A community health nurse is assessing an older adult patient who lives alone. The nurse finds that, although the patient is able to answer all questions appropriately, the patient has a decreased attention span, express his feelings of overwhelming sadness, and has a low energy level. The nurse should identify that the patient is exhibiting manifestations of which of the following disorders? - depression -manifestations: changes in sleep habits, appetite, relationships w/ other, inability to perform ADL's, decreased ability to make decisions/concentrate, anhedonia (inability to feel happy) -manifestation of a delusions: false personal beliefs despite evidence to contrary -manifestation of dementia: severe memory loss and inability to solve problems -manifestations of delirium: sudden onset on confusion, disorientation, altered LOC, inability to focus A community health nurse is visiting home of an older adult patient and her caregiver. The patient has excoriations to her wrists and ankles. Which of the following actions should the nurse take first? - interview pt in private -to gain info abut possible abuse b/c pt might be reluctant to talk w/ caregiver present -provide info on local support groups for individuals who are no longer able to cope w/ burden of caring for older adult -carefully document descriptions of pts wounds for legal purposes -contact adult protective services, abuse is reportable to authorities A home health nurse is visiting an older adult patients who has anemia. Which of the following foods should the nurse recommend to increase the patient's iron intake? - Dried fruit -Greek yogurt increases intake of zinc and calcium -bran muffins increases intake of fiber -peanut butter sandwich increases intake of complementary protein a nurse at a long-term care facility is planning care for an older adult patient who has dementia. which of the following interventions should the nurse include in the plan? - use photographs as memory triggers -such as pic of toilet at entrance of BR. pic of pt as young adult at entrance to her room -use consistent staff, changing staff increases confusion -avoid many choices to decrease confusion and frustration, limit to 1-2 choices
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