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.****
Really? "A"? I can't begin to imagine challenging the patient to alter distorted thought patterns...what the heck? In late stage? I had an uncle and a mother in law with that horrific disease and "A" wouldn't have been an option...they were non-verbal. Maybe the quetsion didn't give enough info to answer it. I still say "D"
patty, reread the op, the answer is the one that DOESNT belong
I would of picked D from the start. It is okay to use humor as long as it is appropiate and at the right time.
A. Seems like a correct intervention. We always want our patients to be in touch c- reality. They must know date, time, etc.
B. Seem like a correct intervention. Its okay to look back on past events
C. Seems like a correct intervention as well because you always want the patient to be able to express his/her painful emotions.
I'm a pretty good task taker. So I love these types of questions " Which one is not"
I first read the question, and apply each answer to see if its the right fit. So if three of them are the right interventions, its clear to see which one is the wrong one. Also D, was the only answer that used the verb avoid, the other three used positive verbs like Challenge, allow, and etc. You must also look at the commonalities of the other three answers. Which one was different.
if the patient is TRULY in the LATE stages of this horrible disease; none of the options are appropriate....but i would have chosen A........NO you dont always try to orient a confused person....and the calendars and such are there because "state" wants them there, not that they serve a usefull purpose.....
Why won't you try to orient a patient in the late stages ? I always orient patients in the late stages. Just because you personally don't think it woud work, it doesn't mean it doesn't help. Hearing is the last thing to go anyway.
Why won't you try to orient a patient in the late stages ? I always orient patients in the late stages. Just because you personally don't think it woud work, it doesn't mean it doesn't help. Hearing is the last thing to go anyway.
you dont do it , because it cant be done.......if your patient can tell you the date, they are NOT in the late stages.....and trying to orient some folks in th latter part of mod. dementia only leads to frustration, anger and acting out in the patient.....meet them were they are! if you force the issue...you may well have bigger issues on your hands
I think that the answer is D. You are assuming that the pt. can't appreciate humor. Humor is like pain, it's not objective data. As long as the client can hear you and it's not inappropriate humor, what can it hurt? Like another poster said, it may very well improve their quality of life.
And I've been told that you always try to orient your client, even if it doesn't work, and challenging doesn't have to be a bad thing. I think in this scenario challenging=encouraging, and why wouldn't you encourage a client to know what's going on around them?
I hate these questions and find them counterproductive overall. They do make for interesting discussion but I don't think it's right to have the "correct" answer factor largely into passing or failing. And since most nursing school tests are less than 100 points and need at least 78% to pass, each question counts for a lot!
Choosing D over A doesn't really indicate a better understanding of Alzheimers or nursing care since as we can see here that both can be supported. So then it comes down to some wording issue or intrepretive issue that has nothing to do with evaluating a student's' relevant comprehension or retention of material. Ugh!!!!!
At my school, we can contest questions we got wrong and if our rationale for the answer is good, they give us the points. If you really feel that it was A and can explain why, why don't you talk to your instructor about it and see if they have a similar policy.
I would have picked A because as an end stage Alzheimer pt, why would the nurse care to orient to present day? How many times a day does the pt need to go through the pain of knowing his wife or ?? is dead? We were taught in ns that is is sometimes better to be in their world rather than make them be in ours.
If D is the right answer, I would have to know the rationale..... I get the avoid humor, but some people you can be humoruous with and others you can't. That seems to be more subjective...
you dont do it , because it cant be done.......if your patient can tell you the date, they are NOT in the late stages.....and trying to orient some folks in th latter part of mod. dementia only leads to frustration, anger and acting out in the patient.....meet them were they are! if you force the issue...you may well have bigger issues on your hands
I've never said that the patient may be able to tell the date in the late stages, if they could why would I try to orient them in the first place. All I'm saying is that is doesn't hurt, and beside as nurses we should be able to try all nursing interventions as appropriopiate and I believe this would be appropiate. I never force, I love to guide and encourage patients.
I'm sorry, that I don't under estimate patients and how they can remember things even when others thought they couldn't. By the way I have tried to orient patients in the latter of mod. dementia and it DID NOt lead to fustration, anger, and etc. So another thing.... Dont ever Generalize patients. What works for one dementia patient, may not work for another.
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morte, LPN, LVN
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