Define the following terms:

1
Define the following terms

• Cognition
• the ability to think logically and quickly.
• Cognitive impairment
• loss of ability to think logically concentration
  and memory are affected.

2
1. Describe normal changes of aging in the brain

• Remember the following points about aging and the
  brain
• It is normal for a person to lose some ability to
  think logically and quickly as he ages.
• Elderly residents may lose memory of recent
  events.
• Help by encouraging residents to make lists,
  write down names, events and phone numbers.
• Reaction time may slow and it may be harder to
  find the right word.
• Elderly people tend to sleep less.

3
Define the following terms

• Confusion
• the inability to think clearly.
• Delirium
• a state of severe confusion that occurs suddenly
  and is usually temporary.

4
2. Discuss confusion and delirium

• Remember these points about confusion
• Interferes with ability to make decisions
• Personality may change
• Anger, depression, and irritability are other
  signs
• Can be temporary or permanent

5
2. Discuss confusion and delirium

• All of the following can cause confusion
• Low blood sugar
• Head trauma or injury
• Dehydration
• Nutritional problems
• Fever
• Sudden drop in body temperature

6
2. Discuss confusion and delirium

• Causes of confusion (contd.)
• Lack of oxygen
• Medications
• Infections
• Brain tumor
• Illness
• Loss of sleep
• Seizures

7
Transparency 19-1 Care Guidelines for Confusion

• Do not leave 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.
• Do not rush the resident.
• Talk about plans for the day.
• Encourage the use of glasses and hearing aids.
• Promote self-care and independence.
• Report observations to the nurse.

8
2. Discuss confusion and delirium

• Causes of delirium include the following
• Infections
• Disease
• Fluid imbalance
• Poor nutrition
• Drugs and alcohol

9
2. Discuss confusion and delirium

• Remember these 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

10
2. Discuss confusion and delirium

• REMEMBER
• It helps to be gentle and to keep ones voice low
  when communicating with someone who is confused
  or disoriented. Use the persons name and speak
  clearly in simple sentences. Reduce distractions
  as much as possible.

11
Define the following terms

• Dementia
• a general term that refers to a serious loss of
  mental abilities, such as thinking, remembering,
  reasoning, and communicating.
• Progressive
• term used to mean that a disease gets worse,
  causing greater and greater loss of health and
  abilities.
• Degenerative
• something that continually gets worse.

12
Define the following terms

• Onset
• in medicine, the first appearance of the signs or
  symptoms of an illness.
• Irreversible
• incurable.

13
3. Describe dementia and define related terms

• REMEMBER
• Dementia is NOT a normal part of aging.

14
3. Describe dementia and define related terms

• Common causes of dementia include
• Alzheimers disease
• Multi-infarct or vascular dementia (a series of
  strokes causing damage to the brain)
• Lewy Body disease
• Parkinsons disease
• Huntingtons disease

15
3. Describe dementia and define related terms

• Remember these points about diagnosing dementia
• Involves getting a patients 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 (EEG) may be
  performed.
• Diagnosis of dementia helps rule out other
  possible diseases with similar symptoms.

16
Define the following term

• Alzheimers disease
• a progressive, degenerative, and irreversible
  disease which causes tangled nerve fibers and
  protein deposits to form in the brain, eventually
  causing dementia.

17
Transparency 19-2 Facts About Alzheimers

• AD is the most common cause of dementia in the
  elderly.
• As many as 5.2 million people in the U.S. are
  living with Alzheimers.
• 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
  three to 20 years.
• Each person will show different signs at
  different times.

18
4. Describe Alzheimers disease and identify its
stages

• REMEMBER
• There are three stages of Alzheimers disease
  (outlined on pp. 349-350 of the textbook).
  Behaviors and ability for self-care will be very
  different at different stages of the disease.

19
4. Describe Alzheimers disease and identify its
stages

• Think about this question
• Which resident would be more of a caregiving
  challenge a resident in the second or third
  stage of Alzheimers disease?

20
4. Describe Alzheimers disease and identify its
stages

• Remember the following points
• Every person with Alzheimers progresses
  differently, showing different symptoms at
  different times.
• AD residents should be encouraged to do self-care
  and keep their minds and bodies active for as
  long as possible.

21
Transparency 19-3 Helpful Attitudes for AD
Resident

• Do not take things personally.
• Put yourself in their shoes.
• Work with symptoms and behaviors you see.
• Work as a team.
• Take care of yourself.
• Work with family members.
• Remember the goals of the resident care plan.

22
5. Identify personal attitudes helpful in caring
for residents with Alzheimers disease

• Think about these questions?
• Which situations with an AD resident might
  require a team effort?
• Which might require the family to provide
  information about the resident?

23
Define the following term

• Perseveration
• repeating words, phrases, questions, or actions.

24
6. List strategies for better communication with
residents with Alzheimers disease

• Remember the following communication tips when
  dealing with residents with Alzheimers disease
• Approach from the front.
• Determine how close to stand.
• Communicate in calm place.
• Identify yourself and use the residents name.
• Speak slowly in a lower voice than normal.

25
6. List strategies for better communication with
residents with Alzheimers disease

• If resident is frightened or anxious
• Keep him calm.
• Speak in a low, calm voice. Use a room with
  little background noise and distraction.
• Describe what you are going to do.
• Use simple words and short sentences.
• Check your body language.

26
6. List strategies for better communication with
residents with Alzheimers disease

• 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.

27
6. List strategies for better communication with
residents with Alzheimers disease

• If resident has trouble finding words or names
• Suggest a word that sounds correct. Try not to
  correct a resident who uses an incorrect word.
• If resident seems not 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.

28
6. List strategies for better communication with
residents with Alzheimers disease

• If resident wants to say something but cannot
• Ask him or her to point, gesture, or act it out.
• Offer comfort with a hug or smile if resident is
  upset.
• If resident does not remember how to perform
  basic tasks
• Break each activity into simple steps.
• If resident insists on doing something that is
  unsafe or not allowed
• Limit the times you say dont. Redirect
  activities instead.

29
6. List strategies for better communication with
residents with Alzheimers disease

• If resident hallucinates or is paranoid or
  accusing
• Do not take it personally.
• Try to redirect behavior or ignore it.
• If resident is depressed or lonely
• Take time one-on-one to ask how he or she is
  feeling. Listen to the response.
• Try to involve the resident in activities.
• Report depression to the nurse. (More about
  depression in Chapter 20.)

30
6. List strategies for better communication with
residents with Alzheimers disease

• If resident is verbally abusive or uses bad
  language
• Remember it is the dementia speaking and not the
  person. Try to ignore the language. Redirect
  attention.
• If resident has lost most of 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.

31
7. Explain general principles that will help
assist residents with personal care

• Remember these three general principles
• Develop a routine and stick to it.
• Promote self-care.
• Take good care of yourself, both mentally and
  physically.

32
Define the following term

• Intervention
• a way to change an action or development.

33
8. List and describe interventions for problems
with common activities of daily living (ADLs)

• Think about this question
• Read Handout 19-1. How might these caregiving
  tips apply to residents in different stages of
  Alzheimers disease?

34
Define the following terms

• Agitated
• the state of being excited, restless, or
  troubled.
• Triggers
• situations that lead to agitation.
• Sundowning
• becoming restless and agitated in the late
  afternoon, evening, or night.

35
Define the following terms

• Catastrophic reaction
• overreacting to something in an unreasonable way.
• Pacing
• walking back and forth in the same area.
• Wandering
• walking aimlessly.

36
Define the following terms

• Elope
• in medicine, when a person with Alzheimers
  disease wanders away from the protected area and
  does not return.
• Hallucinations
• illusions a person sees or hears.
• Delusions
• persistent false beliefs.

37
Define the following terms

• Repetitive phrasing
• repeating words, phrases, or questions.
• Pillaging
• taking things that belong to someone else.
• Hoarding
• collecting and putting things away in a guarded
  manner.

38
9. List and describe interventions for common
difficult behaviors related to Alzheimers
disease

• REMEMBER
• A person with AD cannot and does not steal.
  Pillaging and hoarding is not considered
  stealing.
• In addition to the interventions listed in
  Handout 19-2, you should be familiar with the
  tips on pp. 360-361 of the textbook for providing
  home care for an AD client.

39
Define the following term

• Validating
• giving value to or approving.

40
10. Describe creative therapies for residents
with Alzheimers disease

• Remember these four creative therapies that may
  be used with AD residents
• Reality orientation
• Validation therapy
• Reminiscence therapy
• Activity therapy
• Think about these questions
• When are these therapies useful?
• What are the benefits of each?

41
11. Discuss how Alzheimers disease may affect
the family

• Remember these points about the adjustments
  required of the family of a resident or client
  with AD
• How well family copes depends in part on the
  familys emotional and financial resources.
• Families of people with AD who live alone may be
  afraid of what happens when nobody else is there.
• If a person with AD is living with family this
  can cause stress for all involved.
• It is very difficult to watch a loved ones
  personality change and health and abilities
  deteriorate.

42
11. Discuss how Alzheimers disease may affect
the family

• Adjustments required of the family of a resident
  or client with AD (contd.)
• Family members usually feel guilty about making a
  decision to place a loved one in LTC, and they
  worry about the quality of care the person will
  receive.
• Allow residents families to express their
  feelings.
• Be sensitive.
• Refer families to supervisor if help is needed.

43
12. Identify community resources available to
people with Alzheimers disease and their families

• The following resources are available for people
  with AD and their families
• Alzheimers Association helpline, 800-272-3900 or
  alz.org
• National Institute on Agings Alzheimers Disease
  Education and Referral (ADEAR) Center,
  800-438-4380
• Counseling, support groups, healthcare
  professionals

44
12. Identify community resources available to
people with Alzheimers disease and their families

• REMEMBER
• Inform the nurse if you think residents and/or
  families could benefit from a list of community
  resources.

45
Chapter Exam

• 1. Which of the following should a nursing
  assistant do if a resident is confused?
• (A) Rush the resident.
• (B) Stay calm and provide a quiet environment.
• (C) Leave the resident alone.
• (D) Do all care for the resident.
• 2. Confusion may be caused by
• (A) Too much television viewing
• (B) An unpleasant roommate
• (C) Exercise
• (D) Dehydration

46
Chapter Exam (contd.)

• 3. The ability to think logically and quickly is
  called
• (A) Cognition
• (B) Dementia
• (C) Awareness
• (D) Dysphagia
• 4. Nursing assistants can help residents with
  memory loss by
• (A) Doing as much as possible for them
• (B) Encouraging them to make lists of things to
  remember
• (C) Reminding them every time they forget
  something
• (D) Telling them to snap out of it

47
Chapter Exam (contd.)

• 5. Which of the following terms means a serious
  loss of mental abilities?
• (A) Cognition
• (B) Irreversible
• (C) Dementia
• (D) Onset
• 6. Which of the following statements is true of
  Alzheimers disease (AD)?
• (A) Skills a person has used over a lifetime are
  usually kept longer.
• (B) Residents with AD will show the same signs at
  the same times.
• (C) NAs should do everything for residents with
  AD.
• (D) Alzheimers disease is a normal part of
  aging.

48
Chapter Exam (contd.)

• 7. When a resident with AD is frightened, the NA
  should
• (A) Speak in a room where the television is on
• (B) Check her body language to make sure she is
  not tense or hurried
• (C) Use long sentences
• (D) Not tell the resident what she is going to do
  
• 8. When a resident with AD is perseverating, the
  NA should
• (A) Repeat herself using the same words
• (B) Tell the resident that she already answered
  that question
• (C) Not answer the question after the third time
  it is asked
• (D) Use a thesaurus to find new ways to say
  things

49
Chapter Exam (contd.)

• 9. When a resident with AD cannot understand
  basic instructions, it is a good idea to use
• (A) A notepad to write out instructions
• (B) Longer words to catch the residents interest
• (C) A very loud voice
• (D) Short words, pictures, and gestures
• 10. If a resident with AD has lost most of his
  verbal skills, the NA should
• (A) Assume the resident cannot understand what is
  being said
• (B) Use touch, smiles, and laughter
• (C) Ask the resident questions
• (D) Do not involve resident in activities

50
Chapter Exam (contd.)

• 11. How can a nursing assistant best work with
  the symptoms and behaviors he sees in residents
  with AD?
• (A) By assuming that all residents with AD are
  going through the same thing at the same time.
• (B) By telling the resident with AD he is
  offended if the resident forgets who he is.
• (C) By working with the behaviors he sees on any
  given day.
• (D) By using exactly the same approach with every
  resident in his care.

51
Chapter Exam (contd.)

• 12. Why is it important for a nursing assistant
  to take care of him- or herself while caring for
  a resident with AD?
• (A) It is not importantit is much more important
  to work hard to care for the residents.
• (B) Caring for someone with AD is a completely
  thankless job.
• (C) It will inspire residents with Alzheimers
  disease to improve.
• (D) The NA can give better care if he or she is
  rested and is eating well.

52
Chapter Exam (contd.)

• 13. If a resident with AD is incontinent, the
  nursing assistant should
• (A) Withhold fluids
• (B) Dim the bathroom lights
• (C) Mark the restroom with a sign or picture
• (D) Check resident every 3 hours to help
  determine a bathroom time
• 14. If a resident with AD has problems with
  bathing, the nursing assistant should
• (A) Schedule bathing when the resident is least
  agitated
• (B) Hurry the resident through the bath
• (C) Insist that the resident bathe even if she
  does not want to
• (D) Surprise the resident with the bath

53
Chapter Exam (contd.)

• 15. One way for a nursing assistant to help a
  resident with AD with eating is to
• (A) Put a few types of food on the plate at the
  same time
• (B) Use dishes without a pattern and a simple
  place setting
• (C) Withhold fluids
• (D) Serve steaming hot foods and drinks
• 16. If a resident with AD has problems with
  dressing, the nursing assistant should
• (A) Lay out clothes in the order they should be
  put on
• (B) Dress the resident in the hallway
• (C) Choose the residents clothing for the
  resident
• (D) Give the resident multiple steps to follow

54
Chapter Exam (contd.)

• 17. A good way for a nursing assistant to respond
  to hallucinations is to
• (A) Argue with the resident, telling her that
  what she thinks she sees isnt real
• (B) Tell the resident that she can see the
  hallucination, too
• (C) Reassure a resident who is upset and worried
• (D) Laugh at the resident
• 18. A nursing assistant can respond to sundowning
  by
• (A) Adding more caffeine to the residents diet
• (B) Setting a bedtime routine and keeping it
• (C) Restricting exercise during the day
• (D) Scheduling activities during this time

55
Chapter Exam (contd.)

• 19. Which of the following factors are most
  likely to affect how well a family deals with
  having a loved one suffering from AD?
• (A) Their emotional and financial resources
• (B) How much television the family watches
• (C) Whether the loved one is a man or a woman
• (D) What time of year it is when the person is
  diagnosed with AD
• 20. If a resident with AD shows violent behavior,
  the nursing assistant should
• (A) Hit back
• (B) Remove triggers
• (C) Leave the resident alone
• (D) Yell at the resident

56
Chapter Exam (contd.)

• 21. Which of the following is a good way for a
  nursing assistant to respond to inappropriate
  sexual behavior?
• (A) Let other residents know what is happening
• (B) Take the resident to a private area
• (C) Inform other nursing assistants that the
  resident has a dirty mind
• (D) Loudly reprimand the resident to shame him
  into stopping
• 22. When a resident with AD pillages and hoards,
  the nursing assistant should
• (A) Tell the family that the resident is stealing
  things
• (B) Lock the resident in his room
• (C) Warn the other residents that the resident
  with AD is a thief
• (D) Provide a rummage drawer

57
Chapter Exam (contd.)

• 23. When is using reality orientation a good idea
  for residents with AD?
• (A) Late stages of AD
• (B) Early stages of AD
• (C) When residents are totally disoriented
• (D) Never
• 24. Which of the following statements is true of
  using validation therapy?
• (A) An NA makes a point of reorienting the
  resident to actual circumstances.
• (B) An NA uses things like calendars and
  newspapers to orient the resident to reality.
• (C) An NA tries to make up stories that are even
  more outlandish than the residents.
• (D) An NA does not argue with the resident.