Chapter 5. Confusion, Dementia, and Alzheimer's Disease

confusion

the inability to think clearly

Delirium

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

Causes of confusion

UTI, Low Blood Sugar, Dehydration, Fever, Lack of Oxygen, Infections, Brain Tumor

When caring for a resident with 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 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. Keep a routine.

-Promote self-care and independence.

-report observations to the nurse

Causes of delirium

infections, disease, fluid imbalance, poor nutrition, drugs, alcohol

symptoms of delirium

Agitation, Anger, Depression, Irritability, Disorientation, Trouble focusing, Problems with speech, Changes in sensation and perception, Changes in consciousness, Decrease in short-term memory.

Cognition

the ability to think logically and clearly

Cognitive Impairment

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

Dementia

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

Alzheimer's disease

-a progressive, incurable, terminal disease

-most common cause of dementia in elderly

-women are more likely than men to have it

-risks increase with age but not a normal part of aging

-tangled nerve fibers and protein deposits in brain cause dementia

-onset to death can be 3-20 years

-each person will show different signs at different times

common causes of dementia

Alzheimer's disease

Multi-infarct or vascular dementia (a series of strokes causing damage to the brain)

Lewy body dementia (very difficult to treat)

Parkinson's disease

Huntington's disease

when communicating with a resident with alzheimers

-approach from the front

-communicate with little background noise

-always identify yourself. use their name

-speak slowly with a lower tone and calm voice

-repeat yourself as needed, use simple words and short sentences

-check your body language

-try and be as supportive as possible

-if they show memory loss, repeat or use different words

-keep messages simple, break complex tasks into smaller ones

-if they try to do something that is unsafe, redirect them somewhere else

if a resident with AD asks to go home...

- ask them to tell you what their home is like and how they felt being there

- redirect to something they enjoy

- expect questions to continue, remain patient and gentile with responses

guidelines for caring for patients with AD

-develop a routine and stick to it

-promote self-care

-take care of yourself too

-schedule bathing when the pt is least agitated

-give them supplies before bathing (visual aid), keep process simple.

-let pt do as much as they can for themselves, give them choices too

-mark bathroom with a sign or picture, observe toileting patterns for 2-3 nights

-meals at consistent times each day and serve familiar foods

Sundowning

becoming restless and agitated in the late afternoon, evening, or night. remove triggers and stress, set bedtime routine and keep the environment calm.

catastrophic reaction

reacting to something in an unreasonable, exaggerated way. avoid triggers such as fatigue, changes, overstimulation, difficult tasks, pain, hunger, or need for toileting. remove triggers and distract them

Pacing

walking back and forth in the same area

wandering

walking aimlessly around the facility or facility grounds

elope

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

pillaging

taking things that belong to someone else. label their belongings. ask family to report unfamiliar items.

hoarding

collecting and putting things away in a guarded way. label their belongings.

Perseveration

the repetition of words, phrases, questions, or actions

disruptive Behavior

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

Inappropriate Social Behavior

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

Inappropriate Sexual Behavior

Be sensitive, distract, direct to private area, and consider other ways to provide physical stimulation. report any behavior immediately

Sleep Disturbances

-Make sure resident gets moderate exercise/activity throughout the day.

-Allow the resident to spend time in natural sunlight if possible.

-Reduce light and noise during nighttime hours.

-Discourage sleeping during the day.

Reality Orientation

uses calendars, clocks, signs, and lists to help people with Alzheimer's disease remember who and where they are.

validation therapy

allows residents to believe they live in the past or imaginary circumstances. Staff let the residents believe what the resident is saying, without trying to enforce current reality.

reminiscence therapy

type of therapy that encourages people with Alzheimer's disease to remember and talk about the past

Activity Therapy

uses activities that the resident enjoys to prevent boredom and frustration and to promote self-esteem.