She says to the nurse who offers her breakfast, “Oh no, I will wait for my husband. We will eat together” The therapeutic response by the nurse is:
A. “Your husband is dead. Let me serve you your breakfast.”
B. “I’ve told you several times that he is dead. It’s time to eat.”
C. “You’re going to have to wait a long time.”
D. “What made you say that your husband is alive?
Correct Answer: A. “Your husband is dead. Let me serve you your breakfast.”
The client should be reoriented to reality and be focused on the here and now. Orient the patient to the environment as needed, if the patient’s short-term memory is intact. The use of calendars, radio, newspapers, television, and so forth, are also appropriate. Reality orientation techniques help improve a patient’s awareness of self and environment only for patients with confusion related to delirium or with depression. Depending on the stage of AD, it may be reassuring for patients in the very early states who are aware that they are losing their sense of reality, but it does not work when dementia becomes irreversible because the patient can no longer understand reality.
Option B: This is not a helpful approach because of the short-term memory of the client. 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 the completion of tasks.
Option C: This indicates a pompous response. Avoid or terminate emotionally charged situations or conversations. Avoid anger and expectation of the patient to remember or follow instructions. Do not expect more than the patient is capable of doing. Catastrophic emotional responses are prompted by task failure when the patient feels expected to perform beyond ability and becomes frustrated and angry. Responding calmly to the patient validates feelings and causes less stress.
Option D: The cognitive limitation of the client makes the client incapable of giving an explanation. Limit sensory stimuli and independent decision-making. This decreases frustration and distractions from the environment. Decreasing the stress of making a choice helps to promote security. Assist with establishing cues and reminders for patient’s assistance. Assists patients with early AD to remember the location of articles and facilitates some orientation.