5 confusion, dementia, and alzheimer’s disease define the following terms: confusion the inability...

5Confusion, Dementia, and Alzheimer’s Disease

Define the following terms:

Confusionthe inability to think clearly.

Deliriuma state of severe confusion that occurs suddenly and is usually temporary.


1. Discuss confusion and delirium

Remember these points about confusion: • Interferes with ability to make decisions • Personality may change • Anger, depression, and irritability are other signs • Can be temporary or permanent



Causes of confusion may include the following: • Low blood sugar • Head trauma or injury • Dehydration • Nutritional problems • Fever • Sudden drop in body temperature • Lack of oxygen


1. Discuss confusion and deliriumRemember these care guidelines for confusion: • Do not leave resident alone. • Stay calm. Provide a quiet environment. • Speak in a lower tone of voice. Speak clearly and slowly.

• Introduce yourself each time you see resident. • Remind resident of location, name, and date. • Explain what you are going to do using simple instructions.

• Do not rush the resident. • Talk about plans for the day. • Encourage the use of glasses and hearing aids. • Promote self-care and independence. • Report observations to the nurse.


1. Discuss confusion and deliriumREMEMBER:Causes of delirium include infections, disease, fluid imbalance, poor nutrition, drugs, and alcohol.



The following are symptoms of delirium: • Agitation • Anger • Depression • Irritability • Disorientation • Trouble focusing • Problems with speech • Changes in sensation and perception • Changes in consciousness • Decrease in short-term memory



Remember the following points when communicating with someone who is confused or disoriented: • Keep your voice low• Use the person’s name • Speak clearly in simple sentences• Reduce distractions as much as possible


Define the following terms:Cognition

the ability to think logically and quickly.Cognitive impairment

loss of ability to think logically; concentration and memory are affected.

Dementiaa general term that refers to a serious loss of mental abilities, such as thinking, remembering, reasoning, and communicating.

Alzheimer’s diseasea progressive, incurable disease that causes tangled nerve fibers and protein deposits to form in the brain, which eventually cause dementia.


2. Describe dementia and discuss Alzheimer's disease

REMEMBER:Dementia is NOT a normal part of aging.



Common causes of dementia include the following:• Alzheimer’s disease • Multi-infarct or vascular dementia (a series of strokes causing damage to the brain)

• Lewy Body disease • Parkinson’s disease • Huntington’s disease



Note the following points about diagnosing dementia: • Involves getting a patient’s medical history and having a physical and neurological exam

• Blood tests and imaging tests like CT or MRI scans may be ordered

• Tests to trace brain wave activity (EEG) may be performed

• Diagnosis of dementia helps rule out other possible diseases with similar symptoms

5 Confusion, Dementia, and Alzheimer’s Disease

Transparency 5-1: Facts About Alzheimer’s Disease

• AD is the most common cause of dementia in the elderly.

• As many as 5.2 million people in the U.S. are living with Alzheimer’s.

• Women are more likely than men to have AD.• Risk increases with age, but it is not a normal part of aging.

• AD is progressive, degenerative, and irreversible. • Tangled nerve fibers and protein deposits in brain cause dementia.

• Cause is currently unknown and diagnosis is difficult.

• Length of time from onset to death can range from three to 20 years.

• Each person will show different signs at different times.



REMEMBER:• Every person with AD progresses differently, showing different symptoms at different times.

• AD residents should be encouraged to do self-care and keep their minds and bodies active as long as possible.


Transparency 5-2: Helpful Attitudes for Residents with AD

• Do not take things personally.• Put yourself in their shoes. • Work with symptoms and behaviors you see.• Work as a team. • Take care of yourself. • Work with family members. • Remember the goals of the resident care plan.


3. List strategies for better communication with residents with Alzheimer’s disease

These communication tips are helpful with residents with AD: • Approach from the front. • Determine how close to stand. • Communicate in calm place. • Identify yourself and use the residentís name. • Speak slowly in a lower voice than normal. • Repeat yourself, using the same words and phrases, as often as needed.

• Use signs, pictures, gestures, or written words to help communicate.

• Break complex tasks into smaller, simpler ones.


3. List strategies for better communication with residents with Alzheimer's disease

Remember the following interventions for possible communication problems: If resident is frightened or anxious• Keep him calm. • Speak in a low, calm voice. Use a room with little background noise and distraction.

• Describe what you are going to do. • Use simple words and short sentences. • Check your body language.



Interventions for possible communication problems (cont’d.):

If resident forgets or shows memory loss• Repeat yourself using the same words. If a resident does not understand a word, try a different one.

• If resident perseverates, answer questions using the same words each time.

• Keep messages simple. Break complex tasks into smaller, simpler ones.

If resident has trouble finding words or names• Suggest a word that sounds correct. Try not to correct a resident who uses an incorrect word.




If resident seems not to understand basic instructions or questions• Ask resident to repeat your words. • Use short words and sentences. Allow time to answer. • Use the communication methods that are effective. • Watch for nonverbal cues. Observe body language. • Use signs, pictures, gestures, or written words.


3. List strategies for better communication with residents with Alzheimer's diseaseInterventions for possible communication problems (cont’d.):

If resident wants to say something but cannot• Ask him or her to point, gesture, or act it out. • Offer comfort with a hug or smile if resident is upset.

If resident does not remember how to perform basic tasks• Break each activity into simple steps. If resident insists on doing something that is unsafe or not allowed • Limit the times you say “don’t.” Redirect activities instead.




If resident hallucinates or is paranoid or accusing• Do not take it personally. • Try to redirect behavior or ignore it. If resident is depressed or lonely• Take time one-on-one to ask how he or she is feeling. Listen to the response.

• Try to involve the resident in activities. • Report depression to the nurse.


3. List strategies for better communication with residents with Alzheimer's diseaseInterventions for possible communication problems (cont’d.):

If resident is verbally abusive or uses bad language• Remember it is the dementia speaking and not the person.• Try to ignore the language. Redirect attention. If resident has lost most of verbal skills• Use nonverbal skills, such as touch, smiles, and laughter.

• Use signs, labels, and gestures. • Assume people can understand more than they can express.


4. List and describe interventions for problems with common activities of daily living (ADLs)

Remember these three general principles: 1. Develop a routine and stick to it. 2. Promote self-care. 3. Take good care of yourself, both mentally and physically.


Handout 5-1: Interventions for ADLs

• Urinary Incontinence • Make sure resident is drinking enough fluids. • Note when resident is incontinent. Check him or her every 30 minutes.

• Take resident to bathroom before “bathroom time.” • Take resident to bathroom before and after meals and before bed.

• Make sure resident urinates before getting off toilet.

• Mark restroom with sign or picture. • Be matter-of-fact when cleaning episodes of incontinence.

• Observe toilet patterns for two to three nights if resident is incontinent during night.


Handout 5-1: Interventions for ADLs (cont’d.)

• Incontinence (cont’d.)• Make sure there is enough light in the bathroom and on the way there.

• Put lids on trash cans, waste baskets or other containers if resident urinates in them.

• Dressing • Show resident what he or she is going to wear. • Avoid delays or interruptions. • Give privacy. • Encourage resident to pick out clothes to wear. Lay out clothes in order to be put on.

• Break task down into simple steps. Do not rush the resident.

• Use a friendly, calm voice when speaking. • Praise and encourage.



• Bathing • Schedule bathing when resident is least agitated. • Give resident supplies before bathing to serve as visual aid.

• Take a walk with resident down the hall and stop at tub or shower room.

• Make sure bathroom is well-lit. • Keep temperature comfortable. • Give privacy. • Be calm and quiet. • Keep process simple.



• Bathing (cont’d.)• Be sensitive when discussing bathing with resident.

• Give resident washcloth to hold during bath. • Ensure safety by using nonslip mats, tub seats and hand-holds.

• Be flexible about when to bathe. Understand if resident does not want to bathe.

• Be relaxed. • Be encouraging. Offer praise and support. • Let the resident do as much as possible for him- or herself.

• Check the skin for signs of irritation.



• Eating • Have meals at consistent times each day. • Food should look and smell good. • Make sure there is good lighting. • Keep noise and distractions low. • Remind the resident it is mealtime. • Keep the task of eating simple. • Finger foods are easier to eat. • Do not serve steaming or very hot foods or drinks. • Use dishes without a pattern. Use a simple place setting. Remove other items from the table.



• Eating (cont’d.)• Put only one item of food on plate at a time. • Give simple, clear instructions on how to eat or use utensils.

• Place a spoon to the lips. • Ask resident to open his or her mouth. • Guide resident through meal with simple instructions.

• Offer regular drinks to avoid dehydration. • Use adaptive equipment as needed. • Feed resident slowly, giving small pieces of food. • Make mealtimes simple and relaxed. Give resident time to swallow each bite.

• Seat residents with others to encourage socializing.

• Observe for eating and swallowing problems. • Observe and report changes or problems.



• Additional tips • Help with grooming. • Prevent infections. Follow Standard Precautions. • Observe and report potential problems. • Maintain daily exercise routine. • Maintain self-esteem. Encourage independence. • Share in fun activities. • Reward positive and independent behavior with smiles, hugs, warm touches, and thank yous.


Define the following terms:Sundowning

becoming restless and agitated in the late afternoon, evening, or night.

Catastrophic reactionoverreacting to something.

Pacingwalking back and forth in the same area.

Wanderingwalking around aimlessly.


Define the following terms:Elope

in medicine, when a person with Alzheimer’s disease wanders away from the protected area and does not return.

Hallucinationsillusions a person sees, hears, smells, tastes, or feels.

Delusionspersistent false beliefs.

Perseveratingthe repetition of words, phrases, questions, or actions.


Define the following terms:Pillaging

taking things that belong to someone else.Hoarding

collecting and putting things away in a guarded manner.


Handout 5-2: Difficult Behaviors and Management

• Agitation• Remove triggers, keep routine, focus on familiar activity, remain calm, and soothe.

• Pacing and wandering

• Causes: restlessness, hunger, disorientation, need for toileting, constipation, pain, forgetting how or where to sit down, too much napping, need for exercise

• Remove causes, give snacks, encourage exercise, maintain toileting schedule, let pace in safe place, and suggest another activity.

• Hallucinations or delusions • Ignore if harmless, reassure, do not argue, and be calm.


Handout 5-2: Difficult Behaviors and Management (cont’d.)

• Sundowning • Remove triggers, avoid stress, play soft music, set bedtime routine, plan calming activity, remove caffeine, give back massage, distract, and daily exercise.

• Catastrophic reactions • Avoid triggers such as fatigue, changes, overstimulation, difficult choices/tasks, pain, hunger, or need for toileting. Remove triggers and distract.

• Depression • Causes: loss of independence, inability to cope, feelings of failure and fear, facing incurable illness, chemical imbalance

• Report signs, encourage independence, talk about moods and feelings, and encourage social interaction.



• Perseveration or repetitive phrasing • Respond with patience, do not stop behavior, and answer questions each time, using the same words.

• Violent behavior • Block blows, never hit back, step out of reach, call for help, do not leave resident alone, remove triggers, and use calming techniques.

• Disruptiveness • Gain resident’s attention, be calm, direct to a private area, ask about behavior, notice and praise improvements, tell resident about changes, encourage to join in activities, help find ways to cope, and focus on positive activities



• Inappropriate social behavior • Do not take it personally, stay calm, reassure, find out cause, direct to private area, respond positively to appropriate behavior, and report abuse to nurse.

• Inappropriate sexual behavior • Be matter-of-fact, be sensitive, distract, direct to private area, and consider other ways to provide physical stimulation.

• Pillaging and hoarding

• Label belongings, place a label or symbol on door, do not tell others that person is “stealing,” prepare the family, ask family to report strange items, and provide a rummage drawer.


5. List and describe interventions for common difficult behaviors related to Alzheimer's disease

Look at the Residents’ Rights box on pages 114 - 115 of your textbook and think about this question:Can you understand why residents with Alzheimer’s disease are at a high risk for abuse and neglect?


5. List and describe interventions for common difficult behaviors related to Alzheimer's disease

REMEMBER:It is very important for you to prevent elder abuse and neglect. Be vigilant about observing for and reporting suspected abuse and neglect.


Define the following term:

Validatinggiving value to or approving.


6. Describe creative therapies for residents with Alzheimer's disease

Four creative therapies may be used for residents with AD:• Reality orientation• Validation therapy• Reminiscence therapy• Activity therapy


6. Describe creative therapies for residents with Alzheimer's disease

Think about these questions:• When do you think these therapies would be useful?• What benefits can be gained from each of the creative therapies?


Chapter ExamMultiple Choice. 1. Which of the following should a nursing assistant do if a resident is confused? (A) Rush the resident. (B) Stay calm and provide a quiet environment. (C) Leave the resident alone. (D) Do not discuss plans for the day because it adds to

the resident’s confusion.

2. Confusion may be caused by (A) Too much television viewing (B) An unpleasant roommate(C) Exercise (D) Dehydration


Chapter Exam (cont’d.)3. The ability to think logically and quickly is called: (A) Cognition (B) Dementia (C) Awareness (D) Dysphagia

4. Nursing assistants can help residents with memory loss by (A) Doing as much as possible for them (B) Encouraging them to make lists of things to remember (C) Reminding them every time they forget something (D) Telling them to snap out of it


Chapter Exam (cont’d.)5. Which of the following terms means “a serious loss of mental abilities?” (A) Cognition (B) Irreversible (C) Dementia (D) Onset

6. Which of the following statements is true of Alzheimer’s disease (AD)? (A) Skills a person has used over a lifetime are usually

kept longer. (B) Residents with AD will show the same signs at the same

times. (C) NAs should do everything for residents with AD.(D) Alzheimer’s disease is a normal part of aging.


Chapter Exam (cont’d.)7. When a resident with AD is frightened, the NA should

(A) Speak in a room where the television is on (B) Check her body language to make sure she is not tense or

hurried (C) Use long sentences (D) Not tell the resident what she is going to do

8. When a resident with AD is perseverating, the NA should (A) Repeat herself using the same words (B) Tell the resident that she already answered that question (C) Not answer the question after the third time it is asked (D) Use a thesaurus to find new ways to say things


Chapter Exam (cont’d.)9. When a resident with AD cannot understand basic instructions, it is a good idea to use (A) A notepad to write out instructions (B) Longer words to catch the resident’s interest(C) A very loud voice(D) Short words, pictures, and gestures

10. If a resident with AD has lost most of his verbal skills, the NA should (A) Assume the resident cannot understand what is being

said (B) Use touch, smiles, and laughter (C) Ask the resident questions (D) Do not involve resident in activities


Chapter Exam (cont’d.)11. If a resident with AD is incontinent, the nursing assistant should (A) Withhold fluids (B) Dim the bathroom lights (C) Mark the restroom with a sign or picture (D) Check resident every three hours to help determine a

“bathroom time”

12. If a resident with AD has problems with bathing, the nursing assistant should (A) Schedule bathing when the resident is least agitated (B) Hurry the resident through the bath (C) Insist that the resident bathe even if she does not

want to (D) Surprise the resident with the bath


Chapter Exam (cont’d.)13. One way for a nursing assistant to help a resident with AD with eating is to (A) Put a few types of food on the plate at the same time (B) Use dishes without a pattern and a simple place setting (C) Withhold fluids (D) Serve steaming hot foods and drinks

14. If a resident with AD has problems with dressing, the nursing assistant should (A) Lay out clothes in the order they should be put on (B) Dress the resident in the hallway (C) Choose the resident’s clothing for the resident (D) Give the resident multiple steps to follow


Chapter Exam (cont’d.)15. A good way for a nursing assistant to respond to hallucinations is to (A) Argue with the resident, telling her that what she

thinks she sees isn’t real (B) Tell the resident that she can see the hallucination,

too (C) Reassure a resident who is upset and worried (D) Laugh at the resident

16. A nursing assistant can respond to sundowning by (A) Adding more caffeine to the resident’s diet (B) Setting a bedtime routine and keeping it (C) Restricting exercise during the day (D) Scheduling activities during this time


Chapter Exam (cont’d.)17. If a resident with AD shows violent behavior, the nursing assistant should (A) Hit back (B) Remove triggers (C) Leave the resident alone (D) Yell at the resident

18. Which of the following is a good way for a nursing assistant to respond to inappropriate sexual behavior? (A) Let other residents know what is happening (B) Take the resident to a private area (C) Inform other nursing assistants that the resident has

a dirty mind(D) Loudly reprimand the resident to shame him into

stopping


Chapter Exam (cont’d.)19. When a resident with AD pillages and hoards, the nursing assistant should (A) Tell the family that the resident is stealing things (B) Lock the resident in his room if the NA does not have

time to watch him(C) Warn the other residents that the resident with AD is

a thief (D) Provide a rummage drawer

5 confusion, dementia, and alzheimer’s disease define the following terms: confusion the inability...

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