Answer to Question 1
B
Buspirone (BuSpar) is safer for older adults with anxiety than benzodiazepines. Because it can take up to 5 to 7 days for the therapeutic benefit to be realized, it should be used only for chronic anxiety. Stimulants such as methylphenidate (Ritalin) should be administered in low doses in pa-tients with chronic depression. To prevent insomnia, extended-release forms should be adminis-tered early in the morning and short-acting forms at the latest in the early afternoon. Tricyclic antidepressants such as amitriptyline (Elavil) are contraindicated for use with older adults be-cause of the risk for anticholinergic and sedative effects. Tricyclic antidepressants have been re-placed with selective serotonin reuptake inhibitors (SSRIs), which are more effective at lower doses with fewer side effects. Antipsychotic agents such as haloperidol (Haldol) can cause extrapyramidal effects, especially in older adults. For long-term administration, they should be used only after a thorough psychiatric evaluation.
Answer to Question 2
B
Providing uninterrupted periods of rest and sleep is a challenge for the nurse in intensive care. Because of the nature of the patients' illnesses, nurses administer medications and treatments and perform invasive procedures on a 24-hour basis, leaving patients little time for rest. Many patients become delirious in the intensive care unit because the noise, activity, brightness, and disturbance tend to persist around the clock, which contribute to delirium. Patients lose their sources for maintaining orientation and stability; that is, bright lighting at all times, as well as unfamiliar and abrupt increases in noise, can lead to a disruption in the circadian rhythm. In addition, patients in intensive care are more likely to receive multiple medications, and medications that are potentially harmful can aggravate the patient's cognitive difficulties.
Because this patient is intubated and on mechanical ventilation, the nurse cannot apply the MMSE-2; the patient is unable to perform adequately. Besides, assessing for dementia is not a prophylactic measure. Sedation and pain management, although often needed in the intensive care unit, can contribute to delirium. Covering the eyes of a patient in intensive care with oint-ment can be necessary to prevent corneal damage; however, it is likely to contribute to delirium because the patient will be unable to see clearly.
A hearing-impaired patient using an interpreter.
All messages must be documented and placed in the patient's chart.
Sample Exercise Program for Limited Older Adults (cont.)
Patient Information Supplied When Scheduling Hospital Admissions
Selected High-Risk Drugs for Older Adults
Areas of sclerosis (see arrows) in the white matter of a patient with MS.