Chapter 19: confusion, dementia, and Alzheimer’s disease

Guidelines: communicating with resident who have Alzheimer's disease If a resident wants to say something but cannot:

-encourage the resident to point, gesture, or act it out. -if the resident is obviously upset but cannot explain why, offer comfort with a smile, or try to distract him. Verbal communication may be frustrating.

Remember the goal of the care plan

Along with the practical task that nursing assistant perform, the care plan will also call for maintaining residence, dignity, and self steam. Nursing assistance should help residence be as independent as possible.

irreversible

An irreversible disease or condition cannot be cured. Someone itch irreversible dementia (like Alzheimer's disease) will either die from the disease or die with the disease.

Mild Alzheimer's disease (early-stage)

At this stage, the person may show some problems, such as memory loss and forgetting some words and the location of familiar objects. The persons medical examination may show problems with memory and concentration. However, the person may still be independent and able to work, drive, and do other activities.

1. Develop a routine and stick to it

Being consistent is important for resident who are confused and easily upset.

Be aware of the difficulties associated with caregiving

Caring for someone with dementia, can be physically and emotionally exhausting, as well as incredibly stressful. Nursing assistant should take care of themselves so they can continue to provide the best care. Being aware of the body signals to slow down, rest, or eat, better is important. Each nursing assistant feelings are real; they have; a right to them. Mistake should be viewed as a learning experience. Unmanaged stress can cause physical and emotional problems. When stress feels overwhelming, an nursing assistant can't talk to her superior.

As a person ages, some of the ability to think logically and clearly may be lost. This ability is called

Cognition -when some of this ability is lost, a person is said to have cognitive impairment. -how much a cognition is lost depends on the individual.

Cognitive impairments affects

Concentration and memory. -elderly residents may lose their memories of recent event, which can be frustrating for them. -NA must help by encouraging them to make lists of things to remember and writing down names, events and phone numbers.

Degenerative

Disease gets continually worse. It eventually causes a breakdown of body system. It causes a greater and greater loss of health and abilities. -A degenerative disease can cause death.

Severe Alzheimer's disease (late-stage)

During this finale stage, a person may be unable to communicate with others, control movement, or respond to his surroundings. This person needs significant help with activities of daily living including and eliminating. There ability to walk, sit, and swallow may be affected. It is important for nursing assistants to encourage independence, regardless of what signs and symptoms a resident with Alzheimer's disease shows. The resident should be encouraged to do whatever he is able to do. This helps keep the resident mind and body as active as possible. Working socializing, reading, problem solving, and exercising should all be encouraged. Tasks should be challenged but not frustrating NA can help residents succeed in these tasks.

Work with the symptoms and behaviors noted.

Each person with Alzheimer's disease is an individual. Residents with AD will not all show the same symptoms at the same times. Each resident will do some things that others will never do. The best plan is to work with the behaviors that are seen on any particular day. For example: a resident with Alzheimer's disease may want to go for a walk one day, when the day before he did not want to go to the bathroom without help. If allowed by the care plan, the NA should try to go for a walk with him. NA should notice and report changes in behavior, mood, and independence.

Work with family members

Family members can be a wonderful resource. They can help a nursing assistant learn more about a resident. They also provide familiarity and comfort to the person with Alzheimer's disease. Nursing assistant should build relationships with the family members and keep the lines of communication open. In addition, nursing assistance should be reassuring to family members. It is very difficult for families to see a loved one health and abilities decline. When residents with Alzheimer's disease exhibit problem behaviors, it can be stressful for the family. Nursing assistance can help a reassuring family members that they understand that this behavior is part of the disease.

Moderate Alzheimer's disease (mid-stage)

Generally speaking, this stage has the longest duration. At this stage, the person may show signs and symptoms such as forgetting recent events, forgetting some of ones own past experience and background, and being moody or withdraw. Other changes include needing help with some activities of daily living, such as elimination and choosing appropriate clothing. There may be changes in sleep patterns, increased wandering, suspiciousness or delusions, and confusion about time and place.

A diagnosis of dementia involves

Getting a patients medical history and having a physical as well as neurological exam. -blood tests and imaging tests (a CT or MRI scan for example) may be ordered. -an electroencephalogram (EEG), a test using electrodes on the scalp to trace brain wave activity, may be performed. -diagnosis is a process of ruling out other possible diseases that mimic symptoms of dementia.

symptoms of AD appear

Gradually. It generally begins with memory loss. As the disease progresses, it causes greater and greater loss of health and abilities. -people with AD may get disoriented. They may be confused about time and place. Communication problems are common. They may lose their ability to read, write, speak or understand. Mood and behavior change. Ahressivenes, wandering and withdrawals are all part of AD.

After making the decision to place a person with Alzheimer's disease in a long-term care facility, family members usually feel

Guilty, even if they know that placement is a Necessary. -The person with Alzheimer's disease may be angry and unable to understand a decision. Families worry about miss treatment and are sensitive to be in judge by others. They also feel lost any change in the relationship with her family member. -Family members are making emotional adjustments, just as the residents are. They may be experiencing frustration, fear, sadness, anger, loneliness, and depression. It is important for families to be able to express their feelings. -nursing assistant should be sensitive to the big adjustment that residence and their families are making. If it needed, the NA can refer them to her supervisor.

2. Promote self-care

Helping residents care for themselves as much as possible will help them cope with this difficult disease.

Although all timers disease cannot be cured, there are techniques to

Improve the quality of life for residents with Alzheimer's disease. Including the following : -Validating -reminiscence therapy -activity therapy

Each resident is different, and NA should work with each person as an

Individual and should provide person-centered care.

Reminiscence therapy

Involves encouraging residence to remember and talk about the past. The nursing assistant can explore memories by asking about details. Reminiscing therapy can help elderly people remember pleasant times in the past and allow caregivers to increase their understanding of residence. It is helpful in many stages of Alzheimer's disease, but especially with moderate to advanced dementia. Examples: Mr. Benton, and 86 year old man with Alzheimer's disease, fall in the Korean War. In his room are many memories of the war pictures of his war buddies, a metal he was given, and more. The nursing assistant ask him to tell him where he was sent in the war. The nursing assistant ask him more detail questions about his experience. Eventually the residence chairs a lot: the friend he made in the service, why he was given the metals, times when he was scared, and how much he missed his family. Benefits: by asking questions about Mr. Bentons experience in the war, the nursing assistant shows an interest in him as a person, not as a resident. There's less the resident show that he is a person who was competent, social, responsible, and brave. This booty self-esteem. The nursing assistant also learned that Mr. Benton carried very much for his wife and daughter.

Dementia

Is a general term that refers to a serious loss of mental abilities such as thinking, remembering, reasoning, and communicating. -as this dementia advances, these losses make it difficult to perform activities of daily living such as eating, bathing, dressing, and eliminating.

Progressive

Once it begins, a progressive disease advances. To tends to spread to other parts of the body and affects many body functions.

Depression

People who become a withdrawn, isolated, lack energy, and stop eating, or doing things they used to enjoy, may be _________. _______ may have many causes, including the following: -Loss of independence -Inability to cope -Feeling up for failure and fear -Reality of facing a progressive, degenerative of illness -Chemical imbalance If a resident is _________, the nursing assistant should: -Report sign of depression to the nearest immediately. It is an illness that can be treated with medication. -Observer trigger that cause changes in mood -Encourage independence, self-care and activity -Listen to the resident if they want to share their feelings or talk about their moods -Find ways to encourage social interaction

NA should use the same procedures for

Personal care and activities of daily living for residents with AD as they would with other residents. -however, when NAs do the following, they will be able to provide the best care: *develop a routine and stick to it *promote self-care *take care of themselves, both mentally and physically.

Here are some terms that are related to dementia:

Progressive Degenerative Onset Irreversible

Guidelines: communicating with resident who have Alzheimer's disease If the resident insists on doing something that is unsafe or not allowed:

Redirect activities toward something else. Try to limit the times you say "don't"

Sleep disturbance

Residence with Alzheimer's disease may experience in number of _______ ________. If a resident experience sleeping problems, the nursing assistant should : -Make sure that the resident get to moderate exercise throughout the day, appropriate to his condition. The nursing assistant can encourage him to participate in activities he enjoys.. -Allow the residence to spend some time each day in natural sunlight if possible. Exposure to light and dark at appropriate times can help establish best for sleeping patterns. -Reduce lighting noise as much as possible during night time hours -Discourage sleeping during the day if possible.

Elopement

Residence with Alzheimer's disease, or other forms of dementia my try to elope, or leave a facility, unsupervised and unnoticed. It is very important that the resident who elopes are located in return to the facility as quickly as possible. The laundry resident is gone, the greater danger he might encounter. If in a nursing assistant believes a resident, my heavy load, she was alert her supervisor immediately. Resident who elope are often found near where they were last seen, and the earlier a A search is begun, the more likely the resident is to be found nearby and safe.

Many things can be done to improve communication with

Residents who have Alzheimer's disease. Providing person centered care for residents with Alzheimer's disease means responding to each resident as an individual.

Preservation or repetitive phrasing

Residents who have dementia may repeat words, phrases, questions, or activities, over and over again. This is called ________ or _______ ________. Search behavior may be caused by several factors, including disorientation or confusion. The nursing assistant should be patient with his behavior and not try to silence or stop the resident. She should answer questions each time they are asked, using the same words each time.

Resident rights Rights with AD:

Residents with AD may not be aware when their bodies are exposed. NA can protect residents' legal rights to privacy by keeping them dressed or covered when in bed. Residents with AD should be encouraged to make the decisions they are able to make, such as what shirt to wear or where to sit to eat.

Other normal changes of aging in the brain are

Slower reaction time, difficulty finding or using the right words, and sleeping less.

A person with Alzheimer's disease may be living with her family, which can cause

Stress and other emotional difficulties for all involved. The house was scheduled Hass to be changed; family members lose the freedom to come and go as you please. Family members must monitor the loved ones activities and provide constant care. They may lose sleep, as well as lose time to do their own activities and time to relax.

Work as a team.

Symptoms and behaviors change daily. When NA observe and report carefully, as well as listen to others' reports, the care team may be better able to develop solutions. For example: a resident with AD may refuse to eat her means. An NA might discover that if he sits next to the resident and eats something while she has food in front of her, the resident will also eat. The NA may also notice that the resident always eats her bite-sized sandwiches or some other specific food. This is important to report to the team and can help the team provide better nutrition for the resident. NA are in a great position to give details about residents. Being with residence often allows them to be experts on each case. Nursing assistant should make the most of this opportunity. Resident with Alzheimer's disease may not be able to recognize or distinguish between aids, nurses, or administrators. All staff members should be prepared to help when needed.

Confusion may come on suddenly or gradually. It can be

Temporary or permanent. Confusion is more common in the elderly. It may occur when a person is in the hospital.

A person with Alzheimer's disease may be living alone, which can cause

The family to worry about her health and safety. -Financial resources may be limited. Which adds to stress levels. Finding money needed to pay expenses of home care or adult day services can be difficult. Families do not know what goes on when no one is in the home. They may be afraid that the person is not caring for herself, may not take medication properly, and could wander away, or could cause a fire.

Alzheimer's disease (AD) is

The most common cause of dementia in the elderly.

Onset

The onset of a disease is the time the signs and symptoms begin.

Alzheimer's disease requires

The person family to make adjustments, which may be difficult. -This disease progresses at different rates, and people with Alzheimer's disease will need more care as it progresses. Eventually most people with Alzheimer's disease needs constant care. How was the families able to cope with the effects of the disease depends, impart, on the family, emotional and financial resources...

3. Take care of themselves, both mentally and physically

This will help NAs give the best care.

As AD worsens, residents will have

Trouble doing their activities of daily living.

An intervention means a

Way to change an action or development.

Sundowning

When a person with Alzheimer's disease is restless and agitated, in the late afternoon, evening, or night, it is called _______. _______ may be caused by hunger or fatigue, a change in routine or caregiver, or any new or frustrating situation. If a resident experience ______, the nursing assistant should: -Provide adequate lighting before it gets dark. -Avoid stressful situations during this time. Limited activities, appointment, trips, and visit. -Play soft music. -Set a bedtime routine and keep it. -plan a calming activity just before sundowning occurs. -Remove caffeine from the diet. -Provide snacks. -Give a smoothing back massage. -Distract the resident with a simple,calm activity like looking at a magazine. -Maintain a daily exercise.

Catastrophic reactions

When a person with Alzheimer's disease overreacts to something, it is called ______. It is most often trigger by any of the following situation: -Fatigue -Change of routine, environment or caregiver -Overstimulation (too much noise or activity) -Difficult choices of task -Physical pain, or discomfort, including hunger, or in need of use the toilet. The nursing assistant can respond to ___________ ________ as she would two agitation or sundowning. For example, if she can't remove triggers and help the resident focus on a smoothing activity.

Inappropriate social behavior

___________ _________ ________- may include cursing, name-calling, or yelling. As with violent or disruptive behavior, there may be many reasons why resident is behaving in this way. The nursing assistant should try not to take it personally. The resident may only be reacting to frustration or other stress. The nursing assistant should remain calm and be reassuring. She can try to find out what causes behavior. Possible causes include too much noise, too many people, and too much stress, pain, or discomfort. If the resident is disturbing others, the nursing assistant should gently direct him to a private area if possible. Any physical abuse or serious verbal abuse should be reported to the nurse.

Dementia is not a normal part of

aging

The following are a few of the common causes of dementia

-Alzheimer's disease -multi-infarct or vascular dementia (a series of strokes causing damage to the brain) -lewy body dementia (abnormal structures, called Lewy bodies, develop in areas if the brain, causing variety of symptoms) -Parkinson's disease -Huntington's disease (an inherited disease that causes certain nerve cells in the brain to waste away)

Guidelines: communicating with resident who have Alzheimer's disease If the resident is depressed or lonely:

-Take time, one-on-one to ask how he is feeling and really listen to the response. -try to invoice the resident in activities. Always report signs of depression to the nurse.

In general, the HHA can follow the safety guidelines for clients, who wander:

-Use lock doors. These can be installed lower or higher than usual, so the client will not see them. -Install alarm set sound one exit doors are opened -Have clients wear identification. Label can be affixed to or sewn into clothes. -Alert neighborhoods that the client may wander. Show them a recent photo of the client. Keep a recent photo handy, as well as a piece of clothing. The client has worn. These can help police and police dogs attack a client who has wandered away.

Signs and symptoms of delirium include the following:

-agitation -anger -depression -irritability -disorientation -trouble focusing -problem with speech -changes in sensation and perception -changes in consciousness -decrease in short-term memory NA should report these signs and symptoms to the nurse. The goal of treatment is to control or reverse the causes. Emergency care may be needed, as well as a stay in a hospital.

Guidelines: communicating with residents, who have Alzheimer's disease

-always approach from the front, and do not start of the resident. -Smile and look happy to see the resident. Be friendly. -Determine how close the resident wants you to be. -Communicate in a calm area with little background noise and distraction. -Always identify yourself and use the residence name. Do not touch first; this may upset the person. Continue to use the residence name during the conversation. -Speak slowly, using a lower tone of voice than normal. This is calming and easier to understand. -Repeat yourself, use the same words and phrases, as often needed. -Talk about only one subject at a time. Be patient. Use short, simple sentence. -Use signs, pictures, gestures, or written words to help communicate. -Break complex task into smaller, simpler ones. Gives simple, step-by-step instructions as necessary.

Guidelines: communicating with resident who have Alzheimer's disease If the residents seems not to understands basic instructions or questions:

-ask the resident to report your words. Use short words and sentences, allowing the resident time to answer. -note the communication methods that are effective and use them. -watch for nonverbal cues as the ability to talk lessens. Observe body language—eyes, hands, and face. -use signs, pictures, gestures, or written words. For example: a picture of a toilet on the bathroom door can help remind a resident where the bathroom is. Combining verbal and nonverbal communication is helpful. For example, you can say, "lets get dressed now," while holding up clothes.

Guidelines: communicating with resident who have Alzheimer's disease If the resident repeatedly asks to go home:

-ask the resident to tell you what is home was like and how he felt being there. -redirect or guide the conversation and/or the residents activities to something he enjoys. -expect that the resident may continue to ask to go home and be patient and gentle if your response.

Guidelines: communicating with resident who have Alzheimer's disease If the resident does not remember how to perform basic tasks:

-break each activity into simple steps. For instance, "let go for a walk. Stand up. Put on your sweater. First the right arms..." always encourage residents to do what they can.

Guidelines: Confusion

-do not leave a confused 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 the resident. Remind the resident of his location, name, and the date. A calendar can help. -explain what you are going to do, using simple instruction. -be patient. Do not rush the resident. -talk to the resident about plans for the day. Keeping a routine may help. -encourage the use of eyeglasses and hearing aids. Make sure they are clean and are not damaged. -promote self-care and independence. -do not leave cleaning agents, such as liquid soap, or personal care products, such as lotions or toothpaste, where the resident can access them. A person who is confused may try to eat or drink these products. -report observation to the nurse.

These attitudes helps NA give the best possible care to residents with AB:

-do not take things personally -be empathetic -work with the symptoms and behaviors noted -work as a team -be aware of the difficulties associated with caregiving -work with the family members -remember the goals of the care plan

Guidelines: assisting with ADLS for residents who have AD: If the resident has problems with nutrition

-encourage nutrious food, food may not interest the resident, or they may forget to eat, it may be great interest, but they may only want to eat a few types of food. A resident with AD is at risk for malnutrition. -have meals at regular, consistent times each day. You may need to remind the resident that it is mealtime. Familiar foods should be served and should look and smell appetizing. -make sure there is adequate lighting -keep noise and distractions to a minimum during meals. -keep the task of eating simple. If the resident is restless, try smaller, more frequent meals. Finger food (food that are easy to pick up with the fingers) work best. They allow the resident to choose the food they want to eat. Example of finger foods that may be good to serve are sandwiches cut into fourths, chicken nuggets or small pieces of cooked boneless chicken, fish sticks, cheese cubes, halved hard-boiled eggs, and fresh fruit and soft vegetables cut into bite-sized pieces. -do not serve steaming or very hot foods or drinks. -use a simple place setting with a single eating utensils and remove other items from the table. Plain plates without patterns or colors work best. -put only item of food on the plate at a time. Multiple kinds of food on a plates or a tray may be overwhelming -give simple clear instructions. Residents with AD may not understand how to eat or use utensils. Help the resident taste a sample of the meal first. Place a spoon to the lips. This will encourage the resident to open their mouth. Ask the resident to open their mouth. -guide the resident through the meal, providing simple instructions. Offer regular drinks of water, juice, and other fluids to prevent dehydration -use assistive devices for eating, such as special spoons and bowls. As needed. -if the resident needs to be fed, do so slowly offer small pieces of food. -make mealtimes simple and relaxed, not rushed. Give the resident time to swallow before each bite or drink. -seat the resident with others at s,all tables. This encourages socialization -observe and report eating or swallowing problems as we;; as changes in eating habits. Monitor weight accurately and frequently.

Guidelines: assisting with ADLS for residents who have AD: If the resident has problems with elimination:

-encouraged fluids. Never withhold or discourage fluids because a resident has urinary incontinence. Report to the nurse if the resident is not drinking fluids. Follow the schedule in the care plan for drinking fluids -mark the bathroom with a sign or a picture as a reminder to use the toilet and where it is. -make sure the path to the bathroom and rhe bathroom itself are well lit. -note the times at which the resident is incontinent over two three days. Check her every 30 minutes. This can help determine "bathroom times." Take the resident to the bathroom just before her bathroom times. -observe toilet patterns for two to three nights for incontinence in order to try to determine nighttime bathroom times. -take the resident to the bathroom after drinking fluids. Take the resident to the bathroom before and after meals and before bedtime. Make sure the resident actually urinates before getting off the toilet -put lids on trash cans, wastebaskets, or other containers if the resident urinates or defecated in them. -follow the elimination schedule carefully and document urination and bowel elimination as required. -family or friends may be upset by their loved ones incontinence. Be professional when cleaning after episodes of incontinence. Do not show disgust or irritation.

Guidelines: assisting with ADLS for residents who have AD: If the resident has problems with grooming and dressing:

-help with grooming to help residents feel attractive and dignified. -avoid delays or interruptions while dressing. -show the resident some of her clothing. This brings up the idea of dressing. Tell her you are going to help her get dressed. -provide privacy by closing doors and curtains. The resident should be dressed in her room. -encourage the resident to pick clothes to wear. Simply this by giving just a few choices. Make sure the clothing is clean and appropriate. Lay out clothes in the order in which they are put on. Choose clothes that are simple to put on. Choose clothes that are simple to put on, such as slips-on instead of lace-up shoes and pants or skirts instead of dresses. Some people with AD make a habit of layering clothing regardless of the weather. -break the task down into simple steps. Introduce one step at a time. Do not rush the resident. -use a friendly, calm voice when speaking. Praise and encourage the resident at each step.

In general, the HHA can follow the safety guidelines for client to have difficulty walking

-keep areas well, Lit, even at night -Block access to stairs with a gate -Clear walkways of electrical cord and clutter

confusion and delirium: When a communicating with a person who is confused or disoriented, the nursing assistance should:

-keep her voice low and not shout. -use the persons name, and speak clearly in simple sentences. -use facial expressions and body language to aid in understanding. -take action to reduce distraction in the environment, such as turning down the TV - be gentle and try to decrease fears.

In general, the HHA can follow the safety guidelines for general tips, including the following

-keep medication and other chemicals out of reach -Display emergency numbers, including poison control, and the clients home address somewhere they can be easily seen. -use red tape around radiators or heating vents to prevent burns -Check refrigerators and hiding places for spoiled food -Prevent kitchen accidents by removing knobs on stoves, unplugging, toasters, and other small appliances, and supervising kitchen visits

Guidelines: assisting with ADLS for residents who have AD: Promote the resident mental and emotional health:

-maintain self-esteem by encouring independent a=in activities of daily living -share in enjoyable activities, such as looking at pictures, talking and reminiscing -reward positive and independent behavior with smiles and warm touches.

The Alzheimer's association identifies three general stages of Alzheimer's disease:

-mild Alzheimer's disease (early-stage) -moderate Alzheimer's disease (middle-stage) -severe Alzheimer's disease (late-stage)

Guidelines: assisting with ADLS for residents who have AD: To promote the residents physical health

-prevent infections and follow standard precautions -observe the residents physical health and report any potential problems. People with dementia may not notice their own health problems. -help residents wash their hands frequently. -give careful skin care to prevent pressure injuries. -watch for signs of pain. A person who has AD may not be able to express that he is in pain. Nonverbal signs that a resident may be in pain include grimacing or clenching fists. A resident may be agitated or have an angry outbursts. Report possible signs of pain to the nurse. -maintain a daily exercise routine

Guidelines: communicating with resident who have Alzheimer's disease If the resident is verbally abusive or uses bad language:

-remember it is the dementia speaking, not the person. Try to ignore the language, and redirect attention to something else.

In general, the HHA can follow the safety guidelines for clients who pace

-remove clutter and throw rugs -Do not rearrange furniture -Do not wax floors -Be sure shoes and slippers fit and have nonslip soles

Guidelines: communicating with resident who have Alzheimer's disease If the resident forgets or shows memory loss:

-repeat yourself, using the same words if you need to repeat an instruction or question. However, you may be using a word. The resident does not understand, such as tired. Try other words like nap, lie down, or rest. Repetition can also be smoothing for a resident with Alzheimer's disease. Many people with Alzheimer's disease will repeat words, phrases, questions, or actions. This is called perseveration. Do not try to stop a resident who is perseverating. Answer the question, using the same words each time, until he stops. Even though responding over and over may frustrate you, it communicates, comfort and security.. -Keep messages simple. Break complex tasks into smaller, simple ones.

Guidelines: assisting with ADLS for residents who have AD: If the resident has problems with bathing:

-schedule bathing when the resident is least agitated. Be organized so the bath can be quickly. Give sponge baths if the resists a shower or tub bath. -prepare the resident before bathing. Hand him the supplies (washcloth, soap, shampoo, towels) this serves as a visual aid. -take a walk with the resident down the hall, stopping at the tub or shower room, rather than asking directly about the bath. -make sure the bathroom is well lit and is at a comfortable temperature. -provide privacy during the bath -be calm and quiet when bathing a resident and keep the process simple. -be sensitive when talking to a resident about bathing. -give the resident a washcloth to hold. This can distract him while you finish the bath. -always follow safety precautions. Ensure safety by using non slips mats, tub seats, and handholds. -be flexible about when to bathe a resident. A resident may not always be in the mood. Also, be aware that not everyone bathes with the same frequency. Understand if a resident does not want to bathe. -be relaxed and allow the resident to enjoy bath. Offer encouragement and praise. -let the resident do as much as possible during the bath. -check the skin regularly for signs of irritation or break down during the bath.

Guidelines: communicating with resident who have Alzheimer's disease If the resident is frightened or anxious:

-speak slowly in a low, calm voice. Speak in a quiet area with few distraction. -try to see and hear yourself as the resident might. Always describe what you are going to do. -use simple words and short sentences. If helping with care, list steps one at a time. -check your body language; make sure you are not tense or hurried.

Guidelines: communicating with resident who have Alzheimer's disease If the resident has trouble finding words or names:

-suggest a word that sounds correct. If this upset The resident, learn from it and try not to correct the resident again. As words (written, and spoken) become difficult, smiling, touching, and hugging can help show care and concern. Remember however, that some people find touch frightening or unwelcome.

Guidelines: communicating with resident who have Alzheimer's disease If the resident hallucinates (sees or hears things that are not really happening) or his paranoid or accusing:

-try not to take it personally -try to redirect behavior or ignore it. Because attention spans is limited, this behavior usually passes quickly.

Some common causes of confusion include the following:

-urinary tract infection (UTI) -low blood sugar -head trauma or head injury -dehydration -nutritional problems -fever -sudden drop in body temperature -lack oxygen -medications -infections -brain tumor -diseases or illnesses -loss of sleep -seizures

Guidelines: communicating with resident who have Alzheimer's disease If the resident has lost most verbal skills:

-use nonverbal skills. As speaking abilities decline, people with AD will still understand touch, smiles, and laughter for much longer. Remember that some people do not like to be touched. Approach touching slowly and be gentle. Softly touch the hand or place your arm around the resident. A smile can show affection and say you want to help. -even after verbal abilities are lost, signs, labels, and gestures can reach people with dementia. -assume people with AD can understand more than they can express. Do not talk about them as though they were not there or treat them like children.

In general, the HHA can follow the safety guidelines for disorientate clients:

-using signs to Mark rooms, including stop signs on the rooms that should not be entered. -Use calendars and other reminders of day, date, and location -Put bells on doors to indicate when someone is coming or going -Keep pictures and familiar objects around -Put stickers on brightly colored tape on glass doors, large windows, or glass furniture

The Alzheimer's association estimates that more than 6 million Americans are living with Alzheimer's disease.

-women are more likely than men to have Alzheimer's disease and dementia. -blacks are about two times as likely to get Alzheimer's dieases as whites, while Hispanics are about 1.5 times as likely. -although the risk of getting AD increases with age, it is not a normal part of aging.

Save environment for client with Alzheimer's disease

A nurse should assess a home safety before the home health aide visit a client with Alzheimer's disease. She will suggest changes that need to be made. Examples include using gate on stairways, putting locks answer indoors, and removing clutter. When the residence condition changes, the HHA should report it. Another visit will be made to recess the home and make further changes.

Suspicion

A person with Alzheimer's disease often becomes _________ as a Disease progresses. Resident me a cute stuff for family members of lying to them or stealing from them. _________ may escalate to paranoia (having intense feeling of distrust, and believing others are " out to get them.") When a resident is acting _________, the nursing assistant should not argue with them. Arguing just increases defensiveness. Instead, the nursing assistant should offer reinsurance and be understanding and supportive.

Violent behavior

A resident who attacks, hit, or threaten someone is using violence. Violence may be triggered by many situations, including frustration, overstimulation, or a change in routine, environment, or caregiver. If a resident is violent, the nursing assistant should: -Call for help if needed -Block blows, but never hit back -Not try to restrain the resident -Step out of reach and stay calm -Not leave the resident alone -Try to remove triggers -Use the same techniques to call residence as for agitation.

Agitation

A resident who is excited, restless, or troubles is said too be _______. Feeling insecure or frustrated, encountering, new people, or places, and changing a routine can all trigger this behavior. A trigger is a situation that leads to _____. Even watching a movie or a show can cause_______, as a person with Alzheimer's disease, may lose his ability to distinguish friction from reality. If a resident is _____. The nursing assistant should: -Try to remove triggers, keep a routine, and avoid frustration. Redirecting the resident attention may help. -Reduce noise and distractions. Focusing on a familiar activity, such as sorting things are looking at pictures may help. -Stay calm and use a low smoothing voice to speak to an reassure the resident.

Hallucinations or delusions

A resident who sees, here's, smells, taste, or feels things that aren't there is having _______. A resident who believes things that are not true is having _______. If a resident experience ________ and/or ___________, the nursing assistant should: -Ignore harmless hallucination and delusions -Reassure a resident who seems agitated or worried -No are you with a resident who is imagining things. Challenging. The resident serves no purpose and can make matters worse. The feelings are real to the resident. The nursing assistant should not tell the resident that she sees or hears hallucinations. She should redirect the resident to other activities or thoughts. -be calm and reassuring the resident that she is there to help.

Pacing and wondering

A resident who walks back-and-forth in the same area is ______. A resident who walks aimlessly around the facility or the facility ground is _______. ______ and _______ can have many causes, including the following : -Restlessness -Hunger -Disorientation -In continuance of the need to use the bathroom -Constipation -Pain -Forgetting how or where to sit down -Too much day time napping -Need for exercise. If a resident _____ or ______, the nursing assistant should: -Remove causes when possible. For example, giving nutritious snacks, encourage an exercise routine, and maintaining an illumination schedule. -Let residence, pacer wander in a safe, secure (locked) area when staff can keep an eye on them. The residential not be restrained. -Redirect attention to something the resident enjoys, such as taking a walk together -Mark rooms with signs or pictures, such as stop signs or close signs, as this may prevent residence from wandering into an area where they should not go -Report to the nurse immediately if a resident wanders away from a protected area and does not return or elopes.

There are many reasons, such as organization, books, counseling, and support groups, available for people with

Alzheimer's disease and their families. -The Alzheimer association has help lines that is available 24 hours a day, seven days a week for information, referral and support. -The national institution on aging has information available, or on their Alzheimer's disease education referral (ADEAR) center website. Healthcare professionals can also be a assistant.

Do not take things personally

Alzheimer's disease is a devastating mental and physical disorder. It affects everyone who surrounds and cares for the person with AD. People with Alzheimer's disease do not have control over their words and actions. They may often be unaware of what they say or do. A resident with AD may not recognize a caregiver or do what he is supposed to do. He may ignore, accuse, or insult staff members. When this happens, it is important to remember that the behavior is due to the disease.

Alzheimer's disease

Is a progressive, degenerative, and irreversible disease. -AD causes tangled nerve fibers and protein deposits to form in the brain, eventually causing dementia. -there is no known cause of AD, and there is NO CURE. -diagnosis is difficult, involving many physical and mental testing to rule out other causes. However, the only sure way to confirm an A diagnosis at this time is by autopsy. The length of time it takes AD to progress from onset to death varies greatly. -according to Alzheimer's association, on average a person with Alzheimer's disease lives four to eight years after diagnosis. However the person can live as long as 20 years.

Delirium

Is a state of severe confusion that occurs suddenly; it is usually temporary. -some causes are infections, disease, fluid imbalances and poor nutrition. -drugs and alcohol may also causes delirium.

Confusion

Is the ability to think clearly and logically. -a confused person has trouble focusing his attention and may feel disoriented. -a confusing interferes with the ability to make decisions.

Be empathetic

It is helpful if the NA thinks about what it would be like to have Alzheimer's disease. She can imagine being unable to do activities of daily living and being dependent on others for care. It would be very frustrating to have no memory of recent events or to be unable to find words for what one wants to say. NA should assume that people with AD have insight and are aware of the changes in their abilities. They should treat the resident with AD with dignity and respect.

Alzheimer's disease introduces other stressors to. it is very difficult to watch a

Loved one's personality change, and her health and abilities deteriorate. -It is also hard to switch roles.—- to go from being a child who was once cared for by the parent to being the one caring for the parent.

Support groups are often helpful because

Many people in the group are experiencing the same kind of emotions and problems. -people often find it is helpful to know that they are not alone and what they are going through. People in support groups often share tips and ideas for care and interventions for problems, which can be beneficial. Nursing assistant should inform the nurse if they think residents and/or their families could benefit from a list of community resources

Validation therapy

Means letting resident believe they live in the past, or in imaginary circumstances. Validating means giving value to or approving. When using validation therapy, nursing assistant should make no attempt to reorient residents to actual circumstance. She can explore the residence believes and should not argue with or correct 10. Validating can give comfort and reduce agitation. Validation therapy is useful in cases of advanced dementia. Examples: Mr. Baldwin tells the nursing assistant, that he does not want to eat lunch today because he is going out to a restaurant with his wife. The nursing assistant knows his wife has been dead for many years, and that Mr. Baldwin can no longer eat out in a restaurant. Instead of telling him that he is not going out to eat, the nursing assistant ask, what restaurant is he going to and what will he order. She suggest that he eat a good lunch now because sometimes the service is slow in restaurants. Benefits: by playing along with Mr. Baldwin fantasy, the nursing assistant, let him know that she takes him seriously. She does not think of him as a crazy person or a child, who does not know what is happening in his own life. She also learns more about the resident, such as that he used to enjoy eating in restaurant, and like certain dishes. Eating out is something he probably associate with being with his wife. His knowledge can help the nursing assistant give better Care.

Music therapy

Music therapy involves using music to accomplish specific goals, such as manifesting stress and improving mood and cognition. This type of therapy has been used successfully with people who have Alzheimer's disease. Music is a form of sensory stimulation, and hearing familiar songs can cause a response and people who do not respond well, or at all to other treatments. Music in memory is a nonprofit organization that brings personalize music into the lives of the elderly. Their website provides more information.

The persons personality may change. He may not know his

Name, the date, other people, or where he is. -a confused person may be angry, depressed, or irritable.

Residence rights Abuse, and Alzheimer's disease

People with Alzheimer's disease may be at a higher risk for abuse. One reason for this is that caring for someone with Alzheimer's disease is very difficult. There are many psychological and physical demands placed on caregivers. To help manage the stress for caring for people with Alzheimer's disease, nursing assistant, should take care of themselves, both mentally and physically. This will help them give the best care. If needed, a supervisor can provide more resources to help an nursing assistant cope. Nursing assistance must never abuse residents in any way. If nursing assistance notice someone else abusing a resident, he is legally required to report it. All nursing assistants are responsible for resident safety and should take this responsibility Seriously.

Alzheimer's disease generally progresses in stages. In each stage, the symptoms become

Progressively worse. The majorly of people who have this disease are eventually completely dependent on others for care. -each person with Alzheimer's disease will show different symptoms at different times. Ex: one resident may continue to read, but not be able to recognize a family member. Another person may be able to play a musical instrument but may not know how to use a phone. (Skills that a person has used often over a lifetime are usually kept longer.)

Activity therapy

Use activities that the resident enjoys to prevent boredom and frustration. These activities also promote self-esteem. The nursing assistant can help resident take walks, do puzzles, listen to music, read, or do other things she enjoys. Activities may be done in group or one on. activity therapy is useful throughout stages of Alzheimer's disease. Examples: Mrs. Hoebel, a 70 year old woman with Alzheimer's disease, was a librarian for most 45 years. She loves books and reading, but she cannot read much anymore. The nursing assistant obtains book from the facility that are filled with pictures. Mrs.Hoebel sits with the books, sorting them, turning pages, and looking at pictures. Benefits: Mrs. Hoebel can enjoy an activity that always brought her pleasure. She feels competent, because she is sorting books and looking at books, which are task she can handle. The nursing assistant shows her that she cares about her by taking the time to show her an interest in her pass. This may lead the resident to associate positive feelings with the nursing assistant..

Hoarding and rummaging

______ is collecting and putting things away in a guarded way. __________ is going through drawers, closets, or personal items that belong to oneself or to other people. These behaviors are not within the control of a person with AD. _______ and ________ should not be considered stealing. Stealing is planned and requires a conscious effort. In most cases, the person with AD is only collecting something that catches his attention. It is common for those with AD to wander and collect things. They may carry these objects around for a while, and then leave them in other places. This is not intentional. People with AD will often take their own things and leave the, in another room, not knowing what they are doing. If the resident hoards or rummages, the NA shoud: -label all personal belongings with the residence name and room number. This way, there's no confusion about what belongs to whom -Play the label, symbol, or object on the resident room. This helps the resident find his own room. -Not tell the family that their loved one is stealing from others -Prepare the family, so they are not upset when they find items that do not belong to the family members -How's the family to tell staff is a notice unfamiliar items in the room -Regularly check areas where residents store items and return them to proper place. Residents may also store uneaten food in these places. Discard any food you find. Providing a rummage drawer—-a drawer with items that are safe for the resident to take with him—— can help.

Inappropriate sexual behavior

_______ ______ _______, such as removing clothing, touching one on general in public, or trying to touch other can disturb or embarrass, those who see it. It is helpful to stay calm and be professional when this behavior occurs . The nursing assistant should not overreact, as this may reinforce the behavior. Trying to determine the cause of the problem may help. Is this behavior intentional? Is it consistent? Is distracting the resident does not work, the NA can gently direct him to a private area and inform the nurse. A resident may be reacting to a need for physical stimulation or affection. Ways to provide physical stimulation include giving back, rubs, offering a soft, stuffed animal to cuddle. Providing comforting blankets, or giving physical touch that is appropriate.

Disruptiveness

__________ behavior is anything that disturb others, such as yelling, banging on furniture, or slamming doors. Often this behavior is triggered by pain, constipation, frustration, or wish for attention. To prevent or respond to disruptive behaviors, the nursing assistant should: -The common friendly, and try to find out why the behavior is occurring. There may be a physical reason, such as pain or discomfort. -Gently try to direct the resident to a private area. -Notice and praise improvements in the resident behavior, being sensitive to avoid treating the resident like a child. -Tell the resident about any changes in the schedule, routines, or environment in advance. -Involving the resident in developing routine activities and schedule may help -Encourage the resident to join in Independent activities that are safe (for example, folding towels) this helps the resident feel in charge and can help prevent feeling of powerlessness. Independent is power. -Help the resident find ways to cope. Focusing on activities the resident may still be able to do, such as knitting or crafts, can provide a diversion.

Families may make decisions to place a loved one with Alzheimer's disease into a long-term care facility for any number of reasons. They may have

safety concerns, or may not be able to care for the person at home. The family may not be able to handle the issues that Alzheimer's disease causes, such as the problem, behaviors, or the inability to perform personal care. The person with Alzheimer's disease may not want her family to do the needed personal care. There may be no available family caregiver.