Nursing 212

Health Differences Across the Lifespan 2 Study Guide

Treatment Psychopharmacology: • Cholinesterase inhibitors, such as Tacrine (Cognex) or Donepezil (Aricept) can slow the rate of decline in mild to moderate dementia • NMDA receptor antagonist memantine (Nemanda) improves abnormal glutamate activity that may contribute to Alzheimer’s disease • Anti-anxiety agents, such as Lorazepam (Ativan), Trazodone (Desyrel), and Buspirone (Buspar) • SSRIs, which are better tolerated than TCAs in older adults • Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and nefazodone(Serzone) • Atypical antipsychotic agents, such as olanzapine (Zyprexa), quetiapine (Seroquel) and Risperidone(Risperdal) • Use of haloperidol (Haldol), a potent neuroleptic, is controversial and has caused tardive dyskinesia in older adults; small doses of 0.5mg, may help regulate sleep Behavioral Modifications • Use physical restraints carefully and as a last resort • Use sensor devices for patient safety that alert staff when a patient is out of bed or going out • Use reality orientation (large print calendars and clocks) • Discuss patient’s significant life events, family, work, hobbies • Avoid arguing about actual reality • Communicate in a calm, quiet voice with simple, clearinstructions Group and Individual Therapies • “Review of life” therapy: discuss specific life transitions such as childhood, adolescence, marriage, childbearing, grandparenthood, and retirement; discuss pets, music, and special foods to evoke memories of a patient’s past; share positive and negative feelings • Validation therapy: interact with patients on a topic they initiate, in a place and time where they feel most secure; reflect underlying feelings of concern (“Youmiss your wife. Youmust be feeling lonely without her”); reality orientation is geared to person and place rather than time • Milieu therapy: o Special care units (SCU): environmentally designed and specifically programmed to serve needs of residents with Alzheimer’s disease and relateddementias; safe, secure, specially adapted physical environments to accommodate wandering behavior inside and outside; personalized rooms with own furniture and familiar belongings; clean, well maintained, well-lit environment with windows; stimuli from birdcage, fish aquarium, or other pets o Structured programs and activities provide quality interactions between staff, residents, and families

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