Chapter 5: Confusion, Dementia & Alzheimers Disease

Confusion: The inability to think clearly Delirium: A state of severe confusion that occurs suddenly & is usually temporary

Important Points About Confusion:

Interferes with ability to make decisions Personality may change Anger, Depression & Irritability are other signs Can be temporary or permanent
Causes of Confusion:

Low blood sugar level Head trauma or injury Dehydration & nutritional problems Fever or sudden drop in body temperature Lack of oxygen

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 the resident Remind resident of location, Name and date Explain what you are going to do using simple instructions. Do no rush the resident Talk about the plans for the day. Encourage the use of glasses and hearing aids. Promote self-care & independence. Report observations to the Nurse.

Remember these Facts about Delirium:

Delirium is usually caused by illness or imbalance. Causes Infections Disease Fluid imbalance Poor nutrition Drugs and alcohol

Symptoms: Agitation, Irritability and Anger Depression Disorientation and Trouble Focusing Problems with speech Changes in Sensation and Perception Changes in Consciousness Decrease in short-term Memory

Important Points About Delirium:

communicating with someone who is confused or disoriented

Remember the following points when

Keep your voice low and calm Use the persons name Speak clearly in simple sentences Reduce distractions as much as possible

Cognition:
The ability to think logically and quickly

Cognitive Impairment:
Loss of ability to think logically; concentration & memory are affected

Dementia:
A general term that refers to a serious loss of mental abilities, such as thinking, remembering, reasoning & communicating

Alzheimers Disease:
A progressive, incurable disease that causes tangled nerve bers & protein deposits to form in the brain, which eventually causes dementia.

Remember these Facts about Delirium:

Remember that Dementia is NOT a normal part of aging Causes Alzheimers Disease Multi-infarct or vascular dementia Lewy Body disease Parkinsons disease Huntingtons disease

Note the following points about diagnosing dementia:

physical & neurological exam Blood and Imaging tests like CT or MRI scans may be ordered Tests to trace brain activity may be performed Diagnosis of dementia helps rule out other possible diseases with similar symptoms

Involves getting a Pts Medical History & having a

Remember these facts about Alzheimers Disease:

dementia Cause is currently unknown & diagnosis is difcult Length of time from onset to death can range anywhere from 3 to 20 years Each person will show different signs at different times Skills a person used over a lifetime are usually kept longer

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 AD Women are more likely than men to have AD Risk increases with age, but is not a normal part of aging AD is progressive, degenerative, and irreversible Tangled nerve bers & protein deposits in brain causes

Remember these Facts about Alzheimers:

Every person with AD progresses differently, showing

different symptoms at different times. AD residents should be encouraged to do self-care & keep their minds and bodies active as long as possible

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

These communication tips are helpful with residents with Alzheimers Disease:

needed Using signs, pictures, gestures or written words to help communicate Break complex tasks into smaller, simpler ones

Approach from the front Determine how close to stand Communicate in a calm place Identify yourself & use the residents name Speak slowly in a lower voice than normal Repeat yourself, using the same words & phrases, as often as

If residents are frightened or Anxious:

background noise and distraction Describe what your going to do Use simple word and short sentences Check your body language

Keep him calm Speak in a low, calm voice. Use a room with little

If residents shows memory loss: does not understand a word, use a different one Encourage resident to make a list to remember Keep message simple, Break complex task into smaller ones If residents has trouble nding words or names: correct a resident who uses an incorrect word

Repeat yourself using the same words, If a resident

Suggest a word that sounds correct. Try not to

If residents seems not to understand basic instructions or questions:

Ask resident to repeat your words Use short words & sentences, Allow time to answer Use the communication method that are effective Watch for nonverbal cues. Observe body language Use signs, pictures or written words
If residents 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 residents does not remember how to perform basic tasks:

Break each activity into simple steps

If residents insist in doing something the is unsafe or not allowed: instead

Limit the time you say don't

Redirect activities

If residents Hallucinates or is paranoid or accusing: Do not take it personally Try to redirect behavior or ignore it If residents 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.

If residents is abusive or uses bad language:

Remember it is the dementia speaking & not the person Try to ignore the language. Redirect attention.
If residents has lost most verbal skills: Use non-verbal skills, such as touch, smiles, & laughter Use signd, labels, and gestures Assume people can understand more than they can express

Describe interventions for common problems with ADLs: Urinary Incontinence: Make sure resident is drinking enough uids Note when resident is incontinent, check him or her every 30 minutes Take resident to bathroom before & after meals and before bed Make sure resident urinates before getting off toilet Mark restroom with sigh or picture Be matter-of-fact when cleaning episodes of incontinence. Observe toilet patterns for 2-3 nights if resident is incontinent during night.

Dressing: Show resident what he or she is going to wear Avoid delays or interruptions Give privacy Encourage resident to pick up clothes to wear. Lay out clothes in order to be put on Break tasks down into simple steps. Do not rush the resident Use a friendly, calm voice when speaking Praise & encourage

Bathing:

Schedule bathing when resident is least agitated Give resident supplies before bathing to serve as visual aid. Take walk with resident down the hall & stop at tub or shower room Make sure bathroom is well-lit Keep temperature comfortable Give privacy Be calm and quiet Keep process simple Be sensitive when discussing bathing with resident Give resident washcloth to hold during bath Ensure safety by using nonslip mats, tub seats & hand holds Be encouraging, Offer praise and support Let the resident do as much as possible for him/herself Check skin for signs of irritation

Eating: Have meals at consistent times each day Food should look and smell good Make sure there id good lighting Keep noise and distractions low Remind the residents 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 Give simple, clear instructions on how to eat or use utensils Place spoon on the lips, ask resident to open mouth Guide resident through meal with simple instructions Offer uids to avoid dehydration Use adaptive equipment as needed. Seat residents with others to encourage socializing Observe for eating and swallowing problems Observe and report changes or problems

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, & thank yous

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 Elope: In medicine, when a person with Alzheimers disease wanders away from the protected area & 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 Pillaging: Taking things that belong to someone else Hoarding: Collecting and putting things away in a guarded manner

calm, and soothe

Agitation: Remove the triggers, keep routine, focus on familiar activity, remain Pacing and Wandering: Causes: Restlessness, hunger, disorientation, need for toileting,

constipation, pain, forgetting how or where to sit, need for exercise Remove causes, give snacks, encourage exercise, maintain toileting schedule, let pace in safe place, and suggest another activity

Hallucinations and Delusions: Ignore if harmless, reassure, do not argue, and be calm

Perseveration: questions each time, using the same words Violent Behavior: leave resident alone, remove triggers, and use calming techniques Disruptiveness: about behavior, notice and praise improvements, tell resident about changes, encourage to join in activities, help nd ways to cope, and focus on positive activities

Respond with patience, do not stop behavior, and answer

Block blows, never hit back, step out of reach, call for help, do not

Gain residents attention, be calm, direct to a private area, ask

Inappropriate social behavior: direct to private area, respond positively to appropriate behavior Inappropriate Sexual behavior:

Do not take it personally, stay calm, reassure, nd out cause,

Be mater-of-fact, be sensitive, distract, direct to private area

Pillaging and Hoarding: others that person is stealing, prepare the family, ask family to report strange items, and provide a rummage drawer.

Label belongings, place a label or symbol on door, do not tell

Sundowning: Remove triggers, avoid stress, play soft music, set bedtime routine, plan calming activity, remove caffeine, give back rubs, distract, & daily exercise Catastrophic reactions: tasks, pain, hunger, and distract. Depression: and fear, facing incurable illness, chemical imbalance Report signs, encourage independence, talk about moods & feelings, and encourage social interaction.

Avoiding triggers such as fatigue, changes, overstimulation, difcult

Causes: loss o independence, inability to cope, feeling of failure

Validating: Giving value to or approving Four creative therapies may be used for residents with AD:

Reality orientation Validation therapy Reminiscence therapy Activity therapy