What NOT to do
Why is "quizzing" a dementia patient on current events or family names (e.g., "Do you remember who I am?") contraindicated?
It highlights cognitive deficits, causing severe anxiety, shame, and frustration. Give information directly instead.
What class of cognitive medications includes Donepezil and Rivastigmine, and what major autonomic side effect requires monitoring before administration?
Cholinesterase Inhibitors. Monitor for bradycardia and syncope (increased parasympathetic tone).
A patient is handed a toothbrush during morning care. They look at it, have normal vision, but try to use it to brush their hair. Name the specific "A" demonstrated.
Agnosia (loss of ability to recognize the purpose/identity of objects).
Irreversible and progressively worsens
Dementia
A resident insists that their deceased spouse is waiting for them at the bus stop. A student nurse attempts to reorient them by stating, "Your spouse passed away 10 years ago." Why is this intervention wrong, and what should be done instead?
Reality orientation in moderate dementia forces re-experiencing grief and causes extreme agitation. Use validation therapy and redirection (e.g., "You miss your husband today. Tell me about your favorite trip together")
An elderly patient with dementia is given Diphenhydramine (Benadryl) for sleep. Within hours, they become severely agitated and hallucinatory. What mechanism caused this, and what condition was precipitated?
Anticholinergic Toxicity blocking central acetylcholine receptors, precipitating Delirium superimposed on dementia.
A student says, "My patient has expressive aphasia, so I should speak in a loud, slow voice." Explain why this intervention is incorrect and what strategy should be used instead.
Aphasia affects language processing, not hearing. Use simple sentences, picture boards, direct yes/no choices, and give 15–20 seconds of processing time.
Difficulty paying attention
Delirium
A patient becomes verbally resistive and shouts during a bed bath. Why is administering a PRN antipsychotic or finishing the bath quickly the WRONG choice?
Resistance is often a reaction to fear, cold, or pain. First-line action is to stop the task, assess physical comfort (pain, room temperature, full bladder), and re-approach later with a calm demeanor.
Why do atypical antipsychotics (e.g., Risperidone, Olanzapine) carry an FDA Black Box Warning when used for dementia-related behaviors?
Increased risk of mortality (primarily from cardiovascular events or sudden pneumonia/infection) in elderly patients with dementia-related psychosis.
A patient knows they need to put on their coat, but when handed the coat, they cannot coordinate the motor steps to put their arms in the sleeves. What is this called, and what is the priority nursing approach?
Apraxia. Break the task down into one single step at a time (e.g., "Put your right arm here").
Altered and fluctuating level of consciousness
Delirium