Chapter five: Confusion, Dementia, and Alzheimer's disease

What are actions that a nurse can take when a resident is confused?

Don't leave a confused resident alone, Stay calm, Speak in a lower tone of voice, Introduce yourself, Remind resident of location, name, and the date

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 tangles 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

Most Alzheimer's disease victims will eventually need constant care

True

Symptoms of Alzheimer's disease typically appear suddenly

False

Mrs. Hays, a resident with Alzheimer's disease, has awakened from her nap and does not recognize her room or anyone around her. how should the NA respond?

Tell Mrs. Hays 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. How Should Kena respond?

Answer Mr. Collins' 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. How should Kena respond?

Suggest the word if it doesn't upset Mrs. Hays.

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. How should this be handled?

Use short words/sentences and hold up the shoes while saying "lets put your shoes on".

When communicating with a resident with AD, the NA should...

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

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

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

If a resident perseverates, this means he is...

Repeating words, phrases, questions or actions

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

Encourage the resident to do what he can.

Use non-slip mats, tub seats, and handholds to ensure safety during bathing

Good idea

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

Bad idea

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

Good idea

Do not attempt to groom the resident; most people with AD do not care about their appearance

Bad idea

Choose clothes that are simple to put on

Good idea

If the resident is incontinent, do not give him fluids, because it will make 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 the standard precautions when caring for the resident

Good idea

Do not encourage exercise, as it 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 food 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 foods

Good idea

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

Bad idea

Reward positive behavior with smiles and warm touches

Good idea

Mrs. Donne gets upset at about 9:00 p.m. every night. She repeatedly asks for snacks or drinks and refuses to go to bed. How should you address this?

This is what sounds like to be sun downing, I would recommend proving nutritious snacks.

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

Use a low, soothing voice, try to redirect attention. Remove triggers.

Mrs. Martin gets very upset every time she sees the president on the television. She yells at the screen and tells everyone what a poor state our country is in. How should this be handled?

Try to remove triggers, keep the routine constant, avoid frustrations, focus on a soothing/familiar activity.

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 tells anyone unless she is asked to. What should you do?

Observe triggers that cause depressive episodes, encourage independence, 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 grows louder. How should to handle this?

Proper lighting, keep noise and distractions low during meal times, don't serve steaming or very hot foods, serve one food at a time, offer an alternative meal.

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. What should you do?

Answer the question the same way each time she asks until she stops.

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

Give snacks, make an exercise routine, let residents free roam in a safe environment, redirect attention to something they enjoy.

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 her clothes off too. What should be done?

Inappropriate sexual behavior- The resident should be redirected and monitored. Ways to provide stimulation may include back rubs, soft stuffed animal to cuddle, comforting blankets.

Mrs. Rowling 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. What should be done?

Hoarding or Rummaging- Label personal belongings with name and room number, don't tell the family about "stealing", ask family to notify staff if they see unfamiliar items.

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 years and their favorite restaurant has long since closed down. What should she do?

Ignore harmless delusions, reassure resident, redirect to other activities.

Ms. Lee misses her husband, who has been dead for ten years, 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 stories about what they did when they were young and how happy she was when they were together. What type of therapy is this?

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 in years. Keisha knows that Mr. Elking 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. What type of therapy is this?

Validation therapy

Mr. Tennant sometimes gets depressed, especially in the evenings. Keisha knows that he loves classical music, so she starts playing if for him in the evenings a little before he usually starts feeling sad. He sorts through albums and places them in a stack. What type of therapy is this?

Activity therapy