Alzheimer’s Delirium and Dementia Q 65
Which of the following is not included in the care plan of a client with a moderate cognitive impairment involving dementia of the Alzheimer’s type?
A. Daily structured schedule.
B. Positive reinforcement for performing activities of daily living.
C. Stimulating environment.
D. Use of validation techniques.
Correct Answer: C. Stimulating environment.
A stimulating environment is a source of confusion and anxiety for a client with a moderate level of impairment and, therefore, would not be included in the plan of care. Limit sensory stimuli and independent decision-making. This decreases frustration and distractions from the environment. Decreasing stress of making a choice helps to promote security. Instruct the family to utilize distraction techniques, such as soothing music, going for a walk, or looking at picture albums if the patient has delusions. Distraction may be effective to calm the patient if stressful situations occur.
Option A: Maintain consistent scheduling with allowances for patient’s specific needs, and avoid frustrating situations and overstimulation. This prevents patient agitation, erratic behaviors, and combative reactions. Scheduling may need revision to show respect for the patient’s sense of worth and to facilitate completion of tasks. Utilize cognitive function testing to identify current level of dementia.
Option B: Assist with as much activity as needed. Give the patient a washcloth or hand towel to hold on to. This promotes independence and self-esteem when the patient is allowed to control the situation. Patients with AD frequently will grasp the hand of the nurse during a bath, and use of washcloth helps them to have something to hold on to.
Option D: Provide positive reinforcement and feedback for positive behaviors. This promotes patient confidence and reinforces progress. Limit decisions that the patient makes. Be supportive and convey warmth and concern when communicating with the patient. The patient may be unable to make even the simplest choice decisions and this will result in frustration and distraction. By avoiding this, the patient has an increased feeling of security. Patients frequently have feelings of loneliness, isolation, and depression, and they respond positively to a smile, friendly voice, and gentle touch.