this is actually Chapter five we're on number two talking about Alzheimer's disease the risk that they had got cut off there for a second um here's my book described dimension discuss Alzheimer's as a person ages some of the ability to think logically may be lost the ability is called cognition you see how my book is read there you need to underline and circle that also the inability to think clearly it's called cognitive impairment sometimes the elderly residents forget memories they forget recent events they forget stuff doesn't matter what what's going on with them we're still going to take care of them we're gonna do what we can and this is some what we do is a nurse's system so cognitive impairment they will have slower reaction time they have trouble finding or using the right words they sleep less they are impaired one example of that is dimension and there's some several different types of dementia one is Alzheimer's multi-infarct or vascular dementia Lewy body dementia Parkinson's disease Huntington's disease all of those are types of dementia which is a general term that refers to a serious loss of mobility such as thinking remembering reason and communicating as it advances these losses make it hard for them to perform their daily activities are living such as eating bathing dressing and toileting they're the ones who doesn't remember what a toothbrush is maybe they want to write with the toothbrush maybe they're the ones and I always make this is not funny but this is something to watch for they forget what the microwave really is and they want to dry the dome in the microwave you know or something like that so you have to watch behind those a lot of times they don't sleep well either so you have to watch them during the night also Alzheimer's disease is the most common cause of dementia in the elderly the Alzheimer's Association estimates that is it means 5.2 million Americans are living with Alzheimer's one in eight are older Americans well one in eight older Americans have Alzheimer's and women are more likely to have it than me in which I don't like Alzheimer's disease is some a weird disease and the high it grows and they can't diagnose it until you have an autopsy but what it does is cause it's tangled nerve fibers in the brain to grow and depends on where it starts growing is where it starts affecting so these people may remember their name and but they can't remember how to as I said use a toothbrush some folks like this lady in the picture on a picture take your five two maybe she remembers to play in the piano but she has no idea what her name she don't know her daughter's name but the one thing she remembers is that piano or all those different kind of things sometimes it comes and goes there remember one day they'll forget the next um hopefully they it's a terrible thing to watch your feelings get hurt when people you love don't remember you but um it really depends on where that starts in the brain as to what is going to be affected and then different people going to be different at different times well sometimes skills that a person had um that they've used all their life maybe they'll keep that up even down to that instrument that piano she's playing it is important for NIH to encourage independence regardless of the science a person is showing with their ADL's or with their ad with their Alzheimer's um we're gonna help them as much as we can but we're gonna still allow them to do as much as they can we're coming behind them make sure they're straighten up making sure they're doing but I actually let them do because if they don't use it they're losing I'll say that a thousand times but that is the truth having residents to do as much possible for themselves may even help slow the disease they believe if you get them thinking if you get them moving it can help slow Alzheimer's these attitudes can help you do not take things personally being pathetic work with the symptoms sometimes they see and hear things and you can't get over there but you say okay if you think it's 1965 they're hallucinating or they're just imagining they're they just know it's 1965 you say that's fine let's go take a man let's go okay fine you still gotta eat breakfast though we you know aren't you hungry you know make sure to still try to take care of them even though they may be stuck wherever they're in I'll be aware of difficulties associated with it sometimes it is very taxing because you're gonna follow them around to make sure they're not doing anything that they don't really mean to do list strategies for better communication with residents with aiding communication when the resident may be helped if if you do this if you always approach from the front and that's everybody don't startle them that continues to be everybody even your 8880 patients which is Alzheimer's disease communication in a calm area with the calm background always identify yourself and use their name so maybe they can remember what their name is speak slowly using a lower tone of voice repeat yourself over and over if you have to until they get it sometimes they still won't maybe you can use gestures pictures that page 84 is a wonderful picture to use bricks complex tasks into smaller ones make make complex tasks easy by giving them one step at a time you'll have a question that says something about multiple steps at a time that is not the answer you want one step at a time if the residents praying or anxious try to keep the resident calm speak slowly in a calm voice try to see in here what they're thinking they're they're scared of something they're anxious is something and tried to understand and then go from there and maybe you can help calm them down make sure you check their body language you know sometimes they want to fight or head so um stay out of reach if the resident forgets our shows memory loss you can repeat yourself over and over sometimes they don't understand what one word means just use another word you know you do you want to take a mountain do you want to lay down do you want to rest all of those mean the same things but maybe one of them would jog their memory - what it means sometimes they are preservation all preservation is is the patient going over and over seeing the same thing over and over and you want to answer that question the same answer each time sometimes you can distract them to do something else if it's harming or detrimental to them or it's upsetting them you definitely want to try to redirect them into something else and I find food redirects in my life I mean if anything give them some popcorn if they can eat popcorn and you have to ask that question to and distract them brick complex tasks down into one step at a time if the resident has trouble finding words suggest a word you know like I do it here in class you know I lose a word just just give me his word or suggestion and that's the same thing except they do it a lot more often and they'll come out with it if they seem not to understand basic instructions again repeat yourself repeat what you're saying so they can try to understand know the communication methods that are effective maybe they're good at pointing at the card sheet where they can't do anything else maybe they can't gesture it out or maybe they can't tell you but they can point at the card watch for nonverbal cues like the ability to talk declines sometimes you just have to observe their body language when they can't talk any longer you signs pitches and gestures or written words again that picture card is a wonderful thing and how to communicate if they don't understand basic communication skills if a resident wants to say something but cannot ask them to point it out gesture it maybe they just literally physically can but if they can get it out and you know it you tried your best to figure out what your patient wants if the resident does not remember how to perform basic tasks again what have we been saying break each into simple 1 steps such as let's go for a while stand up put on your sweater first the right arm if you can don't hold up a sweater and ask them you know with a question mark look on your face you know would you like a sweater is it cold outside you can show yourself those gestures or show them if there is insist on doing something that they're not don't not say don't do then you're trying to redirect them ask them where they'd like to look at something else but you do not say don't that's kind of childish or how you would treat a child you don't want to do that if they're hallucinating number one do not say you're hallucinating - you do not see Michael Jackson tonight and hear him I'm you do not see that spider on the wall you just don't agree with that but you still they may be there and where they're scared maybe they want to see Michael Jackson but you tell them I don't know Michael Jackson is not there um but if they insist you just said so okay Michael Jackson theater so he's gonna watch us eat today he's gonna watch you do your beading today so you can you know keep your [ __ ] mind focused but or to redirect them they're very easily redirected just because they will forget easy so especially if it's scaring them I'll redirect them to something better if the resin is depressed or lonely then they should always take time one-on-one to talk to your resident if they show any signs of depression tell the nurse if the resident repeatedly asked to go home talk to the patient about going home talk to them about how home is a lot of times again they you may can distract them you make him get it forgiven or forgetting reader a tour guide the conversation to another thought expect that the resident may continue to ask to go home and be patient in general because sometimes they just aren't stuck there they want to go home they want to go home they won't go home where is my daughter she's coming to pick me up you know maybe daughter's been pantsed for two years just know that that might happen also be patient if raisin is verbally abusive always redirect their attention don't you be cussing back to them don't be telling me you're gonna beat them up and they may say that to you but you just say no it's alright not today I know you're mad today whatever higher you get them and try to redirect it if a resident has lost most verbal skills learn to use your nonverbal they can see touch sound laughter a lot of times they can understand see that a lot longer than they can words anyway they can tell that you know with just your hand on their shoulder that you're there and you want to help them remember that even after verbal skills are lost signs symbols and gestures can reach people with dementia brain Maclaurin you pointed the card and maybe they can say yes or no or shake their head yes or no whatever you do try your best to understand what they're seeing always assume that they can understand more than you think they can because you sitting in there talking about the next door neighbor cna next thing you know that that saying patients going down the hall telling somebody else what you said about that cna next door so just don't assume that they're not remembering stuff list and describe interventions for problems will come in activities of daily living now this is actually having to take care of him number one develop a routine and stick to it number two promote self-care number three take good care of yourself both mentally and physically sometimes it can be tiring those Alzheimer's patients run around and do all kind of things try your best to take care of yourself also if a resident has problems with bathing scans obey them when the resident is least agitated you do not want to schedule a bathe in time when people are upset mad at you I'm just gonna be trying to activate a little bit in a happy nice way then I want to take care of you way but not in a you are gonna bathe way because they do have choice doctors not gonna order anything like a fourth bed bath or a fourth bath for shower until it is necessary maybe they see necessary they'll write or order prepare the resident before bathing hand him the supplies sometimes you can just give them the supplies and roll them down the hall and say you know you're taking a shower shower day maybe that'll help make sure the bathroom is well-lit and comfortable temperature provide privacy be calm be sensitive when talking to him about bathing you maybe they get aggravated every time you talk about bathing give the resin or washcloth the hole and that also can distract them let me we want to pull your hair but if you give them something to hold try to do that too I always follow the safety precautions ensure safety make sure you got non-slip mats in the bathroom tub seats and hand holds those are the things they hold on to and that's for everybody not just also nurse be flexible and when to bathe the resident make sure you try to catch them on the end the mood be relaxed and allow the residents to enjoy the van let the resin do as much as possible again for their self we know that and check the skin regularly for signs of irritation every time they're bathing wherever they're it's in the bed in a shower man I tell them always check for a source of irritation if a resident has probably grooming and dressing make sure you help your resident feel attractive avoid delays or interruptions that's what you don't do try not to interrupt them while they're trying to get dressed or do things for themselves you know let them cuz that's gonna just distract them then they got to start focusing again so the resident clothing to put on mats from which one would they like give them a choice make sure you give them a choice because that's a state law and a state skill provide privacy and close your doors and curtains the residents should be dressed in his room don't be dressed in patients out in the hallway encourage the resident to pick close the we're giving a few choices you don't want to give too much because then they'd start getting agitated that's too many choices just give them a choice two choices break the task down into simple steps one by one use a friendly calm voice and if you can look at the figures five five just lay their clothes in the stang as you as they are to put it on because you don't want them and then you will see it with their underwear up over their pants you know however try to put it in the stack so they can just pick it up put it on if a resident has problem with toilet to encourage fluids that sounds a little backwards but you need to encourage fluids because you do not want them to get a UTI the NA should never withhold or discourage fluids because of resonance is incontinent just because they're incontinent does not mean you withhold fluids you can mess them up make sure the bathroom has a sign or a picture on it make sure there's not enough light if you start noticing your resident and you start understanding when they use the bathroom a lot of people get a routine using a bathroom also so about 30 minutes before you can start preparing and if you know all your patients like then you'll be a good see you name observed toilet patterns for two to three days try to figure it out take the resident to the bathroom before and after meals and before bed that's when a lot of people do use the bathroom and I always say after medication past 30 to 45 minutes especially if their blood pressure pills both lecture means they're gonna be urinating not too long after then put lids on the trash cans men wastebaskets they tend to use those as the bathroom remember that family and friends may be upset by their loved ones and countenance the NA should be professional when cleaning episodes of incontinence never throw your nose never look like anything's thinks or or you're disgusted by anything you smiling that is what you're there for you are there to care for and love then you don't have to love but show care concern for that patient if a resident has problems with nutrition and they should always offer nutritionist foods or nutritious foods maybe not even interesting to the Alzheimer's patient maybe you can find them something that they used to like or do like and maybe they can eat that on the way as they're moving around because they will be sometimes they can't sit long enough to eat give them something to walk around in their hand such as chicken no gas chicken the fried chicken leg small pieces are cooked boneless chicken fish sticks cube sticks or cheese cubes boiling something that they can put in their hand and walk with it make sure they can see keep noise and distractions low avoid serving steamy are very hot foods you do want to do that for anybody use a simple place setting with a single eating utensil and understand underline that playing plates without patterns or colors work base also one spoon one one of everything do not confuse them with different utensils like you know my mom used to make me set the table with three different kind of spoons like a salad spoon I don't know a gravy spoon I don't know probably a steering spoon I don't know what that y'all were for I supposed to because I did go to that class but um I didn't know what it was stood on to this day but if you look at picture page 114 that's what they like that plane plate that one spoon also underlined that first one right up under that picture put only one item of food on the plate at a time you won't see that at the nursing home but that is recommended because they don't get confused they know what they're doing and that just that multiple foods can get them irritated give simple clear instructions again that one by one let them taste it first before you give them too much on their spoon that's anybody got the patient through the meal make sure you offer drinks of water juice and other fluids same with all your patients use adaptive equipment such as special spoons and bowls again lot of this is with the same patient you're just focusing on different things with your Alzheimer's feed the resident slowly make mealtime simple make them relax seat the residents together if you can observe and report heating and swaller problems in addition they may should use the following secured for the residents prevent infections and to follow standard precautions you're gonna have to do that with everybody observe the residents physical helping report any potential problems let the nurse know when you see things going down give careful skin care we know that watch for signs of pain sometimes you got to look for their nonverbal signs they may be grimacing they made me clenching their fists whatever they're doing they need help maintain a daily exercise routine maintain their self-esteem give them some confidence tell them they're doing great all sharing activities they love for you to sit down with them and do things if you can reward price of an independent behavior with smiles and warm touches list and describe interventions for calming difficult behaviors if they're agitated what are we going to do most time an agitation or any kind of weird thing that they're doing that is not normal for them some kind of trigger happened to make it happen so what caused them to get agitated we called them triggers so what causes it sometimes it's you sometimes it's a change in routine sometimes you're not their regular CNN whatever it is sometimes they are just aggravating like that or agitated so our number one goal always is to remove the triggers remove the triggers keep a routine and avoid frustration help the resident focus on soothing familiar activity they can try sorting things or looking at pictures stay calm use a low soothing voice place an arm around the shoulder just touch them on just a little bit can cause some agitation go away even it just makes them feel in and redirects their attention sundowning I always remind myself of the two-year-olds you know when you want to put your two year of the bed that's when they wanna wake up and that's what sundowning me as soon as the Sun Goes Down they wake up and that is exactly what sundowning is in Alzheimer's or in your elderly you've got to remove your triggers give snacks and encourage rest so what is a trigger to a person who is sundown in some time is too much noise it looks like the daytime you need to turn down the lights placed off bedtime music um just remind yourself of that when you are trying to help people go to sleep make them tired during the day give them exercise program do something that tivities appointments make them all during the daytime soft music and night recognize when sundown and their curves and give them a common activity before they get started up I make sure there's no caffeine if you can give a map back massage do that make them exercise get them the exercises I should say you don't make them do anything get them to the exercise program make them tired and that's what exercise will do for you and then maybe they'll be able to go to bed at night sometimes they have an overreaction or something and it's Gogol out crazy they've lost lost him and sometimes that's the person sitting in the back of the room you know it's getting out or not around here and it's things are clacking or things are happening and the next person they just yell and the whole classroom just looks that is the cash-strapped direction they have had it enough and they are going to react whatever kind of way maybe they're throwing things maybe that person like that one just yell too dear until everybody did get quiet that's what they needed some quiet and sometimes that's what you have to do just know it can't be triggered by fatigue or attained a routine environment or even the caregiver over stimulation too much noise or activity difficult choices or tasks you know that's the person you don't say hey do you want this this this in this man and then they're sending their home icon and they can't decide and then they just put their hands on the head and just walk away you know I can't decide then this may be the problem physical pain hunger and need for toileting what do we do but we removed the triggers any violent behavior happening I always try to not to make fun of someone who's gotten beat up by an elderly patient because I'm thinking mine didn't you run why didn't you get away why did you let them hit you more than once sometimes they'll get one in just be aware of that most of them they're too weak they even hurt really but I always say them if you don't let them beat you up then all you had to do was just walk a little faster you can bump bowls but never never never hit bang make sure you step out of reach that's number one especially if the patient's in a wheelchair how are you gonna explain that one call for help if needed avoid leaving the resident alone even though their man which you think want to beat you up still don't leave them alone until someone else comes and relieves you they may be mad at you and removing you may calm them down but you still do not leave them alone they may be pacing and wondering what is pacing that's going back and forth in the same area underline an and worn during means walking aimlessly around the facility they are wandering that's what it means some causes of wandering or pacing is restlessness hunger disorientation they may not know what they're doing or where they going they mean need for toileting they may be constipated pain for getting higher or where they even sit down they know they got to use a restroom but then forgot where the restroom is they know they media restroom or maybe they don't they just know the feeling and can't discern that it means you need to go to the bathroom really depends on what's going on with them they may need to exercise that may be why they're pacing because they've got so much energy they need to move around restless legs do mean like that you nee should remove causes when they can for example give nutritious snacks encourage you to exercise maintain a toilet and schedule if residents pace and wander they should do it in a safe and secure place staff should keep an eye on them and that's what you do you make sure they're there mark signs or with the pictures on their doors sometimes you have a patient that he Lopes all that means in that orange box on page 116 is that the person has left and they didn't have permission what we do as a CNA we follow them keep our eyes on them and try to report back to get them back the way they need to be well anytime you find a patient missing you need to notify the nurse hallucinations are delusions no first what it's hallucination is a resident who sees hear smell taste or feel something is hallucinating a resident who believes things that are not true is delusion so how do you describe that now it's used Michael Jackson so do you see Michael Jackson standing in that corner you see him waving you smell him you heard what he said to me that is a hallucination a delusion is different saying okay I believe I'm Michael Jackson I believe I'm Michael Jackson's wife those are not part of your senses though that's a belief that you didn't came up with in your head so that our that's the difference in a hallucination that you can see smell taste that is a hallucination a delusion is the belief that something is happening or the belief that you are somebody or not all of that is the difference I always try to redirect their attention if they're depressed don't let them eat alone try to give them some company even though they really probably don't want you know I don't mean won't but they don't ask for company they may want company they may be feeling all kind of things they may have loss of Independence they feel that way they feel that they've lost them in inability to cope feelings of failure fear reality of facing a progressive incurable illness somebody just told you you got Alzheimer's in every once awhile you remembered in um and that scares them because then they like what what happened the rest of the day you don't remember my nothing um then that happens if a resident is depressed report signs to the nurse encourage independence self-care and activity more they can do for their self the more they feel empowered of their self talk about moods and feelings that the resident wants to be a good listener sometimes they just want to talk what is preservation or repetitive phrasing we actually talked touched on a min ago what do you do preservation is a resident who repeats a word phrase or question or activity over and over they call that preservation repeating a word or phrase is also called repetitive phrasing so however they do it a lot of times they would just sing and I always come up with this one what time is it what time is it they go to everybody asked what time is it that is that preservation or we're pretty phrasing there also make sure you answer the question the same time that's the same thing each time whatever it is if they're disruptive find out what triggered them why are they slamming doors being going furniture why are they doing it when the behavior occurs then they should gain the residents attention she should be calm and friendly and trying to find out what caused the behavior if it's a physical reason such as pain or discomfort let's take care of that um but try to get them to talk to you if a residence RUP t'v gently direct the resident to a private area notice and praising imprint of provements when you see that I'm being mean or hateful today you know let them know you know you are so nice today and I'm glad to have you I'm glad to be working with you maybe you should say that every day but um this day you mean it especially it's a good day tell the president about any changes in schedules routines environment and in advance because they will get disrupted they just don't like changes encourage residents to join in independent activities and that's the same thing get them to do for this self inappropriate social behavior sometimes they may be cursing name-calling other behavior as with violent or disruptive behavior there's many reasons why that be happen they may only be reacting to frustration or stress try to find out what caused the behavior sometimes it's just too much noise too many people too much stress pain discomfort what your main goal is to redirect him or try to get him to a private area the NA should respond positively to any appropriate behavior when they're doing right get my hug do do something that that they feel rewarded for being better inappropriate sexual behavior inappropriate such as removing clothes touching one's own genitals are trying to touch others when dealing with such behavior that you nee should not overreact make sure you'll be sensitive to the matter especially anybody that has been a victim of n if distracting the resident does not work the ena can gently direct him to a private area maybe they did pull out their stuff and they're playing with it in front of people you know okay you can do that but you're not gonna do it in this hallway mr. Jon or mister you know miss miss Cheryl you know go to your room and do it in your room and that's how I'd be even in the real world you know people can't just play with ourselves in front of people even though it's theirs you just can't do that I'm and direct them to another place village in the hoarding pillaging is taking things that belong to someone else a person with dementia may honestly think something belongs to them even when it clearly does not hoarding is collecting and putting things away in a guarded way no those pillaging is taking things that belong to someone else and hoarding is collecting things in a guarded wing you kind of assign feelings to your objects pillaging and wardens should not be considered stealing if you have a teen they just look at something it's pretty they want to take it they like read everything in your closet is read so they take all your read stuff we're not gonna call it stealing the more number one way to fix that is label all their personal belongings make sure you place a label or a symbol or object on the residence door maybe they can find you won't find their stuff ever and everybody else's room because they're not they dine in everybody's room um maybe we can get it back to the original owners on the NA can help lessen problems by not telling the family that their loved one is stealing from others preparing the family that they're not upset when they do find other people's belongings in the room sometimes that's the first time they like whoa who is this I'll never forget my lady with the whole nother family in there she was like yeah that's mine well you know my children in mine my grandmama and she was just naming people and I just you know I'm just about laughing the whole time I'm really thinking it's the picture that just came in the frame because they were white people and she was a black lady but I said well you know this is the new world and it maybe I don't know maybe they adopt her who knows and you know it's a deal so I didn't judge I listened but then just just a couple hours later I was taking care of the lady down the hallway and I'm looking at those pictures and and that's where the late the pitcher bolon she had picked up the lady's whole family and brought him to her room so make sure we label everything so we know who it belongs to regularly checking areas where the residence store items is a good thing to sleep disturbances residents with a day may experience a number of sleep disturbances if a resident experienced these problems make sure that the resident gets moderate exercise activity throughout the day DNA can encourage him to participate in activities that he enjoys allow the resident to spend more time each day in the natural sunlight if possible it helps them not only get the daylight but make sure and it makes your body realize when it's nighttime reduce light noise as much as possible and discourage sleeping during the day if you can get them up just like we do our babies you don't know oh no you're not going to sleep right not right now and you got a family then but for your elderly you give them activities to do something that they like and enjoy um the strike them from going to be in abuse and Alzheimer's it is your responsibility as a nurse assistant now that you have came to this level of training that any abuse that you see you will report um there's no if ands or buts that is what you're going to do because it is your license because now that you if you see abuse happening and you don't report it they're gonna consider you the same because you've seen it you must the like or get abused why you didn't stop it why you didn't report it and you just need to be aware then you now you're legally responsible you're legally required to report it described creative therapies for residents with Alzheimer's all those Alzheimer's disease cannot be cured there are ways to improve life for residents with AD reality orientation there's only one two three activities here that you had to remember reality orientation and remember when it is useful it is useful in the early stages that's just reminding them having a calendar of clock signs where their room is all that is back to reality and that's what you do in the early stages of Alzheimer's validation is a whole different ballgame it's when they have gotten so confused so out of it that they you can't bring them back to normal you can't set them straight so we're gonna have to deal with them where they're in it's letting the residents believe they live in the past or an imaginary circumstances validating means giving value to or approving which I don't like those words but okay mr. Davis you live in 1965 we're gonna okay your daughter's coming to get you you know knowing the daughter's been dead for ten years okay but don't you need to get dressed don't you need to eat some supper no she's I'm gonna go to supper okay but it's breakfast time you you don't want to wait till supper to eat let's see some breakfast okay you think she's coming that's fine but do you want a jacket to put on just in case you know and it's cold outside you try to work with them and they call that validation therapy it's just trying to get them to do but under their choices under they're stuck places and remember that it's only useful validation therapy is on useful and moderate to severe during disorientation you would not be trying to use reality or orientation in the last stages because they're too gone too far gone they're not gonna know what you're talking about they and they are not gonna get it they're not gonna get that is you know November 12 2017 they're not gonna get that you just keep on taking care of oh and there is another therapy it's called reminiscence therapy so there's four of them reminiscence is really remembering the past and I always put that in there so you can remember that that is the real things that happen validation is not that's imaginary reminiscence is what really happening you're just talking about it just like the good old days and that's as useful in all the stages if they can remember what went on if you can get them to talk about it that's fine let them talk that's called reminiscing we reminisce in activity therapy you know what that is get them do wall exposes listen to music do whatever do beads John jack-o'-lanterns do an Easter egg hunt I've seen it all um they always celebrate every holiday activity director activity therapy is a nice place to dig they also have a music therapy now music is getting people to waking up that you know and I believed I might be that person I like music like that in this man they use music therapy on him he wasn't talking at all but when he heard music he was just talking and they just continued to play that music for me ninety talks so much more clear he's like he came back to life when he was just bout staring into space so that music can talk to people but that is the end of chapter five I hope that on all this comes in in handy and in hopes that we taking care of our CNAs you know and not our CNAs but taking care of our elderly in a wonderful way okay