patient feels safe taking the medication, such as having a favorite nurse or relative give it.
What class of drugs are the mainstay or pharmacologic treatment of dementia?
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Acetylcholinesterase inhibitors (AChEI).
How do Acetylcholinesterase inhibitors (AChEI) work in the treatment of AD?
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They increase cholinergic activity by inhibiting AChEI, delaying the decline in cognitive functioning (but not restoring lost function).
What are the primary side effects of AChEI medications?
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N/V/D
When are Acetylcholinesterase inhibitors (AChEI) indicated for the treatment of AD?
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When the patient is diagnosed with mild to moderate AD.
  
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