CNA - Chapter 5: Confusion, Dementia, and Alzheimer's Disease

Communicating with a confused or disoriented patient

- keep your voice low - use the person's name - speak clearly in simple sentences - reduce distractions as much as possible

Interventions for problems with common ADLs of AD patients

1. develop a routine and stick to it. 2. promote self-care 3. take good care of yourself, both mentally and physically

Managing catastrophic reactions

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

Managing inappropriate sexual behavior

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

Managing 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.

Managing 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.

Managing 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.

Managing 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.

Managing 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

Communicating with residents with AD

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. 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. 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. 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.

Managing Hallucinations and Delusions

Ignore if harmless, reassure, do not argue, and be calm

catastrophic reaction

Overreacting to something

Managing sundowning

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

Managing Agitation

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

Managing perseveration or repetitive phrasing

Respond with patience, do not stop behavior, and answer questions each time, using the same words.

dementia

a general term that refers to a serious loss of mental abilities, as thinking, remembering, reasoning and communicating - dementia is NOT a normal part of agin causes: - 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

Alzheimer's disease

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

delirium

a state of severe confusion that occurs suddenly and is usually temporary causes: REMEMBER - infections, disease, fluid imbalance, poor nutrition, drugs, and alcohol symptoms: - agitation - anger - depression - irritability - disorientation - trouble focusing - problems with speech - changes in sensation and perception - changes in consciousness - decrease in short-term memory

sundowning

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

hoarding

collecting and putting things away in a guarded manner

Reminiscence therapy

encouraging residents to remember and talk about the past

validating

giving value to or approving

rummaging

going through drawers, closets, or personal items that belong to oneself or others.

hallucinations

illusions a person sees, hears, smells, tastes, or feels

elope

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

Music therapy

involves using music to accomplish specific goals such as managing stress and improving mood and cognition

Validation therapy

letting residents believe they live in the past or in imaginary circumstances

cognitive impairment

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

delusions

persistent false beliefs

pillaging

taking things that belong to someone else

cognition

the ability to think logically and quickly

confusion

the inability to think clearly - interferes with ability to make decisions - personality may change - anger, depression, and irritability are other signs - can be temporary or permanent causes: - low blood sugar - head trauma/injury - dehydration - nutritional problems - fever - sudden drop in body temp - lack of oxygen

perseverating

the repetition of words, phrases, questions, or actions

Activity therapy

uses activities that the resident enjoys to prevent boredom and frustration

wandering

walking around aimlessly

pacing

walking back and forth in the same area

Confusion Guidelines

•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.

Interventions for ADLs: Eating (AD patient)

•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. •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.

Interventions for ADLs: 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.

Managing rummaging 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.

Interventions for ADLs: urinary incontinence (AD patient)

•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. •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.

Interventions for ADLs: Bathing (AD patient)

•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. •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.

Interventions for ADLs: Dressing (AD patient)

•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. top-bottom as follows: - underwear - t-shirt - socks - elastic-waist pants - pullover shirt •Break task down into simple steps. Do not rush the resident. •Use a friendly, calm voice when speaking. •Praise and encourage.