Abnormal or normal?
Is this normal or abnormal: Forgetting people's names once in a while
What is Normal
At least 25% of people over the age of 75 have some form of dementia
What is true.
Dementia is not a specific disease but describes a group of symptoms affecting thinking and social abilities
Dementia caused by Alzheimer's Disease is GRADUAL or SUDDEN?
What is gradual.
The first sign is often a decline in short term memory
Name one possible strategies for caring for patients with dementia
-Address the patient directly & keep it simple
-Gain the person's attention
-Maintain eye contact
-Speak clearly and at a natural rate of speed
-Reorient the patient with every interaction
-Support and reassure the patient that you are there to keep them safe and take care of them
-Use simple, direct wording
-Rephrase rather than repeat
-Reduce background noise
-Present ideas and directions one at a time
-Offer easy choices- Use yes or no
-Encourage family to bring in pictures from home to help reorient the patient
Definition: "A change in baseline cognition that cannot be better explained by a pre-existing or evolving neurocognitive disorder. The disturbance develops over a short period of time, is often acute, usually hours to days, and tends to fluctuate during the course of the day.
What is delirium
Is this normal or abnormal: Forgetting how to do something you've done many times before.
What is Abnormal
Dementia is a normal part of aging.
What is false. Dementia is NOT a normal part of aging.
Definition: Progressive, degenerative brain dysfunction describing a group of symptoms affecting thinking and social abilities. If severe enough, can interfere with daily functioning.
What is dementia
Various items including crossword puzzles, word search puzzles, glasses, hearing amplifiers, cards, coloring books, crayons are found _____
What is the delirium bin/box.
Name three possible symptoms of delirium
Symptoms include: agitation, anxiety, illusions, hallucinations, hyperactivity, disorientation, disordered speech, defective perception.
Is this normal or abnormal? Asking the same questions repeatedly.
The most common causes of dementia are Alzheimer's Disease and Multiple Strokes.
What is true
These are examples of______ for dementia: Age, family history, genetic factors, sedentary lifestyle, head trauma, vascular disease....
What are risk factors for dementia
You are the sitter for a patient who was verbally aggressive with staff yesterday and was trying to get out of bed repeatedly. Patient has history of dementia, is here with COPD exacerbation, and normally lives at home with a caregiver and his wife. What are 3 actions you can take to keep yourself and the patient safe?
1. Provide reorientation with each interaction
2. Green blanket and Green Safety Stop Sign
3. Call Code Grey for additional security support
4. Non-slip socks on the patient
5. Least restrictive restraints- lap belt, mittens, restraints
6. Maintain a calm, predictable environment
7. Addressing any underlying problems: pain, fatigue, full bladder, SOB, position change
8. Consider a trip outside for fresh air and sunshine once patient is following commands and redirectable.
9. Encourage repetitive hand activities like folding towels or shuffling cards.
10. Ensuring that there is a clock in the room and that the care board is updated.
Name two strategies to assist someone with hygiene (toileting, bathing, toothbrushing) who has dementia and is currently delirious.
-To avoid falls, never leave the person unattended in the shower or bath
-Focus the person's attention by giving short and simple instructions
-Do not wake up a patient in the middle of the night for routine hygiene measures (unless warranted)
-Establish routines that are consistent with the person's pre-delirium activities
-Consistency is important so encourage that the same caregiver assists with the patient
Is this normal or abnormal: taking a moment to pause to think before saying a sentence.
What is normal
It is a normal part of aging for patients over the age of 75 to exhibit signs of sundowning behavioral problems including restlessness, agitation, irritability, or confusion common later in the day that can last into the night.
What is false- this is not a normal part of aging
This is called sundowning- try to limit caffeine intake after 12pm, encourage mobility during the day, dark environment at night.
Alzheimer's disease, vascular dementia, mixed dementia, Parkinson's, Pick's disease, Lewy body dementia, Huntington's disease are examples of different types of ____
What is dementia. These are all irreversible.
There are many types of dementia- dementia is caused by damage to brain cells, depends on the different brain regions. There are also reversible causes to dementia caused by metabolic/endocrine disorders (however more rare).
Name two potential complications of dementia
1. Falls- due to disorientation, poor judgment, weakness, and poor balance
2. Urinary tract infections- incontinence, poor hygiene, and reduced PO intake
3. Aspiration PNA- due to difficulty swallowing
4. Pressure ulcers- reduced mobility, poor nutrition and hydration, weight loss
5. Depression- stress and life changes
Name two potential causes of delirium
-Drugs (side effects, withdrawal), dehydration, deprivation (sleep)
-Eyes and ears (missing glasses or hearing aids, sensory deprivation)
-Low O2 sat (COPD, PE, CHF, MI, ARDS)
-Infection (UTI, PNA, sepsis)
-Retention/Restriction (urine retention, constipation, restraints)
-Injury/ictal: over or under treatment of pain, stress, possible stroke or seizure
-Unfamiliar environment: noise, room changes, foley, IV, roommate
-Metabolic/malnutrition: low blood sugar, electrolyte imbalance
Is this normal or abnormal: Having trouble handling money or making change.
What is abnormal
It is important that you employ these strategies with dementia patients: speak in front of the person as if he or she were not there, use "baby talk", attempt to argue or reason with the person, scold the person for bad behavior, and give multi-step instructions.
What is false.
Those are strategies to AVOID when communicating with someone with dementia
Memory loss, difficulty communicating, difficulty with complex tasks, difficulty with planning/organizing, difficulty with coordination and motor functions, problems with disorientation (getting lost), personality changes, inability to reason, inappropriate behavior, paranoia, agitation, hallucinations
What are the three subtypes of delirium?
What is hyperactive delirium, mixed motor type, and hypoactive delirium.
Hyperactive delirium: predominately restless and agitated, restlessness, wandering
Mixed motor type: evidence of both subtypes in the previous 24 hours
Hypoactive: predominately drowsy and inactive (commonly mistaken for depression or dementia), decreased activity, decreased action speed, decreased speed of speech, reduced awareness of surroundings, listlessness, withdrawal
Name three non-pharmacologic interventions that you can take to help care for a delirious patient
-Assistive devices: glasses (available in delirium bins on the floors) and hearing aid
-Mobility aids (walkers, cane, etc)
-Call light always within reach
-Address patient in their preferred language
-Keep room bright in the daytime and dark and quiet at night
-Keep TV volume low, use care channel
-Offer toileting, eating, and repositioning at set intervals
-Encouraging family to visit
-Play music or video that they enjoy
-Consolidate care at night