1. The patient has Advanced Directives includes a Do Not Resuscitate Order (DNR).
What
interventions directly related to the DNR order?
Ideally, a DNR order is created, or set up, before an emergency occurs. A DNR order
allows you to choose whether or not you want CPR in an emergency. It is specific about CPR.
It does not have instructions for other treatments, such as pain medicine, other medicines, or
nutrition. The interventions directly related to the DNR order includes simple efforts such as
mouth-to-mouth breathing and pressing on the chest known as CPR, electric shock to restart
the heart, breathing tubes to open the airway.
2. The patient’s daughter calls for information about the status of her mother (Minnie Frost). What
should the nurse consider before responding?
The nurse needs to ensure that they are speaking to the substitute decision maker or if
the patient has
given consent to release the information about her health status to this person.
3. The patient is becoming increasingly confused and agitated. They are trying to pull out their
intravenous (IV) and climb out of bed. When should restraints be considered?
Restraints should not cause harm or be used as punishment. Health care providers
should first try other methods to control a patient and ensure safety. Restraints should be used
only as a last choice. Caregivers in a hospital can use restraints in emergencies or when they
are needed for medical care. When restraints are used, they must limit only the movements
that may cause harm to the patient or caregiver and can be removed as soon as the patient
and the caregiver are safe.
4. The patient suddenly deteriorates and the patient’s elderly husband is He is elderly, has a
chronic respiratory condition and thus is at high risk due to COVID-19. How would you handle
this situation?
Considering that he is elderly, has a chronic respiratory condition and thus is at high risk
due to COVID-19 but demanding to come in and stay at her spouse bedside. I must first
consult the nurse manager if what policy can be used in this kind of situation and what are the
other choices we can give to the husband.
5. As the patient has a change in cognitive status, how should the nurse best differentiate
between delirium, dementia, and depression?
As the patient has a change in cognitive status, the nurse should best differentiate
between delirium, dementia, and depression by outlining some of the characteristics that can
help differentiate delirium from dementia and depression. Delirium is a sudden change in the
brain that can cause an altered mental state. It is reversible once the underlying issue is
addressed. It is usually caused by illness, medications, drugs/alcohol, or changes in metabolic
processes. Dementia is a term used to describe symptoms associated with a decline in
cognitive function such as thinking, memory and reasoning. Depression is a mood disorder
that causes persistent feelings of sadness, loss or anger. It is believed to be caused by things
such as a chemical imbalance in the brain, changes in hormones and even biological/genetic
traits.
Delirium Depression Dementia
Onset Rapid, hours to days Rapid or slow Progressive, develops
overs several years
Cause Medications, infection, Alteration in Progressive brain
dehydration, metabolic changes, neurotransmitter damage
fecal impaction, urinary retention, function
hypo- and hyperglycemia
Duration Usually less than one month but Months, can be Years to decades
can last up to a year chronic
Course Reversible, cause can usually be Usually recover within Not reversible, ultimately
identified months; can be fatal
relapsing
Level of Usually changed, can be Normal or slowed Normal
consciousness agitated, normal, or dull, hypo- or
hyperactive
Orientation Impaired short-term memory, Usually intact Correct in mild cases;
acutely confused first loses orientation to
time, then place and
person
Thinking Disorganized, incoherent, Distorted, pessimistic Impaired, impoverished
rambling
Attention Usually disturbed, hard to direct Difficulty Usually intact
or sustain concentrating
Awareness Can be reduced, tends to Diminished Alert during the day;
fluctuate may be hyper alert
Sleep/waking Usually disrupted Hyper or hypo Normal for age; cycle
somnolence disrupted as the disease
progresses
