An older adult diagnosed with moderate dementia is seen in the geriatric clinic. As the nurse is evaluating the client, the client's wife states that her husband has developed an increasing number of episodes of incontinence. She does not know what is precipitating the episodes, and states "maybe he just doesn't remember that he needs to urinate or maybe it's me, it takes me a while to walk him to the bathroom." The nurse develops a plan of care for this client and includes which of the following interventions to manage the incontinence? (Select all that apply.)
Use of a commode close by to where the client spends most of his time
Development of a toileting schedule
Use of an external catheter
Bladder diary to be completed by the client's wife
Correct Answer : A,B
Choice A reason: Use of a commode close by to where the client spends most of his time can reduce the distance and time required for the client to reach the toilet, and thus prevent accidents and embarrassment. It can also promote the client's independence and dignity.
Choice B reason: Development of a toileting schedule can help the client to establish a routine and habit of voiding at regular intervals, and thus prevent the bladder from becoming too full or overactive. It can also reduce the risk of urinary tract infections and skin breakdown.
Choice C reason: Use of an external catheter is not recommended for older adults with dementia, as it can cause irritation, infection, and obstruction of the urinary tract. It can also increase the client's confusion and agitation, and interfere with his mobility and comfort.
Choice D reason: Bladder diary to be completed by the client's wife is not a direct intervention to manage the incontinence, but rather a tool to assess the pattern and severity of the problem. It can help the nurse to identify the possible causes and triggers of the incontinence, and to evaluate the effectiveness of the interventions. However, it may not be feasible or reliable for the client's wife to complete the diary, as she may have other responsibilities or difficulties in observing and recording the client's urinary habits.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D"]
Explanation
Choice A: Reduce the proportion of older adults with untreated caries. This is a correct answer because it is one of the Healthy People 2020 oral health objectives for older adults¹. Untreated caries can lead to pain, infection, tooth loss, and reduced quality of life². Reducing the prevalence of untreated caries can improve the oral health and well-being of older adults.
Choice B: Reduce the proportion of adults with untreated dental decay. This is an incorrect answer because it is not specific to older adults. The Healthy People 2020 oral health objectives for adults include reducing the proportion of adults aged 35 to 44 years with untreated dental decay¹. However, this does not address the unique needs and challenges of older adults, such as increased risk of root caries, dry mouth, and periodontal disease².
Choice C: Prevent and control oral and craniofacial diseases, conditions, and injuries. This is a correct answer because it is the overall goal of the Healthy People 2020 oral health objectives¹. Oral and craniofacial diseases, conditions, and injuries can affect the function, appearance, and quality of life of older adults². Preventing and controlling these problems can help older adults maintain their oral health and general health.
Choice D: Improve access to preventive services and dental care. This is a correct answer because it is one of the Healthy People 2020 oral health objectives for older adults¹. Access to preventive services and dental care can help older adults prevent oral diseases, detect problems early, and receive appropriate treatment². However, many older adults face barriers to accessing oral health care, such as lack of dental insurance, transportation, or awareness³. Improving access to oral health care can reduce these disparities and improve the oral health outcomes of older adults.
Correct Answer is ["B","C","D"]
Explanation
Choice A reason: This is incorrect because providing antiseptic mouthwash (such as Listerine) for the patient can worsen xerostomia, or dry mouth. Antiseptic mouthwash can contain alcohol, which can dry out the oral mucosa and reduce saliva production. Saliva is important for lubricating the mouth, preventing infections, and facilitating chewing and swallowing. Therefore, antiseptic mouthwash should be avoided or used sparingly in patients with xerostomia.
Choice B reason: This is correct because encouraging the patient to brush and floss teeth regularly can help prevent dental caries, gingivitis, and periodontitis, which are common complications of xerostomia. Xerostomia can increase the risk of oral infections and tooth decay, as saliva helps wash away food particles, bacteria, and plaque. Therefore, oral hygiene is essential for patients with xerostomia.
Choice C reason: This is correct because encouraging the patient to drink water frequently can help moisten the mouth and relieve the discomfort of xerostomia. Water can also help flush out food debris and bacteria, and prevent dehydration, which can exacerbate xerostomia. Therefore, water intake is beneficial for patients with xerostomia.
Choice D reason: This is correct because providing saliva substitutes can help mimic the functions of natural saliva and improve the symptoms of xerostomia. Saliva substitutes are artificial saliva products that contain water, electrolytes, and lubricants, such as glycerin, carboxymethylcellulose, or xylitol. They can be applied as sprays, gels, rinses, or lozenges, and can help lubricate the mouth, prevent infections, and facilitate chewing and swallowing. Therefore, saliva substitutes are useful for patients with xerostomia.
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