Chapter 5 Flashcards
Confusion, dementia and Alzheimer’s disease
Confusion
The inability to think clearly
A confused person may be angry, depressed or irritable
Confusion can come on suddenly or gradually.
It can be temporary or permanent
Confusion/delirium guidelines
Do not leave an acutely confused resident alone
Remind the clients of their location, name and the dates. A calendar can help
Be calm. Provide a quiet environment if possible
Address the client by name and speak clearly and slowly in a low tone of voice. Use simple sentences
Be gentle and try to decrease fears
Use facial expressions and body language to aid and understanding
Do not leave cleaning agents or personal care products where the resident can access them. They may try to eat or drink them
Delirium
A state of severe confusion that occurs suddenly; it is usually temporary
Some signs and symptoms include:
Disorientation
Problems with speech
Changes in sensation and perception (hallucinations)
Decrease in short-term memory
Dementia
A general term that refers to a serious loss of mental abilities such as thinking, remembering, reasoning and communicating. It is not a normal part of aging
Alzheimer’s disease
Causes Tangled nerve fibers and protein deposits to form in the brain. They eventually cause dementia. There is no cure. It may take anywhere from 4 to 20 years to progress, but it always ends in death.
Mood and behavior changes
Aggressiveness, wandering and withdrawal are common symptoms
Encourage working, socializing, reading, problem solving and exercising.
How to work with AD
Do not take things personally
Be empathetic
Work with the symptoms and behaviors noted
Work as a team
Be aware of difficulties associated with caregiving
Work with family members
Remember the goals of the care plan
AD guidelines
Always approach from the front and do not start all the resident
Smile and look happy to see the resident. Be friendly
Read how close the resident wants you to be
Always identify yourself and use the residence name. Continue to use the residence name during the conversation
Speak slowly, using a low tone of voice.
Repeat yourself. Use the same words and phrases is often as needed
use signs, pictures, gestures were written words to help communicate
Break complex tasks into smaller, simpler ones. Give simple, step by step instructions as necessary
If the resident has trouble finding words or names suggest a word that sounds correct. If it upsets the resident, learn from it. Try not to correct a resident who uses an incorrect word
Watch for nonverbal cues as the ability to talk lessens
If the client seems not to understand basic instructions or questions ask the client to repeat your words. These signs, pictures, gestures or written words if necessary.
Combining verbal and nonverbal communication is helpful. For example, you can say “let’s get dressed now,” while holding up clothes
If the client wants to say something but cannot ask them to point, gesture or act it out
If the client is upset but cannot explain why, offer comfort with a smile, or try to distract them (tasks)
If the client cannot remember how to perform basic tasks break the activity into simple steps.
If the client insists on doing something that is unsafe or not allowed redirect the activities towards something else. Try to limit the times you say “don’t”
If the resident hallucinates or is paranoid or is accusing try to redirect the behavior or ignore it if harmless. It usually passes quickly. Do not challenge or participate in the hallucination/delusion. Redirect the client to other activities or thoughts.
Engage the resident if they seem depressed or lonely. Ask how they’re feeling and really listen. Try to involve them in activities.
If the client repeatedly ask to go home, ask them to tell you what their home was like and how they felt being there. Try to redirect the conversation and/or the activities to something they enjoy
If the client has lost most of their verbal skills use nonverbal skills. Use touch, smiles and laughter. Approach touching slowly. Softly touch the hand or place an arm around the client
Assume that people with AD can understand more than they can express. Do not talk about them as though they were not there or treat them like children.
Use a simple place setting with a single eating utensil. Remove other items from the table plane plates without patterns or colors work best. Put only one item of food on the plate at a Time. Use adaptive utensils and bowls as needed.
Help the client wash their hands frequently
Watch for signs of pain such as grimacing or clenching fists.
Maintain a daily exercise routine.
Sometimes television programs can agitate clients with AD. Remove them from the situation and redirect their attention
If a client shows symptoms of sundowning or has a catastrophic reaction, remove the trigger and try playing soft music, offer a soothing back massage, engage in a calm activity like looking at a magazine.
If a client with AD becomes violent, call for help, step out of reach and stay calm. Try to remove triggers
If a client elopes, notify the charge nurse immediately
If the client is being disruptive try to find out why the behavior is occurring. Gently direct them to a private area. Notice and praise improvements in the client’s behavior. Encourage them to engage in independent activities that are safe (for example folding towels)
Do not overreact to inappropriate sexual behavior as this man reinforce it. Try to distract them or direct them to a private area. Try to determine if it’s intentional, or consistent.
For the clients who rummage or hoard, provide them with a rummage drawer full of items that are safe for the client to take with them.
If the client is having difficulty sleeping allow them to spend some time each day in natural sunlight if possible. The exposure to light and dark can help establish restful sleep patterns. Ensure moderate exercise / activity throughout the day. Discourage sleeping during the day. Reduce lighting noise as much as possible during night time hours.
if the client with AD is frightened or anxious
Speak slowly in a low, calm voice. Bring the client to a quiet area with you distractions
Always describe what you are going to do to the client
Make sure not to be tense or hurried
If the AD client forgets or shows memory loss
Repeat yourself. Use the same words if you need to repeat an instruction or question. However you may be using a word the client does not understand, such as tired. Try to use other words like nap, lie down, or rest. Repetition can be soothing.
If the client is perseverating answer the questions using the same words each time, until they stop. It may be frustrating, but it communicates comfort and security.
Guidelines for assisting AD clients with ADLs
Develop a routine and stick to it
Promote self care
schedule bathing when the client is the least agitated. Be flexible about when to bathe
Prepare the client by handing them the supplies (washcloth, soap shampoo etc.) This serves as a visual aid
Give the client to washcloth to hold while bathing. This can distract them and help you finish the bath.
Have them choose the clothing they want to wear if possible. Lay them out in the order in which they are to be put on. Some people with AD layer clothing regardless of the weather
Guidelines for assisting AD clients that have problems with elimination
Encourage fluids even if incontinent
Mark the bathroom with a sign or a picture
Note when the resident is incontinent over 2 to 3 days
Check every 30 minutes. This can help determine “bathroom times”
Take the client to the bathroom before and after meals and before bedtime
Creative therapies for clients with AD
Validation therapy: is letting residents believe they live in the past or in imaginary circumstances. Explore the clients beliefs. do not argue or correct them. Example: Mr Baldwin says he’s not eating lunch today because he’s going out to lunch with his wife who is deceased. You can ask what restaurant he is going to and what he’s going to order.
Reminiscence therapy is encouraging residents to remember and talk about the past. Ask for details about the client’s memories and past. Example: Mr Benton fought in the Korean war. In his room he has warm mementos and pictures. You can ask him where he was sent in the war and even more detailed questions. Try and get the client to share
Activity therapy uses activities that the resident enjoys to prevent boredom and frustration. You can help the client take walks, do puzzles, listen to music, read or do other things they enjoy. Activities can be done in groups or one-on-one. Example: Mrs habel was a librarian for almost 45 years she loves books and reading but cannot read much anymore. You could obtain books from the facility that are filled with pictures for her to peruse.
Apply music therapy. Music and Memory is a nonprofit organization that brings personalized music into the lives of the elderly. musicandmemory.org
