CNA Care of Cognitively Impaired Residents 1

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A resident with Alzheimer’s disease tells the nurse aide that she smells smoke. The nurse aide should

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Often the first symptom of Alzheimer's disease is a loss of short-term memory. The client can still recall events and information about the past until the disease progresses to complete loss of brain function. Depending on the stage of Alzheimer's, a client could certainly detect the smell of a fire.

The primary reason for combative behavior in a resident is

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The most common cause for combative behavior in clients with dementia is confusion about their care. Because of memory loss, clients become confused when staff members try to help them. Clients may not recognize their caregivers, or may not want to do what the caregiver is telling them, such as getting up, eating, or taking a shower. The clients' automatic reaction will be to say "No" and push, hit, or kick. Always allow plenty of time when dealing with the clients. Speak softly and explain what is happening. Don't argue. Remain calm and be prepared to try again in a few minutes.

When getting dressed, a client always wants to wear her favorite outfit. What is a good solution?

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Getting dressed can be a source of confusion for a client with dementia. Simplify the process by limiting choices of clothing. If the client has a favorite outfit, try to get several identical sets. Clothing should be comfortable and easy to get on or off. Help the client by placing clothes in the order they are put on.

All of the following are clues to aggressive behavior EXCEPT

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Knowing the signs of aggressive behavior can help you prevent a situation from escalating. An aggressive episode can develop unexpectedly. If the client has a clenched jaw or fist, or suddenly begins to pace or rock, act quickly. Assess the situation to find a possible cause. Is the client in pain? Tired or hungry? Overstimulated? Confused? Use a calm manner to deal with the client. Eliminate distractions and try to focus on a new activity.

Reality orientation should include

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Reality orientation involves repeating information to help clients understand their surrounding. To keep a client oriented, their name is used frequently. Information such as date and time are reinforced with calendars and clocks.

A way to make sure a resident with dementia gets adequate nutrition is to

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Eating can become a challenge for a resident with dementia. Start by reducing distractions so that the resident can focus on the meal by making the dining area quiet and calm. Make it easy for the resident to eat by serving finger foods, using bowls instead of plates, and putting lids on cups. Small meals and snacks are appropriate for the limited attention span of these residents.

Communication with a resident who has late-stage dementia or Alzheimer's includes

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Residents with late-stage dementia or Alzheimer's lose their ability to communicate with speech. They are still able to understand some verbal communication, so talking to them in simple sentences is useful. They can also express themselves with facial expressions, emotions, and body language.

A resident who has not been discharged insists she is going home. What should the nurse aide do?

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It is beyond the scope of practice for a nurse aide to deal with some client situations, such as leaving against medical advice (AMA). Immediately inform the nurse or a supervisor. Stay with the client and reassure her that the nurse will help her. Try to redirect her focus or offer a new activity.

A resident has difficulty remembering what day it is and where they are. How can you best help the resident?

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Memory prompts are ways to help clients stay oriented to place and time. A calendar and a clock in each client's room are useful. Bulletin boards and public areas can be decorated for seasons and holidays. Repeat information at regular intervals to reinforce where the client is and what is happening.

What is an important way to help the resident feel comfortable in a long-term facility?

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During any change or transition, it is important to have familiar objects nearby. Special possessions, such as small pieces of furniture, blankets, photos, or mementos are important. Even personal items like soaps and shampoo can make a new environment more comfortable. If the resident has family, encourage them to visit so that the resident does not feel abandoned.

When caring for a confused resident what should a nursing assistant do?

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When speaking to a client who is confused or agitated, use a calm voice. Talk directly to the client, saying their name. Use short sentences and allow time for the client to respond. Be respectful and always treat the client like an adult.

As dementia progresses, incontinence can become an issue. How can the nurse aide assist?

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As dementia progresses, the resident may have episodes of incontinence. Do not immediately begin the use of adult diapers. Establish a toileting schedule and take the resident to the bathroom at regular times. Do not wait for them to let you know. Begin to watch for signs of need to go to the bathroom. Is the resident restless? Crossing legs? Pulling at clothing? Don't wait for the next scheduled time, and take them immediately. When going out, prepare by bringing a change of clothing and watching for restrooms. If an accident happens, stay positive to reduce the resident's embarrassment.

Residents with cognitive impairments often have difficulty sleeping. What can be helpful?

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Confusion and other symptoms can become exaggerated with fatigue. Causes of sleep problems for all residents can include the natural aging process, medication side effects, pain, and nightly urination. For residents with dementia, there is also a disrupted circadian rhythm, as well as fewer deep sleep cycles. Establishing a bedtime routine can reset the internal clock and make it easier for residents to fall asleep. Increasing physical activity during the day can improve the quality of sleep.

A confused resident tells you there is a monster in the closet. The nurse aide should

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If a client is confused, do not play along. This only adds to the client's fear if you support the confusion or hallucination. Sensible explanations will not be helpful, because the client absolutely believes the fantasy. The best approach is to calmly address the situation directly. Accompany the client to the closet, reinforcing reality. Remain with the client, reminding them of their surroundings.

While the nurse aide is giving care to Mr. T., he calls the nurse aide by the name of his son who died several years ago. The nurse aide’s BEST response is to

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Because of their memory loss, it is common for clients with dementia to mix up names of others. They may even be aware that they are confused, but can't figure out why. When they refer to someone who is no longer living, they may have been thinking about the person. Help them remember by asking about the person. If there is a photo or memento of the person, show it to them and help them reminisce about happy memories.

If a resident displays paranoid behavior, what is important for the nurse aide to know?

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Delusions happen when residents interpret a situation with a false understanding. For example, a resident may hear others talking in the dining room and decide there is a plot to poison his food. When dealing with delusions, remember the Three R's: reassure, respond, and refocus. Do not try to explain why the resident is wrong. Acknowledge the fear, and address it from your perspective. "I don't know how anyone could poison your meals, but you seem upset." Offer a solution, such as "I can get your tray directly from the kitchen." Remember that the resident will have a difficult time telling the difference between reality and fantasy, so your reassurance will have a calming effect.

A resident is standing in the hallway holding a bag, and asks the nurse aide when the train is due. The aide should tell her

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If a client is confused, do not play along. This only adds to the client's confusion and frustration. Gently tell the client where she is and guide her back to her room. Use her name, remind her of her surroundings, and stay with her until she feels calm and reassured.

Which of the following is NOT true of dementia?

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As dementia progresses, a client can exhibit any of the "Four A's" of agitation, anxiety, anger, or aggression. These behaviors are not intentional, but signs of the disease. Remain calm and reassuring during these episodes. Redirecting the client is often a good way to end the behavior.

A client with dementia has developed a fear of taking a shower. What can a nurse aide do?

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A shower or bath can become a frightening experience for a client with dementia. Be patient and plan ahead. Gather everything needed and make sure the room is warm. In a gentle voice, tell the client what is going to happen throughout the process. Encourage the client to do as much as possible. Don't rush and never leave the client alone. If the client refuses to shower, give a bed bath and try a shower another day.

The end of the day can bring a common behavior for residents with dementia, called

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Caregivers can notice a big change in late afternoon or evening with clients who have dementia. Fading daylight seems to trigger confusion and agitation. It is also connected to hunger, poor vision, and less natural light. Take time to recognize the response of each resident who displays different behaviors. Does the twilight seem to cause confusion? Are lamps or other lights on? Could the residents be hungry? Does poor vision make it difficult to see?

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