Ch 5 Workbook

What are 10 actions that a nursing assistant can take when helping care for a resident who is confused?

• 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 the resident.

• Remind the resident of his or her location, name, and the date. A calendar can help.

• Explain what you are going to do, using simple instructions.

• Do not rush the resident.

• Talk to confused residents about plans for the day. Keeping a routine may help.

• Encourage the use of eyeglasses and hearing aids. Make sure they are clean and are not damaged.

• Promote self-care and independence.

• Report observations to the nurse.

Name four possible causes of delirium.

infections, disease, fluid imbalances, and poor nutrition. Drugs and alcohol may also cause delirium.

Dementia is the loss of mental abilities such as thinking, remembering, reasoning, and communicating.

true.

Dementia is something that happens as every person gets older.

false.

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

true.

Men are more likely to have Alzheimer's disease than women.

false.

Alzheimer's disease causes tangled nerve fibers and protein deposits to form in the brain, eventually causing dementia.

true.

There is no cure for Alzheimer's disease.

true.

There is one simple exam that is performed to diagnose Alzheimer's disease.

false.

Each person with Alzheimer's disease will show different signs at different times.

true.

Eventually most people with Alzheimer's disease will be completely dependent on others for care.

true.

Symptoms of Alzheimer's disease typically appear suddenly.

false.

Mrs. Hays, a resident with Alzheimer's dis-ease, has awakened from her nap and does not recognize her room or anyone around her.

Tell her where she is, who she is, and identify others in the room.

Kena, a nursing assistant, has been trying to give Mr. Collins, a resident with AD, a bath. Mr. Collins has become agitated and is asking Kena "Who are you?" over and over again, although Kena has already identified herself twice.

Answer his questions using the same words each time until he stops.

Mrs. Hays has been telling Kena a story about her niece. She is showing Kena a necklace that her niece gave her as a gift. She is having trouble remembering the word necklace and is getting upset.

Suggest the word if it does not upset her.

Kena is helping Mr. Collins get ready to go to dinner. Kena asks him to put on his shoes, but Mr. Collins does not understand what Kena wants him to do.

Use short words and sentences. Hold up the shoes while saying, “Let’s put on your shoes.”

When communicating with a resident with Alzheimer's disease, the NA should:

A. Quietly approach the resident from behind

B. Stand as close as possible to the resident

C. Communicate in a loud area to help cheer up the resident

D. Speak slowly, using a lower tone of voice than normal

D.

If a resident is frightened or anxious, which of the following should the NA do?

A. Check his body language so he does not appear tense or hurried

B. Turn up the television to try to distract the resident

C. Use complex, longer sentences to calm the resident

D. Give multiple instructions at one time so that the resident has time to understand them

A.

If a resident perseverates, this means they are

A. Repeating words, phrases, questions, or actions

B. Suggesting words that sound correct

C. Hallucinating

D. Gesturing instead of speaking

A.

If a resident does not remember how to perform basic tasks, the NA should

A. Do everything for him

B. Encourage the resident to do what he can

C. Skip explaining each activity

D. Say "don't" as often as the NA feels is necessary

B.

Use nonslip mats, tub seats, and handholds to ensure safety during bathing.

Good Idea.

Always bathe the resident at the same time every day, even if the resident is agitated.

Bad Idea.

Break tasks down into simple steps, explaining one step at a time.

Good Idea.

Do not attempt to groom the resident; people with Alzheimer's disease usually do not care about their appearance.

Bad Idea.

Choose clothes that are simple to put on.

Good Idea.

If the resident has urinary incontinence, do not give her fluids, because it makes the problem worse.

Bad Idea.

Mark the bathroom with a sign or picture as a reminder to use it and where it is.

Good Idea.

Check the skin regularly for signs of irritation.

Good Idea.

Follow Standard Precautions when caring for the resident.

Good Idea.

Do not encourage exercise, as this will make the resident more agitated.

Bad Idea.

Serve finger foods if the resident tends to wander during meals.

Good Idea.

Schedule meals at the same time every day.

Good Idea.

Serve new kinds of foods as often as possible to stimulate the resident.

Bad Idea.

Put only one kind of food on the plate at a time.

Good Idea.

Use plain white dishes for serving food.

Bad Idea.

Do not encourage independence, as this can lead to aggressive behavior.

Bad Idea.

Reward positive behavior with smiles and warm touches.

Good Idea.

Ms. Torres gets upset at about 9:00 p.m. every night. She repeatedly asks for snacks or drinks and refuses to go to bed.

Sundowning. Remove triggers. Give snacks or encourage rest. Avoid stressful situations during this time. Limit activities, appointments, trips, and visits. Play soft music. Set a bedtime routine and keep it. Recognize when sundowning occurs. Plan a calming activity just before. Remove caffeine from the diet. Give a soothing back massage. Distract the resident with a simple, calm activity. Have a daily exercise routine.

Mr. Noble is playing chess with a friend and becomes angry when he loses the game. He shoves his friend, and when the NA approaches, he tells her he is going to hit her.

Violent behavior. Block blows but never hit back. Step out of reach. Call for help if needed. Do not leave resident alone. Try to remove triggers. Focus on a soothing, familiar activity. Stay calm. Use a low, soothing voice to speak to and reassure the resident. An arm around the shoulder, patting, or stroking may soothe some residents.

Mrs. Martin gets very upset every time she sees the President on television. She yells at the screen and tells everyone what a poor state our country is in.

Agitation. Try to remove triggers. Keep routine constant. Avoid frustration. Focus on a soothing, familiar activity. Stay calm. Use a low, soothing voice to speak to and reassure the resident. An arm around the shoulder, patting, or stroking may soothe some residents.

Ms. Desmond used to enjoy talking to people and reading, but lately she does not seem to enjoy anything. She sleeps most of the day and never talks to anyone unless she is asked to.

Depression. Report signs of depression to the nurse immediately. Encourage independence, self-care, and activity. Talk about moods and feelings if the resident wishes. Be a good listener. Encourage social interaction.

Whenever Mr. Fejer does not like what is being served for dinner, he bangs on the table with his fists and shouts about how much he hates his food. When people try to get him to stop, he only seems to grow louder.

Disruptiveness. Gain the resident’s attention. Be calm and friendly. Gently direct the resident to a more private area. Find out why the behavior is occurring. Ask the resident about it if possible. Tell the resident of any changes in schedules, routines, or the environment in advance. Involve the resident in developing routine activities and schedules, if possible. Encourage the resident to join in indepen-dent activities that are safe. Focus on positive activities he or she may still be able to do. This can provide a diversion.

Ms. Storey is walking around the facility asking everyone she meets what time it is. Even though she has been told several times, she still seems unsatisfied and keeps asking the question.

Wandering and perseverating. Remove causes when you can. Give nutritious snacks. Encourage an exercise routine. Maintain an elimination schedule. Let residents wander in a safe and secure (locked) area. Keep an eye on them. Suggest another activity, such as going for a walk together. Answer questions each time they are asked. Use the same words each time.

About an hour before dinner every night, Ms. Foley starts walking up and down the hall as quickly as she can. She does not speak to or acknowledge anyone else while she is doing this.

Pacing. Remove causes when you can. Give nutritious snacks. Encourage an exercise routine. Maintain an elimination schedule. Let residents pace or wander in a safe and secure (locked) area. Keep an eye on them. Suggest another activity, such as going for a walk together.

Whenever a female resident comes into the television room, Mr. Radcliffe tells her that he loves her and starts removing his clothes. If she stays in the room long enough, he will ask her to take off her clothes, too.

Inappropriate sexual behavior. Be professional when dealing with such behavior. Do not overreact. Be sensitive to the nature of the problem. Try to distract the resident. If this does not work, gently direct him or her to a private area. Tell the nurse.

Ms. DuVernay loves the color red. She has a lot of red clothing that she enjoys wearing. Whenever she sees a piece of red clothing, even in another resident's room, she picks it up and takes it back to her room.

Hoarding. Label all personal belongings with the resident’s name and room number. Place a label, symbol, or object on the resident’s door. Prepare the family so they are not upset when they find items that do not belong to their family member. Ask the family to tell staff if they notice strange items in the room. Provide a rummage drawer.

Mr. Bullis tells his NA that his wife has just called him. She is coming to pick him up, and they are going to dinner at the place they went on their first date. The NA knows that his wife has been dead for several years and their favorite restaurant has long since closed down.

Delusions. Ignore harmless delusions. Reassure a resident who seems upset or worried. Do not argue with a resident who is imagining things. Redirect resident to other activities or thoughts. Be calm. Reassure resident that you are there to help.

Ms. Lee's husband died 10 years ago and she misses him very much. Keisha, an NA who works with her, always asks about her life with her husband and what it was like. Ms. Lee seems to enjoy telling Keisha stories about what they did when they were young and how happy she was when they were together.

Reminiscence therapy

Mr. Elking tells Keisha that he has a date with Rose, the pretty girl who lives across the street. He is going to take her dancing and out to a movie. Keisha knows that Rose lived in his neighborhood when he was a teenager and that he has not seen her for years. Keisha knows that Mr. Elking rarely gets out of bed. Instead of correcting him, Keisha asks him what kind of movie they are going to see and what he thinks he should wear.

Validation therapy

Mr. Tennant sometimes gets depressed, especially in the evenings. Keisha knows that he loves classical music, so she starts playing it for him in the evenings a little before he usually starts feeling sad. He sorts through CDs and places them in stacks.

Activity therapy