Chapter 53 dementia quiz

Signs of AD memory loss that disrupts daily life

- forgets newly learned information -forgets important dates or events -asks for the same information over and overs -relies more on memory aids-reminder notes, electronic devices -relies on family members for things usually handle alone

Signs of AD Decrease or poor judgment

-Changes in judgment or decision-making -Poor judgment with money—giving away large amounts is an example -Pays less attention to hygiene and grooming

Signs of AD problems with vision and spatial relationships

-Difficulty reading -Difficulty judging distance -Has problems with color or contrast -Has trouble driving

Signs of AD problems completing familiar tasks

-Has a hard time with tasks in the home, at work, or with recreation -Has problems driving to familiar places -Has trouble managing a budget -Forgets the rules to a favorite game

Signs of AD problems with speaking or writing

-Has trouble following or joining a conversation -Stops in the middle of a conversation and does not know how to continue -Repeats himself or herself -Has trouble finding the right word -Calls things by the wrong name—calling a "watch" a "hand-clock" is an example

Signs of AD problems with planning or problem solving

-Has trouble making a plan or working with numbers -Has problems following a recipe -Has trouble keeping track of monthly bills -Difficulty concentrating -Takes longer to do things than before

Signs of AD Mood and personality changes

-Is confused -Is depressed -Is suspicious, afraid, or anxious -Is easily upset at home, at work, with friends, or in places where he or she is less comfortable

Signs of AD confusion with time or place

-Loses track of dates, seasons, and passing of time -Has trouble understanding something that is not happening right away -Forgets where he or she is -Forgets how he or she got to a certain place

Signs of AD Withdrawal from work or social activities

-No longer does hobbies, social activities, work projects, or sports -Has trouble keeping up with a favorite sports team -Has trouble remembering how to do a hobby -Avoids being social

Sings of AD Misplacing items and being unable to find them

-Puts things in strange places -Loses things and is unable to retrace steps to find them -Accuses others of stealing

Confusion-Care Measures

-follow the care plan -provide for safety -face the person speak clearly -call the person by name each time you have contact -state your name. show your name tag -give date and time -explain what is going on -give clear simple directions and answers to questions -break tasks into small steps -have person wear hearing aids or eyeglasses -use touch for communication -place familiar things close to them -maintain day and night cycle

Recommended activities to maintain cognitive health

-get regular exercise -eat a healthy diet -spend time with family and friends -keep the mind active -control type 2 diabetes -maintain health blood pressure and cholesterol levels -maintain a health weight -do not smoke - get help for depression -avoid excess alcohol intake -get enough sleep

Risk factors

-greatest risk factor is increasing age -risk increase after age 65 -about 1/3 of people age of 85 and older have AD -family history of AD increases persons risk -women due to longevity of life

Dementia signs and symptoms

-memory loss -problems with common tasks -problems with language and communication; forgetting simple words -getting lost in familiar places -misplacing things and putting things in odd places -personality, mood, and behavior changes -poor or decreased judgment

Nervous system changes from aging

-nerve cells are lost -nerve conduction slows -reflexes, responses, and reaction times are slower -vision, hearing, taste, smell, and touch decrease -sensitivity to pain decreases -blood flow to the brain is reduced -sleep patterns change -Memory is shorter: forgetfulness occurs -dizziness can occur

Home Care

A person who wanders should not be left alone. The following may prevent wandering from home. • Keep doors locked. A keyed deadbolt or locks at the top and bottom of doors (Fig. 53-6) may be used. Or door knob covers are used. The device turns instead of the door knob. In case of emergency, a caregiver must be present to help the person exit.

Agitation and Aggression

When agitated, the person is restless or worried and cannot settle down. The person may pace, move about, or not sleep. Agitation may lead to aggression. The person may yell, scream, swear, hit, pinch, grab, or try to hurt someone. Common causes are: • Pain or discomfort. • Anxiety, depression, or stress. • Loneliness. • Drug interactions. • Fatigue. • Too many stimuli. Too much noise or too many people in the room are examples. • Hunger or thirst. • Elimination needs, constipation, and incontinence. • Feeling lost or abandoned. • A feeling of loss. Missing driving or caring for children are examples. • Care measures (bathing, dressing) that upset or frighten the person. • Feeling pressured to do something that is now hard or impossible. Remembering an event or person are examples. • Change in routine, caregiver, or setting. • Caregivers. A caregiver may rush the person or be impatient. Or mixed verbal and nonverbal messages are sent. For example, a caregiver talks too fast or too loud. Consider how your behaviors affect the person.

Stage severe of AD

• Depends on others for care • In bed most or all of the time • Cannot communicate • Weight loss • Seizures • Skin infections • Difficulty swallowing • Groaning, moaning, or grunting • Increased sleeping • Loss of bowel and bladder control

causes of dementia

damage to brain cells

Cognitive function

involves memory, thinking, reasoning, ability to understand, judgment, and behavior

Alzheimer's disease

most common type

Fronto-temporal disorders

nerve cells in certain areas of the brain (front and sides) break down

plaques

protein pieces that build up in the spaces between neve cells

Rummaging

searching through things by moving them around

hallucination

seeing, hearing, smelling, feeling, or tasting something that is not real

vascular dementia

stroke or other blood vessel problems damage vessels that supply blood to the brain

dementia

the loss of cognitive function that interferes with daily life and activities

tangles

twisted protein fibers that build up inside cells

Validation therapy

way to communicate with persons with dementia. Validate means to show that a person's feelings and needs are fair and have meaning. Behaviors signal the need to express feelings and needs—safety, security, comfort, love and belonging, feeling useful, and so on. • All behavior has meaning. • A person may have unresolved issues and emotions from the past. • A person's mind may return to the past to resolve issues and emotions. • Caregivers need to listen and provide empathy. • Attempts are not made to correct thoughts or bring the person back to reality (reality orientation). For example: • A person talks about waiting for the bus to go to work. The caregiver does not say: "You don't work anymore." Instead, the caregiver says: "Tell me about your work."

elopement

when a patient or resident leaves the agency without staff knowledge

Changes in intimacy and Sexuality

Intimacy is a special bond between people who love and respect each other. It includes the way people talk and act toward each other. Sexuality involves the way partners physically express feelings for each other (Chapter 55). The person with AD may: • Depend on and cling to a partner. • Not remember life with a partner. • Not remember feelings for a partner. • Fall in love with another person. • Have side effects from drugs that affect sexual interest. • Have memory loss, brain changes, or depression that affects sexual interest. • Have abnormal sexual behaviors.

Elopement

Leaving the agency without staff knowledge

Review Questions Circle T if the statement is TRUE and F if it is FALSE. 1. T F Cognitive function involves memory, thinking, reasoning, understanding, judgment, and behavior. 2. T F The onset of delirium is gradual. 3. T F Depression can cause cognitive changes. 4. T F A person with AD is agitated and restless. A caregiver may have caused the behaviors. 5. T F A person with AD keeps moving an empty cup back and forth across the table. You should take the cup away. 6. T F A person with AD hides things. You should check wastebaskets before emptying them. 7. T F The person with AD can control behavior. 8. T F The person with AD can tell you about pain, constipation, and other discomforts. 9. T F The person with AD is at risk for infection from poor hygiene after elimination. 10. T F A set routine is important for the person with AD. 11. T F You can use gestures or point to things to communicate with persons who have AD. 12. T F Restraints help improve the behaviors of AD. 13. T F Family members continue their hobbies and holiday events. They are abusing the person with AD.

1. T 2 F 3. T 4. T 5. F 6. T 7. F 8. F 9. T 10. T 11. T 12. F 13. F

Mixed dementia

2 or more types of dementia occur together

delusion

A false belief

AD

Alzheimer's disease

Safety with Paranoia

Behaviors may not mean paranoia. Fears of harm, strangers, stealing, mistreatment, and so on may be real. Some people abuse vulnerable adults (Chapter 5). This includes sexual and financial abuse. Abuse may be by phone, mail, e-mail, or in person. The abuser may be a friend or family member. Financial abuse occurs when money or belongings are stolen. Financial abuse can include: • Forging checks or cashing checks without permission • Taking retirement and Social Security benefits • Using the person's credit cards or bank accounts • Changing names on wills, bank accounts, insurance policies, or titles to homes or cars • "Scams" such as identity theft, phone prizes, and threats • Borrowing money and not paying it back • Giving away or selling the person's property without permission • Forcing the person to sign over property Protect the person from harm, abuse, and mistreatment. Report the following at once. • What the person is saying • The person seems afraid or worried about money • Missing items • The person's behaviors • Signs and symptoms of problems • Visitors or family members acting strangely

CMS

Centers for Medicare and Medicaid Services

Communication Changes

Communication skills gradually decline. The person has trouble expressing thoughts and emotions. Communication changes include: • Struggling to find the right word • Problems understanding the meaning of words • Attention problems during conversations • Losing one's train of thought when talking • Problems blocking background noises—radio, TV, music, phones, others talking, and so on • Frustration with communication problems • Being sensitive to touch, tone, and voice volume

long term care people with AD

Many nursing centers have secure memory care units (Chapter 1). Entrances and exits are locked. Residents cannot wander away. They have a safe setting to move about. Some persons have aggressive behaviors that disrupt or threaten others. They need a secured unit. According to the Centers for Medicare & Medicaid Services (CMS), persons on a secured unit must be protected from involuntary seclusion (Chapter 5). The agency must identify the reason for placement on the unit. The reason must not be: • For staff convenience or discipline. • Based on a diagnosis alone. Placement is made on an individual basis. • By request of the family or the person's representative without a medical reason. The person's medical record must include: • The reason for placement on the unit. • How the resident or resident's representative was involved in the decision. • If the secured unit is the least restrictive approach to protect the person. • The person's reaction to placement on the unit. • On-going review and revision of the care plan as needed. For example, are interventions meeting the resident's needs? Is a secured unit still needed? At some point, the secured unit is no longer needed. For example, a person's condition progresses to severe AD (see Box 53-7). The person cannot sit or walk. Wandering is not a concern. The person is transferred to another unit.

NIA

National Institute on Aging

Wandering and Getting lost

Patients and residents may try to wander to another nursing unit or out of the agency. Serious injury and death have resulted. State and federal guidelines to prevent elopement are followed. All staff must be alert to persons who wander. Wandering is allowed in safe areas (Fig. 53-4). Unsafe areas include kitchens, shower rooms, and utility rooms.

Activities of AD living people

Persons with dementia need to feel useful, worthwhile, and active. This promotes self-esteem. Therapies and activities focus on strengths and past successes. For example: • A person who used to cook helps clean fruit. • Once a good dancer, activities are planned so the person can dance. • A person who likes to clean helps with dusting.

Repetitive Behaviors

Repetitive means to do over and over. The person repeats the same motions, words, or questions over and over. For example, the same napkin is folded over and over. Or the person says the same words or asks the same question over and over. Such behaviors are not harmful. However, they can annoy caregivers and the family.

Screaming

Screaming to communicate is common in persons who are very confused and have poor communication skills. They may scream a word or a name. Or they just make screaming sounds. Possible causes include hearing and vision problems, pain or discomfort, fear, and fatigue. Too much or not enough stimulation is another cause. A person may react to a caregiver or family member by screaming. The following measures and those in Box 53-8 may be helpful. • Provide a calm, quiet setting. • Play soft music. • Have the person wear hearing aids and eyeglasses. • Have a family member or favorite caregiver comfort and calm the person. • Use touch to calm the person.

Sundowning

Signs, symptoms, and behaviors of AD increase during hours of darkness • Fatigue • Hunger or thirst • Depression • Pain • Boredom • Confusion and fear (poor light and shadows cause the person to see things that are not there)

Promoting safety and comfort

Some behaviors are caused by illness, injury, or drugs—not AD. Without treatment, life may be threatened. Always report changes in behavior.

Rummaging and hiding things

To rummage means to search for things by moving things around, turning things over, or looking through something such as a drawer or closet. The behavior may have no meaning. Or the person is looking for a certain item but cannot tell you what or why. Or boredom or hunger is the cause. The person may hide things, throw things away, or lose things. Eyeglasses, hearing aids, and dentures must stay with the person. Always make sure these items are safe. Money, jewelry, and other important items usually are sent home with the family.

Care of Persons with AD and Other Dementias

The entire staff must protect the person from harm. Look for dangers in the person's room and in hallways, lounges, and dining and other areas. Remove the danger if you can and tell the nurse at once. If you cannot remove the danger, also tell the nurse at once. To ensure quality of life, surveyors look at all aspects of dementia care. For example: • Are bathing, dressing, and grooming needs met? • Is independence promoted? For example, does the staff give cues so the person can dress himself or herself? • Is the person reminded to use the toilet at regular times? • Is the person in a calm, quiet setting for meals? • Are enough fluids offered to prevent dehydration? • Does the staff respond to the person in a dignified manner? • Is a safe setting provided? • Does the staff provide supervision for safe behaviors? Federal laws require that nursing assistant education and training include dementia management and preventing abuse. Annual in-service training also is required. Surveyors will review employee records to make sure requirements are met.

Family of people living with AD

The person may live at home or with a partner, children, or other family members. Or someone stays with the person. Home care may help for a while. Adult day care and assisted living are options (Chapters 1 and 57). Nursing center care is needed when: • The family cannot meet the person's needs. • The person no longer knows the caregiver. • Family members have health problems. • Money problems occur. • The person's behavior presents dangers to self and others.

Catastrophic reactions

These are extreme responses to normal events or things. The person reacts as if there is a disaster or tragedy. The person may scream, cry, or be agitated or combative (ready to fight). These reactions are common from too many stimuli. Eating, music or TV playing, and being asked questions all at once can overwhelm the person.

15. A person is confused. Which should you question? a Restrain in bed at night. b Give clear, simple directions. c Use touch to communicate. d Open drapes during the day.

a

20. A person with AD is screaming. You know that this is a A way to communicate b An agitated reaction c Caused by a delusion d A repetitive behavior

a

23. Which can cause delusions in persons with AD? a Mirrors b Eyeglasses c Hearing aids d Night-lights

a

29. You are caring for a person with AD. You should avoid a Trying to bring the person back to reality b Offering support to the family c Following a set routine d Providing a quiet setting

a

paranoia

a disorder(para) of the mind (noia): false beliefs (delusions) and suspicion about a person or situation • The person forgets where he or she put something. The person thinks the item was stolen. • The person forgets you are a caregiver. The person thinks you are a stranger and does not trust you. • The person forgets people whom he or she has met. The person believes strangers are harmful. • The person forgets the directions you give. The person thinks you are trying to trick him or her.

confusion

a state of being disoriented to person, time, place, situation, or identity

delirium

a state of sudden, severe confusion and rapid changes in brain function

Lewy body dementia

abnormal protein deposits in the brain (Lewy bodies) affect chemical sin the brain

ADL

activities of daily living

14. A person is confused after surgery. The confusion is likely to be a Permanent b Temporary c Caused by dementia d Caused by a brain injury

b

19. A person has AD. To communicate, you should a Give orders b Limit choices c Correct mistakes d Ask open-ended questions

b

24. A person with AD keeps telling you that someone is stealing things. What should you do? a Nothing. The person has paranoia. b Tell the nurse. Someone could be abusing the person. c Replace missing items. d Send other items home with the family.

b

26. Which can help with rummaging? a Keep the person's room locked. b Provide safe places to rummage. c Ask the person to explain the behavior. d Hide items the person looks for.

b

17. During the final stage of AD, the person is likely to a Wander and become lost b Follow simple commands c Need total assistance with ADL d Repeat questions over and over

c

21. Which statement about sundowning is true? a AD behaviors improve at night. b Encouraging activity late in the day can help. c Being tired or hungry can increase restlessness. d Dim lighting or darkness is calming.

c

22. A person with AD has delusions. Which should you question? a Distract the person with an activity. b Tell the person you will provide protection. c Tell the person the beliefs are not real. d Use touch to calm the person.

c

27. Which is unsafe for persons with AD? a Safety plugs are placed in electrical outlets. b Cleaners and drugs are locked up. c The person keeps smoking materials. d Sharp objects are removed from the setting.

c

30. Validation therapy involves a Support groups and counseling for persons with severe AD b Drugs to treat AD c Helping the person with AD express needs and feelings d Orienting the person with AD to reality

c

Alzheimer's Disease (what happens in brain)

cells are destroyed and die, the brain shrinks from nerve cell death and tissue loss

delirium- signs and symptoms

changes in -alertness -sensation -awareness -movement -drowsiness -confusion about time or place -memory -thinking -concentration -speech -incontinence -emotional changes : agitation, anger, depression, euphoria, irritability

16. A person has AD. Which is true? a AD is a normal part of aging. b Diet and drugs can cure the disease. c AD and delirium are the same. d AD ends in death.

d

18. Which is common in persons with AD? a Paralysis b Dyspnea c Headache d Sleep disturbances

d

25. A person with AD is at risk for elopement. Which should you question? a Make sure door alarms are turned on. b Make sure an ID bracelet is worn. c Assist with exercise as ordered. d Remind the person not to wander.

d

28. A person with AD is upset. Which is a correct response? a Try to reason with the person. b Ask what is bothering the person. c Ignore the problem. d Provide reassurance and try to find the cause.

d

Family Caregivers—Taking Care of Yourself

• Ask for help when you need it. Asking for something specific may be useful. For example: • "Can you make Mom's dinner Sunday night?" • "Can you stay with Dad from 2 to 4 Monday afternoon?" • "Can Mom stay at your house Saturday afternoon?" • Join a support group. • Take breaks every day. • Spend time with friends. • Maintain hobbies and interests. • Eat healthy foods and exercise often. • See a doctor regularly. • Keep health, legal, and financial information current. • Remember that these feelings are normal—being sad, lonely, frustrated, confused, angry. Say to yourself: • "I'm doing the best I can." • "What I'm doing would be hard for anyone." • "I'm not perfect and that's okay." • "I can't control some things." • "I need to do what works for right now." • "Even when I do everything I can, there will still be problem behaviors. They are caused by the illness, not what I do." • "I will enjoy our peaceful times together."

Stage mild of AD

• Memory loss • Poor judgment, bad decisions • Loss of spontaneity and initiative • Taking longer to do daily tasks • Repeating questions • Problems handling money and paying bills • Wandering and getting lost • Losing things or misplacing them in odd places • Mood and personality changes • Anxiety or aggression

Stage moderate of AD

• Increased memory loss and confusion • Cannot learn new things • Problems with language, reading, writing, and working with numbers • Trouble with thoughts and thinking logically • Shortened attention span • Problems coping with new situations • Problems with tasks having multiple steps—getting dressed is an example • Problems recognizing family and friends • Hallucinations, delusions, and paranoia • Impulsive behavior—undressing at inappropriate times or places and using vulgar language are examples • Outbursts of anger • Restlessness, agitation, anxiety, tearfulness • Wandering—especially in the late afternoon or evening • Repetitive statement or movements, occasional muscle twitches

Communication—Persons With AD or Other Dementias

• Treat the person with dignity and respect. • Approach the person in a calm, quiet manner. • Approach the person from the front—not from the side or the back. This avoids startling the person. • Make eye contact to get the person's attention. Maintain eye contact. • Have the person's attention before you start speaking. • Identify yourself and other people by name. • Call the person by name. • Avoid pronouns (he, she, them, it, and so on). For example, instead of saying: "She is here," say: "Mary is here." • Follow the rules and measures to promote communication (Chapter 7). • Do not talk about the person as if he or she is not there. • Control distractions and noise. TV, radio, and music are examples. • Speak in a calm, gentle voice. • Be aware of your body language. Smile and avoid frowning, grimacing, or other negative actions. Standing with the arms folded tightly signals tension or anger. • Use gestures or cues. Point to objects. • Watch the person's facial expressions and gestures. Expressions may show sadness, anger, or frustration. Pulling at under-garments may signal incontinence or elimination needs. • Comfort the person with touch. Hold the person's hand while you talk. • Speak slowly. Use simple words and short sentences. • Do not "baby talk" or use a "baby voice." • Ask or say 1 thing at a time. Present 1 idea, statement, or question at a time. • Give simple, step-by-step instructions. • Explain all procedures and activities. • Repeat instructions as needed. Allow time to respond or react. • Ask simple questions with simple answers. Do not ask complex questions. • Let the person speak. Do not interrupt or rush the person. • Give the person time to respond. • Try other words if the person does not seem to understand. • Provide the word the person is looking for if he or she is struggling to communicate a thought. • Do not criticize, correct, interrupt, argue, or try to reason with the person. • Give consistent responses. • Practice the measures in Chapter 46. • To promote hearing • To communicate with speech-impaired persons • For blind and visually impaired persons

Behavior and Function Change of AD

• Wandering and getting lost • Sundowning • Hallucinations • Delusions • Paranoia • Catastrophic reactions • Agitation and aggression • Communication changes • Screaming • Repetitive behaviors • Rummaging and hiding things • Changes in intimacy and sexuality