1. Define important words in this chapter airway the natural passageway for air to enter into the lungs. anxiety uneasiness or fear, often about a situation or condition. artificial airway any plastic, metal, or rubber device inserted into the respiratory tract for the purpose of maintaining an airway and facilitating ventilation. coma state of unconsciousness in which a person is unable to respond to any change in the environment, including pain.

1. Define important words in this chapter combative violent or hostile. confusion the inability to think clearly and logically. defense mechanisms unconscious behaviors used to release tension and/or help a person cope with stress. depression an illness that causes social withdrawal, lack of energy, and loss of interest in activities, as well as other symptoms.

1. Define important words in this chapter disorientation confusion about person, place, or time; may be permanent or temporary. impairment a partial or complete loss of function or ability. masturbation to touch or rub sexual organs in order to give oneself or another person sexual pleasure. tracheostomy a surgically-created opening through the neck into the trachea. ventilation in medicine, the exchange of air between the lungs and the environment.

2. Identify communication guidelines for visual impairment Define the following term: impairment a partial or complete loss of function or ability.

2. Identify communication guidelines for visual impairment Some residents you care for will be visually impaired. There are many causes for visual impairment, including diseases such as diabetes and glaucoma. A visual impairment is also something that can exist at birth. People of all ages can be visually impaired, and it can affect one or both eyes.

2. Identify communication guidelines for visual impairment Remember these guidelines for visual impairment: Announce yourself when entering the room. Look at the resident while speaking to him. Make sure there is proper lighting. Explain care you are going to provide. Talk to the resident while providing care. Do not shout.

2. Identify communication guidelines for visual impairment Guidelines for visual impairment (cont’d.): Use the face of an imaginary clock to explain the position of objects. Make sure the resident has his glasses on if he wears them. Do not move personal items or furniture without permission. Put things back where you found them. Read menus to the resident.

2. Identify communication guidelines for visual impairment Guidelines for visual impairment (cont’d.): Encourage resident to use other senses. Announce when you leave the area. Do not play with or distract guide dogs. Offer helpful items such as books on tape or large-print newspapers. Be empathetic.

3. Identify communication guidelines for hearing impairment Residents may have different kinds of hearing impairment. Having a partial hearing loss in one ear is one example. Being completely unable to hear at all is another example. Hearing may also be temporarily impaired due to the noise level in the room.

3. Identify communication guidelines for hearing impairment Symptoms of hearing loss to observe and report: Trouble hearing high-pitched noises Trouble hearing soft consonants, such as “s” and “t” Trouble hearing what is said in a setting that has background noise Not understanding the meaning of words

3. Identify communication guidelines for hearing impairment Symptoms of hearing loss (cont’d.): Being unable to hear people when they are not in the same room Favoring one ear over the other one Avoiding movies or special events due to not being able to understand the words spoken Ringing in the ears Resident complains of pain in one or both ears.

3. Identify communication guidelines for hearing impairment Remember these guidelines for hearing impairment: Get resident’s attention before speaking. Stand or sit so the resident can see your face. Look at the resident directly while speaking. Make sure hearing aids are turned on. Be familiar with any hand gestures residents use.

3. Identify communication guidelines for hearing impairment Guidelines for hearing impairment (cont’d.): Turn off TV or radio. Speak clearly in a low tone of voice. Do not chew gum or cover your mouth while speaking. Do not exaggerate pronunciation of words. Use simple words and short sentences. Use pen and paper or picture cards.

3. Identify communication guidelines for hearing impairment Think about these questions: How would it feel to not be able to hear? If you were in this position, what things could others do that you would appreciate?

4. Explain defense mechanisms as methods of coping with stress Define the following term: defense mechanisms unconscious behaviors used to release tension and/or help a person cope with stress.

4. Explain defense mechanisms as methods of coping with stress Defense mechanisms can prevent a person from dealing with his or her real feelings. Can you think of examples of each of the following defense mechanisms? Denial Displacement Projection Rationalization Repression Regression

4. Explain defense mechanisms as methods of coping with stress Think about this question: How can it be helpful for you as a nursing assistant to be aware of different defense mechanisms?

5. List communication guidelines for anxiety or fear Define the following term: anxiety uneasiness or fear, often about a situation or condition.

5. List communication guidelines for anxiety or fear REMEMBER: Feeling anxious is not the same as feeling afraid. Anxiety is a vague emotional state. The unpleasant feelings are coming from the anticipation of something bad that could happen or a future danger. The danger is not happening in the present time. With fear, one is dealing with the present. Fear is a reaction to an actual danger.

5. List communication guidelines for anxiety or fear Remember these guidelines for communicating with a resident who is anxious or fearful: Greet the resident when you enter the room. Do not touch the resident until you have identified yourself. Speak softly, slowly, and calmly. Reduce the noise level. Listen to the resident. Be empathetic, calm, and reassuring. Avoid demanding behavior. Reassure the resident that he is safe.

6. Discuss communication guidelines for depression Define the following term: depression an illness that causes social withdrawal, lack of energy, and loss of interest in activities, as well as other symptoms.

6. Discuss communication guidelines for depression Discussion: Many losses and changes occur in a person’s life when he or she has to move into a facility. Think about what this would feel like. What do you think would be the hardest loss or change to deal with if you had to move into a facility?

6. Discuss communication guidelines for depression Remember these guidelines for communicating with residents who are depressed: Be pleasant, respectful, and supportive. Use touch to help comfort the resident (with permission). Listen carefully to the resident. Think before you speak and be empathetic. Use a normal tone of voice. Talk about feelings if the resident wishes. Encourage social interaction.

6. Discuss communication guidelines for depression REMEMBER: Depression is an illness, just like any other illness. Depressed people cannot simply choose to be well.

6. Discuss communication guidelines for depression Think about this question: What can happen if a nursing assistant mistakenly thinks that residents who are depressed can simply choose to be well?

6. Discuss communication guidelines for depression REMEMBER: Your role is to be supportive and compassionate. Try to make each day as pleasant an experience as possible for a resident who is depressed.

7. Identify communication guidelines for anger Anger is a natural human emotion. You may see residents, their families and friends, and staff members express anger. Residents may feel angry due to illness, fear, pain, grief, loneliness, or a loss of independence. Even minor things, such as a change in the dinner menu, can trigger anger. Anger may also just be a part of someone’s personality.

7. Identify communication guidelines for anger Remember these guidelines for angry behavior: Be pleasant and supportive. Try to find out what caused the anger. Watch the resident’s body language. Think before you speak. Do not argue with the resident.

7. Identify communication guidelines for anger Guidelines for angry behavior (cont’d.): Stay calm. Treat the resident with dignity and respect. Answer call lights promptly. If the resident’s anger increases, get the nurse immediately. Try to involve the resident in activities.

8. Identify communication guidelines for combative behavior Define the following term: combative violent or hostile.

8. Identify communication guidelines for combative behavior When anger increases, a person may become combative. Combative means violent or hostile. Such behavior includes hitting, shoving, kicking, throwing things, and insulting others. Combative behavior may be due to a disease affecting the brain. It may be due to a worsening of anger or frustration. Medication or changes in health may cause a resident to become combative.

8. Identify communication guidelines for combative behavior REMEMBER: Combative behavior is generally not a reaction to you. Try not to take it personally.

8. Identify communication guidelines for combative behavior Remember these guidelines for combative behavior: Call for the nurse immediately. Keep yourself and others at a safe distance. Stay calm and do not appear threatening to the resident. Be reassuring. Try to find out what triggered the behavior. Do not respond to insults. Follow direction of the nurses. Report facts you know. When anger passes, comfort the resident.

8. Identify communication guidelines for combative behavior REMEMBER: When a resident becomes combative, your role as a nursing assistant is to keep everyone safe.

9. Identify communication guidelines for inappropriate sexual behavior Define the following term: masturbation to touch or rub sexual organs in order to give oneself or another person sexual pleasure.

9. Identify communication guidelines for inappropriate sexual behavior REMEMBER: Older adults, like all humans, are sexual beings. Residents have the right to choose how they express their sexuality.

9. Identify communication guidelines for inappropriate sexual behavior Sometimes residents will show inappropriate sexual behavior. This behavior does not seem normal or makes you or others uncomfortable. It includes sexual advances or comments. Inappropriate behavior also includes things like removing clothing in public places, such as the dining room or hallway.

9. Identify communication guidelines for inappropriate sexual behavior Remember these guidelines for inappropriate sexual behavior: Do not overreact. Try to distract the resident or move her to a private area. Listen to the resident and do not judge the behavior. Report inappropriate behavior to the nurse.

9. Identify communication guidelines for inappropriate sexual behavior Think about this question: What are some examples of inappropriate and appropriate sexual behavior?

9. Identify communication guidelines for inappropriate sexual behavior REMEMBER: If you encounter consenting adults engaged in sexual behavior, you must provide privacy and leave the area.

10. Identify communication guidelines for disorientation and confusion Define the following terms: disorientation confusion about person, place, or time; may be permanent or temporary. confusion the inability to think clearly and logically.

10. Identify communication guidelines for disorientation and confusion Think about these questions: What is the difference between disorientation and confusion? What are some possible causes of confusion?

10. Identify communication guidelines for disorientation and confusion Remember these guidelines for disorientation or confusion: Do not leave a confused resident alone. Stay calm and provide a quiet environment. Speak in a lower tone of voice. Introduce yourself each time you see the resident. Remind the resident of the location, his name, and the date. Repeat directions, if needed.

10. Identify communication guidelines for disorientation and confusion Guidelines for disorientation or confusion (cont’d.): Be patient with the resident. Listen to the resident closely. Tell the resident the plans for the day. Encourage the use of eyeglasses and hearing aids. Tell the resident when you are leaving the area. Report observations to the nurse.

11. Identify communication guidelines for the comatose resident Define the following term: coma state of unconsciousness in which a person is unable to respond to any change in the environment, including pain.

11. Identify communication guidelines for the comatose resident A person in a coma cannot respond to any change in the environment, including pain. A coma usually occurs due to an illness, such as meningitis, a condition, such as a drug overdose, or an injury, such as a motor vehicle accident.

11. Identify communication guidelines for the comatose resident REMEMBER: A comatose resident deserves your respect in the same way that an alert resident does.

11. Identify communication guidelines for the comatose resident Remember these guidelines for caring for a comatose resident: Introduce yourself when entering the resident’s room. Explain each step of each procedure you will be performing. Do not hold personal discussions while caring for the resident. Announce when you are going to leave the room.

11. Identify communication guidelines for the comatose resident A person in a coma can transition to a persistent vegetative state (PVS), which means the person may have some level of consciousness. He may open his eyes and have some facial movements, but these are mostly physical reactions and not a response to external stimuli. A minimally conscious state (MCS) is different than a coma or vegetative state. The person exhibits some cognitive behavior and shows sporadic signs of consciousness, such as crying or laughing appropriately.

12. Identify communication guidelines for functional barriers Define the following terms: airway the natural passageway for air to enter into the lungs. artificial airway any plastic, metal, or rubber device inserted into the respiratory tract for the purpose of maintaining an airway and facilitating ventilation. tracheostomy a surgically-created opening through the neck into the trachea. ventilation in medicine, the exchange of air between the lungs and the environment.

12. Identify communication guidelines for functional barriers Functional problems that may cause residents to have difficulty speaking: Lip, mouth, or tongue sores Dental problems of any kind Poorly-fitting dentures Birth defects, such as cleft palate Paralysis of one side of the mouth, due to stroke

12. Identify communication guidelines for functional barriers Remember these guidelines for functional barriers: Give resident plenty of time to speak. Ask the resident to write down anything you don’t understand. Do not tire the resident. Do not remove a resident’s oxygen for any reason. Report mouth sores, poorly-fitting dentures, or complaints of pain. Use other methods of communication such as writing notes, drawing pictures, and communication boards. Be reassuring, calm, and empathetic.

12. Identify communication guidelines for functional barriers REMEMBER: When a resident has trouble breathing, never push him or her to speak.

Exam Multiple Choice. Choose the correct answer. 1. One way for a nursing assistant to communicate effectively with a visually-impaired resident is to: (A) Wait until the resident speaks to her before identifying herself (B) Move the furniture in the resident’s room to make it easier for him to get around (C) Avoid talking to the resident during care (D) Use the face of an imaginary clock to explain the position of objects 2. If a resident is hearing impaired, a nursing assistant should: (A) Approach the resident from behind (B) Make sure the light is on the nursing assistant’s face (C) Raise the pitch of her voice (D) Chew gum while speaking to the resident

Exam (cont’d.) 3. While passing out meal trays, Brenda gives the wrong meal to a resident who has diabetes. She says that the resident distracted her by complaining about the food. Which defense mechanism is she using? (A) Denial (B) Projection (C) Repression (D) Rationalization 4. Laura’s supervisor reprimands her for being late to work. Later that day, Laura yells at a resident for being incontinent. Which defense mechanism is she using? (A) Displacement (B) Regression (C) Denial

Exam (cont’d.) 5. A good way to communicate with an anxious resident is to: (A) Gently ask the resident what is bothering him (B) Speak loudly and quickly (C) Touch the resident before speaking to him (D) Insist that the resident stop worrying 6. A good way to communicate with a resident who is depressed is to: (A) Use body language that shows empathy and interest (B) Avoid eye contact with the resident (C) Discourage other residents from talking to him (D) Avoid talking about feelings

Exam (cont’d.) 7. If a resident is angry, a nursing assistant should: (A) Ignore her (B) Try to find out what is causing her anger (C) Tell her to stop being childish (D) Restrain the resident if she becomes combative 8. Which of the following is an example of aggressive, rather than assertive, behavior? (A) A resident tells a nursing assistant that she needs help cutting her food. (B) A nursing assistant tells her supervisor that she does not have the training to complete an assigned task. (C) A resident tells a nursing assistant that she is clumsy and is moving too slowly. (D) A nursing assistant tells a resident that he has a stain on his shirt and helps him clean it.

Exam (cont’d.) 9. Which of the following is true of combative behavior? (A) It is usually a reaction to a specific person. (B) Combative behavior by a resident is not a threat to staff or other residents. (C) Combative behavior may be caused by disease or medication. (D) Insulting others is not considered combative behavior. 10. If a resident becomes combative, a nursing assistant should: (A) Try to find out what triggered the behavior (B) Leave the resident alone (C) Tell the resident that he will be in a lot of trouble if he doesn’t stop what he is doing (D) Argue with the resident to make him understand what is best

Exam (cont’d.) 11. When it is appropriate for a nursing assistant to hit a resident? (A) When a resident is uncooperative during care (B) When a resident threatens the nursing assistant or others (C) When a resident hits the nursing assistant first (D) Never 12. If a resident is demonstrating inappropriate sexual behavior, a nursing assistant should: (A) Distract the resident or direct her to a private area (B) Ignore the behavior (C) Tell the resident that everyone is very upset by this behavior (D) Tell the resident that she is going to tell other residents about the behavior if it continues

Exam (cont’d.) 13. When a resident is confused, a nursing assistant should: (A) Leave her alone (B) Provide a quiet environment (C) Avoid telling the resident about plans for the day since she won’t remember them (D) Speak loudly 14. A person in a coma may still be able to: (A) Hear (B) Speak (C) See (D) Walk

Exam (cont’d.) 15. When communicating with a resident who has a functional barrier, a nursing assistant should: (A) Give the resident time to speak (B) Remove oxygen before the resident speaks (C) Insert the tracheostomy tube before the resident speaks (D) Insist that the resident speak