CNA Care of Cognitively Impaired Residents 2
A good way to reduce confusion or agitation for residents with dementia is
Residents with dementia can have fearful thoughts, such as if anyone is going to help them or if they are going to starve. With a regular schedule, they know what is going to happen next: I wake up, I go to the toilet, I get dressed, I have breakfast, etc. Routines are predictable and reassuring, even if they are boring for the staff.
A nurse aide finds a resident looking in the refrigerator at the nurses’ station at 5 a.m. The resident, who is confused, explains that he needs breakfast before he leaves for work. The best response by the nurse aide is to __________.
When residents who are confused think they still have a job, or are excited about a new job, do not contradict them or try to convince them they have no such thing. Do not play along with their misunderstanding. Simply ask them about the job and redirect them. You can say, "That sounds important. Let's have breakfast first, okay?" Give them a task, take a walk, or take them to another activity.
When you approach a resident with dementia, how should you behave?
Patients with dementia can detect moods and attitudes, and act in a similar manner. If you are not involved, distant, or busy, the resident can detect this and react in a fearful way. If you are meek, they may try to take advantage of you. With a positive attitude, they can sense your nonjudgmental and relaxed demeanor and will respond accordingly.
When preparing to give peri-care to an incontinent female resident with dementia, the CNA knows
Even under the best situations, giving peri-care can be awkward or embarrassing for a resident. For a resident with dementia, cleaning the genital area can cause various reactions. If the resident feels threatened or fearful, they may strike back. If they have a history of unwanted sexual actions, they may cry or complain of being assaulted. Always tell the resident what you are going to do and why. Describe each step before you do it. Speak in a calm manner.
If a resident's behavior becomes combative, the nurse aide should
If you are hit by a resident while giving care, notify the nurse. You may be asked to complete an Incident Report. If you are injured, get treatment. Always remove yourself from harm by stepping out of the way of the resident's reach. Remain calm and explain that hitting is not acceptable.
A 90 year-old resident tells you that his mother is coming to visit on Sunday. What is your most appropriate response?
When residents who are confused about the past, do not contradict them or try to convince them they have no such thing. Do not play along with their misunderstanding. Look for the meaning behind their words and behavior. You can say, "Tell me what your mother was like. What are your best memories?"
Which of the following can be a cause of intellectual disability?
Intellectual disability (ID) is a below-normal intelligence and ability to perform basic tasks. ID can be caused by something that happens before birth, such as exposure to alcohol or drugs, or an infection. An example of a chromosomal disorder is Down syndrome. ID can be caused by an inherited condition such as Tay-Sachs disease or PKU. Problems with the birth, such as oxygen deprivation or premature delivery are two more reasons. Even infections such as meningitis or Whooping cough can result in ID.
If a resident becomes confused, you should
When a resident seems confused, start by offering basic information. "Hello, Mr. Roberts. I'm Sally, your nurse aide. Do you remember me?" From there, offer other ways to help him regain his sense of time and place. "It's Tuesday, August 26. You had chicken for lunch and watched the movie." Returning the resident to his room to look at familiar objects and photos can also be helpful. Always remain calm and friendly.
Reality orientation therapy should include
Reality orientation involves repeating information to help clients understand their surroundings. To keep a client oriented, their name is used frequently. Information such as date and time are reinforced with calendars and clocks.
Which one of these behaviors is NOT a signal of possible combativeness?
Non-verbal signs can tell you more about a person's mood than their words. Non-verbal cues oten come from instinct. Observe the signals that tell you a person is angry and ready to strike. If words and behavior do not match, always believe the behaviors or actions.
In a reality orientation program you would do all of the following EXCEPT
Reality orientation is a formal program that involves repeating information to help residents understand their surrounding. To keep a residents oriented, their name is used frequently. Information such as date and time are reinforced with calendars and clocks. Show residents the weather, and ask them to identify smells and tastes.
A resident with dementia has wandered to another unit. What should the nurse aide say after finding the resident?
6 out of 10 patients with dementia will wander. Even in the early stages, a resident can become confused for a short time. They may be restless or trying to do former activities, such as going to work or "go home."
Mrs. Johnson, a resident with dementia, loves to wear her favorite blue plaid shirt with her favorite green striped pants. What should you do?
Respecting each resident includes allowing them to make as many choices as possible. There is no harm in mis-matching clothing. There is probably a reason that Mrs. Johnson likes these clothes and feels good in them. Ask her to tell you, if she can. Allow her to select her outfits as often as possible.
Some patients may exhibit some "false beliefs" not supported by facts or reality. This is known as
Delusions are false beliefs that involve a misinterpretation of experiences. A person may believe that they are being followed, tricked, or spied on. They may also be convinced that songs or books contain special information meant for them. Attempts to show the person that their belief is wrong or irrational are not accepted by the person.
Mr. Russell keeps getting up from his wheelchair. Instead of using a restraint, you should ask him if _________.
It is never appropriate to use a restraint for punishment or staff convenience. Also, never threaten a resident with restraints. Restraints can only be applied with a doctor's order for specific reasons. Try to find out what the resident needs. Often they require toileting, are thirsty or hungry, or have a reason they want to get up.
The Global Deterioration Scale (GDS) helps caregivers understand how people decline when they have dementia. Of the seven stages, which stage has no sign of dementia?
CNAs who work in a facility with residents who have dementia or Alzheimer's disease will became familiar with the GDS. Stages 1-3 are pre-dementia, with none for few signs of decline. Stage 4 has signs of inability to concentrate, finishing tasks, and social withdrawal. Stage 5 includes some assistance with ADL and inability to recall current information, such as date or where they are. Stage 6 requires extensive help with ADL, incontinence, and inability to recognize family members. Stage 7 requires complete care, as well as inability to speak or walk.
When caring for a confused resident what should a nursing assistant do?
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.
While the nurse aide tries to dress a resident who is confused, the resident keeps trying to grab a hairbrush. The nurse aide should _______.
Offering a resident something to hold while performing a task can make the resident feel secure and allow the nurse aide to proceed more easily. For example, let them hold a washcloth during a bed bath. If they have a favorite small object, that can also be a good source of comfort.
A resident with Alzheimer's disease has a baby doll that she carries with her and cares for. When she misplaces the doll, she begins to cry. What should the nurse aide do?
Dolls therapy can be useful for people with Alzheimer's disease. Studies show that dolls can calm and soothe residents, as well as decrease wandering. A doll can also improve speech and communication. Because the doll is "real" to the resident, the loss is treated accordingly. After a short time, a new doll can be introduced to the resident. It is important to note that males can enjoy dolls, too.
A person with dementia is being admitted to your facility. Which statement is correct?
People who have dementia or Alzheimer's disease have a different process for their transition into a long-term care facility. The process is fast, with much of it done before the person arrives. To help them adjust, the family does not stay, but leaves so the staff can begin to help the person meet others with similar conditions and learn their new routine. Sometimes the family does not return until the staff feels the person is ready for a short visit.
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