Expressed suicidal ideation or a plan — initiate suicide precautions and notify the provider immediately.
Before you read
Test yourself first: 3 questions
Question 1 of 3
The nurse is assessing a newborn for Hirschsprung disease. Which finding in the first 48 hours of life is most suggestive of this disorder?
Answer: A. Failure to pass meconium within 24 to 48 hours of birth is a hallmark of Hirschsprung disease, caused by absence of ganglion cells in a segment of the distal colon. Frequent loose stools, projectile vomiting, and excessive meconium passage are not characteristic.
Question 2 of 3
A child is diagnosed with hand-foot-and-mouth disease. The nurse expects to find which characteristic lesions?
Answer: A. Hand-foot-and-mouth disease, caused by coxsackievirus, produces painful vesicular lesions in the mouth and on the palms and soles. It is usually self-limiting, and care focuses on hydration and comfort.
Question 3 of 3
A nurse is assessing a 78-year-old client. Which finding is a normal age-related change rather than a sign of disease?
Answer: A. Decreased skin elasticity and turgor is an expected aging change due to loss of subcutaneous tissue and collagen. Resting tachycardia, productive cough, and a new confusion onset are not normal aging and warrant evaluation.
Keep the streak going with more questions like these, each with a full rationale.
What is huntington disease?
Symptoms usually begin between ages 30 and 50, after most patients have already had children, and the disease is relentlessly progressive over 10 to 20 years. Each child of an affected parent has a 50 percent chance of inheriting the gene. There is no cure; treatment is symptomatic and supportive.
Key points to remember
- Autosomal-dominant inheritance: each offspring of an affected parent has a 50 percent chance of inheriting the defective gene, and genetic testing can confirm the diagnosis.
- Classic triad: choreiform (jerky, writhing, uncontrollable) movements, progressive cognitive decline/dementia, and psychiatric/behavioral changes including depression and irritability.
- Chorea and dysphagia worsen over time, leading to high risk for falls, aspiration, malnutrition, and weight loss.
- No cure exists; tetrabenazine and deutetrabenazine reduce chorea, and antipsychotics/antidepressants manage behavioral symptoms.
- Suicide risk is elevated due to depression, loss of independence, and a known fatal prognosis.
Signs & symptoms
- Chorea: jerky involuntary moves
- Progressive dementia
- Mood swings, depression
Nursing priorities
- Prevent aspiration: assess swallowing, provide thickened liquids and soft foods, position upright for meals, and have suction available.
- Maximize caloric intake with high-calorie, high-protein foods because constant movement greatly increases metabolic demand.
- Maintain safety: pad the environment, use proper positioning and seating, and implement fall and injury precautions.
- Assess mood and screen for suicidal ideation; provide emotional support and psychiatric referral.
- Offer genetic counseling and support resources for the patient and family, and facilitate advance care planning.
Patient teaching
- Offer genetic counseling to the patient and at-risk family members; testing can be done before symptoms appear.
- Eat frequent high-calorie, high-protein meals and use soft or thickened foods to reduce choking and meet energy needs.
- Use safety measures such as padded surfaces, supportive seating, and fall precautions as movements worsen.
- Recognize and report signs of depression or thoughts of self-harm.
- Complete advance directives and discuss long-term care planning while able to participate.
Red flags: report now
- Expressed suicidal ideation or a plan — initiate suicide precautions and notify the provider immediately.
- Coughing, choking, or new fever with meals indicating aspiration — stop oral intake and reassess swallowing.
References
Clinical references for this topic
