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A nurse is talking with an older adult patient who unexpectedly mentions
having trouble sleeping. What tool besides the Pittsburgh Sleep Quality
Index (PSQI) can the nurse use to assess for sleep disorders? - Answer:
SPICES: An Overall Assessment Tool for Older Adults
Rationale:Approximately half of adults complain of sleep disorders,
especially insomnia. Although the SPICES tool is an overall assessment tool,
it also provides insight into potential sleep disorders. The other tools assess
for depression, abuse, and cognitive decline, respectively.
Why are first-generation antihistamines (e.g., diphenhydramine [Benadryl])
considered inappropriate for the older adult? - Answer: These drugs have
anticholinergic effects and should not be administered to the older adult.
Rationale:First-generation antihistamines should be avoided in the older
adult because they have anticholinergic effects and may cause blurred
vision, urinary retention, confusion, hallucinations, dry mouth, constipation,
and delirium. Trouble waking, euphoria, and nocturnal wandering have not
been documented as side effects of older adult anticholinergic use.