Questions 51-55 Instructions. Read and Answer questions appropriately and in Full Sentences.

Maria Sanchez, a 75-year-old retiree, is brought to the Emergency Department by her grandson because she is gasping for air. Maria is currently taking medications for diabetes, hypertension, and hyperlipidemia. Upon examination, Maria appears disheveled, has poor hygiene, and is underweight and dehydrated. She has difficulty seeing and hearing. Maria tells the nurse that her glasses and hearing aids have been missing since last year and no one has been able to find them. After receiving a breathing treatment, Maria is much calmer and eager to answer questions. Her social history reveals that after the death of her husband of 54 years, Maria became unable to manage her house and had to move in with her daughter, her son-in-law, and their four children. Further evaluation reveals that Maria misses her long-time friends from her hometown, spends most of her day at home as she is afraid of getting lost in the big city, and struggles with her health issues. On two different occasions, Maria tells the nurse that she wishes the Lord had taken her instead of her husband. Her mood appears depressed, she keeps focusing on the good life she had with her husband, and she looks forward to the day the two

of them will reunite. After gentle questioning by the nurse, Maria states that she is having difficulty coming to terms with the fact that she has lost most of her independence. She has a difficult time watching her son-in-law get drunk almost every night and verbally abusing her daughter and the children. Maria denies experiencing physical abuse, but she reports that, along with her glasses and hearing aids, some of her jewelry and money are missing. Although Maria enjoys peaceful weekends alone at home when the family takes trips, she feels unwelcome and is afraid that if she has more health problems, no one will help her.

51. List at least five actions the nurse should take during the assessment when caring for an older adult who may be a victim of abuse.

52. Given the above type scenario what types of possible abuse is Maria experiencing? List at least four indicators that may support a finding of abuse?

53. List areas that require further exploration.

54. What Mental Health Issues is Maria Facing?

55. List at least for steps the nurse should take to address the clients needs.

Questions 56 -60

You have been working with a clients family for three years in a clinic that treats clients with Alzheimers disease. The clients illness has deteriorated, but his family is still able to care for him at home. He lives with his 40-year-old daughter, her husband, and their three children. His wife died 5 years ago. The client is now in Stage 2 of the illness. He has experienced progressive memory loss, communication difficulties, and his sundowningand wandering behaviors have gradually increased. His daughter says, He just seems to make up things when he cant remember. She wants to keep him at home a little longer and is aware that this cannot go on long-term.

56. What should you consider as you develop interventions with the daughter to ensure the clients safety at home?

57. The family has asked for help in improving communication with the client. What communication guidelines would you discuss with them?

58. The daughter states that the client wanders from room to room and calls out for his deceased wife.

What interventions for wandering can you suggest to the family?

59. The family has asked for help in managing the increased confusion and agitation that occurs later in the day. What measures would you suggest to promote optimal conduct and impulse control?

Karmella is a 38-year-old who recently graduated from college. She has been able to move her family from a dangerous neighborhood into a townhouse in a safer neighborhood. She has been admitted to the acute psychiatric unit for severe anxiety with episodes of panic attacks. She has had previous hospitalizations for crisis-type symptoms after break-ins to her apartment and social problems her older children were having due to their unsafe environment. On her third day of hospitalization, she approaches the nurse and says she feels as if she is going crazy. When she returns to her room, she asks that the door be left open and describes to the nurse a situation she experienced on her way home after a night class where she was held captive for 23 hours and gang raped. She said she never told anyone because she was fearful for her familys welfare.

The nurse explains that many of the problems she is facing may relate to this incident, since she did not receive any treatment to deal with this trauma.

60 (a).Based on the assessment of Karmellas crisis and trauma, what are her coping habits? What type of treatment will be suggested?

60 (b) What should be included in the client education and interventions to help her heal?