The primary nursing intervention in working with a client with moderate stage dementia is ensuring that the client:
A. Receives adequate nutrition and hydration.
B. Will reminisce to decrease isolation.
C. Remains in a safe and secure environment.
D. Independently performs self-care.
Correct Answer: C. Remains in a safe and secure environment.
Safety is a priority consideration as the client’s cognitive ability deteriorates. Close observation of client’s behavior is indicated if delusional thinking reveals an intention for violence. Client safety is a nursing priority. Assess the degree of impaired ability of competence, emergence of impulsive behavior, and a decrease in visual perception. Impairment of visual perception increases the risk of falling. Identify potential risks in the environment and heighten awareness so that caregivers are more aware of the danger.
Option A: This is an appropriate intervention because the client’s cognitive impairment can affect the client’s ability to attend to his nutritional needs, but it is not the priority. Maintain a regular daily schedule routine to prevent problems that may result from thirst, hunger, lack of sleep, or inadequate exercise. If the needs of a patient with AD are not met, it may cause the patient to become agitated and anxious. Predictable behavior is less threatening to the patient and does not tax limited ability to function with ADLs.
Option B: Patient is allowed to reminisce but it is not the priority. Frequently orient the client to reality and surroundings. Allow the client to have familiar objects around him or her; use other items, such as a clock, a calendar, and daily schedules, to assist in maintaining reality orientation. Provide an opportunity for social interaction, but do not force interaction. Helps prevent isolation. Forcing interaction usually results in confusion, agitation, and hostility.
Option D: The client in the moderate stage of Alzheimer’s disease will have difficulty in performing activities independently. Teach prospective caregivers how to orient the client to time, person, place, and circumstances, as required. These caregivers will be responsible for client safety after discharge from the hospital. 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.