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 (cont’d.):
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 one’s voice low when communicating with someone who is confused or disoriented. Use the person’s 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
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

15. 3. Describe dementia and define related terms
Remember these 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.

16. Define the following term:
Alzheimer’s 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 Alzheimer’s
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.

18. 4. Describe Alzheimer’s disease and identify its stages
REMEMBER:
There are three stages of Alzheimer’s disease (outlined on pp of the textbook). Behaviors and ability for self-care will be very different at different stages of the disease.

19. 4. Describe Alzheimer’s 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 Alzheimer’s disease?

20. 4. Describe Alzheimer’s disease and identify its stages
Remember the following points:
Every person with Alzheimer’s 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 Alzheimer’s 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 Alzheimer’s disease
Remember the following communication tips when dealing with residents with Alzheimer’s disease:
Approach from the front.
Determine how close to stand.
Communicate in calm place.
Identify yourself and use the resident’s name.
Speak slowly in a lower voice than normal.

25. 6. List strategies for better communication with residents with Alzheimer’s 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 Alzheimer’s 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 Alzheimer’s 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 Alzheimer’s 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 “don’t.” Redirect activities instead.

29. 6. List strategies for better communication with residents with Alzheimer’s 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 Alzheimer’s 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 How might these caregiving tips apply to residents in different stages of Alzheimer’s 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 Alzheimer’s 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 Alzheimer’s 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 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 Alzheimer’s 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 Alzheimer’s 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 family’s 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 one’s personality change and health and abilities deteriorate.

42. 11. Discuss how Alzheimer’s disease may affect the family
Adjustments required of the family of a resident or client with AD (cont’d.):
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 Alzheimer’s disease and their families
The following resources are available for people with AD and their families:
Alzheimer’s Association helpline, or alz.org
National Institute on Aging’s Alzheimer’s Disease Education and Referral (ADEAR) Center,
Counseling, support groups, healthcare professionals

44. 12. Identify community resources available to people with Alzheimer’s 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 (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

47. 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.

48. 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

49. 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

50. Chapter Exam (cont’d.)
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 (cont’d.)
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 important—it 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 Alzheimer’s disease to improve.
(D) The NA can give better care if he or she is rested and is eating well.

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

54. Chapter Exam (cont’d.)
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 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
18. 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

55. Chapter Exam (cont’d.)
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 (cont’d.)
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 (cont’d.)
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 resident’s.
(D) An NA does not argue with the resident.