Chapter 5 - Confusion, Dementia, and Alzheimer’s Disease

These flashcards cover confusion, delirium, dementia, and Alzheimer's disease management for Nursing Assistants.

Confusion

The inability to think clearly and logically; it can cause trouble focusing attention and feeling disoriented.

Impact of confusion on decision-making

Confusion can interfere with a person's ability to make decisions.

Confusion duration and onset

Confusion may be temporary or permanent and may begin suddenly or gradually.

Possible causes of confusion

Examples include UTI, low blood sugar, head injury, dehydration, nutritional problems, fever, lack of oxygen, medications, infections, disease, sleep loss, or seizures.

Delirium

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

Common causes of delirium

Infections, disease, fluid imbalances, poor nutrition, and sometimes drugs or alcohol.

Distinguishing features of delirium

It usually begins suddenly and is usually temporary.

NA response to a confused resident

Keep the resident safe, stay calm, provide a quiet environment, speak clearly and slowly, and do not leave the resident alone.

Orientation for a confused resident

Remind the resident of their name, location, and date; calendars and familiar routines may help.

Giving instructions to a confused resident

Use simple instructions, explain what you are going to do, and do not rush the resident.

Role of eyeglasses and hearing aids

They can improve sensory input and may reduce confusion.

Management of cleaning agents

Keep them out of reach because a confused resident may try to eat or drink them.

Dementia

A general term for a serious loss of mental abilities such as thinking, remembering, reasoning, and communicating.

Dementia and aging

Dementia is not a normal part of aging.

Cognitive impairment

Loss of the ability to think logically and clearly.

Abilities affected by cognitive impairment

Concentration, memory, reasoning, and communication.

Alzheimer's disease (AD)

A progressive, incurable disease that causes dementia and gradually affects memory, thinking, and behavior.

Most common cause of dementia

Alzheimer's disease is the most common cause of dementia in older adults.

Alzheimer's disease gender prevalence

Women are more likely to have Alzheimer's disease.

Brain changes in Alzheimer's disease

Tangled nerve fibers and protein deposits form in the brain and contribute to dementia.

Curability of Alzheimer's disease

There is currently no cure.

Alzheimer's disease diagnosis method

Diagnosis involves evaluating symptoms and ruling out other causes; there is no single simple test.

Alzheimer's symptom variability

Each person may show different symptoms at different times; not everyone shows the same signs at the same time.

Onset of Alzheimer's symptoms

Symptoms usually begin gradually rather than suddenly.

Progression of Alzheimer's disease

Symptoms gradually worsen over time and most people eventually become dependent on others for care.

Early signs of Alzheimer's disease

Memory loss, difficulty with familiar tasks, communication problems, disorientation, poor judgment, and changes in mood or personality.

Initial approach to an Alzheimer's resident

Approach from the front, smile, make eye contact, and identify yourself.

Speaking style for Alzheimer's residents

Speak slowly in a calm, low tone and use simple words and short sentences.

Communication environment for AD

A calm, quiet environment with limited distractions.

Arguing or correcting AD residents

Avoid arguing, criticizing, or repeatedly correcting the resident.

Perseveration

Repeating the same words, phrases, questions, or actions over and over.

Responding to perseveration

Answer calmly and patiently, then redirect the resident when possible.

Handling word-finding difficulty

Suggest a word that sounds correct, but do not rush or embarrass the resident.

Misunderstood instructions in AD

Repeat or rephrase using simple words, give one instruction at a time, and allow time to respond.

Value of gestures in AD

Gestures, pictures, and demonstrations can make instructions easier to understand.

Handling resident fright or anxiety

Stay calm, use a low soothing voice, reduce distractions, and make sure body language is relaxed.

Response to requests to go home

Do not argue; acknowledge the resident's feelings and gently redirect the conversation or activity.

Responding to verbally abusive language

Stay calm, do not take it personally, and redirect attention while remembering the disease affects behavior.

Basic task forgetfulness

Break the task into simple steps, demonstrate if helpful, and encourage the resident to do as much as possible independently.

Importance of Resident Independence

Independence supports dignity, self-esteem, remaining abilities, and quality of life.

Bathing safety equipment

Nonslip mats, tub seats, and handholds.

Agitation during bathing

Do not force the bath; stop, allow the resident to calm down, and try again later.

Explanation of bathing tasks

Break them into simple steps and explain one step at a time.

Simplifying dressing for AD

Choose simple clothing, lay clothes out in order, and give only a few choices.

Fluid intake and incontinence

Fluids should not be restricted because of urinary incontinence; residents still need adequate fluids.

Helping a resident find the bathroom

Use a sign or picture and keep the path well lit and easy to find.

Incontinence toileting routine

Take the resident to the bathroom regularly, such as every two to three hours, and observe patterns.

Regular skin checks

Used to identify irritation or skin breakdown early in residents with incontinence.

Standard Precautions in AD care

Standard Precautions should always be followed when caring for residents with AD.

Exercise in AD care

Maintain a daily exercise routine appropriate to the resident.

Helping a resident who wanders during meals

Provide finger foods that are easy to pick up and eat while moving.

Benefit of regular mealtimes

A consistent routine can reduce confusion and make eating easier.

Optimal food types for AD

Familiar, appealing, easy-to-eat foods served in a simple way.

Serving one food at a time

This practice can reduce confusion and overstimulation during meals.

Use of plain dishes

They make the food easier to see and reduce visual distraction.

Reinforcement of independent behavior

Provide praise, smiles, encouragement, and warm appropriate touches.

Agitation

Restlessness or excitement that may include pacing, irritability, or difficulty settling down.

Sundowning

Increased confusion, agitation, or restlessness that occurs later in the day or evening.

Assisting with sundowning

Keep a consistent routine, reduce evening noise and stimulation, provide adequate lighting, and plan calming activities.

Catastrophic reaction

An extreme emotional response to stress, frustration, fatigue, overstimulation, or a change in routine.

NA response to catastrophic reaction

Stay calm, reduce stimulation, remove triggers if possible, reassure the resident, and give the resident space.

Hallucination

Seeing, hearing, smelling, tasting, or feeling something that is not actually present.

Responding to a hallucination

Do not argue that it is not real; reassure the resident, keep them safe, and redirect attention.

Delusion

A false belief that the resident strongly believes is true.

Responding to a delusion

Do not argue or reinforce the false belief; acknowledge feelings, reassure the resident, and redirect.

Wandering

Walking around without a clear destination or purpose, sometimes repeatedly.

Responding to wandering

Allow safe walking, monitor the resident, secure unsafe areas, and redirect when necessary.

Pacing

Walking back and forth repeatedly in the same area.

NA action for safe pacing

Allow it when safe, observe the resident, and redirect if needed.

Signs of depression in AD

Loss of interest, withdrawal, sleeping more, sadness, fear, or decreased activity.

Responding to resident depression

Report the signs to the nurse and encourage safe activity, independence, and social interaction.

Handling aggressive behavior

Stay calm, step out of reach, remove triggers if possible, do not hit back, and get help as needed.

Handling inappropriate sexual behavior

Remain professional, protect privacy and safety, gently redirect the resident, and report the behavior.

Hoarding

Collecting and storing objects, sometimes including items belonging to others.

Rummaging

Going through drawers, closets, or personal items repeatedly.

Response to hoarding or rummaging

Do not shame or accuse the resident; provide safe items/areas to explore and return others' belongings discreetly.

Validation therapy

A therapy in which caregivers accept and work within the resident's perceived reality instead of repeatedly correcting them.

Reminiscence therapy

Encouraging a resident to remember and talk about pleasant experiences from the past.

Activity therapy

Using enjoyable, meaningful activities to promote involvement, function, and well-being.

Music therapy

Using music to promote mood, memory, cognition, relaxation, and socialization.

Example of reminiscence therapy

A resident talking about happy memories with a deceased spouse.

Example of validation therapy

An NA going along with a resident's past-time reality rather than correcting it.

Example of activity therapy

Activities such as folding clothes, sorting objects, or doing puzzles.

Example of music therapy

Using favorite songs to improve mood and encourage participation.