Comprehensive Nursing Pharmacology Q 25
The nurse is caring for an elderly client who has been diagnosed as having sundown syndrome. He is alert and oriented during the day but becomes disoriented and disruptive around dinnertime. He is hospitalized for evaluation. The nurse asks the client and his family to list all of the medications, prescription and nonprescription, he is currently taking. What is the primary reason for this action?
A. Multiple medications can lead to dementia.
B. The medications can provide clues regarding his medical background.
C. Ability to recall medications is a good assessment of the client’s level of orientation.
D. Medications taken by a client are part of every nursing assessment.
Correct Answer: A. Multiple medications can lead to dementia.
Drugs commonly used by elderly people, especially in combination, can lead to dementia. In general, sundown syndrome is characterized by the emergence or increment of neuropsychiatric symptoms such as agitation, confusion, anxiety, and aggressiveness in the late afternoon, in the evening, or at night. Sundowning is highly prevalent among individuals with dementia. It is thought to be associated with impaired circadian rhythmicity, environmental and social factors, and impaired cognition.
Option B: Assessment of the medication taken may or may not provide information on the client’s medical background. However, this is not the primary reason for assessing medications in a client who is exhibiting sundown syndrome. Neurophysiologically, it appears to be mediated by degeneration of the suprachiasmatic nucleus of the hypothalamus and decreased production of melatonin. A variety of treatment options have been found to be helpful to ameliorate the neuropsychiatric symptoms associated with this phenomenon: bright light therapy, melatonin, acetylcholinesterase inhibitors, N-methyl-d-aspartate receptor antagonists, antipsychotics, and behavioral modifications.
Option C: Ability to recall medications may indicate short-term memory and recall. However, that is not the primary reason for assessing medications in a client with sundown syndrome. Prinz and Raskind6 defined sundowning as a marked increase in confusion, disorientation, and possibly agitation in an elderly or severely cognitively impaired subject at sunset or when daylight is reduced. Other clinical manifestations associated with sundowning are screaming, delusional thinking, moaning, and wandering.
Option D: Medication history should be a part of the nursing assessment. In this client, there is an even more important reason for evaluating the medications taken. It is a well-known fact that virtually, any pharmacological agent and combination of different medications may induce cognitive, affective, and behavioral changes in patients with dementia. Moreover, medications that are used to treat above mentioned changes may worsen previously existing pathology. Hypnotics, benzodiazepines, and low-potency antipsychotics are among conventional therapy that used to manage evening agitation and behavioral disruptions associated with sundowning.