1. Define the following terms:
Confusion
the inability to think clearly.
Delirium
a state of severe confusion that occurs suddenly and is usually temporary.

2. 1. 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

3. 1. Discuss confusion and delirium
Causes of confusion may include the following:
Low blood sugar
Head trauma or injury
Dehydration
Nutritional problems
Fever
Sudden drop in body temperature
Lack of oxygen

4. 1. Discuss confusion and delirium
Remember these 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.

5. 1. Discuss confusion and delirium
REMEMBER:
Causes of delirium include infections, disease, fluid imbalance, poor nutrition, drugs, and alcohol.

6. 1. Discuss confusion and delirium
The following are 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

7. 1. Discuss confusion and delirium
Remember the following points when communicating with someone who is confused or disoriented:
Keep your voice low
Use the person’s name
Speak clearly in simple sentences
Reduce distractions as much as possible

8. 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.
Dementia
a general term that refers to a serious loss of mental abilities, such as thinking, remembering, reasoning, and communicating.
Alzheimer’s disease
a progressive, incurable disease that causes tangled nerve fibers and protein deposits to form in the brain, which eventually cause dementia.

9. 2. Describe dementia and discuss Alzheimer's disease
REMEMBER:
Dementia is NOT a normal part of aging.

10. 2. Describe dementia and discuss Alzheimer's disease
Common causes of dementia include the following:
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

11. 2. Describe dementia and discuss Alzheimer's disease
Note the following points about diagnosing dementia:
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 (EEG) may be performed
Diagnosis of dementia helps rule out other possible diseases with similar symptoms

12. Transparency 5-1: Facts About Alzheimer’s Disease
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 Alzheimer’s.
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.

13. 2. Describe dementia and discuss Alzheimer's disease
REMEMBER:
Every person with AD progresses differently, showing different symptoms at different times.
AD residents should be encouraged to do self-care and keep their minds and bodies active as long as possible.

14. Transparency 5-2: Helpful Attitudes for Residents with AD
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.

15. 3. List strategies for better communication with residents with Alzheimer’s disease
These communication tips are helpful with residents with AD:
Approach from the front.
Determine how close to stand.
Communicate in calm place.
Identify yourself and use the residentís name.
Speak slowly in a lower voice than normal.
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.

16. 3. List strategies for better communication with residents with Alzheimer's disease
Remember the following interventions for possible communication problems:
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.

17. 3. List strategies for better communication with residents with Alzheimer's disease
Interventions for possible communication problems (cont’d.):
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.
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.

18. 3. List strategies for better communication with residents with Alzheimer's disease
Interventions for possible communication problems (cont’d.):
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.

19. 3. List strategies for better communication with residents with Alzheimer's disease
Interventions for possible communication problems (cont’d.):
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 “don’t.” Redirect activities instead.

20. 3. List strategies for better communication with residents with Alzheimer's disease
Interventions for possible communication problems (cont’d.):
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.

21. 3. List strategies for better communication with residents with Alzheimer's disease
Interventions for possible communication problems (cont’d.):
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.

22. 4. List and describe interventions for problems with common activities of daily living (ADLs)
Remember these three general principles:
1. Develop a routine and stick to it.
2. Promote self-care.
3. Take good care of yourself, both mentally and physically.

23. Handout 5-1: Interventions for ADLs
Urinary Incontinence
Make sure resident is drinking enough fluids.
Note when resident is incontinent. Check him or her every 30 minutes.
Take resident to bathroom before “bathroom time.”
Take resident to bathroom before and after meals and before bed.
Make sure resident urinates before getting off toilet.
Mark restroom with sign or picture.
Be matter-of-fact when cleaning episodes of incontinence.
Observe toilet patterns for two to three nights if resident is incontinent during night.

24. Handout 5-1: Interventions for ADLs (cont’d.)
Incontinence (cont’d.)
Make sure there is enough light in the bathroom and on the way there.
Put lids on trash cans, waste baskets or other containers if resident urinates in them.
Dressing
Show resident what he or she is going to wear.
Avoid delays or interruptions.
Give privacy.
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.

25. Handout 5-1: Interventions for ADLs (cont’d.)
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.
Keep temperature comfortable.
Give privacy.
Be calm and quiet.
Keep process simple.

26. Handout 5-1: Interventions for ADLs (cont’d.)
Bathing (cont’d.)
Be sensitive when discussing bathing with resident.
Give resident washcloth to hold during 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.
Be encouraging. Offer praise and support.
Let the resident do as much as possible for him- or herself.
Check the skin for signs of irritation.

27. Handout 5-1: Interventions for ADLs (cont’d.)
Eating
Have meals at consistent times each day.
Food should look and smell good.
Make sure there is good lighting.
Keep noise and distractions low.
Remind the resident it is mealtime.
Keep the task of eating simple.
Finger foods are easier to eat.
Do not serve steaming or very hot foods or drinks.
Use dishes without a pattern. Use a simple place setting. Remove other items from the table.

28. Handout 5-1: Interventions for ADLs (cont’d.)
Eating (cont’d.)
Put only one item of food on plate at a time.
Give simple, clear instructions on how to eat or use utensils.
Place a spoon to the lips.
Ask resident to open his or her mouth.
Guide resident through 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.

29. Handout 5-1: Interventions for ADLs (cont’d.)
Additional tips
Help with grooming.
Prevent infections. Follow Standard Precautions.
Observe and report potential problems.
Maintain daily exercise routine.
Maintain self-esteem. Encourage independence.
Share in fun activities.
Reward positive and independent behavior with smiles, hugs, warm touches, and thank yous.

30. Define the following terms:
Sundowning
becoming restless and agitated in the late afternoon, evening, or night.
Catastrophic reaction
overreacting to something.
Pacing
walking back and forth in the same area.
Wandering
walking around aimlessly.

31. Define the following terms:
Elope
in medicine, when a person with Alzheimer’s disease wanders away from the protected area and does not return.
Hallucinations
illusions a person sees, hears, smells, tastes, or feels.
Delusions
persistent false beliefs.
Perseverating
the repetition of words, phrases, questions, or actions.

32. Define the following terms:
Pillaging
taking things that belong to someone else.
Hoarding
collecting and putting things away in a guarded manner.

33. Handout 5-2: Difficult Behaviors and Management
Agitation
Remove triggers, keep routine, focus on familiar activity, remain calm, and soothe.
Pacing and wandering
Causes: restlessness, hunger, disorientation, need for toileting, 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 pace in safe place, and suggest another activity.
Hallucinations or delusions
Ignore if harmless, reassure, do not argue, and be calm.

34. Handout 5-2: Difficult Behaviors and Management (cont’d.)
Sundowning
Remove triggers, avoid stress, play soft music, set bedtime routine, plan calming activity, remove caffeine, give back massage, distract, and daily exercise.
Catastrophic reactions
Avoid triggers such as fatigue, changes, overstimulation, difficult choices/tasks, pain, hunger, or need for toileting. Remove triggers and distract.
Depression
Causes: loss of independence, inability to cope, feelings of failure and fear, facing incurable illness, chemical imbalance
Report signs, encourage independence, talk about moods and feelings, and encourage social interaction.

35. Handout 5-2: Difficult Behaviors and Management (cont’d.)
Perseveration or repetitive phrasing
Respond with patience, do not stop behavior, and answer questions each time, using the same words.
Violent behavior
Block blows, never hit back, step out of reach, call for help, do not leave resident alone, remove triggers, and use calming techniques.
Disruptiveness
Gain resident’s attention, be calm, direct to a private area, ask about behavior, notice and praise improvements, tell resident about changes, encourage to join in activities, help find ways to cope, and focus on positive activities

36. Handout 5-2: Difficult Behaviors and Management (cont’d.)
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.
Inappropriate sexual behavior
Be matter-of-fact, be sensitive, distract, direct to private area, and consider other ways to provide physical stimulation.
Pillaging and hoarding
Label belongings, place a label or symbol on door, do not tell others that person is “stealing,” prepare the family, ask family to report strange items, and provide a rummage drawer.

37. 5. List and describe interventions for common difficult behaviors related to Alzheimer's disease
Look at the Residents’ Rights box on pages of your textbook and think about this question:
Can you understand why residents with Alzheimer’s disease are at a high risk for abuse and neglect?

38. 5. List and describe interventions for common difficult behaviors related to Alzheimer's disease
REMEMBER:
It is very important for you to prevent elder abuse and neglect. Be vigilant about observing for and reporting suspected abuse and neglect.

39. Define the following term:
Validating
giving value to or approving.

40. 6. Describe creative therapies for residents with Alzheimer's disease
Four creative therapies may be used for residents with AD:
Reality orientation
Validation therapy
Reminiscence therapy
Activity therapy

41. 6. Describe creative therapies for residents with Alzheimer's disease
Think about these questions:
When do you think these therapies would be useful?
What benefits can be gained from each of the creative therapies?

42. Chapter Exam Multiple Choice.
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 not discuss plans for the day because it adds to the resident’s confusion.
2. Confusion may be caused by
(A) Too much television viewing
(B) An unpleasant roommate
(C) Exercise
(D) Dehydration

43. Chapter Exam (cont’d.)
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

44. Chapter Exam (cont’d.)
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 Alzheimer’s 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) Alzheimer’s disease is a normal part of aging.

45. Chapter Exam (cont’d.)
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

46. Chapter Exam (cont’d.)
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 resident’s 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

47. Chapter Exam (cont’d.)
11. 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 three hours to help determine a “bathroom time”
12. 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

48. Chapter Exam (cont’d.)
13. 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
14. 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 resident’s clothing for the
resident
(D) Give the resident multiple steps to follow

49. Chapter Exam (cont’d.)
15. 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 isn’t 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
16. A nursing assistant can respond to sundowning by
(A) Adding more caffeine to the resident’s diet
(B) Setting a bedtime routine and keeping it
(C) Restricting exercise during the day
(D) Scheduling activities during this time

50. Chapter Exam (cont’d.)
17. 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
18. 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

51. Chapter Exam (cont’d.)
19. 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 if the NA does not have time to watch him
(C) Warn the other residents that the resident with AD is a thief
(D) Provide a rummage drawer