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Delirium and DementiasPsychiatric Nursing: Contemporary Practice

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What is the difference between illusions and delusions in AD?
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Illusions are a false perception, like thinking your grandson is your son?triggered by actual external environmental stimuli. Delusions are a fixed, false belief, triggered by internal stimuli.
What are common delusional beliefs experienced by people with AD?
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Belief in: marital infidelity, someone is trying to hurt them, someone is stealing from them, strangers are living in their home, or that people on the television are real.
When are depressive symptoms most prevelant in patients with AD?
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In the early stages
How is assessment of depression performed in patients with AD who are non-verbal or in the advanced stages?
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Assessing for changes in baseline behavior
What is a catastrophic reaction?
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Overreactions or extreme anxiety to everyday situations when environmental stressors are allowed to continue or increase beyond the patient's threshold of stress tolerance.
Excessive amounts of _________ causes excitotoxicity in patients with AD, causing destruction of neuronal cells in the brain.
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glutamate
__________ is the substance in the cell that is released when a cell dies in the brain, releasing free radicals and further damaging the brain.
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Mitochondria
What are behaviors that are indicative of a catastrophic reaction in a patient with AD?
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Verbal/Physical aggression, violence, agitation, anxiety, emotional outbursts, noisy behavior, compulsive or repetitive behavior, agitated night awakening or other behaviors in which the patient is cognitively or socially inaccessible.
What are factors that can cause a catastrophic reaction in a patient with AD?
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Fatigue, changes in routine, demands beyond the patient's ability, overwhelming sensory stimuli, or physical stressors such as pain or hunger.
What general behavioral responses occur from AD?
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Apathy, loss of empathy, restlessness, agitation, anxiety, hypevocalizations, disinhibition, hypersexuality, and increased sensitivity to stress.
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When does restlessness commonly occur in patients with AD?
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During medication changes or adjustments, side effects should be suspected.
How can a nurse prevent future occurrences of restlessness in patients with AD?
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Evaluating the antecendents of restlessness in a patient and plan nursing care that prevents those events
___________ can be a sign of conditions like dehydration, medication reactions, pain or infection in patients with AD.
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Fidgeting, picking at clothes, wringing their hands or hypervocalizations.
What are hypervocalizations?
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The screams, curses, moans, groans, and verbal repetitiveness that are common in the later stages of AD
What is important in assessing the cause of hypervocalizations?
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Identify when the behavior is occurring, antecendents of the behavior, and any related events (like a family member leaving or a change in stimulation).
________ is the term for acting on thoughts and feelings without exercises appropriate social judgment.
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Disinhibition
_______is the term for inappropriate and socially unacceptable sexual behaviors.
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Hypersexuality
_________ therapy is a cognitive therapy tool that focuses on the emotions and subjective reality of the patients with AD. Individuals with cognitive impairment are viewed on one of four stages of a continuum: malorientation, time confusion, repetitive motion and vegetation.
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Validation
How can you determine the length of a patient's short term memory?
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Timing the amount of time a person asks you the same question over and over again.
How is validation therapy different from traditional therapy for patients with AD?
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Traditional therapy involved reorienting the patient to time and place. Validation therapy involves respecting the individual's current sense of reality without attempting to reorient them.
What interventions can a nurse use to reinforce short and long term memories for a patient with AD?
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Remind them what they ate for breakfast, who their visitors were, encourage them to tell stories of their past, Fill in the blanks matter of factly when they are word searching, use scents to stimulate memory retrieval.
  
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