mental health chapter 11-12

8/14/2019 Mental Health Chapter 11-12

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~UTLIWEAgingCanfusionRevemible ConfwionDdh'hm)Causes ofRever~ibleConfusionData Cdeceion

Nursing Careof the ConfUsed ClientR d t y OrientathnIrreversible ConfusonDisease PragressionNursing CareDepression in heuderlySqmrPt-sComnnicamgwith the Depressed ClientTreatmentMedications

KEY TERMSmau-- -

confusionreversibleconfusion@h+nm]hypo&hypotheniaelectmIytesdata cal ldonpsyehosoeialbistarymental sfatusamnmiii

agnosiaaphasiad t y rientationirreversible eonfusionAlzheimer's &easedepression, endogenousdepression, r e a dpseudodanentiaeIectrownMllsive therapy(ECT3


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Z@@ Chapter 11

AGINGOld age is arbib"aa1.yd&d as sixty* years and older. "I% @~po u pcontainsa very divme ppodationphpf*, mentally, and m o m l ;ally U ~ ~ ~ ,imy peopkdl elieve the s t e r a a d pi-of the aged as debilitated, pov- s idwn 0~~~ and confused.@ronie &eases are more preadent in the a g d but the per:ceatage that is diSabIed is very siilaa. Perm& doe8 not p a d i mchangeasonebecomesold= ItgraduaUydevtlaps throughoutThe ificycle. Iftheindividwl is abletumeetthe developmentd tmb of*age b d nd cope with d e &es$em wcountered, the older perseapill not ijuddenIy become cranky oh his or her six@-% b-arCdwion is not a part of normal gin$ but a SympD~f d&WZilAlthoagl~here are ce* poor elderly, most law adequateincomes nd assea to livewmEnfab& l?xe agingpersonmaybe deal-ingwith a cmentmentalh d t h ptoblm aswellas a g e n d medidcondition,such as heart W s e , chronfc obstmdive lung@we,diabetesThen&r of&rlyhasgreai&naz&sedin thepast f e w p a 6an d is expected tamntiaueto& stead^ This s prinoarily dueto themtimpmvement8 inm&md and childhealth, h e r e 4 echnalo~inheal& aswellas he large andagio$babYhomer pop~hfibnThere i~ a big dBkrence between the old old and J T O ~M.Thosewho are t m h g dxtycfive today are healthim,better dn~a t ed ,~more afnuent and more outspokenthan heir oIdes p m . Theyspeakingup andletting theirneeds b e h o r n Theyareusing porn&powerm ushthroughimpmvments in their lives and p d m k r l y f ~health care.As amdt therehasbeen a surgeof inter& ih the prablem ofthe aged.Thecare of the aged withmental health pmhlenas bas unfom-natdy lagged bebind Deins t imt ion~onad the e%et of m o mthementally dW!essed elderlyinto nii"ghom~s,tyharehe acilitiesandp r e p d m of the p m n d re gene&' ina-te to m e %bf&en Although rhssituationis improving,most of thehealth &+dplioes find little challenge in w~rkhgwnh the elder~y, he morecomfno~smental healfh pro6ledis of the aged,melr adW66m,dementia,and deprasbn ansamsidered to bewithin the realmofthegeneral pmctitionaiUWughthe elderlywho are meW& distressedaremore concenzatedin nursinghomes,manyarebeingtaken careo m heitfm-llies. In the future, t is likely that fewer elder& personsdl e catedforinSWnrsingfacilitiies,Nmes m r w n hgspid~,n inetb~s'offiw, and in the anmnxmiparemoreapt tobe the .to seethesedients.Xfhur~esm abIe to m e o w he dB-f types ofpmblesl~~l..-- w-

GeriatricMental HeathI thzy may be able to save Borne cIi- greatexpensein kz-rmsof time,money, stre%, &%stemnd independence.More than afew lderly&me pmblems aredie ind tbemsel~8 n instimiom ratherthan Eying independentlyat home simp&because the d m i mwaspatmoed

Confusion is not deatly detined. It means different things to d@er-ent people. tJienh canbe termed confused if theydonot ~ W W herethey are or the day's date. If the answer to a .questionis #nappropr&eor behavior does rrotmeet acceptablestandaide, the olderperson tn*SIlbe labeled codwed.Iftheyappearto have ablank stare or$porn 8irn-pledfr&ns, olderpepplewiUm;osta&&ly becomidered canfusedCimtMon i s oneof he maat cornmenproblem in old age andIS x t x d y detrimentalto he qualttyof lifeb n y e m . Colifusionk m t a n d p ~ a f ~ b u t w M t R o m t h e m t e m a l a T u l ~ -nal sf?t%~orsilany ofthe olderpmm's body 8ystems. Confusion isdivided &to fhreemain caregories: (1)c o W o n referred to as deliri-um, rwults &omacnte ilhms, drugs, emotional strew, oren&onmenental a- (this 46 themost common type ofconftlsionSerninthisagegroup andis g a d y wers,ible ifbaed wlyl; izS confusionwdt-ing ffom brain damage, wmmonly referred to as dme* and C3]mnhion associatedwith&&e disordem and pychosis.

Befare labeling a clientas confused,them s e must be certainthat theproblem isnot a result offafactors that mimfcconfusion (Pignxe11-1).tis assumed tha~veryoneliving in thesame rea shares thesame ul-tureand speah Zhe same language. It IShard for mosr young peopleto reaIize that the d t u r e ofthe elderly is quitemerit f h a he cul-ture today.Theamoms ndmannersleamed in youth arecaniedintoold age. The elderlyperson's owncultu~eontinuesto influencehis orherbehavior even though the world a r o d s changmg. Foremnple,

M rs Jones, age seventy, was admined to fhe hospitd twodaysago. Hernurseshadlabeledh e r d e d . Whilegrow-% up in the old country,her f ' y telunch atnoon anddinnerat 10:00 EM, a customshe continued to &e. Whenher dinner .traywas served at5:00P.M., she refused to eatbecause itwasnotherdinnmime;A t 1o:OO P.M., after eveq-one was in bed she demandedher dinner, statingthat shehad hadnothingto a t incenoon Althoughhernurses did


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t wdvd rhis, ma. JDW, WB SWYOWJ Causes of ReversibleCanfuslonb ~ o y e onlyd m fie he^,;h aW- Reversible confusion is the mosf common type of confusion&~lY Pi\- aged Until d&tdy proved acbmvise,a onfusion ,&odd besidered revemible so tha'tattaptswilIbemade to k d nd ekthe causesDhle ll-1).HY P d a s aladr 0fsxpp;en in thebrain.ApprcKimately20 per-centofthe totalOqgenconmption isused by thebrain.Nme *@m o t iveformorethana fmminut@WQWtB@we &re no&pJ& as a visual ~u&%ltio~. storage a% the brain must get s acatinuous supply of m e n .~~~1~~~~ mady fieamal@ngprocess Conditions such as respiratory disease, cardiac pwbIems7k=&yp

ineo- awos% f canfusioninyet motherVSJ? roidism,hypotdop, ndanemia&ern t h e o a e nsup& to *bo@the&&of i w e g ~WWiry@ and thm to the'brain.IseeaflSe&emd f heaidg4 Hmothermia is a lowaing dfthe body temp- & ld-rangehere s dw& po&izay 6f selxmy erIy Ev -itib?. to thiscc1nditi:mThey donot sense cold as ew-pidual turps ka fpvoritepm e otshehas to up he*bh3@ ily as younger people do, andtheir tempmmm can &OP to--eapthe ha ~~it&", m .k ayer OUS Ie-1~9~dddy. P1emperatp-emt?p1029 wn~itI@ed,m-aeraw.&s pkon ear hese d he th- and it toot erinpresetitas c~nfusi~nnthe lderlyM ) ~ e ~ m ~heh& a d@ p d t s 'Thtrst S ~f?en=ig IL~~yolderpeople.Theym y &beatyHTe ofmenie de]:&pmn is a,&ii& rnt@?,$mpol'tane~o them itmaybe toomuch trouble trt geta Brinkqw~ is, fr - ma ne&y 02waterm y einae~ssiljleo thea ehydxatia& a very dangero*,fao iqe &a den&mwsund,, tiiiea~y-for=P@ , cbik-iiflon or the aged, ,&d fhe ~nlly'mptom aybe confusioaT&to fOOrgere&reor we.U&rtnnately. when fie is W P ~ ~ Prue when electmlytes a& involved. Electrolytes med~e~this~&~~!5he isWXAd~*d ~~ em i c a I secwary for the hctlo- of thenmea. a g hq

usstadmitt& the ho$pit& aderlpdimsmaywaka:Q. in balancewith eaeh other, confusionm h ..middleof%e night and wheac they 'ng$^~gof bed and tMan&:h,anm , p ta rient& d W *Way-be , @ ~gure s r&g & ablank lost look on@ss& a m w no doubt be cantiidad confusede andD -prob4wility. be pput ba& &j bed andmU&Xeded& s !*ey~d;mlost ;tnd nw,bg unlwwiplgl~&d. ~ ~ ~ o m ~ ~ r n l r a

to tbie&dta@~~iS. HM&i&Jj 6hmkt+iis@eei1jrad cek'ffph,&,"g&Ju t p m r n " ~nm.c;m. . ...~WIJD!+&&;r*$ien IRmectfVeEr#m qellPuft@o@t~@ticiseova fack.of~&&~lwDFU& AdWrSeIV:+ffb~ ialnewfo@m@nf

,n Dsrq@st#ht ,C O G ~ B B @ ~ ~. Brrcinishesbrain cell fun&fanfng$ensnsoly.laepriw&n ChaWs bmmenvfr~nment.DegrW$a,p slawsbraln cell .&nettoningh1nutWcrq DtmlnTSh%',b@thell ftinctloningfns-thebrain's environmentP a , . .. , I . . . , Dimhismesrirp cell furicf15h1nd as a

.*L'.. Wult oistress ef~aots.

1 CON EFFECT


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, DRUG EFFECT

mnhion, part of which is treatable. If drug-induced confusion fs rec-ognked, another drug canbe substtbted that haeases dariQ in heclient'smind Too often mnfirsion is atttibured to old age and is nottreated at an.

Mrs. Stevens, age eighty&e, was visiting her daughter. Thedaughter noticed rhat her mother seemed mnfused. Shesether suitcage down and the next minute could nor $nd itShe turned d e faucet aq saying she wanted a drink ofwater, but t h a quickly forgot and I& thewata running.v

She never did get her drink Even though she had been infhe house many times,she wnld not seem to remeruberwhere the bathroom The daughter to& Mrs. Staznsto see the doctor, who admitted her to the hospital.-Mrs. Stevens had been on a maintenance dose of digitalisfollpwiaga heartam&severalyeafsago. Shetold rhenurs-es that shedid notwant h a heart pill anymore.Because itwas believed that she needed the drug, itwas given to herby njectionAs time went on, she became more wnfbed.hally, the doctor told Mrs. Stevens's datlghta that ahemust consider nursing home. placement for her m o w ."A f t e r aU, UT mother is eighty-five.It is -time; the doctorreasoned! Thedaugbtpl-relnchntlydid asb a e d Shet h a


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chapter 11

sold her mother's house and disposed of mast of her fur-hitun?,clothes, and household goods.Mer aIZ her motherhad no use for them anymore, and she needed the moneyto pay the expensivenursinghome bib.In thenursinghome,Mrs.Stevens told the newnurses thatshedid notwanther "little yellow* the digitalis.Whenitwasbmght to her, heclenched her eeth and steadfast-ly&wedto takeit% time, o injectionsweaegivenThedrugwas offeredto herwhen itwas due+but if she refused,no attemptwasmade to f m er to ake it Mr6. StmmS'sconfusion,having been caused by the digidigitalis, began todearup andeoenkdy shewas discharged.U n f o r m n a ~ ,by that- she had no home to go to and no belon-to callher own. is happened because the confusionwaswrongly assumed o be irrevmible.m.VIL &red a littlebetter. H e w diagnosedasAlzhdiner's disease. He was confused, presented bizarrebehavior, andwas hostile toward his wife When the chg-nosis was made, hiswife gothimto sign a power of attor-ney and then admitted him to a riming home, Becausethenursing homewas in wfher town, the client had to haveanotherdoctozThe newdoctor sawno reason why pheny-toin OMantin), an anticolrrmlsant had been ordered andbegan to wean the client from it As the DiIantin level felLMr. Kobeas'&ion began to daar up.The nmi& s M n o M he change ib his behavior andsoon questioned his diagnosis They asked the dodor toorder a serumphenytoin CDihnth) lev& which was doneAlthough hrlr. %Roberts w e mproving,his Dilanti~ e dwasdangerouslyhigh.With the problem and treat-e& however,he continued to improveHew a t to seniora mtm and to c h d ocials Hemademany&ends and one lady fiend inparticdmmthe got bis p o w of attorney back and then decided todivorcehis wife in orderto bewith his newMend. HeWable to leave the nursing home andmove inwith his kdyfriend fara happier endingIn addition, wimplethin@ Ekeconstipationpain, immobilit~~other formsofemotionaland physid stress canalsocam ~ n f Uin the ettefly

Data collectionThe thsf part of fhe nursing process is assessment data r0lIeetioncontibutes to the totalw w m e n t The LPN/LVN gathers data andgives infmation to the RW. Before doing any assessmentfor confu-sion,thenurse 111ustseethatdients have theirglassesandhearingaids,if needed. The nurse also must be certain that he or she knows theanswers o the questions. For instance, to test long-termmemov thenurse canask 'What isyour birthdater Clientsmay be confused andhave no idea, but they mayknow nough to realize that the nmse isaskmg fora date and give ane.To recognize a change,he n m e mustbe aware of the Jient's his* and past behaviors.This informationshould be contained in a good psychosocialhistory.

A psychosodal history c o n ~ u t e so determine the type of con-fusion and is the h t tep in asseasingconflwion or any ofthe otherproblems ofthe aged f there isreason to believethat the client is con-fused, information should be obtained from family membw or atIeastM e d y them. It isbest to obtain thehistoryinan nformalset-ting (see Chapter 7 for interviewingW q u e . 9 .The familyandlor clientmust firstbe awareofthereasonfor thebistoq Time should be taken o establish some rapport. This canbe

done taking a bu t noncontro& subjeers like theweather.Thebasiciden* information can be collected eacjlyafter thatQienfsname, ddress,maritals ta tus ,nder ofchildren,ebgiouspreference,type ofwork done, and educational evelare example^ ofbasic identi-fying information@gm 11-31.M s m e n t ools are &o availabIeCbmmanlyused toolsaretheBriefCognitive Rating Scale (BCRSI and heMini-Mental tatusExam(MMSE). These tools look at changes in wgnition orm& s t a tmTheminimum data set (MDSI or another appmved form con-'aining the same information,is required to be wed by all nm!hghomes having ce&kd Medfwe beds (see Appendix). It is a compre-hensive assessment tooL but it isa minimum data setand other infor-mation may be needed This assessment must be starzedon admissionand wmpIeted within f o m m calendar days,The assessment, alongwith its accompanyingprmcols and %ger rapsheets, help thenursedetermine needs and tmsfer these needs to the care p h otowlshelp the nurse understand theprobIem he or she has assessed and toabout other problems that might be related. The rap key gives

rime guidelines in care planning.The MDS must be monlinateda nurse, but 0th i s~phe s aycomplete aspem of theMDs.


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Geriatric MentalHealth-

Arizona Elks M@r Projects, IRC.LONO T@RMEAREUWff DATE:SOCIALHISTORY Hospital NOTne tnfoymation on thts f o m W be used solely t o alU in heacUusment~f your relative and youto thenursing home 11% YOUare not obl lmeflta anewerany auestfons ha t you d w m ntruSIVe or U~neCemW,urai lInFormationavenwlll be Comlderefl confldentbl.clienfsname: Dateadmttted:Age: mt e of birih: How long InTucson:Marl@l us: M I I W I 1 D f 1 St 1 PreulousaW:m~iglotx c~ergman'sname:ResBonsibleperson: andaddress'.amnosis: R,&WOnShlP:I.A. Tell meabout

befwe hem m e n.Wna9tyseOFpewonw s hhV3(How WouldYOU deSWbB hTma)

9. HOW waul@ oudMCflbe his kebtive'5N&W RdatMnshlD:rel~onshlp lth hlsfamHV7IRremeyabletovisltP)

C. HOW wauid W M ~ i850it)B his~ea%onshp wffnprtgnds?fire Uteyabie0VW

D. was rel@ionanImPorta~ yes t ) NO I commentpamrm nrs rife?E. WhatllindofWOrkdldhedo?

(EdudlOtlal eV&I%iIHW m g UWPIOW? tMred?)

E HOW id neusuallv handlepmbtems Or dlfflcUl8eSln. AFTER IUNESSA Datew d n s kB. whtcn of me dhaneesmatYOU

hsye&iced concernedYOUthemom

C mat factors didvou considel'beforedeciarngon nursmhomeplacement7

UI. M E 5 WO DWJKESA Doeshe haveany wlents?

tsnglng, dancmg, pslntina.writing, 6tc.L

FIGURE 11.3 psychosocial historyand assessment samples. IB. WhatthTtlghdoes hepertlculaflyuks? tm,

OBfSCts,auituaes,amons,actlvit?eslc wnat thmgs doesneparncu1ari~sl~ks?coblac%,attitudes,aetlonS.adlvltier~o. DffiEflbenfr dany mutlnepriorto qomlng o meEBS.e. m a tpOSSeSOhsaremostImportantto him?

LONG TERM CAR#?UNIT PSYCHOSOCIALN U A T M NName. [email protected]: MI Iw ( 1 D t s I 1 ~ g eAdmitted mril: Adrmttedtoward:I.C I U I S S T R E N G T H S $ R I D ~A. Pm71vsuppori Yes1 1 Nor I

I wno was7 comment:2. Frequency3, Cllant's lieact~mo vlslts ,. . .a ~amllysamontoc~ienr - , I s ., I

B. Aalument to llllrsss .a4. Knowl%dgewtllnesc; I uhaward I I tlmlted

I ) modwte I I well aware2 Stage of loss t t denfa1 I !anger

( I baraalh I acceptance3. IhdBPBndehtasmuchas Yes1 I NO [ )

possmle? cornmsneC. AdJuSmm@o the nstlNtMn

I . Aceepts therapeutic n s ~N O ( I~roenrn comment:

2.Aecspts need to b~ fn yes1 I #o f Inurstng home comment:a occup~es ime YBSI I NO ( Iconstnrmweiy comment:

D. Sdcfallzation1.Relateswell to ather VBS( 1 NO1 1Olienk ~0mment:2. Paytblpat~nacthffies Y-1 ) NOI I

commentFIGURE 11-3 Continued.- 4.-


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9 Chapter I1 I- -E.meml CauacltyI.mert yes( I W I I

P,orlented TIW I 1 wrsun 6 1 Place I I3. AUPTODPF;~M otlons Vest I No( 1c n m m

pdstwan& 1 I PreserEevents I 1

I Ia. MBmW

F. Pemna l chaa@frristi$sI. o~~tge~naes I NO I 7. Mature Yes1 I Me1 1 In inteu1gant Yes l I No l 1 8. S ~ R S I G V ~ Yest f No t I3. QUlet Yes l l No l ) 4 HaPPV Y e% ( I N O L i4.~ggmwve ye$ I I ~g 1 "1.oemawing Yes 4 NO I 1 I5.APUTsTG Yes I 1 No ( ) 4 % Coping I6. Selffhh Y S ) NO [ 1 ~echamm11.UKESAND

A. ACttVR&P .0. FOO(1:C. OM@&.D. AmtuaesIll. FmLY \I ), IA stageof10s ~enlal( Anger I 1 18ar9emS 1Dgpreslon ( I Resignation 1 18. Rel&mnnnlpwrtn slienk I I"IV PO'PEW1IRLPRDBLXPIISk la^^M s t [ i n ~ ~ n I J L

GeriatricMental Health-he p~~ history provides a haelink to u\thicb presentbehavior can he mrnpmd It proaides ihf'omatiidn on the client'ssrrengths and sup~oftystemavailable t?shim or her. TheMary.canhelp det&dnewhe@er the confusion is rwersibleand pmdde duesas to the cawe and Wtment of the c0nWan.The hbmq can betaken at a f o d but mom rrftenthe inftnm@i(mg o W e d&ugh inEennalc o n ~ t i o n sEigwe 11-%I,

Mer rereipcing the basic identityWrmatio~henurse can asktheM y ernhemajm problem,the ehaviorthatledthemtobelievethe clienf needed help. How the hefam1y views the henfbion andhowthey ta& about their eIdwiyrelativewill give the nntse anSdea oftheamoun! and m e of fa^@ support avafkble. The number of"Mendswith whom the clierit still bas hasntact aad the strength ofrehgotlsbelie&arealso indicators ~fmpportvadI&le to the client

To detaminewhetherthe pmentbehavior is a w e I he nurseneeds toh o w hat the clientW& Wtem o a i yWashe outgoingorolbnw?Was she fastidious or sloppy?Did he slwp well at n&htawake often? TXIas she practical or a dwmez?Rid he m abwadrugs? Dfd shekepbusy or appearbored?Did he hold B ~Broblemin or did he talltthemOW t as a fspicalday.like?Concerning~e h e i o n , he nwse shoukl ask que%timsuehas the ii,Itavin$:W e n did the confusedbehavior stiu~?~a s theomer gradmi or s u d d d Tan the funfly think of Borne sW&event &at happened us t before the con hegap?"%&at afb&avi~i+oesthedient e&iiit nwf "W tbeca&sian gottenWOMor betterr"


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3.What sari? are we in?e \what isto&ys date15. isthi this?It is possible for a person to m a kamistakewith the day's dateWithout bebg&ed The par is anathermatter. Ifit is Em2 a d

the cIient says t is 1945,mnfUsion is pmen t Thne is themost eas&lost sphereoferimtaion; therefore it is important to detgrmine allfair sphw.Abstract Thinking.Thb s the abiiiyto generah anti categodzethings.It h htgher cagnffimpow~lrhat is loa when wnfusign Be@in. Ib resf &sttact thc clfent ccm be asked k, in- aptoverbsnr$as'"Ilze~ssahYa~$reenerontheothet+side"Someatherpmcibswe % "atitchin t h ewvm nine" or "d& mtyourchickensbefmtheyarehateheddEtheEhnt is stiilaMeto&&k&stmet$, heorshewillbe ableto generabe thepmverh.Forinsma!,the cornbedpasonmay interpretthe k t r o d asTh e neig&mbaspeeherg w P This is concreb 'ffthe clientk ble to g en e r h , heox*hed ay that it means that pesple o h ee o r h a ashiroingttimgsbEtterthantheybase.Amorhwwayto test fbr tib$tFact thinking isto ashsach quektio~~as

1.Hm re un apple and an q e like.?2.How area bid and a pIme alike?It does n8tmatter what fhe client mwem as 10% ashe or shevsesthewordsrhq.both.The client cmw'Thgrbotheat,th$i.bcrthhave hair,ortheybothmakegood pefs!Wbaf thenume i s lookul$ for

istheabiliykogm aW The catha hatrand thebM has feathersdisa~~hcreteassluer.~he&ientmpondirrginthiswaywouldfailthetaatH p a r e d t w ~ uen& ifBngZishishis OF hersecond1angu~,he cUentMtinnot m d m d hepprouerb.Judgment.The client inrho lorn judgment ism d a A person whoisnotc o ~ w i u g i v e w em to hefo11omhj~ttestiona that reflecthis or her underspandkg of s a f q What would do i f p u sinvSDm%anedropaI i g M &game bn the caipet?s"Howwuld yougetsomethjag bicrma highs h eState of Consciausness.This area isobseryed.Do &en= showaninterest in&bigs a r m d them? re therial& and amre


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Intellectual Functtoning. Thedient'g abilityto cnmuniEate isanin&cationofhis or her intellectnalfunctioning.Can the client carry ona ogioal wnve~sation?oes he or sheuse words conecw IStk can-vemlion cm&.t&t? h e he an- relevmtl U: the dient & post-stroke, he client maJT have:sa afmda-itn k b i i o r d ast eqmlences (mmpkte or

partidlagnosfa-failure to req@ze or identify objects. Sensorgabilityis intact.aphasia-difficulg or i n a b w to expressw d s andphrasesA couple of stherways to assess i n t e g d h ~ t k d n greWsee if the ean o h t least aUhree-8tep iss@~CtimTake&spaper, fold it inhalf,then oldit in balfagain,andthen earitalongthefolded Iin& isanm p l e ofamdt4,Ie-step &?&on The clientcanaIso be aked to de a m a t h m a 1problem such as S& threes orsevens.

Emotions.Then m e mmt obsemethec l i d sbehavior.Dee8 i8rninappr0priate-lIf it do= the numemustThendetamhe wh&wiS i~a &mge in b&ai01B~ardleessf havbiz= ~r bppropriilte theclientsb W m , be or orhem a e tonsidered confused unless fhabehavior is a change.When ShirleyAdam, a&eeighfy4woIwas admitted to thehosph& she was in need of a bath. Herhair war; messedand clothes were db+qand ton Shortly after admis-sfon,shehad aciphed a stack of paper -6, toweb pins,match pads, a d ens.Shshad hiddenthem inherbedsidetable ThiSbehavior dow mtm ~ e ta q t a b l ~tand@& SOshe would most emtaidy be cansideEd confu8ed.However, $8 a o ahis- had been Wn,itmnld haverm d d&at $hirlqbadb m hiswaydlherHe. hewasbrought up in a very poor fkidy. dpater was a pfdi)mcommodii and there was little for bathing md wahingclothes. .TheM y ad ver$litile,$0 hq savd whatmaitem they couldfindTI&%as$one in case &erewas a usefomd fbr&em W.Sbirley'g's action8were p a fher life-longpa- SheWBSnat r& confused,Ras the.&nt reoently s h m & g f ~ ~f depression, anKiq~rpa.rm&? T h e onditions,vvbi& w Wablerhaoebeen lmotraWc-e amfwioa

Hwrtmtd lung Heartaqd Iungsoundsfunctioning CQIOTndcanamonof the skinPualltyof the pulseand refpirafton

Pain

.-1. Vml signs.These are very sensitive indicaton of change in the

state of the elderly's hcalth 'I3r.v can indicate dehydration,poor circulation w d the prescnn- of disease2. IIraring.The nurse must ask simpleyes-and-noquestions. Ireor shecanalso ask a clicnt to repeatwhat was heard.


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5. Nutritional Sttitus. Has there been a weight change?Are thereloose &nturs or bad teeth? How good is fhe dienfsappetite? W"nat 1 of foad ishe or she eeariag? Who doesthacooking? How many mealsperdaF

6.En*-% Ha6 there been a recent k g e m theclient'slife'?Does hc or she b e w t h i n g s around? IsM eenough S~TJ.WVtimulation vdthout being toom&?rethere orienting ifems amwd such as docksi calendarsdendnewspapers?Ts thm awindmm the clientcansee night andday??Is h e a night-lightturned on?Z Eliminatim.Is&me a problemwithwm ~par ion r diarrhea?Is fk e &ent able to get to the ba&oarnT 18 there embarrass-maat aboutusing a bedpan?mat does the &ent w u d y take-fra constipation?

8.Paia, Is pain present? Where isit?When did it start? Howm e s it?Is itwmtant or %term%fimtP s therea nwgthat priggem it?D m heordered medication help?8. Mqbili@Thenursemust dewtnine wherher clientsa ~ ebIetowalkw i d or without t19sistancc Me They like@ o f . r ethey able to turn hemsdw inhi?

GerimicMental Health !

20.ChronicDisease Has therebeen a change in any of the pres-ent chronic diseases?The nurse needs information about thediseases that d e c t f3ecirculation or endocrine s y s km inparticular because theseare most likely to cause confusion

tl. Medicatiom.Tt is important to determinewhat medicationsthe clieht is taking. Is tbe client raking any over-the-counterdrugs? When it is determined that confusion results, thenurse should think about medications &t There are manymedieations that cause amfusion in the elder&.

U. AmQxHowmuch activity does the client have?What kindof activiiy does he or sheenjoy?The nurae is only one of marg who assist in determiningwhefher confusion d t s . If it is determined to &st the confwion

should always be thought of as reversfble. The psychosocial l & t qand the assessment shouldgive dues as to the cause.Treat the causeand the confusion will di8app;n: It is important to remember thatthere can be a reversible coconfusionsupaimposedon irreversible con-

NursingCare of the Confused ClientRwmible wnfusion canbeprevented. Nurses have controlwermanyof the aspect4 that can cause or contribute to the confusion Thatm e w there ismuch theyon o to prevent it Vheneveznun= havean elderly client admitted to their care, t h q should scethat theclienthas orienting item in the environment such as clocksz alendars, ndrealityorientation boards. They shoula encourage*its by l k i l y and&ds who have familiar faces. It is irnpoRant too, that they makesure their elderly client has sufficient fluids. Nmes must attend toother activitiesof daily livingas we& such as adequatenutrition?goodhygiene, and physical activity.Be alert for sundownersyndrome.Thisclient confuses day and night and wants to sleep aU day and be awakeallnight The clientcan become agitated and quite difEicuftto redire&Reallty OrientationReality orientation is a pmms by which confused people arereminded oforienting cues in he environmentThey are taught to usethese cus to reorient themselves in time and place. Reality orientationgoes on for tww-fow hours a day.mmediacp, 8impliagr1and con-sistency are the main @am.mmediacy means that the nurse mustrespond to c3ienltsquickly.If he or sheasks them a question,shemustallow them time to aaSWert but not so much time that clienf9 loseinterest Clients' q ~ e ~ f b ~ ~ust be answered right away, and they


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GeWilc Mental Health

As with the aggressive client a l l tasks need to be broken downinto simple steps.Thedirection$ or each tep aregiven one at a time.Clients rhenneed time to respondTheir cbncentratlon is limited ivldmemory for recent events ispoor, sq it is a good idea to call confusedclientsby their firstm e .Generally, the earlier something is learned,the longer it is retained.For some clients, reality orientation takesweeks to accomplish asimple change, and for others a takesmonths. Some clients do notbenefit from itat all. The importantthing s that thenursenot becomediscouraged. Withoutconsistency,the processwill defintdynotworkThe reasons fca e~nfusionnd the stage of the ilInes6will be factorsthat will affect the appropriat~ess f reality orientation. If used atinappropriate times, it can rustrate the cIientReally orientationgoes on twenty-fourhours a day.The client istold where he or she is, the day, the date, and the nurse's name firstthing in the morning and several times throughout the day. Otheri n f o d o n that can be induded is the time of the nextme& theweather, or upcoming events.A realityorientationboard is oftenpasted in a prominent plare(Figwe 11-7). It s e s o provide the same orienting information Theboardshouldhave a colorfulbackground.Itmnsrbeat eye evel. Itmaybe necessaryto havetweboards,one forambulant clients and one fortho~en wheelchairs. Needless to say, all reality orientation boardsshould be current

IW h is is h e E lks Long T e r w Care CenterT h e d a y is: Fr idayThe da te is: M a y 8 ,2002The c i ty is: TucsonThe state is: Ar izonaThe nex t Ho l id ay is: M o t h e r s D a y

1 The weather ou ts ide is: Su n n y I


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WP Chapter?I Getiatilc Mental Health

Mimy institutim aJso have a formal oirgutation clas5 to supple-ment the twenrj-four-honr prue;ram,The classesme hdd ti^ ad-lighted, quier place 61&.en to thirty minutes each day, %ch d ms h d d be limited to h e w sh p"p1e Besides enmm@g redky,these @essim re used to help clients r e l m a task such as tellingtime?@g s h o ~rwritingwith a pencil Audio&nals such as pic-mm, word and picture cards, arge blo* and puzzles, felt boar*,mhmm, and a tape r w d a s well as mock-UPSof docks and calen-dars, are necessaq tomakq the 1es8m con-, h p e dshing tom a ormalpro$ram must beginbyc o ~ ~lltheau&o andVjsu-a1d a l vailable.The elass mustbeweli planned, Theleadmshdd have a setgoaland objectks in mindand should go slowly to allow eaeh client toprogress a c e a b r her ab&ies. Theleader should try o keepthe class lively and maid putting my' lient on tkes p d If he oz she&a &nt a qwtTonand geD no response, hetxZr&eC a n q 1 9 f i*Iwould h t o elpyou idmtf@ hisor read this or m r his?' what-

emrfhe ase may be.The dea isk?p m e loss of selfesteem@cow@ ammrem orwm attemps at ZB shouldbe InajsedThe%qmtanceof touch should n e w be forgo=A typicalseasion maygo ike thL%Nurse "Goodmorning,John Stevens! Sbewauld thenpro-&togreeteach clientby~ldmk emeddngtheimpr-W e f much, shewould d d e theirhands. l k b s OLErealityorientation&a Itis pIafinedtohe@ h p ~ V ~ m u n -ory andexercisethemindIt is ela;aeno1&Ckinthem m -ing. The sun is shining and The t m p m m s e m f i v ewees..XSaan,mwtenmNhatmon@b?Vthereis noanswerJshewouldwait a minute andthas;tylwouldm eto help you answer that qne&on, B m t is s u mm an mD o y o u l i k e s m w B m ~ X S a m orno, hise f b td d e phed A"Bfc0u~seummer is agreatWe,isn't it?Georgq canyon&& of somegoodthingsto do inthe summ&eT If Go* says "G0 a ~ ~ @ i d ~ ~he aursemightmppd with "That5 dght W s g m t idea Vecoulds i thdesunor takeadAndre~r~do~touenjoygoing outside?Namesareahyapmentioned~ w h ~ a q u e s t i o ns ob?bed.This alerts the cliJiept to &e 03- ngatiion. m e co* dli-shuld never be given a nkhatbebp he care$=, ineluw Top;""Em: of 'Deadeat: C .

8 7 , / r ;t

NotaU &ntsMm e e d o fhe ame degree?and some nmsucceed at all. It is essential that the ppersomel d&g with them donot become&conraged Redii orientaton tskes time.Reminiscing is an integral part of orientation and b I v a hediscussion ofWe experienwYaithina group. Because the person withdemen6awill rememberpast eventslongerthanCurrentones, the pastwents provide a topic for communication Gommunication ismeans by which people validate their self worth If a person f aaccepted by a group SewFwteaa.d l e improved. Most ofken thegroup bacomes supportive. Their acceptance acts as a hS e r a g h tthe manly lossm felt by the elderlyVerbalizing about We experienm give8 clients a n opportuniq torethink andreorganize.theirEm. lloeyfan hen see themeanings ofsame pa ~ tventsand mdnew m e w s or ofhers. These rn-sh&lpto &te thewoah fffthe clients' h'es.aemnsw provides a means of e f k t b nteractionwith thementally impairedelderly It also provides a tie te presentday r&qsThe n m e or therapist takes people kom where they are n memoryand guides&em to fhe prpresentIRREVERSIBLECONFUSIONThere is no sure way ta tell whether a &at has reversible or ine-vexsible eonfusion; therefore, it is bRst to as$ume that confiasion isrevmibIe qnd rule out all possible mUses. The nnrse is only arre ofm y hovvillpaaidpate in malting fhis detennkdoa but he or $heis in a position to &many dues.Immmible eonfusion ismned dementia,0C brainm o m eCOBS), $Mile&anent&or, incorrectly,seni l i ty . S ~ S i m p l y r e f e r 6oold age. The was popular when dementia wes believed to beanormal part of aging, but nnfurhlnatdyitmnahs in use.The cause ofirrwmiible Eonfafiion is brain damage. '&ereare several. causes of brain datnage, but the most common fsAlzheimer's disease. Other major causes aremui- or smr-a1smal l strob,which aceounts far 2b t~ 25 percentAhheher'smult%oEarctwhich a r m s or5 to 20percent;andan others,suchasamiosclerosis, Creutzfeld-Jakob'sdisease, and adult hydrocepbalu~,which account for 5 to 10percent Eable 1l-f).Mukih&ct refers to a series of smsU vascular accidents tm-mody called si?vk.Themost common cawe &strokes in the elder-ly is a blod dot in oneof the brain vessels. Theclot nrts&&w-genandglucosesupplybebind i t Theresult isdearh to the pan oftheb rm denied mygen. Fkfmrhagea can also be a came of brain&-age but aremom apt o o m n a younger person,


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Gerlatrlc MentalHealth "-

I n t mml a lneoplasm

Alzheimer's

pick's

..> . . hemlplegpWemhs lon , dlniness,. - ..o r e hd t i c hypotenSief3, :beridaclles, %t@pl,qes6 ,i

usually aff&.gliomas HtaZlacbe,&~!&l%ibh$.. 4causeut@hwb blurred~tsten,severesnx~&~~ n h e ~ i w d ~ n v o i y ~u$o$ ..*movemen*,~ l o c ~ a g enne ~~ogmrsslveaemtatton,dmlnwe of erassesPeetwhen walkingcere~r0splnalluid~lowmtingvlrus. R~P~#PT@Q~~.@A,mu.ple atroppylnjuw lmrn,@latenonprogres%ivedetBf!oraMon

iMulilpte May tiav? ,beep ,o@@a, ,.,,,sevare.paln, nstdlau I ,begmnlng, grog&sl$gle , :,Ydeteriotatron; .;..,, . . : j 1~ t ro p h vf me rrontql Progiesslve freveBID@'and Gemporal lobes& memow ~ossand! . ;1:ithebmin, aqo"oig,m dptgloratlOn dPwttn a~aono~tsm i n k m I f w 6 i g ~ , , 13'

When dementia results from small sfrokes, the m e t is abruptConfusion starts as soon ss the blood flowto the brain is jeopapdidbut it doesnot increase. Each time the client has a small strokebe orshebecomes moreconfused. Therecan e someimpmvementas brainedema subsidqdbut the client never my recovm. Alang with themental symptoms, the clientwill have the usual physical symptem~fstroke, such asweakness,pmalysison one side, or oss of speechArteriosckosis is hardening ofthe ftaies.Becausethisresultsless blood going through the vessels, blood supply to the brain cen6 iSdiminihed. Arteriosclerosis is also accompanied by high blood greSsure. Ifthepressurebecomeshigh enough,brain hemorphagecan -Creutzfeld-Jahb's disease is also very r e t is causes by prior%and theWUIS~ fthediseaseis rapid.

h dulthydrocephalus, the k a ddkn in the oe9sek that drainthecerebrospinalfluid fmmrhe brain Thefitridbuilds up inthe kunand c a w damagetothebrain&. Thedamaae &adv done m o tbe repaired, httt futllre damagew be p m t z y~m&calIy iacinga shrmt in the bra& Ag long as the shmt remrdna open, it drah&thtt excess fluid'Alvheimer'a is by far the most cammon cause_ of dementia,a~countingor E ro 60 percent The ornet Is8bw and gradualB thenp~~~gmsesvith itlaw@ngconfbion until dmth QCCLBS, asuaIIpfrompneumonia, d n q rinaryhfectbns, or other complicationsofinnno-bilits.Thef w ymayredl same &essfirl eu~nt, uchss s u r p y , thathappened shortly befine &e mConfon became a p p m Stress doesnot came demenrh but tf seems to s p e d up the progrim ofAlzheimer's &ease, The co&d~n awming bgfm the eve~tmayhave been so tilight rhat the -paid M e a f t e n or pasmi it a f Fas no& f o ~ ~ .Thexe am wo major changes that ocnrt m &e tend n m u ssystem, Deposits d a tarchlikeprotein in the brainme 5 m n a m psy; These plaques, a% hey ared& ntm&e with t r m s i o n ofimpulses through the nem die, Theneaiby nemns Eigme 11-81,undergo the seamil dban$e.The nemon abtapbiw,and the axan andWrites then map ammd tbeEeIls and entangle&em in a mass oftissue,Thesearea W y& $a~.TheydevelopmostlyQthe COPtexwd cause forgettingofihe high* C O ~ V EunctionsGrst

FICURG 11-8 m e euron. InAlzhetmerers isease, t h e axan a11ddendri tes entangle themselves a round the a t raph ied bodV ofthe cell.


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.- - _ _,3Q6 Chapter 71-

The muse ofthe & w e is not known, ~ L Gearchis on%O%.Swemltheories have beenadvanced,b u t n e u m m m m i ~eemtabe&e mW pmmisiog at fhe mdment The posqible factom associatedwith the dwdopmenta f A & e b ~ s&dude:e her^.A genehas clearlybwa dentivied that muses one typeof &z&imer's disease. Clientswith De,wnwngyndromealmst& d y developAleheim&s E heyb e phst fhirty.Isi r$ge.TheM d e n e ofM e b d s @a w e swithge. Upeopleget 0 1 6 ~ ~hey s e a obemme mare vulnerable to thc dbea&e,m I& nIuiihm crmam&rn tn & &miinThese has been .aaincreasedduminm (Ymc13ntratbnhmd infhe br- o f p wplewith z&l&&f$ &ease Fora time itwas&ohought anincreasedingaiion of aluminum might be the culprit P d e r, studies have shownthat it is p r ~ b b bresultmther =thanmuse of ba na na

Slopa-@a&ngwifirs. B e r a ~ s eyrnptamsof meld-J&ob 'S@to ~~s disease, some e t a& have looked atas a came Thus kr


15/36

I Nurslsag Care PBa;n:The tlient with kizlselmer'sDisease IJ e s bRobbb, a sfny&gh~ye%r-oldormer $choolte&er, isadmittedto heShadyOakNumingRadlitywitha diagnosisofstage3Akheimefs d~sftase.he isawornPaa;ed by h a seven-tyyearaldhusbandfoe,andaaugh6erwhoareasd5tb1g hertowalk by inta1ork;irig their arms. The dau@m states thatJessicahas becomepragpessivelymore fag- a n d mnfusedover the last foury&s. Sh e rwedygot last going to thegr6-cay fore in he mall towwhere sheEm%. The policefaundher and mti5ed the daughter,The daugbrer relates &at Joereinin& hes to bathe and to change her do- b hedrmlebhemelf,sheat times puts ha ra ontheout6irteafherblouw and her sacksm r her shaes.Twoweeks agoshe staa-edvvettinghem% As the danghm elates th e information othe m e , erm start rolling d m oeia6%FinallyIhe says1donot to admither, ut her we isheea- taomuchfor me Recently shehas stamdyehg at mewhen I&ageewithher.' ZAe nurse completresa thorough assesanem aacer-taining whether data indicate p~9siblewuses for mmibleconfY&on. He relam his assessment dab. to thephysh andthey agree that there is no euLdwce fm rwemiHe c&sionandthe diagnosis is %heh&$ disease.

I L Jessica bathe hm&three times aweek [widin hreew*). I2. j&ca will applydothiaginc o r n order twfthinsixweeks3.


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r Nursing Intenrentions RationalesDetexdne and mntinuewithpresent habitual bathkg timeandmannef.Develop a W q rientationb o d far Jessica and statebath dayan appropriatedays.Assistwith thebath asneeded.

Decrease exfernal stimidid ~ r -ingbathing taskKeep batlmom and watertmpmm wann Ea dentspreference

I Evaluation

prment memory pattern willbe d om e d .A reality~rientatisnoardWin.'1assist in dentatingTessiira PO, Idate, time, plaee,a d ath $ay;.lAssistance with d e ba&!

focused an the wk at ,


17/36

Eertatri~MentalHealth &I&- - d L-

F I G U ~ 1-15 ContriDuting a e s o elderly sulclde.befote their death. Although hanging k+ the chiefmodeof d& forelda1ymen,inthe p u p eventy-fbet~ eighty-four here has beenan n m e ndeathsdueto kirms.Spousalhoxqicide+uicideoccmrswith lnanyofthe perpetcaro~~ein$ &e eldetIyp e r m whohas takenon d ~ eegiw!role.Depression b robab1y themo&cmmon problem of the eldet-lyand the mest %as%treated,yer ffis the most underdiagnosed andleast treaEd of d.OPher conditions maskThe.depression, and $ymptam, if apparenf, are often no*taken seriouslpsvmptomsThep w n who is &pressed has prolonp3 or etrtrme sadness. E isa g e n e r M sadness; that i$l it b not mmected to a p a r t l ~oss.These diem are wT&dram and s~mtimes gitated, hostile, andpmne to xumhati~n. heycan also be confused Called psendode-mentta [Table 11-63,depression inmhres amclactionin acttvq"obses-Smemrqyhg an d sleep disturbances.The clien.tZsabiliitytoreason andmember is dhidhe t l ahd he or she ismotepessimistiticThe elderly depressed person usuaUafhas more physical mm-plaints. In In& h q i p o c h ~ B Ws wmmeaPhysical mmpainta:e meven bethe symptomofdepres$ion.Eld* depressed c lh t s aremore apt tp be *qStipa;red. and theym venbe inconihatt


18/36

EwkttVc MentalHmkh&&

lmpatrment is inconsistent Irnpalrrnent is cons~stent ndprogressive

Onset is mpld Onset ISstow and InSidiOUS --More llKelV to answer quetitons More likely to cover up bv givlngwith "I o not know." an answer thatmay be close tocorrectMore likelyto give up easlly Tles tostay independentas long a!possible v1ommunicatingwith t h e Depressed ClientWiththeclientTbirlets himo~her~w~it isal lr ight . tohes i lenOand putsnopresm-eontheclient totaac It also letshim or her h e wdat thenume caresaou.gh lo take thetimeAfter sittingsilently or a tima thenursem b e g i o talk abbofnonthreatming things. He or she mu b@ to build &en@' s&

there needs be a h i t on the numher oft imes an incidentan e,repeaTed.AS6 ll other d$tregsed &ensI the n m e ne& to ETlX&!l

ralnz He or sheusee simple,concretesentences and does nut a W P ?to argue,probe, or jntmagate. The n m ccepts dim'ts'anger*hufpabove a& he or she eontindy strestres r d t y ITreatmentTreatment o f dep~e$siohependson themast%Depression canbea!re%& of physic& illnessor drugs. ItIt e themdt of h g s n9


19/36

C&rWcMentalHealth

to &e surgical orKT nit by c or wheelGThem s somememory loss following theprocedure that is usu-

MEDICATIONSBecauseelderlyd i e rede&rg with both their mentalhealthproh-lemsand ftzeir ~oniclIlnesses,t is extreme% m p o m t o cmdnetad o t i o n =view. Ahow teoim the number of meditations pre%&bedM u ib in g multiple medications is railed p&pharmacp; Ap lwmd s t nee& to be u)~SuItedo assist with information aboutdnrgmos dmgdmg inw.meti0n.k Cnrrent d o q e s imp~rtant@ ?he


20/36

:@@~.


21/36

ChaDm 1 4

4. Themost mmmonmentalh& problem in the eider&E;o A. depmionP B. mnfasI.ot~.C.Alzheimefs disease.P D. dementia

5.Beactitre ddq;l+essions a r d t fD & some stressfd event0 B. a change inneur0tWBmiEm.a .byposhanWie.a D. [email protected], Em elderly clientis d"pre9sed without a preripiBW cBz1se6is&loa- and feeJ.8gtd&, the dient probablyh;rS0 A, req- depression.D B. endegennmdepzesgioaGIC,bipolar dlsordecP D. pseudodepfessionD A . a f 3 ~ a mP B.blood chembay.P C.sisual ob$eMatioflof thebrain. ~D D. a mental status e % ~ ith g o d%WW

8, The path010~n Alzheimer's &easeinel-udes0 A. ta@e8 aadplaques.in theBrain.O 8. e m ~ ~ &Wmf themom.P C. de9m3ction a f theb l o o & - w d m .12d. i n m einmagnesiumin fhebmIn

9. Clients&a m coafw~d eedU A fimtmgb &ectim5., gB. change andaabw.ti C. simpledirections.R D. &&one given in a OU& f%mmice. .,

10.m e most &&ve tool fb tbdpbg the mafused client&Q d gychotherapy0 B.arpmentation.0 C, WE^ orientarion.P D. conffmtatiotL

APPLY LEARNING3. Multiple Choice. Selectthe one best answer.

1.A practical nurse contribbutes to the plan of w e or a 79-year-old clientwith advanced&heimer"s disease. Itwould beimponant to contribute interventions f w e d onD A ~dacinghe rigk of infection.P B.@&ping differentcaregiwm ~ a c hay;P C. indudiqg the ck nt in @oup therapy.J2 . isolating the dient from others.

2.An elderly client is diagnosedwith pneumonia and adminedto a medid unit The client becomes irritable and sestIessan$ aysfn he nurse, '?need to feed mycat"A family mem-her Sate6 thed i d has been living indepenrtenty and manag-ing ahousehold.Whichproblem should he nurse smpect?R A dementiawith irreversible confusionD 3.dekiurnwith rever~ible onfwiohCIC. depression accompanied byeo db io n0 D, ear& stage Alzheimer's disease

3. The nurse gathers data to deferminea client's orientationWhich question belm would thpnursemt use?Q A. T h a t s trxbfs daWXQ B."What is pourfuII narae?"0 C. "Whatkind ofplace arewe in?D D. m e r e were you born?'

4.Thenume in . skilled carefacilityprepares a reality orienta-tion board. Which informationwould the m e ncrude?P R oday's menu for breal$ast, lunch, anddinnera B. daily visiting ham at the f a W2 C , todify's day>d date, and identification of thc placeU D. namc and phonc numbcr of the client representative

5.A nurse p.lans care for a clientin the secdnd stage ofdlzheimefs disease. Which inkerventianls?would be ma&anaromiaw?.. .2 A. assist with grooming and fceding2 B. provide dcviccs to aid ambulationD C strategies for care of incontinenceD D. a n t i - d e pmedimtiom for hostility


22/36

2. List thenursing needs of the client with dementia.

4. Dierenfiatabetweea dementia and pseudo deme n~

2. The pros and cons of treat@ the elderkin n m omesrather than rnenfal health facilitia.

3. Theways inwhlch prevalent attitudes toward agingaff0.dtbcare of dients =&th eumible confns'10n.


23/36

cent; thus inkacing alcoholprefepence and leading to an inmxsedrisk for aicohoUsa The role ofenvironmental factors and geneficcou~seliitgeeds tobemoredearly delineated It is often a progressiveand fatal &east? and &aracmhd bv imvaired control over dridine,'7preoccupationwith alcohol.useofaiwhA with adverse consequencesand distortion in thinking, and denial of the siffnificancef the drink-ing andawarenas thataIwholabuse is a probfan. Thereareaof dehitions f a lcoholism but most de6nitionsindude the ~oIIQw-ing four k e n *Excessive consumption of alcoholPsyCholopicaldisturbances caused by alcohol

R Distmbanw ofsocial and economic functioojngLoss of control over alcbhol cansumption . .. . .EM. Jellinek, a pioneer in alcoholism research defines alco-holism as anyuse ofan alcoholic-age that causes damage o heindividual,sod* or bothThe person with alcoholism is often thought of as a skid-TOWbum. However, only seven percent of people w i t h alcoholism fit thisstereotype.Th e remaining83 percentarefound in every l e d of sod-etyand in eve@y occupation,Thermmber of women wirh alcoholismi s inu'easing.Clientswith almholipmmayshow igns of6nd rejection of themrld about them. They may withdraw from personal contact withothessand notevenattendto theirneeds ofdaily lming.The clientwith

alcoholism needs empathy and not misplaced sympatIq hovatkeapproaches for carem necessary for each client The nurse shoulddemonstrate qualities of consistency, h f i r m n e s s ,honesty, andpatienceTo do this,he or she must first det ermh p o n a l prejudicesm-cew the c k awithalcohelism.

Prejudice is a prejudgment UsuaIly, it is an unfavorable judg-mentbased on nsufsdentreasons.Nursesneed to examine heirownpmdices beeawe they canbereflected inn m b g carp.Nurses shouldthink thmugh their prejudices and recognize their fears and lack ofinformation, FeWsofWeriorityandinseapityneedtob eWtwithOnceprejudicesaremghized, nurses ca n akeresponsib'ityfortheiraM ehaviorwith others.Nurses p&&iy need to be understand-ing -in their interactions with a l l clients They render rare and do notpass iudBment.Th"& is no single cause of alcoholism Alcoholism is a disease,not a habit Researchen have found that sodeties that inducemilt andconfusion ~ g wrinking b e h i o m are more m y o';u.odueea l a h l i ~ ~ .t alw has been found that people w h o d d o p dnnlang


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1, ad ~haptsrl2Y '6

I HISTORY OF ALCOHOL ABUSEI , ' Theuse, misuse, and abuse ofalcoholis thought to dateback to prim-itive tunes. During the StoneAge, humans found that chewby:certainberries made theirheads light This accidental discoverybroughtaboutthe international manufacture of alcoholic beverages. By 3,000 B.C.,P@pt had perfectedthe IT ofmanufacturingbeer andwine. Themak-ing of wine also became popular in the Mediterranean countries.Dun% the Middle Ages, grapes were cdtivated throughout Europe,1 and monasteriesbegan perfe* the manufacture of wines.Distillation introduced a new and more potent alcoholicbever-age. Instead ofbeers and wines containing G to 14percent alcohol,hev-eragm containing as much as 50 percent alcoholwere made. The liter-atureof this period reports drunkenness as a scrim problem.Alcoholwas available for rehgxous and medicaluse when the colonists settled

F~GURE 2.1 FM, mends, and lots Of fQuor. good--or very in America Alcohol sometimes accompaniedfamily meals. However(dangerouS-trio. somerel.iomscorned the excessive use of alcohol.Factors suchas thediminishing family structure, the Iessening influence of relrpion, andthedislocationofwarhelped cause an i n w e n alcoholconsumptionAlcohol became a social concern toward the end of the eigh-

pmbfems m m &dy to experience interne relief a d e ha ti^^. teenth century.At this time the temperancemovement which stressed&omalcohol.The personwithafcoholi~m W a of- ' moderation in the use of intoxicatingbeverGesbegaa Strong supportsons form,he rrutsom may d u d e he fofI&(I: for the movement came from religious groups, legislators, fanners,businessmen, and schools. By 1919, wentyfive states participated ingg Relienngt m i on , , , ,,, the Prohibition Amendment The amendment made it unlawful toB1 Helping UmKind . , / ' a manufacture, distribute, or sell alcoholic beverages. Thirteen ~ a r s@ Droaatng mmow later, it was repealed as a failure.Denying people access to alcoholicbevera$es was a simplisticwayto dealwith a complicatedissuepa Making one feel free Alcoholism is a problem among an ages. It can be seen in the@ elpin& one be sociable nmborn as a result of maternal alcoholism and in the child, adoles-~~y people expdmce increclsedaCbIXyrh q h m , ad sma5fh- ' cent and adult Alcohol eonsumption is a way that somepeople copeflowing s p e d d t h the conmmption of alcoholic b~verW@j . with stress. One method to screen clients who have problems with

12-13. &coho1 can produce a tmporaty feeling of but ' alcohol is to have them complete the CAGE questio~aireTable$epressesthe n w ~ ~ystem. Alcohol abuse can havenegim .' 12-11.sea m d ~ezsonalo~~quences .D& 1FardnWwhile I There is an increasing number of teenagers who drink on a reg-(- and public intojration [PD can oulut With al] the hem~li*b ular basis. Liquors such as vodka and tequila have become popular.ed lad ~ l v ~ m t s .-Eealthproblems &er disease,gamin*d ' among teenagers because they are difBcult to detect on the breath.b l e w ~ o ~ ~ o - g e a larices], ammoHe and =@od acciden% Parents do not always recognize alcohol as a drug. When told theirandbpwob functioningcan tuntribute o a&~1?td@e. child a drinking problem. many parents are extremely th-dependace causesaninmased ~ ~ U m P t i o nfalcabbJ that at least their child is not on drugs.and an inamo sopnnkuq: ntil intoxkated.Thhking becomes Parental influence can be a factor in teenage d ~nanyanfused and &oqanized M concentration, jdP-6 and households, children see their parents enjoying daily cocks beforeperoeptionaredulledDepression,&wkaZi0& a d @ ? V are " and after dinner. Peer pressure is another influence in teenage drink-tfie problem mused dehok %.When people have equaI standing within a group force or cajolei .

' - = -


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I'&* l a ,-

STAGES OF ALCOHOLISM

Occasionaldrinkingconstantrelief drinkingI n w e n dcohol tohancePRODROMAL,onsetand in- of memory bIackout8Seaetive drinking~eoceup&nwith alcoholGulpingfirstdrink

Alcoholism W~--Guilt f e w without drinkingInability to dlsccusproblemInuease in memov blackoutsCRUCIALLoss of contmlW & t io n of drinking behaviorFailure in &brb to control drinkingGrandiose and aggressive behaviorTmuble withfw and employerSelf-pipLoss of outside interestsUnreasonable resentmeatNeglect of foodTremorsMorning drinldngCHRONICProlonged intoxicationPhysicaland moral deteriorationImpaired thinkingIndekdle metiesObsession with drhkiqConstam dibibisgiven

PHYSIOLOGICAL BFFECTS OF ALCQhDLThenurseshouldhave an mderstand'i of fhephysiologjcaleffectsofalcohol.A small amount of aIcohol may bring about skeleml musclerel?~xatibn.n maeased amount Can impair the respiratory and car-d i o v ~ystems.AIcohol physically depwses; while tensions andfear8 appear to ease. W1th alcohol constunption, mental activiwchanges and judgment and seEconm are reduced With increasedLweIs of alcohol, a staggering gait is noted. DifBcultyin standing Pol-lows.Rnally the person falls and i s unable to get up. A larger dose ofalcoholcan produce stupor. TBis is a serious comphca'tion that usual-ly follows a prolonged drinking spree. Wheh almhol is taken on anempty stomach it is absorbed immediaelyand the effect an the cen-tral newom system is felt in Iemthan twenty minutes.TH E CLl@lUTWITH ALCOHOLISM IN THE HOSPITALThe majoriw OfcJkrmwith a lco h o h nm & d and depart-mem of a gaS@ ho~pftdre admirced wiih a diagnosis orheF rhanalmlroli$m,The COI dy seen dia@06& include


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-,,c&pwqg Alcoholisma .~ ~ @ ~ & ~ B Vitamin therapy@he person with alcoholism usually has a defl-dency ofmagnesium, thiamine,B complex vitamins, niacin,g l q , . - ,. and f& atid]r wem: ilMonitoringfor alkmtion in serum gluwse&=I* ml$qdm *rAntic~h~&antsdilantin,phmobadzital)&b&&B. U* The client with alcoholism needs t o be observed closely fox

Gflmpli@tions associated with long-term alcoh~lismareWernitke-Ko+sakoffqnilrome nd hdts disease:sWernicke-Ko~akoffgmbme is chmara-ed by c o e ~disorientationand amnesiawitb confabulation.

Pick's disease is ehractwhed by earlyonset in the m i m e swith p r m i l e dementia. There is a geneticpredisposition.NURSING CAREManydiEcultiesthat occurwithdimtswith alcoholism are a result ofwithdrawal symptoms b e g h h g 6 to B hours the last drinkClientsm miIrTwitl&awal may suffer only tremblingand agitatimAmore smre withdrawal.in~~Ives-um trem& W3.In deh-ilrm b m s he eat has extreme restlessnessand posS@&sekqes.Delirum tremens maynot o m u n t i l thesecondoftilM da~rdftreat-mentor later.The client mustbe mefully observed for anyw i t h h -d ympxm. Thesemayinduder ETO* sweating

P increased agitationHallucinationsIncreased bloodpre&m

It is'impartanttonoteZhar antimx&eQdrugS reintendedtopre-mt deliriumwemefls (DTc)and, therefore, should lyeYe l i b e r aThe presence ofd ~ t r e m e n s a m e d i d emergen9.,may;s f i r @ ~a@ii$tatfempts to feed orbathethem Thenursemu strew^ hwdientstswgd f& be aware &.&


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Alcoholism ato alcohol?What has led to relapse ia the pmt? Rdapseis not *mu-d and the Jislt nee& to pay irEenti0n towarnine;signs. %dayr m ypmgmm hdu&ean aftercarepmgraunto help the clientwith thea-sition&to abstinenceand evqday life experiences.IndividualgroupXand couple wansehg and job guidance are pravided to build self-esteem and s e I f F d e n c ~POSTACUTE WITHDRAWALP o s ~ ~ithdrawalPAW)nitid9w oaur wen o fourteendays abstinencebut may peak at 3 to G months after abstinencebegins. Bymptoms indude&3 habiUty to think clearlya Emotionaloverreactionar numbnessB Memory p~ohIemsCshonterm andsign%oultpa& pasteat@8Sleepdisturbances dreams m nightmares)B Physi-1 coordination problemsREPLACEMENT THERAPYNaltrexone (Revial is an opioid aniagonist hat rednees chances thatthe clic~ientwZlrink i n k f i b y h m f i n g lwurable &Q. Itiswell tdwated lymost clients, although side &eds canbe niluseanWnm,headache, or anrmbappymood,hepatotoxicityrbhmustbemnsidefed lris impor~anto note tbat drug9 with opiate-Ifkeproper-ties [Le,, morphine, heroin) carmot be e e n with ndttexone. Naltrmonetherapy quires a cEentLs ibfbrmed c0nseXta d he clientneedsto cany a naltre?conewarning w d o show to doetom and den&ts.REHABILlTATlONOF THE CLIENTWITH ALCOHOUSMIn1972,k m &Health,E d u e a b andV V b stabkhedthe National Institute of luwhol&we and Alwholism mIAAA1.Tnpurposeis to help thc nation @T a bmerknowIedge of the &cfs ofalcohol and to bemme aware of the reresp~mibilitiesw d a t e d withwing alwhol. The instifute encourages public discussion &cgrfmu-nitydrfnkmgprob1ems.Tbk brces w e omedto studymalor drink-ingpatternsOf problem @ups within themnundtg, Prevention isnowbehgremgnke+laseesentialin hebase to reduce alcoholabmalbminimize alccllrol abuse, atteation should be given to the generalpopulationandwt m 4 Y he problem dmker.It is important to a@eady indiscowagingprimaryalwhol abuse patterns.


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I 'T.. NursingCare Plan: 9The Clientwith Aleoholl Abuse

& ~ ~ l ~ i wmfbeemdngherektefto then W W &Miif& a barin oBmand he hasm a t e d alcohd on h@br& swerdtime laplywhen shemmes'home&omw dRe states&atwfientbe couple &9h has be=.ha* twodrinks, o his on% -

'NURSiNOW N O S i S~'i

Nur'singoutoomesL ~ef01-e hhai-ge S a r a h d den* ~tms@inhe~Ef".

ofhospitalbation

NUrSlng Interventionsla. Spend timewith Saraheneouraging her to discussher job respomibjlities.~ b .iamsa: $ 4 -em@Inher life.

Ba UtWe therapeutioe m -mmicatioti and cgwelin$skills, a n ddiscusswapSmh is prmentIphandlingmess.

2b.Make r~?fhaIsa tom-dm nd communiyorgadmtions a8neaed.

3, h& t in helping Sarahb d ewways to mpewith swwes.

Rationales Ila Having&ah discuss preseatjob r e s p o 1 1 s i ~ il lassisth r n iden*pz"t~mt aesseslb .Discussingsmsseswillgiveb igh t to&+hatarahsees as StreSSOrs,ZaDiswiry:premzt stressmanagement &ts in

iden-g &edive andin&* coping strate-gies.2b.O W esourcwmaybeable to wsistSamb incup-ing with %tress.3. Newcopingmetbods

give S ~ p o e i t i v eurLetpforhandling saw,

Evaluation Ikrqh is ab1e ta list present swsors in her Job. Shea b l g e a that she is not effeslively hmdling sixes now.Samh Iistens in* as them e b w omeopgmhthuthat help people handle stress dkctively.NURSING DIAGNOSIS 2h t e q twd famf~p@W$@-@:aWi,Siz+aorsiandnmeswdUse ,ofali%hoI~s &uide@& 'b& a&% ,&&:she h~ job.a w * a 4worW,:lerrghems,mdher mfhe ha3 w&d &whOlon her br& InQE efrequqy andhwwd mnsrinztytion at $o@al.&&ts.

I . . _ . - - _Nursing Outcomes ISM's familywill comdca t e eon- ofjob reqonsikdi-tit% tD each other and implement effective coping m a -hbllls.


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holic and needs rehabilitation. This is r bytimilies,who m dto protea persons with alcoholirmand frequentlydeny he problem

&sesging 6 id . y dynatni*~ lbIeraalag stress is a probtern for p o n s with alcohoIism.in id@- mles and I m p e d methods of copingmust be learned It is necessary to 6nd asatisfactory substitute for alcohol because alcohol aas as a tehsion-reducingagentThevalues andmmms of thewmrnunitginwbkh the individ-f i n ~ ~ ~ ~ q g e f f u n i l p d e r ~ t oYm ~ w d * ual influence his or her drinlring behavior. Par example, a l everbalize their feelings. -bertosharehisorher h ~ l i n ts a significantpmblem amongNat k Amaican9.A commu-~t"+ons Qfthe mtidn, n i y s attitudes, concerns, and involvement with the problem of a h -the staffga& a c k m m e hohm need tobe Communityresources suchasm y erv-ofm y ntern- . ices agencies, mental health clinics, isitingnurseagencies,police, anddepartmentsmust be made availabletohelp he alcoholic It isinteresting to note that recent stndie$have shown that the black population is dispropordonately targeted for liquor adm-kimnents.Billboards are rammed into poor areas, nd he piuwx%vividly con-nect alcohol ~ t homance, p m , and succm. Cognac and maltliquor aretwo beverages fiequatlydepicted In some neighhhoods,community leaders are banding togetherand wbihwhing biIbmr&

as a show of d e h c e and to deliser a foreefol message to cha~gead- approaches.It is importantthatthecommunityoffer diversifredrehabilitationprograms. These pmgmm.9 might include emergencymedical care,~&e&&ml.sasdedlag, ~&lww- 11 OUtcIient dinics, nclientfacilities,and haIfway houses. Outreachwork-t~ SONork&, , o m n ~ h ~ m o m a deal&&the siN- can be helpful in oisiting ethic areas of communities to iden*p ~ & & ~ q & & &tion. theirparticularneeds.Thenurse can play a role n m e inding, refer-e & s m - - m &&@- have fleedm to raLand morrtination of wmmwity servicesb s , &pe M im .&boa interact as needed The person wi t . a psychiatxic illness and a coexisti~gIcohol81~0- 4 n o n v . f A s q p t W k W ~ t abuse pmblem is a major challqeThe goal is to monitor within

eacomagesaaustW6ns@ cmmtmities seriously d~$~~~bionallients, attempt to stabilize heir~the&&familBfaciW behavior, and fmprove their socialhctioning. Careful assessment ofcombined alcoholand drugabuse isneeded becausepersonswith dualdiagnoses can be noncompliant, and reshant to treatment Theseclientsdl sually deny or minimizetheirsubstance ese/abuse,yet anastutemental hezlth professional will note increased psychiatric hos-pifdhtions and exacerbationof e d sychoticsymptoms

Itis important to note that theincidence ofalcoholisminwommhas risen and has contributed to increased suicide, death &om acd-dents, and othea alcohol-related diseases. The literature desaibeswomen as drinking in response ro many stressfulevents:ma&l pmb-1 POveap and single pa r en . , midlife crisis, empty-nest syn-drome, and w a n t e d pregnanw A great mncem with pregnmt

n e & l e c e p h r e t o & ~ b femaleswho drinkalchohol isfe&d alcohol syndmme WAS). ASdidienrwithalcoho~ a&% the cenid nemoua system of the fetus. Growth patterns are


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~ ~ U R Ez.z init+&wkl &Ilcohol syndrome. rinted wltnpermlsslan. Rtrelssguth kndesman-~wyer,., Martin, J. C.. %Smith, D.W. (qc~so).rerat-,- r ~ c ffects of alcohol in humans andllaboratOlV animals. science, 209tIS): 353-361)inhib'idtvith lowbirthwekghwandtad infwo.UnusudEa&&@*act&tics are present i ndung eye slits, low p l ammt of ftre&,an d awideBat foreheadwith a flatnose @gae 1Z-2). 1ALCOHO'L USE &ND YOUTH'Shemediamess* toyou&%ht&&&q batem* MI^&b-day lifeMini-marketseven seK beer andwine, dang With gaS0--b e , food,add snacks. It is easy tO obtain an alcoholicbeverage?aus%m a rewad a h sports victory or completionof a day atwurk&od Studies reveal bat addiction to alcohol is anderb@xosedM&e young although t leading cause ofdeathmenqane years of age is alcohol-relatedmo.efFectsof alcoholwe or abuse on youth are asfolows:sl Family d c t sa Problems& chool perfofmane

S&QO~ a b~~Ce6 (mq, nmeaseadropmt rates

f a s ~rfpeerrelationsMpsUnprotected, unplanned sexual ntercourse

U hff- risk of physid or sexualabuseSuicidal thoughts andpossay a pIanIf the youth has a parent who abus~s lchohoI studies haveobserved that these children ar e at high risk for delinquent behavior,lmmbg disordem hyperactivity,psydbasomaticcomplaints,and prob-lem d l h k h g as adults.Adolescenrs atyounger andyoungerages arebeing presented to91coh~lehabilitatian emtiera They are brought inby their parents,peers, orthe wenile judicial system,Theelderlyare at riskfor alwhdsmManyexperiencelongperi-ods of iaolatioo and lonehess and drhkiug go0rtre.g &we f e w .Family members canmnttse their p e w s depression and pa~a~o iawith growing old iaseniLiWand fail to recognize theneed foralcoholmafment The elrlery frequently a ~ excluded from intense alcoholtreatment pmgrams.Howeverh f alcohol use or abuse is suspected it

can topar6izeth& gc healthwe and possibility for residentidplacementNurses can also develop alc~hohm.mpaired by alcohol con-sumption, t h q will lack .sufficientinsight and judgment to practicethek profession It i s a moral and le@ Sef;poesibilityto report theimpaired nurse. Many areas provide intensive therapy program rnather an inclient or outcIien? and the pmm'e job position remainsintact d w he rehabilitation period.TREATMENTfa contrast to the. rapid respoase to treatment elf many physical ill-nesses, esponse to treatment s genedyvety slow.Beatmentmeth-Eyds for alcohobm v q .Mmy authoritiesbelieve &at a mnlti&cetedappr0ar.h i s best in meetlng the needs of the cUent with alcoholismL%@k"=*q. - -ltifaceted Approach t o Treating AlGoholis&[Coh~lhs nunymous ~ o tealurommc hl%a~~ .-.,.,v.--.-...-@ ~ f i o ~ l :motiveWlerapy !jet@gmmt@me~tefsPlndustrlal alcohol program* Judtcta'lmhabilitatibn!Antabuse./&lcohoip r o g m or fhe aged ~~ansaceonaln&i6:Walfwayh0ust.s'- .mL? - - mK!&


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I Chapter 12

b1oohol~~csnonymous5Ieelildiwa P a n m 64AI is an organkitionm @ ormerdcoholirs whose pezmnd expenen- with aIcoIrol enable theni t~understand the p b 1 m of thepersoa wihdmholfsrn. T h q earn&omd i r e obsmtion ofthe ntanyremvered &om aleohoTism iatheorganization,B e goal of Aloohnlies h n y m o u s is for members toahstab &omdrid&g gne day at a tirae Sobrietyhelp toprovide &gperson with dmholim wiih a grawing sense ufse&cn&%71, a&eve-megt and mgsteqz This provides M e r mativation to &dm fr-oandrhkhg.There is an nmaseda- of self as the p m m beghto d e r s m d his or her prob1e.m and feeliqp- tlA meetings use astmdmed gmup approach with a w&-d&i?d W d d e p prognun[.Table l2-32.%& membrhasa sponsorand takes m e &tbaA lead is a presentation of a pesson's strugglewifh pltwlnup it1~0hU1and the devamjlfing&kc@ of al&l on bLs or her lifk Each persogdefines his or her own spiritual&? an6 hipher power and tbW&Firmw selk+kem nd hopeAA bemmes a d]N&al part of8-fd sob-&&on (family pups ) and Ahteen ( v j ircus on tkq :eEects ofalcah- on familyand dhil&rmACOQ (AdultChjldren Q$AlwholicsJprovidesp e m d contaM vwreh other9 whogrevvup ind pf h m t i o ~& network This pm n a l eontacf is therapeutic andprovides emutianal6uppaR.mtronral Emotive merapyAlmhobn b eenbyproponents ofratiaQal bmotiyek a p y as b q , ,a means of coping, Thegad of this the~apys to help the pasonaleabolism I t am to to le rerhe stixssors &at eomewith ]i&g @use coping meihnbnm @@ are less seIf.de-. Itteachespwa ;Fwlrh aleohobm to ~ e c o g n i z e i n a ~ d e sn their By &@&ing ffi& views ofthemsehrrsand h e envitonment,they ma -%!!heir behvior. The rational emottve thempi&ME%@hat imtiendthinhg leads to irrationaldrfnkhg.Transa~tLonalAndysis~ a c e f o n a l y s k& another W a p y &pproa& o aItoholism tW-3has f b d ome sueow. Theg d f transactional and* is to helpwith &oholism stop playhg gain@ andM &e meir*satpta, AIwhoIism inoolves s d e 8 and a variety ~f a*With ?he cafsatim of game plawg, t-he mderIiqg psohlemS met$@more cI&a~Ay.Clientsare &en able to wpc with -theirp rmh l e ~m9tedir%al$

Alcoholism &&". ."

PsychoanalysisPsychoanalysisinvalves the direct interaction of the clientwftk a ther-apist The objective istogain insightinto behavior throughtaIking.Thetherapist assists the client to clarifyand work through stressful areasinhis or h a ife. The clientmaybe in therapyfor a long time.


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Chapter 12-Group ~ h e r a p yGroup therapy involves meaningful interactiongroup. The group members relate their p a dother.Themain objedive isfor each group membher impact an others through i n m e d~ r n m ehavior and relatiomhips. Theichapm 77).Antabuse (Disulfuram)Antabuse (dimlfuram]is taken dailynence from alaohol Antabme interferes with the metabolismhol and poduces a toxic reaction when combined with ithow they will suffervery unpleasantreactions f they do nUa&omdeinking.The drug is usuallywell tolerated,but t h mrimes side egects. These side eff& usually &appear asadjusts to the druggThemost common side eff& indndefatigue, acne, and a metallic aftertasteIf clients drink alcohol while this drug is still in their

effects may last hmtbirtg minutes o severa lhours;times ouw~ed uring the reaction, the client is insituation and should beand consentW clients should be thoroughly m c d agsuming alcohol in any form. Over-the-countm medication

tal iuness. Successwith Antabuse depends on a firm rperson wIthalcoholimto abstainfromw g .seldom used because it is a simptisticapproach to a cornplW,, p


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people permission to do Eor t h e an be dtfRclalt to put intopractice.M a $ ersonal choicesmd developingthe ab@y to say rnM y jmiubhestheir sympton~.n ecawery, he codependent mustbe aware of 9abof~girrgehaviors of other6 and identify those peopleNho m&ently "suck them innMonitoring passive or a@Rssivebehaviors wi!J assistwith inmmed numbm of as&e&iveencawmwith &ers in their personaland workplace endronments. h o t l mhcipful approach is ehe praetce of daily personal affirmation&i4flkmdom are1statements chmt~dfienayor out bu d to oneaPXI desem satisfittion, cmtenfment a fmEIling rehtkmshipI d q x e s s my feelingstodag~ ctfn an a s s e e

manner todayhewering codependen@make their own daily choice8 and w etheir beIi@vahxes;ystemsthrough acriofl-oried belmiors.TREATMENT FAClLITlESVarious treatment fadlitie are mailable to meet s p d c or ga &dneed@ f the&at =with alcoholism Detoxffication cent= axep h ~where the &enwith aleahobm r&es treatment and care duriiagthe withdrawal proces~. hey comprise the ikfirst s%p in t reafpef l tIa~w,he &nt patidpat@ina canttnuisgw e [email protected]& ate fpequdymade to la - te rm f r e a ~ ~ e n trogtam~.Other times, the & a t s transiferedto a residentid treatmmentcenter:Theh a h yhome isa n i n m d i a t e r & h c e for the clientbefbi~he or s h e ~ a t e nhec m u n i v Hgure;U3).Pequ&, the&Weis located in the client's commUrn:ty. W i v i d e d a n d o ndhomelike atmospheeare just two advwtages of tbe program Mo~tihalfcvsvhouses are oriented toAlAlcoIIes Amaymow aad enmm&ge

$SUE2-3 A halfway house may look like ally m er home intne communiw.environment is an exellent s e w or early- iden- and @eat-m a fproblemdrinkm.For more thaa 35Q eam pubficimoxica6onw a under the jurbdictian of aimhal law The penniless drunk; m h r e d through aprows of afiegt jail, release, md reatTest Sn the past IIRr s ,p r om h e beenmade toward fmn&king theproblem drinker 6omthP penal $ysem o treamentpragrams. It isnow recognize8 that theperson with aloohcJlism needs ae treatnwt and rebabih-rim.Legfslatim isproviding theh e w o r k forthis needed treatmeac

3chQal aIa,h01 program are a preventiw measme+T e e n mneed alcoholeducationprograms .intke scfioeIr;. The rommticrtlea ofalcohol e sem in the media must be challeqgxt The r d acts andpatined Iiteratwre shonld be presented Alcaholism is the mst-neglected health problem inAmerica an d msds to be p~smredo theado1esmt in fits true lightFew reatment W t i e s @tpe for the nee& of the aged with a~ g p r o h l e m .hea@d need therapeutic progritms geared to t k kunderlying strpssors. %earmat fficUitles shouldhave anh d i v t d u mapproach that attemp@ o &cover the pmitcdar problems of eacha$tng ~ W D . ewl~ping ew &adships and a sense ofwell-being

&+ goup tneetkgshelps all& lonelinms.Lo%-- goals of a pmgram for tbe aged person with aicuh~lism e tomake we wmh di le to help him Qr er see h&ans,12~therhan dead eads,


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Oganize a resource file on alcoholism. Obtain fnformation bywriting for literature concaning alcoholism &omThe National Cornoil fbr AlwholiFmInc.2 ParkAvenwNew Yo&, IVY l 0O lGThe National InstituteofAlcoho1Abuse and Alcoholism5600 Fiscber LaneRoom 11A 58RoclaSlle,MD 20852

REVIEW- -XNOW AND COMPREHENDA Mdtiple choice. Select the onebest answer.

1.TheamendmentEotbiddtng themanuFacture, distributian,andsaleof alcoholicbeverageswas theD d TemperanceAmendmentEl B.PsohibitionAmendmeatP C.DBtinatimAmendmentO D.AlcoholicAmendment

2. Thetreatmentmethod that fowes on changingbehavior bychanging the clients' iewrs of themsdw and their eravirokment is termedP k ransactionat analysis.D B. rleto*cation method0 C.AlcoholicsAnonymous.Cl D. rational emotiw therapy

3. h reatment approach Bat tries to help the client to stopgameplaying and rewrite his orher life saipt sP A. rational emotivetherapy0 B. transa&onal anal*.P C. drug therapyD D. AlfflholicAnonymous.

4. Which of the following below arcuratelydescribesalw-holiam?D R serious problem that develops&er adolescenceP B. apmpsive, fatal, and mmplex diseasetl C. an effective way to cnpewith stressEl D. a habit of drinking more than m e infended


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Alcoholism

APPLPTOURL-B, WaMple Cholerr, &led bP one a& answet:

4. A practicalnurse w& clients in an alcohol t r eamer t tcenterabwt their disease.XVhich client is in the earliest stageofthe rehabilltationprocess? The client who sap:O A *I understand that alcoholisfn is a lifelong tiiseaseproces8:5 B. My chinkinghas awed prablens inmyfamily rela-ticinships?U C "I'venever had a problemh d t n g or Keeping a job."5 D. 'Tve oftenM guilry aboutmy drinkhg?

5. Themrse cares For anMtnt with feral alcohol syndromePAS). Qahich characteristicis moat likelypresent in theinfant?Q A. lowWeight&fPU B.m w ~ointeilnosea c.wide, bulging qes5 D,edematous extremities

6You area nursetYarkingon a m & ~ ~ s q i dnit Du rbgthe s h i change repm at the b e g i g of a new shiR younotice thesm$ of alcohol on another nuwe's skin andbreath. Based on tbb o b m t i o n which actionwouldyouhplement?A in- thenutae ofyour obsemttion5 B. observe fhg nume for impaired performance5 C.ask a wwmker if they smeli alcohaI5 D, noti@thenursing supervisurofthe obsemtion

C. Brieflymwe r the following,1. ?%%ats thepnrpose of theWa'tionalInmimtefor&&IAbase andNcohoIlsm?


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4- List siX sympt~ms f almholwithdrsd

5. List ten nming interventionswhen caring for the clientwithalcoholism.

6.B r a y desuibe theobjdves of=& o f t h e folloMimg corrnunityprograms.A.AEcohoUresAnmyraous

I),hotmeals psograms

mental health chapter 11-12

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