CNA Vocab: Block 9

Confusion

The inability to think clearly

Delirium

A state of severe confusion that occurs suddenly and is usually temporary

Cognition

The ability to think logically and clearly

Dementia

The serious loss of mental abilities, such as thinking, remembering, reasoning, and communicating

Cognitive Impairment

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

Alzheimer’s Disease

A progressive, incurable disease that causes tangles nerve fibers and protein deposits to form in the brain, eventually causing dementia

Perseveration

The repetition of words, phrases, questions, or actions

Agitation

The state of being excited, restless or troubled

Sundowning

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

Catastrophic Reaction

Reacting to something in an unreasonable, exaggerated way

Triggers

Something that sets off a memory tape or flashback transporting the person back to the event of their original trauma

Pacing

Walking back and forth in the same area

Wandering

Walking aimlessly around the facility or facility grounds

Hallucination

Seeing, hearing, smelling, tasting, or feeling things that are not there

Delusion

False ideas or beliefs, especially about oneself

De-escalation

Refers to behavior that is intended to escape escalations or conflicts. It may also refer to approaches in conflict resolution

Redirection

The action of assigning or directing something to a new or different place or purpose - used with patients with dementia

Stress

The state of being frightened, excited, confused, in danger, or irritated

Validation Therapy

A technique used for interacting with people with dementia in which the caregiver acknowledges the person’s reality, rather than correcting the person.

Bathing Tips

• Schedule when they’re least agitated

• Give them supplies while waiting as a visual cue

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

• make sure bathroom is well lit

• make sure it’s warm

• be calm and quiet when discussing bath with resident

• give them a washcloth to hold during the bath

• ensure safety by using nonslip mats, tub seats, and hand holds

• be flexible about when to bathe, and understand if they don’t want to

• be relaxed

• give them as much privacy as possible

• check skin for irritation

Toileting

• Encourage fluids, even if they have issues with incontinence

• Mark bathroom with sign or picture

• make sure there is enough light in the bathroom and on the way there

• Note when the resident is incontinent, and check them every 30 minutes, and take them to the bathroom before bedtime

• observe bathroom patterns

• take residents to the bathroom after drinking fluids, before, and after meals

• put lids on trash cans, wastebaskets, or other containers if resident urinates in them

Nutrition

• Be professional when cleaning after episodes of incontinence

• have meals at consistent times each day

• serve familiar foods that look and smell appetizing

• keep noise and distractions to a minimum

• keep the task of eating simple

• ensure adequate lighting

• finger foods are often easier

• use plain plates without pattern or color, and remove other items from the table

• put only one item of food on a plate at a time

• place spoon to the lips

• ask resident to open their mouth

• give simple instructions

• offer drinks often to avoid dehydration

• use adaptive equipment as needed 

• give them time to swallow each bite

• let them sit next to others and socialize

Additional Tips

• Prevent infections/follow standard precautions

• observe and report potential problems

• give careful skin care

• watch for signs of pain

• maintain daily exercise routine

• maintain self-esteem. encourage independence

• share in enjoyable activities

• rewards positive and independent behavior with smiles, hugs, and warm touches

Coping Tips

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

Sundowning: Remove triggers, avoid stress, play soft music, set bedtime routine, plan calming activities, remove caffeine, give back massage, distract, and encourage daily exercise

Catastrophic Reactions: avoid triggers; fatigue, changes, overstimulation, difficult choices/tasks, pain, hunger, need for toileting. Remove triggers and distract

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

Pacing/Wandering: Remove causes, give snacks, encourage exercise, maintain toileting schedule, let resident pace in a safe place, suggest another activity

Hallucination/Delusion: Ignore if harmless, reassure, do not argue, stay calm

Depression: Report signs, encourage independence, talk about moods and feelings, encourage social interaction

Preservation or Repetitive Phrasing: Respond with patience, do not stop behavior, answer questions each time using the same words.

Disruptiveness: Gain their 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, focus on positive activities

Inappropriate Social Behavior: Don’t take it personal, stay calm, reassure, find out cause, direct to private area, respond positively to appropriate behavior, report abuse to nurse

Inappropriate Sexual Behavior: Be sensitive, distract, direct to private area, consider ways to provide physical stimulation

Sleep Disturbances: make sure residents get moderate exercise, allow residents to spend time in natural sunlight if possible, reduce the light and noise during nighttime hours, discourage sleeping during the day

Pillaging and Hoarding: Label belongings, place a label or symbol on door, don’t tell others that person is stealing, prepare the family, ask them to report unfamiliar items, provide a rummage drawer

Creative Strategies

• Reality Orientation: Use clocks, calendars, signs, and lists to help residents remember who and where they are

• Validation therapy: Allow residents to believe they live in the past or in imaginary circumstances

• Reminiscence Therapy: encourage residents to remember and talk about the past

• Activity Therapy: use activities that resident enjoys to prevent boredom and frustration and to promote self-esteem