This question is killing me, please help me clarify?

[tabz4u2]

On my exam last Friday i had this question:

You a nurse who is providing a care plan for a nursing assistant for a client who has Stage II Alzheimers. Which would be appropriate to add to the care plan?

1. Put deadbolts on the doors on the outisde.

2. Put a padded rug by the bedside.

3. Use black and white knobs for the kitchen stove.

4. Turn the lights off in the bedroom at night.

I picked 4

[Esme12, ASN, BSN, RN]

There are 3 stages of Alzheimer disease.........

• The early stage
  
• The middle stage
  
• The late stage
  

The signs of this disease get worse as time goes on and the disease continues to progress. The signs of each of the 3 stages are below.

Early Signs

The first sign of this disease is usually short-term memory loss. The person may forget things that have recently happened. They can remember things that have happened a long time ago but they may not be able to remember what they had for lunch or dinner the day before or they may not be able to find their car keys because they forgot where they put them the day before. These people can remember things that happened a long time ago (long-term memory) but they forget things that are recent (short-term memory loss).

People in the early stage also:

• Repeat what they have already said. They forget what they have already said when they are speaking with other people.
  
• Forget the word they want to use. These people just can not find the right word to use in a sentence. They may even use a word that makes no sense at all.
  
• Forget how to do some simple things. Some may forget how to make their favorite stew, for example.
  
• Stop being able to do some “hands on” things. They may no longer be able to knit or drive a car as well as they did in the past.
  
• Have personality changes. They may become angry, aggressive, depressed and “moody”.
  
• Become disoriented. They may forget what day of the week it is.
  

Some of these changes are very small and hard to notice. It is often the family that notices it. The person may not even know they are having trouble.

The Middle Stage Signs

As it continues to progress, the person will become more forgetful, confused and disoriented. They will have both short-term and long-term memory loss. The early stage signs get worse during the middle stage and the patient may also:

• Be restless and confused at night. This is often called “sun downer’s”.
  
• Have trouble reading and writing.
  
• Repeat actions over and over again. These acts have no purpose but they are done over and over again anyway.
  
• Wander and get lost. This is a big safety concern.
  
• Be at risk for harm. Falls, self harm and getting lost are a problem. These patients no longer see and stay away from danger. They do not have good judgment and common sense.
  
• Become aggressive and very angry. These behaviors may place the patient, staff and other patients at risk for harm.
  
• Not recognize family, friends and familiar place.
  
• No longer be able to take care of themselves without the help of others.
  
• Have hallucinations and delusions.
  
• Personality changes. They may be sad and depressed, have fears, anxiety and other personality changes.
  
  
  
• Lose social skills. These patients may stop spending time with others and doing things that you used to like doing.
  

The Late Stage Signs

During the late stage, the patient can no longer care for himself or herself. They need complete care. All of the early and late stage signs continue to get worse and the patient also:

• Loses control of urine. They become incontinent of urine.
  
• Loses control of stool. They become incontinent of stool.
  
• Can no longer eat without a lot of help or a feeding tube. Patients may have eating and swallowing problems..
  
• Becomes underweight and thin. These patients are at risk for malnutrition, dehydration, infections and aspiration.
  
• Is highly irritable.
  
• Very sleepy and not responsive.
  

http://wps.prenhall.com/wps/media/objects/737/755395/alzheimers_disease.pdf

Now which is the correct answer....remember all apply start with the most dangerous for the patient.

[nurseprnRN, BSN, RN]

You a nurse who is providing a care plan for a nursing assistant for a client who has Stage II Alzheimers. Which would be appropriate to add to the care plan?

1. Put deadbolts on the doors on the outisde.

2. Put a padded rug by the bedside.

3. Use black and white knobs for the kitchen stove.

4. Turn the lights off in the bedroom at night.

Esme has done yeoman's work giving you the information you need to make a better choice. Remember that nursing takes responsibility for overseeing the CNAs and delegating care to them. If that is so, then...what does the nurse know about managing Alzheimer's that the aide doesn't? The progression of the disease and how very important safety is.

So now your answer is ... ?

[eyesopen_mouthshut, CNA]

As a student, I would say the answer with the deadbolt... would that be correct?

If it's stage II, they are at the point where they begin to wander... you are providing an addition to the care plan...

1. a rug would do little if anything to hinder a fall, if not exacerbate the risk of a fall (tripping, etc.)

2. different color knobs? why? perhaps if the option were knobs with "hot" and "cold"..?

3. turn off the lights? i don't see how that would have anything to do with anything.

4. deadbolts are the only thing that make sense, keeps the pt in a safe, secure area

seems like a common sense question to me?? would that be the correct answer?

[nurseprnRN, BSN, RN]

Remember, this is an instruction you give to the CNA. Does this help?

[BrooklynRN11201]

I would have picked 4 as well, if only for the sun down syndrome.

[stephanie.]

I say deadbolt. But part if me wants to say the lights too but I patients become disoriented at night, shouldn't the lights be left on? Hmmmm

[nurseprnRN, BSN, RN]

OK, OK.

Deadbolts are a hazard for everyone inside-- what if there's a fire? How do you all get out? You can sometimes use locks that are above the normal eye level-- they won't see them there but you can get at them.

Alz gets sleep cycles all screwed up. Normal environmental cues are sometimes helpful -- lights out at bedtime

Soft rug at bedside-- falling hazard

I'd take the knobs off the stove entirely to reduce chances of burns or fires

[eyesopen_mouthshut, CNA]

so it would be lights out at bedtime then, if we are going based on the progression of the disease... I understood it as the pt was in stage 2, which is why I chose deadbolt. but now I understand the reasoning for lights out. I'm still not convinced though! I need better critical thinking skills I guess

[SWM2009]

The way I answered this was to think of it in terms of patient safety ...deadbolt aren't safe, they may keep the patient in but as was mentioned above what if there was a fire? Padded rug would be a risk for falls. Knobs on the stove should be removed and hidden away so the Alzheimer's patient isn't able to start the stove.

That left me with the lights out option as the best answer even though I didn't quite have the rationale for why till GrnTea gave it above (normal environmental cues helpful for Alzheimer's patients who may have messed up sleep cycles).

[bluedove1]

They don't mean putting the locks on the outside of the door they mean on the doors that you exit out of like your "front" door or your side door....I am sure everyone of you have deadbolts on your doors you lock them every time you exit out of your homes or you unlock them every time you enter your home. My Med-sug book even calls front doors outside doors and I had the longest argument with my professor about the meaning and it took me a minute to wrap my head around the author's meaning. It all boiled down to different regions word meanings.

[SWM2009]

They don't mean putting the locks on the outside of the door they mean on the doors that you exit out of like your "front" door or your side door....I am sure everyone of you have deadbolts on your doors you lock them every time you exit out of your homes or you unlock them every time you enter your home. My Med-sug book even calls front doors outside doors and I had the longest argument with my professor about the meaning and it took me a minute to wrap my head around the author's meaning. It all boiled down to different regions word meanings.

Ah, I see what you mean.

For this particular question I would still pick the lights option as the best option. This is something that will be carried out by the nursing assistant. Would the assistant be the one installing deadbolts on the door?