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.****
WHY, what purpose does it serve? make the nurse feel better?
No, if they are having a moment of clarity, they may be frightened or confused and not because of their diagnosis. Remember these pts are not here for psych reasons. Although they may not believe you you should attempt to reorient them, in my opinion not doing so is wrong. Don't push the issue though, just tell them the correct day, time and place and move on. Harping on the issue will most definitely agitate them...
I think of it as thinking of the patient as they were (when they were vibrant and alert) than as they are now
That's a nice sentiment, too many people see working with the elderly as stinky poo duty rather than tapping into their vast wells of knowledge and experience. You can take care of my family anytime.
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.
That's what I was trying to say when I said it's a trick question..it is all in the wording..I would answer D. Thank you for saying it clearer than I did.:)
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.......
Okay, alright. The correct answer was D( which was the one I would of chose in the first place)... Thats all that matters at this point.
WHY, what purpose does it serve? make the nurse feel better?
Yes as a nurse it would make me feel better, that I took the time to try to orient a patient with demenia. Its heartwrenching that so many people give up on these type of patients. It may seem purposeless to you, but to me It'll be necessary. I try my best to treat patients as if I would want to be treated or my family members.
Another A answer here. Why would you challenge the client to view the world and himself in a more realistic manner---you will surely lose that battle. I think A is worded poorly. The word 'challenge' is different to me than 'encourage,' which, to me, is what you really want to do. I think the word 'encourage' would totally change this, IMO.
I think that you are viewing "challenge" as a negative thing. For dementia patients, challenging their thought processes can be simple things like showing them a picture of their loved ones and talking about the people in their lives to help "work" their brain, per say. Even though he is in his end stage of life, it is helpful to continue to challenge dementia patients. This has shown to improve their quality of life and has also been suggested that it can prolong their lives. You want to keep their brain exercised, so helping them to remember their past and critically think about life as they know it is very beneficial.
You would never take this term "challenge" to mean that you would correct them or tell them that they are wrong or crazy. Just "help" them process their thoughts in more coherent ways.
Humor is also beneficial for the dying. It too has been shown to improve the quality of lives. A person with dementia may not be able to process humor the same ways we do, but there are appropriate ways to keep these patients laughing. The correct answer is definitely D.
As did I. I guess I better start thinking differently NOW! (not starting NS until next Spring)
Another A answer here. Why would you challenge the client to view the world and himself in a more realistic manner---you will surely lose that battle. I think A is worded poorly. The word 'challenge' is different to me than 'encourage,' which, to me, is what you really want to do. I think the word 'encourage' would totally change this, IMO.
When a medical pt is dying from something incurable we are essentially fighting a losing battle, but we as caregivers are obligated to fight that battle... Why would you not at least TRY to orient a demented pt and even if we lose at least we tried...
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...
Notice the use of "Avoid" in choice D and the word "except" in the stem. If you are saying that humor is acceptable for use (I agree, by the way)... then you would not want to include "Avoid the use of humor" in his care plan. Therefore, D would be the correct answer.
I think the word "challenge" has a negative connotation...we tend to say, "I shouldn't challenge him/her." But it is correct to "reorient" the patient, which is how I interpret choice A.
Edited to add:
I didn't read through all of the posts before replying...seems like others have said the same thing already.
At first I thought it was A but if you read the WORDING, it must be D. It says which would "NOT" be included. "Avoiding humor" would NOT be included. Therefore, "Using humor" would be included!
Nurse Salt
330 Posts
No, if they are having a moment of clarity, they may be frightened or confused and not because of their diagnosis. Remember these pts are not here for psych reasons. Although they may not believe you you should attempt to reorient them, in my opinion not doing so is wrong. Don't push the issue though, just tell them the correct day, time and place and move on. Harping on the issue will most definitely agitate them...