An older adult patient with Alzheimer's disease is admitted to ...

[luvbio]

An older adult patient with Alzheimer's disease is admitted to the hospital. The patient's spouse reports that the patient is often confused and gets lost walking to the store, which is 3 blocks from their home.
 
  That evening, the nurse observes the patient pacing the hall and screaming. What will the nurse do?
  a. Notify the provider of this patient's worsening symptoms.
  b. Prepare the patient's spouse for impending death from Alzheimer's disease.
  c. Request an increase in the medication dose to treat the exacerbation in symptoms.
  d. Tell the spouse that this is an expected progression of the disease.

Question 2

An older adult patient has confusion, memory loss, and disorientation in familiar surroundings. The patient has been taking donepezil (Aricept) 10 mg once daily for 6 months.
 
  The patient's symptoms have begun to worsen, and the patient's spouse asks if the medication dose can be increased. What will the nurse tell the spouse?
  a. The dose can be increased, because the patient has been taking the drug for longer than 3 months.
  b. The dose can be increased to twice daily dosing instead of once daily dosing.
  c. The increase in symptoms is the result of hepatotoxicity from the medication's side effects.
  d. The patient must take the drug for longer than 1 year before the dose can be increased.

[daiying98]

Answer to Question 1

ANS: D
This patient is showing signs of the natural progression of AD. Behavior problems such as these occur in 70 to 90 of patients with AD as the disease progresses. There is no need to notify the provider to report these symptoms, because they are expected. The time from onset of symptoms to death usually is 4 to 8 years, but it may be as long as 20 years; this progression does not represent the final stages. Medications are not effective for preventing disease progression, and their effects on memory and cognition are modest, so requesting an increase in the drug dose would not help in this situation.

Answer to Question 2

ANS: A
Donepezil is given for mild, moderate, and severe AD, and dosing may be increased, although it must be titrated up slowly. For patients with moderate to severe AD who have taken 10 mg once daily for at least 3 months, the dose can be increased to 23 mg once daily. Donepezil is not given twice daily. Donepezil does not cause hepatotoxicity; hepatotoxicity occurs with tacrine, the first acetylcholinesteras e (AChE) inhibitor, which now is rarely used. Dosing is increased after 3 months, not 1 year.

[luvbio]

TYSM

[AngeliqueG]

Gracias!