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

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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.****

Specializes in 6 yrs high-risk OB.

I would've picked A too - I have always been told that you don't "challenge" what an alzheimer's patient believes - you aren't going to "win" and you'll just end up upsetting them if you try to convince them what they believe isnt' real.

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Edited to add- I misread the question before- I failed to note the very important word- "NOT" in the question.

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Specializes in Medical.

Humour requires non-concrete thinking, because to 'get' a joke you have to be able to skip from one meaning to another, or extrapolate from infoirmation not obviously available, which is what makes something funny. For example:

What's brown and sticky?

A stick

It's funny because we're thinking of 'sticky' as a texture, rather than 'having a stick-like qualities.' People with cognitive disorders, including autism, acquired brain injury and dementia, aren't able to jump trains of thought, which means they don't understand the joke. That can make them feel left out, frustrated or angry.

That said, I would have gone with A.

And now I've reread the question (which I must say I find a little confusing, with all the double negatives), it seems to say that you should include humour, and not include reorientation etc. Is that right, or am I now hopelessly confused?

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Specializes in LTC, Home Health.

it's a trick question...which intervention would not appear in this plan of care?

d. is saying to avoid humor...so the poc would not say to "avoid" humor..am i making sense?

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Specializes in LTC, Home Health.

I thought hospice was about allowing a person to die with dignity. If so, then allow me dignity, help me to remember who I am and who my loved ones are.

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Specializes in Medical.
I thought hospice was about allowing a person to die with dignity. If so, then allow me dignity, help me to remember who I am and who my loved ones are.

Sometimes it's less distressing to the patient to go along with them than reorient them - "your husband isn't here right now" rather than "your husband died six years ago." I had a patient for whom the realisation her husband had died was fresh every time - she would scream in truly heart-rending distress and sob. Until she forgot again.

There's a reason why a number of long-term care facilities have non-functioning bus stops for their patients - waiting for the bus until they forget is a lot less distressing than reminding the patient they're in hospital/long-term care and have nowhere they need to go to. Going along with them reduces aggression and distress both for those patients and for the other patients around them (who can become distressed, agitated, angry or fearful from the atmosphere).

I'm not saying never reorient confused patients, but for those who have advanced dementia, it often helps neither the patient nor the staff. I think of it as thinking of the patient as they were (when they were vibrant and alert) than as they are now

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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. :p

me thinks you need to reread my post, i did say SOME, not all......and if a patient can be oriented to the date they are not in late stage dementia.......

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Humor in good taste, is always appropriate, if not for the patient, then for the therapist. As long as it does not confuse or further disorient. Also, it is theraputic to laugh, regardless of if we get the joke. When people laugh and smile, other people who know nothing of the scenario that led up to the humor will laugh and smile. This releases all kinds of body and mind healthy hormones. It is a genetic way of bonding together into safe groups. Our bodies will reward us if we are happy.

If only the question was reworded to replace "Challenge" with "Encourage", this would be a no brainer, as I too immediately thought, (wrongly, as I now think about it more) negativity in the word "challenge". Therapy though, often comes with a tough aspect. Late stage may indeed be too late, but we can't just give up completely d/t an end stage Dx. Wouldn't anyone enjoy a brief moment of clarity if it were available to us during our final days?

Great post, and I think it is a great question, even as easy as it looks to me now. It forces you to acknowledge the benefit of humor, and also to look at "challenges" not always with foreboding, but with optimism.

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Specializes in medical surgical ward and operating room.

as i red the question....i agree that the answer will be letter D because choices A,B,C are related with each other when caring for patients having alzheimers disease. have a nice day!!!

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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.....

Yes, you DO want to try and orient a confused person... It may seem pointless, but it is VERY necessary...

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Yes, you DO want to try and orient a confused person... It may seem pointless, but it is VERY necessary...
WHY, what purpose does it serve? make the nurse feel better?
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The instructor said the answer is D?

She must be nuts.

Any experienced nurse would say the answer is A. I think your instructor is dead wrong.

I say D and I am a nurse experienced with dementia pts (and not nuts :))... Its in the wording, "avoid humor." Why? Afterall, laughter is the best medicine, right? I laugh with my pts all the time, even if they don't "understand" they can tell I am non-threatening and are consequently more at ease.:twocents:

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