A nurse is providing teaching to the caretakers of a client who has Alzheimer’s disease with mild cognitive decline. The client is beginning to experience sleep disturbances. Which of the following instructions should the nurse include?

Choice A reason:

A client with new-onset delirium is experiencing an acute and often fluctuating disturbance in attention and cognition. Delirium is typically caused by an underlying medical condition, substance intoxication, or withdrawal. Assertiveness training would not be appropriate for this client as the primary focus should be on identifying and treating the underlying cause of the delirium.

Choice B reason:

A client experiencing auditory hallucinations is likely dealing with a psychotic disorder such as schizophrenia. The primary treatment for such clients involves antipsychotic medications and psychotherapy aimed at managing symptoms and improving reality orientation. Assertiveness training is not suitable for clients in the acute phase of psychosis as their ability to engage in and benefit from such training is compromised.

Choice C reason:

A client experiencing mania, a state characterized by elevated mood, hyperactivity, and impulsive behavior, is typically seen in bipolar disorder. During a manic episode, the client may have difficulty focusing and controlling their impulses, making it challenging to participate effectively in assertiveness training. The priority for these clients is to stabilize their mood with medication and supportive therapy.

Choice D reason:

A client with somatic symptom disorder experiences excessive thoughts, feelings, and behaviors related to physical symptoms. Assertiveness training can be beneficial for these clients as it helps them express their needs and concerns more effectively, reducing the focus on physical symptoms and improving their overall functioning.

Choice A reason:

ECT is not contraindicated in clients with psychotic symptoms. In fact, it is often used to treat severe depression with psychotic features, as well as other conditions such as mania and catatonia. ECT can be highly effective in reducing symptoms of psychosis when other treatments have failed.

Choice B reason:

ECT is delivered through electrodes attached to the head. During the procedure, a small amount of electrical current is passed through the brain to induce a controlled seizure, which can help alleviate symptoms of severe depression and other mental health conditions.

Choice C reason:

ECT can be administered to clients with suicidal ideation. It is often considered when rapid symptom relief is needed, such as in cases of severe depression with a high risk of suicide. ECT can provide quick and significant improvement in mood and functioning.

Choice D reason:

ECT is conducted under general anesthesia, not regional anesthesia. General anesthesia ensures that the client is unconscious and does not feel pain during the procedure. Muscle relaxants are also administered to prevent physical convulsions during the induced seizure.