This was a question on our test today. What do you think the answer is?

[JDotHamp, BSN]

mr. winston is an 89-year-old who was diagnosed with alzheimer's disease 5 years ago. since he is in the last stages of his disease, he has been referred to a local hospice program. the interdisciplinary team meets to discuss his plan of care. which intervention would not appear in this plan of care?

a.challenge the client to alter distorted thought patterns and view self and the world more realistically. b.reminisce about past experiences with the client, as appropriate. c.assist the client in labeling the painful emotion that he is feeling. d.avoid using humor with the client because he will not understand.

****i picked a but the correct answer is d. of course they couldn't offer me a reason. the reason i chose a was because in the last stage of the disease no matter what you say if they want to go ride a plane that is what they are "going" to do.****

[ElliShay]

I am not a student--but will go out on a limb and say that 'A' is the correct answer...

[Atheos]

A.Challenge the client to alter distorted thought patterns and view self and the world more realistically. B.Reminisce about past experiences with the client, as appropriate. C.Assist the client in labeling the painful emotion that he is feeling. D.Avoid using humor with the client because he will not understand.

I would say A is the answer that doesn't belong.

A - Why would you try to challenge what is the reality for a patient. The patient is experiencing and feeling things that are real to them. There is no 'more realistic' view. Their view is their reality and trying to change it may only agitate them. We DON'T want to agitate them.

B - Reminiscing is actually quite good for those with memory issues. It helps them relate to and sometimes remember things in their past they might have trouble remembering.

C - You do want Alzheimer's patient to try and express their feelings. Many times their 'acting out' is due to the inability to express themselves.

D - One of our patients now responds only humor, laughing and smiling and sometimes her name. It's a form of communication and I am pretty sure that even in their state they appreciate all the communication they get. Even if it is just laughs and smiles.

[anewday]

I would have picked A as the answer.

[twoangels]

I would go for A.

[shoegalRN, RN]

I would got with A as well. You do NOT want to challenge a dying Alzheimer's patient to alter disorted thoughts and to view the world more realistically. That sounds like something you would do for a Mental Health patient, not a patient who's at the last stages of Alzheimer's and is dying, hence the referral to Hospice.

[mom35]

I, too, say A.

[flightnurse2b, LPN]

it's between A or D for me. A is incorrect for obvious reasons but... D is also an incorrect intervention. patients with alzheimer's may not understand your humor, but they can still appreciate the emotions and may even smile with you. humor can still be therapeutic.

the word challenge in the A option is what's leading me to believe that's the choice your instructor was looking for...

[silverbells_star]

I agree, A is the best answer. I work in hospice (not as a nurse) but in another support unit and am a member of the interdisciplinary team meetings. The goal of hospice is quality of life. What I usually see is our team supporting the Alzheimer's patient with where they are at that moment, not to challenge their view of their reality and view the world more realistically. Answer B is something you would want do do because Alzheimer's patients usually like to reminisce abouttheir life and that is something encouraged in hospice. I didn't really like answer D much either, I don't think you need to entirely avoid humor.

I'm not sure if they have covered this yet in your class, but at the end stages of Alzheimer's disease, these people are not usually talking, they lose their ability to smile, sleep alot and often are in their own little world. Our goal at my work is to meet them where they are and assist them in having a good quality of life, however long that may be.

[llg, PhD, RN]

The word "challenge" is interesting. Many people automatically assume that a "challenge" is combative or confrontational in nature. However, a gentle challenge can be a positive thing -- a nudge towards helping the patient stay in contact with the moment-to-moment reality of his life to keep his consciousness in this world as much as possible.

Having not studied the course content tested on the exam, I am not sure what the right answer is. But I would probably choose D. I don't think humor should be automatically ruled out as a possibility -- though if the patient is completely beyond comprehension, then I would choose A for all the reasons mentioned by the other posters.

[janbug]

I would go with A.

[CardioTrans, BSN, RN]

I would have chosen A.......... not necessarily because of the word "Challenge"... but because of "to view self and the world more realistically".............. in an alzheimers patient... the world they live in IS their reality.... Im not saying to always "play along", but in late alzheimers, it is hard to re-orient.