CNA Chapter 5: Confusion, Dementia, and Alzheimer's Disease

define confusion

the inability to think logically and clearly

define delirium

state of severe confusion that occurs suddenly and is usually temporary

what are facts to remember about confusion?

•Interferes with ability to make decisions

•Personality may change

•Anger, depression, and irritability are other signs

•Can be temporary or permanent

what are possible causes of confusion?

•Urinary tract infection (UTI)

•Low blood sugar

•Head trauma or injury

•Dehydration

•Nutritional problems

•Fever

•Sudden drop in body temperature

•Lack of oxygen

•Medications

•Infections

•Brain tumor

•Diseases or illness

•Loss of sleep

•Seizures

what to od when caring for 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.

•Be patient. Do not rush the resident.

•Talk about plans for the day. Keep a routine.

•Encourage the use of eyeglasses and hearing aids.

•Promote self-care and independence.

•Do not leave cleaning agents or personal care products where the resident can access them.

•Report observations to the nurse.

what are possible causes of delirium?

•Infections

•Disease

•Fluid imbalance

•Poor nutrition

•Drugs

•Alcohol

what are possible 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

define cognition

ability to think logically and clearly

define cognitive impairment

loss of ability to think logically and clearly

define dementia

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

define Alzheimer’s disease

progressive, incurable disease that causes tangled nerve fibers and protein deposits to form in brain, which eventually causes dementia

what are common causes of dementia?

•Alzheimer’s disease

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

•Lewy Body disease

•Parkinson’s disease

•Huntington’s disease

how is dementia diagnosed?

•Involves getting a patient’s medical history and having a physical and neurological exam.

•Blood tests and imaging tests like CT or MRI scans may be ordered.

•Tests to trace brain wave activity (like EEGs) may be performed.

•Diagnosis of dementia helps rule out other possible diseases with similar symptoms.

what are some facts about dementia?

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

•More than 6 million people in the U.S. are living with Alzheimer’s disease.

•Women are more likely than men to have AD.

•Risk increases with age, but it is not a normal part of aging.

•AD is progressive, degenerative, and irreversible. 

•Tangled nerve fibers and protein deposits in brain cause dementia. 

•Cause is currently unknown and diagnosis is difficult.

•Length of time from onset to death can range from 4 to 20 years.

•Each person will show different symptoms at different times.

what points should NAs remember when caring for residents with AD?

•Every person with Alzheimer's progresses differently, showing different symptoms at different times.

•Residents should be encouraged to do self-care and keep their minds and bodies active for as long as possible.

what are helpful attitudes for working with residents with AD?

•Do not take things personally.

•Be empathetic.

•Work with symptoms and behaviors noted.

•Work as a team.

•Be aware of the difficulties associated with caregiving.

•Work with family members.

•Remember the goals of the care plan.

define perseveration

repetition of words, phrases, questions, or actions

what are some strategies to use when communicating with a AD resident?

•Approach from the front.

•Smile and look happy to see the resident. Be friendly.

•Determine how close the resident wants you to be.

•Communicate in a calm area with little background noise and distraction.

•Always identify yourself. Use the resident’s name and continue to use the resident's name.

•Speak slowly, using a lower tone of voice.

•Repeat yourself, using the same words and phrases, as often as needed.

•Use signs, pictures, gestures, or written words to help communicate.

•Break complex tasks into smaller, simpler ones.

what should NA do if resident is frightened or anxious?

•Speak in a low, calm voice. Speak in a quiet area with few distractions.

•Try to see and hear yourself as residents might. Describe what you are going to do.

•Use simple words and short sentences.

•Check your body language. Make sure you are not tense or hurried.

what should NA do if resident forgets or shows memory loss?

•Repeat yourself using the same words. If a resident does not understand a word, try a different one. If resident perseverates, answer questions using the same words each time.

•Keep messages simple. Break complex tasks into smaller, simpler ones.

what should NA do if resident has trouble finding words or names?

•Repeat yourself using the same words. If a resident does not understand a word, try a different one. If resident perseverates, answer questions using the same words each time.

•Keep messages simple. Break complex tasks into smaller, simpler ones.

what should resident do if they do not seem to understand basic instructions or questions?

•Ask resident to repeat your words. Use short words and sentences. Allow time to answer.

•Use the communication methods that are effective.

•Watch for nonverbal cues. Observe body language.

•Use signs, pictures, gestures, or written words.

what should NA do if resident wants to say something but cannot?

•Encourage resident to point, gesture, or act it out.

•Offer comfort with a smile if resident is upset or try to distract her.

what should NA do if resident does not remember how to perform basic tasks?

break each activity into simple steps

what should NA do if resident insists on doing something unsafe or not allowed?

limit the times you say “don’t”, redirect activities instead

what should NA do if resident hallucinates or is paranoid or accusing?

try not to take it personally

try to redirect behavior or ignore it

what should NA do if resident is depressed or lonely?

•Take time one-on-one to ask how he is feeling. Listen to the response.

•Try to involve the resident in activities. Report signs of depression to the nurse.

what should NA do if resident is repeatedly asking to go home?

•Ask the resident to tell her what his home was like and how he felt being there.

•Redirect to something he enjoys.

•Expect questions to continue, and remain patient and gentle with responses.

what should NA do if resident is verbally abusive or uses bad language?

•Remember it is the dementia speaking, not the person. Try to ignore the language. Redirect attention.

what should NA do if resident has lost most verbal skills?

•Use nonverbal skills, such as touch, smiles and laughter.

•Use signs, labels and gestures.

•Assume people can understand more than they can express.

what should NAs caring for residents with AD remember for providing care?

•Develop a routine and stick to it.

•Promote self-care.

•Take good care of yourself, both mentally and physically.

what are some tools NAs can use for problems with bathing?

•Schedule bathing when resident is least agitated.

•Give resident supplies before bathing to serve as visual aid.

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

•Make sure bathroom is well-lit and at a comfortable temperature.

•Provide privacy.

•Be calm and quiet. Keep the process simple.

•Be sensitive when discussing bathing.

•Give resident washcloth to hold during the bath.

•Ensure safety by using nonslip mats, tub seats, and hand-holds.

•Be flexible about when to bathe. Understand if resident does not want to bathe.

•Be relaxed. Offer encouragement and praise.

•Let the resident do as much as possible for himself.

•Check the skin for signs of irritation. 

what should NAs do when problems with grooming and dressing?

•Help with grooming.

•Avoid delays or interruptions.

•Provide privacy.

•Show resident the clothing to put on.

•Encourage resident to pick out clothes to wear. Lay out clothes in order to be put on.

•Break task down into simple steps. Do not rush the resident.

•Use a friendly, calm voice when speaking. Praise and encourage.

what should NA do for problems with toileting?

•Help with grooming.

•Avoid delays or interruptions.

•Provide privacy.

•Show resident the clothing to put on.

•Encourage resident to pick out clothes to wear. Lay out clothes in order to be put on.

•Break task down into simple steps. Do not rush the resident.

•Use a friendly, calm voice when speaking. Praise and encourage.

what should NAs do for problems with resident’s nutrition?

•Have meals at consistent times each day. Food should look and smell appetizing.

•Make sure there is proper lighting.

•Keep noise and distractions low

•Keep the task of eating simple. Finger foods are easier to eat.

•Do not serve steaming or very hot foods or drinks.

•Use plain plates without a pattern or color. Use a simple place setting with a single utensil. Remove other items from the table.

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

•Give simple, clear instructions for eating or using utensils. Place a spoon to the lips. Ask the resident to open his mouth.

•Encourage nutritious food.

•Guide the resident through the meal with simple instructions. Offer regular drinks to avoid dehydration.

•Use adaptive equipment as needed.

•Feed resident slowly, giving small pieces of food.

•Make mealtimes simple and relaxed.

•Give resident time to swallow each bite.

•Seat residents with others to encourage socializing.

•Observe for eating and swallowing problems. Observe and report changes or problems. Monitor weight frequently.

what should NAs do to help AD residents physical health?

•Prevent infections and follow Standard Precautions. 

•Observe the resident's physical health and report any potential problems

•Help the resident wash their hands frequently. 

•Give careful skin care to prevent pressure injuries.

•Watch for signs of pain. Report possible signs of pain to the nurse. 

•Maintain daily exercise routine.

what should NAs do to promote AD resident’s mental and emotional health?

•Maintain self-esteem by encouraging dependence. 

•Share in enjoyable activities, looking at pictures, talking and reminiscing.

•Reward positive and independent behavior with smiles and warm touches. 

define sundowning

becoming restless and agitated in the late afternoon, evening, or night

define catastrophic reaction

reacting to something in an unreasonable, exaggerated way

define pacing

walking back and forth in the same area

define wandering

walking aimlessly around facility or facility grounds

define elope (in healthcare)

when a person with AD wanders away from a protected area and does not return

define hallucinations?

false or distorted sensory perceptions

define delusions

persistent false beliefs

define rummaging

going thru drawers, closets or personal items that belong to oneself or others

define hoarding

collecting and putting things away in a guarded way

how to best deal with agitation?

Remove triggers, keep routine, reduce noise, focus on familiar activity, remain calm, and soothe.

how to best handle sundowning?

Avoid stressful situations, limit activities and appointments, play soft music, set a bedtime routine, plan a calming activity, limit caffeine, provide snacks, give a back massage, distract, and maintain a daily exercise program.

how to best handle catastrophic reactions

Avoid triggers such as fatigue, changes, overstimulation, difficult choices/tasks, pain, hunger, or need to use the toilet. Remove triggers and distract. 

how to best handle violent behavior?

Call for help, Block blows, never hit back, step out of reach, do not leave the resident alone, remove triggers, and use the same  calming techniques as for agitation and sundowning.

how to best handle pacing and wandering?

Causes: restlessness, hunger, disorientation, incontinence or need to use the toilet, constipation, pain, forgetting how or where to sit down, too much napping, need for exercise.

Remove causes, give snacks, encourage exercise, maintain toileting schedule, let resident pace in safe place, redirect attention, and mark rooms with signs or pictures such as stop signs. 

how to best handle hallucinations or delusions?

Ignore if harmless, reassure, do not argue, and be calm.

how to best handle depression?

Causes: loss of independence, inability to cope, feelings of failure and fear, facing an incurable illness, or a chemical imbalance. 

Report signs, observe for triggers that cause changes in mood,  encourage independence, talk about moods and feelings, and encourage social interaction. 

how to best hand perseveration or repetitive phrasing?

Respond with patience, do not stop behavior, and answer questions each time, using the same words.

how to best handle disruptiveness?

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 activities the resident may still be able to do.

how to best handle 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.

how to best handle inappropriate sexual behavior?

Stay calm and be reassuring, try to determine the cause of the problem is the behavior intentional?), direct to a private area, and consider other ways to provide physical stimulation. 

how to best handle hoarding and rummaging>

Label belongings, place a label or symbol on door, do not tell others that person is stealing, prepare the family, ask the family to report unfamiliar items, and provide a rummage drawer.

how to best handle 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.

define validating

giving value to or approving

what are creative therapies to try when working with AD residents?

•Validation therapy allows residents to believe they live in the past or in imaginary circumstances.

•Reminiscence therapy encourages residents 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.