Jena Boen
Lakeview College of Nursing

	
1.	 What might be the cause of Mrs. Stokes hallucinations?
Since Mrs. Stokes is an older adult, the provider must be careful when giving her Morphine IV.  According to Clark, “opioids should be started at the lower dose, about 25%–50% of the dose given to younger patients” (Chau, Walker, Pai, & Cho, 2008, para. 5).  It should have been an eye raiser that Mrs. Stokes has had 3 doses of Morphine since her surgery, as well.
2.	The nurse reports to her health care practitioner that Mrs. Stokes is having visual hallucinations.  Based on the article, what treatments might the nurse anticipate to be ordered for Mrs. Stokes?
The nurse should anticipate for Mrs. Stokes to be ordered a dose reduction.  The dose reduction should be about 25 to 50% of the dosage. (Chau et al., 2008)  If the reduction of Mrs. Stokes’ Morphine dosage interferes with her pain control, it could be anticipated that the doctor would “add adjuvant therapy such as steroids, neurontin, or low dose tricyclic antidepressants” (Chau et al., 2008, p. 1).
3.	What other acute health problems might be the underlying cause of these hallucinations in Mrs. Stokes?

4.	The physicians start Mrs. Stokes on Quetiapine (Seroquel) to treat her hallucinations.  What would you teach her and her family about this medication?
I would teach Mrs. Stokes family that there are some adverse effects to this medication that include: drowsiness, headache, orthostatic hypotension, and weight gain.  (Abrams, Pennington, & Lammon, 2009)  I would also instruct the family to check the dosage of Mrs. Stokes’ medication carefully before giving it to her and to give it in 2 to 3 daily doses.  
5.	Quatiapine (Seroquel) is also recommended for those with Parkinson’s disease; what is the rationale?
The rationale behind using Seroquel for Parkinson’s disease is that Seroquel is an antipsychotic that has a very low tendency to produce extra pyramidal symptoms.  (Abrams, 2009)  
6.	Use the section on the causes of visual hallucinations to explain the hallucations to 17-year old Carol.
7.	Carol says she understand, but wants to know what to say when her Grandmother says she is seeing bugs.  What may be a therapeutic response?
Carol should reorient her Grandmother and explain that there are no bugs on the walls.  She shouldn’t get angry with her Grandmother and should not yell at her Grandmother.  Carol should remain understanding and just reorient her Grandmother in a calm way.
8.	Mrs. Stokes asks whether she will have the hallucinations again.  How would you respond?
I would respond with the fact that the visual hallucinations may in fact return, but that we will do our best to improve her symptoms.   There is no treatment for visual hallucinations.  (Chau et al., 2008)

References
Abrams, A. C., Pennington, S. S., & Lammon, C. B. (2009). Clinical Drug Therapy (9th ed.). : .
Chau, D. L., Walker, V., Pai, L., & Cho, L. M. (2008). Opiates and elderly: Use and side effects. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2546472/
Mauk, K. L. (2010). Gerontological Nursing  (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers.