Unit 4 & 5: Special Care Situations & Transitioning From Student To Employee PDF

UNIT 4 SPECIAL CARE SITUATIONS 294 18 Providing Care for People with Specific Illnesses 295 19 Providing Care for People with Cognitive Changes and Dementia 311 20 Providing Care for People at the End of...

UNIT 4 SPECIAL CARE SITUATIONS 294 18 Providing Care for People with Specific Illnesses 295 19 Providing Care for People with Cognitive Changes and Dementia 311 20 Providing Care for People at the End of Life 327 21 Providing Care to Infants and Children 338 22 Providing Care for People in Their Homes 356 UNIT 5 TRANSITIONING FROM STUDENT TO EMPLOYEE 372 23 Entering the Workforce 373 24 Enjoying Professional Success 382 Appendices 400 A Medical Terminology and Abbreviations 401 B Body Basics 405 C Math and Measurements Review 417 D Additional Skills 429 E Answers to Questions for Review 434 Glossary 437 Resources 451 Index 462 Contents | v 18 19 20 21 22 SPECIAL CARE SITUATIONS UNIT Providing Care for People with Specific Illnesses 4 Providing Care for People with Cognitive Changes and Dementia Providing Care for People at the End of Life Providing Care to Infants and Children Providing Care for People in Their Homes 294 | | Nurse Assistant Training  C H A PT E R Providing Care for People with Specific Illnesses 18 After reading this chapter, you will have the information needed to: Describe the nature of acute and chronic conditions and explain what it can be like to live with a chronic condition. Describe the characteristics of several common conditions that people receiving health care may have. Goals Describe the nurse assistant’s role in caring for a person with one of these common conditions. Chapter 18 | Providing Care for People with Specific Illnesses | 295  Key Terms: acute condition aspiration paralysis cancer pneumonia chronic condition paraplegia tumor chronic obstructive arthritis pulmonary disease quadriplegia benign osteoporosis (COPD) diabetes malignant angina pulse oximetry insulin metastasize chronic heart asthma hypoglycemia chemotherapy failure Parkinson’s disease hyperglycemia radiation hypertension multiple sclerosis (MS) kidney (renal) depression influenza hemiplegia failure suicide pneumonia hemiparesis dialysis anxiety requires ongoing treatment to manage it. Sometimes a The first time you went to Craig and Karen person can have a chronic condition that continues for Trainer’s home to provide care for 63-year-old years without many serious symptoms, and then suddenly Mr. Trainer, he had received a diagnosis of lung cancer it flares up. When it flares up, the chronic condition is in 2 months earlier. He had surgery to remove part of an acute phase. The person feels ill and may need medical his left lung and is receiving chemotherapy. You are attention. After treatment, the acute phase resolves, but there to help with personal care and to observe how he the person continues to live with the chronic condition. tolerates chemotherapy treatment. Many people in your care will have chronic conditions, When you arrive, Mrs. Trainer greets you at the door especially if you work in a nursing home. Living with a and you can see that her eyes are puffy and red and her chronic condition can be very difficult for a person. Often, eye makeup is smudged. After you hang up your coat the condition affects the person’s ability to manage in the hall closet, you ask Mrs. Trainer what you can do activities of daily living (ADLs) independently. The person to help her. “Nobody can help me!” she says in a loud, may have good days, when she is able to do quite a high-pitched voice. Then she sits down in a chair and lot, and bad days, when pain or disability prevents her bursts into tears. You put your hands on her shoulders from doing much at all. A chronic condition also impacts to try to comfort her. When she calms down, she says, a person’s emotional health. The person may become “I’m sorry. It’s just that the cancer has made everything depressed or angry because the condition affects her so difficult. We can’t go out together because I can’t ability to do the things she likes to do. It can be very handle his wheelchair and oxygen tank, and I’m afraid difficult for the person to cope day to day with a condition to leave him alone. I feel like a prisoner. I never get out that may prevent her from ever feeling really well. As of this house. All I do is take care of Craig. I don’t mind a nurse assistant, you must try to help the person live taking care of him, because I love him. But I’m so tired. the fullest life possible. Show empathy, and recognize I don’t see how we can continue to live like this.” that the person’s abilities may change from day to day. Therefore, your care and the amount of assistance you provide may need to change from day to day as well. Family members and friends are also affected by the Think about the last time you were sick. Did the illness person’s chronic condition. If a person’s diet changes, his occur suddenly? Perhaps one day you felt fine, and family may have to eat differently, too. If the person cannot the next day you were ill with a cold or an infection. Or move without help, he may need assistance with a variety of perhaps someone you know had surgery to remove an tasks. Family members and friends may also be sad, angry infected appendix (appendicitis). In both of these cases, or depressed about the change in the person’s health. the illness is considered an acute condition. That is, the illness happened fairly suddenly and lasted a short time. Some illnesses, such as diabetes and arthritis, do MUSCULOSKELETAL not resolve with time. These conditions are chronic conditions. In many cases, a person who has a chronic CONDITIONS condition lives the rest of his life with an illness or Common conditions that affect the musculoskeletal condition that never really goes away, and the person system include arthritis, osteoporosis and hip fractures. 296 | | Nurse Assistant Training Arthritis Encourage the person to use assistive devices as needed. For example, toothbrushes, hair brushes Arthritis is a condition that causes joints to become and combs with built-up handles may be easier for inflamed, swollen, stiff and painful (Figure 18-1). A few a person with arthritis in the hands to hold, allowing or many joints may be affected. The smooth tissue that more independence. covers the ends of bones becomes rough or wears away, causing painful friction between bones when Osteoporosis the person moves. The remaining tissues around the joints swell, which leads to stiffness. This stiffness Osteoporosis (a disease in which loss of bone tissue makes normal movement difficult. Even an activity like causes the bones to become very fragile and prone to unscrewing the lid of a jar or walking up stairs can be breaking) occurs mainly in older women but may also occur difficult and cause pain. in men. The disease is caused by a gradual loss of minerals, especially calcium, in the bones. Calcium helps make bones Imagine what it might be like being in constant pain hard and strong. When calcium is lacking, bones become or not being able to move without pain. When you soft and weak, and they break more easily. Fractures in the provide care for a person with arthritis, focus on spine can cause the person to develop a stooped posture relieving pain, assisting with mobility and promoting and a rounded upper back (Figure 18-2). This posture is very independence. painful for the person. As the disease progresses, the person Let the person know that you understand that may have severe pain in the parts of the body that support movement is painful and that you are there to help. her weight. The person often tires easily and may be fearful Ask the person about ways to make movement of falling while walking. If a person with osteoporosis breaks easier and less painful. a bone, it can take a very long time for the bone to heal. If the person takes pain medication, plan her When you provide care for a person who has morning care so that it is scheduled to occur after osteoporosis, it is important to focus on safety. In she takes her morning dose of pain medication. addition, do the following things: When the person has less pain, she may be able to Help the person exercise as much as he can do participate more in her own care. comfortably. Gentle exercise may help slow down Because warm water and heat soothe joints and bone loss. help reduce stiffness and pain, assist the person with tub baths, warm soaks or heat therapy, according to the person’s care plan. To reduce stiffness and pain, encourage the person to wear warm clothing that covers the affected joints. Encourage the person to exercise the affected joints, or assist her with range-of-motion exercises according to the care plan. Activity promotes independence and keeps the joints more flexible. However, never move a joint that is painful, red or swollen. Figure 18-2 A person with osteoporosis may develop a rounded upper Figure 18-1 Arthritis affects the joints and makes movement difficult back. This happens when the bones of the spine weaken and collapse. and painful. © iStockphoto.com/Richard Rudisill © 2012 Custom Medical Stock Photo, Inc. Chapter 18 | Providing Care for People with Specific Illnesses | 297  Use a transfer belt when assisting the person to walk or move, according to the person’s care plan. Use the belt very carefully. Remember, the person’s bones are very fragile. Keep areas where the person walks clear and free of tripping hazards, such as throw rugs. Make sure that chairs are the proper height and that grab bars are fastened in appropriate places. These precautions help reduce the risk of injury. Follow care measures that may be necessary because of medications the person is taking to treat the osteoporosis. For example, the person may have to remain upright and may not be allowed to have food or fluids for a period of time after the medication is administered. These measures, if applicable, will be detailed on the person’s care plan. Be aware that the person’s visual range may be limited due to postural changes, which cause her to lean forward and down and make it difficult for her to look up. Place objects the person needs where she can see them easily, and ensure the person’s safety while walking. Report any new pain, loss of function or swelling. These could be signs of a broken bone. Hip Fracture Figure 18-3 A person who is recovering from hip joint replacement A hip fracture is a break in the bone of the upper thigh, surgery may use an abduction pillow to keep the hips properly aligned until the joint heals fully. just below the hip joint. Hip fractures are very common in older people who experience a fall and can have serious consequences. Hip fractures are usually treated with with pivoting to the chair using only the unaffected leg. surgery. Sometimes the bone can be repaired, but other As the person continues to heal, these weight-bearing times it is necessary to replace the entire hip joint with restrictions may be changed. For example, at first the an artificial joint. Following the surgery, the person will person may not be allowed to bear any weight on the require weeks to months of physical therapy. Sometimes, affected leg, but as healing progresses, the person may other conditions that the person has will make surgical be allowed to increase weight bearing to 25%, then 50%, repair impossible. In this case, the person will be put and so on. The physical therapist will teach the person on non-weight-bearing status and physical therapy may how to use appropriate assistive devices for walking. You possibly not be permitted. should encourage the person to practice the skills she has While the person recovers from a hip fracture, he learned in physical therapy, and you should monitor her will have difficulty changing position on his own. technique to make sure that she uses assistive devices You will need to assist the person with repositioning properly. Always follow the person’s care plan exactly, according to the person’s care plan, to lower the regarding how much, if any, weight the person is allowed person’s risk for pressure ulcers. Encourage the person to bear. Bearing too much weight too soon could result to help as much as he can by using assistive devices in increased pain, swelling and possible re-fracture of the such as a trapeze suspended above the bed. Use hip, which would delay the person’s recovery. positioning aids, such an abduction pillow as ordered, A person recovering from a hip fracture may require a to keep the hip joint aligned properly (Figure 18-3). It is great deal of emotional support. The person may be also important to make sure that the person maintains frustrated by needing so much assistance and by the good alignment when seated. The person’s feet should length of the recovery period. In addition, the person may be flat on the floor, and his hips should be flexed no be very worried about whether she will fully recover from more than 90 degrees. the fracture, and what this could mean for the future. The person may also have weight-bearing restrictions. Listen to the person’s concerns, practice empathy and During this period, the person will need assistance provide encouragement by acknowledging the person’s with transfers by using a mechanical lift, or assistance progress toward recovery. 298 | | Nurse Assistant Training  frequency of urination. As always, answer requests CARDIOVASCULAR CONDITIONS for help promptly. The cardiovascular system transports nutrients and Measure and record the person’s intake, output and oxygen to all the tissues of the body and then carries weight every day, or according to the person’s care away the wastes from these same tissues. Common plan. These measurements are used to determine conditions that affect the cardiovascular system include how well the person is eliminating excess fluid. angina, chronic heart failure and hypertension. Be aware that a person with chronic heart failure may also have fluid restrictions in place. Angina Provide diversion (such as enjoyable activities) to calm the person and reduce strain on the heart. Angina is chest pain that occurs because the heart is not getting enough oxygen. An angina attack can be caused by activity, exercise or stress. A person who has angina may Hypertension take nitroglycerin to relieve the chest pain. The nitroglycerin Hypertension is chronically high blood pressure. Blood may be in the form of a pill that is placed under the tongue pressure that remains elevated over time places a great or in the form of a patch that is applied to the skin. deal of stress on the heart and blood vessels. Hypertension When caring for a person with angina, be aware that the often does not cause symptoms but can cause serious person may try to limit activity out of fear of bringing on an health problems. Many people who have been diagnosed angina attack. Encourage the person to be as independent with hypertension take medications to lower blood as possible by allowing him to move at his own pace. If he pressure. It is important that the person take these does feel any chest discomfort with activity, encourage him medications as ordered. If a person tells you that he has to rest and breathe deeply to help relieve the pain, and then stopped taking blood pressure medication (for example, report the episode of angina to the nurse. because he is not having any symptoms, or because the medication causes unwanted side effects), report this to the nurse right away. The nurse can help explain to Chronic Heart Failure the person the importance of taking the medication. If In people with chronic heart failure, the heart muscle the person has stopped taking the medication because is weak and cannot pump effectively. Heart failure may of unpleasant side effects, the nurse can work with the cause fluids to build up in the body, resulting in swelling person’s primary care provider to adjust the person’s of the feet, legs, hands, and face and difficulty breathing. medication regimen to eliminate or reduce the side effects. Shortness of breath can cause the person to feel anxious and restless. The shortness of breath and anxiety may be worse when the person lies down. If you notice that a As you talk with Mrs. Trainer, she mentions person in your care becomes anxious and short of breath that she has hypertension for which she takes only when lying down, report this to the nurse. This could medication. She says, “But honestly, I’m under so be an early sign of heart failure. much stress right now, and so focused on Craig, my own health is the least of my worries. Half the time When you provide care for a person who has chronic I don’t even remember to take my medication.” heart failure, do the following things: How would you respond to Mrs. Trainer’s Provide frequent rest periods when helping the comment? person with daily care activities. People with chronic heart failure often become tired after only a little exertion. Help the person see that by pacing her activities during the day, she accomplishes more. Help the person maintain a position that lets her RESPIRATORY CONDITIONS breathe more comfortably. Many people find a sitting The respiratory system supplies the body with oxygen position supported by pillows to be best. Keep the and rids the body of carbon dioxide. Disorders of the person’s legs elevated to reduce swelling of the legs respiratory system include influenza (flu), pneumonia, and feet. chronic obstructive pulmonary disease (COPD) Provide regular mouth care. A person with chronic and asthma. heart failure may breathe through the mouth or receive oxygen, which makes the mouth dry. Provide frequent opportunities for the person to use Influenza the toilet. The medications used to manage chronic Influenza is a highly contagious viral infection that heart failure can increase both urinary output and affects the respiratory tract. Symptoms of influenza Chapter 18 | Providing Care for People with Specific Illnesses | 299 include a sore throat, stuffy nose, dry cough, headache When you care for a person with pneumonia, be aware and body aches, fatigue and fever. that droplet precautions may be in effect. Follow the person’s care plan carefully regarding turning and ELDER CARE NOTE. An older adult may positioning schedules, and encourage the person to not have typical signs and symptoms of the drink fluids, rest and cough. You may be required to flu. In an older adult, a change in behavior, obtain a sputum specimen for testing. Have the person body temperature that is below normal, take one or two breaths, cough deeply and expel sputum decreased blood pressure, rapid pulse, fatigue directly into the specimen container. Having the person and decreased appetite may be signs and cough deeply helps to ensure that the sample contains symptoms of the flu. thick mucus (sputum) from deep within the lungs, rather than saliva. As when you are collecting any type of specimen, observe standard precautions and make sure Influenza is highly contagious. Flu season is from the container is labeled and stored properly. November until April, with peak activity between late December and early March. In young adults and middle- aged people, influenza is usually a mild disease, but in Mr. Trainer is receiving chemotherapy that older adults, people with chronic illnesses and people places him at risk for infection. In addition, he has had with compromised immune systems, influenza can be a portion of his left lung removed. Together, these put life-threatening. The best protection against influenza him at risk for developing pneumonia. is prevention. To lower your risk of getting the flu (and possibly passing it to those in your care), you should What areas would you need to focus on when receive an annual flu shot in the fall, before the peak flu giving him care? season. You should also encourage those in your care to do the same. If a person in your care does become ill with the flu, be sure to practice strict infection control measures to help prevent others from getting sick. Chronic Obstructive Pulmonary Disease ELDER CARE NOTE. Receiving an annual flu shot can reduce an older person’s risk of Chronic obstructive pulmonary disease (COPD) being hospitalized because of influenza by is a term used to describe lung disorders that make 50 to 60 percent, and the risk of death by it difficult for air to enter or leave the lungs. There are 80 percent (U.S. Department of Health and different forms of COPD. One form occurs when alveoli Human Services, Centers for Disease Control (tiny air sacs where gas exchange takes place in the and Prevention, www.cdc.gov/flu). lungs) are damaged. The alveoli break and lose their ability to expand with air. As a result, air gets trapped in the lungs. Another form occurs when the airways Pneumonia are constantly inflamed and irritated (for example, by cigarette smoke). The irritation and inflammation cause Pneumonia is inflammation of the lungs. Because of the the airways to produce excessive mucus, which clogs inflammation, the air sacs in the lungs begin to fill with fluid. them and makes it difficult for air to pass through. Oxygen has trouble reaching the bloodstream. Pneumonia may be caused by infection with bacteria, viruses or fungi A person with COPD often has a great deal of trouble and is often a complication of the flu. A person may also breathing, which can be very frightening. Because the develop aspiration pneumonia, which occurs when person is not getting enough oxygen, she tires easily. foreign material (such as food, fluid or vomit) is inhaled She may carry herself with bent posture, with her into the lungs. The foreign material can damage the lung shoulders elevated and her lips pursed, because these tissue or introduce bacteria that can cause an infection. measures make breathing easier. The person’s chest People who are in a coma or who are receiving nutrition may be enlarged and rounded, like a barrel, because through a feeding tube are especially at risk for developing over several years, the air trapped in the lungs causes aspiration pneumonia. the chest cavity to enlarge. The person may have a poor appetite. As her condition worsens, the person will ELDER CARE NOTE. Several factors, including require supplemental oxygen. reduced immune function that occurs with When you provide care for a person who has COPD: age, immobility and a reduced ability to cough forcefully (because of muscle weakness), Encourage the person to relax and breathe slowly can put an older person at increased risk for but as deeply as possible. Relaxation and slow, deep developing pneumonia. Pneumonia can be a breathing increase the flow of oxygen to the lungs and very serious, even fatal, illness in older adults. help maintain flexibility in the chest wall. The person 300 | | Nurse Assistant Training  may have special exercises to do to improve her perfume or cologne, and stress or anxiety. People who ability to relax and breathe slowly. If so, encourage the have asthma usually know what can trigger an attack and person to do these exercises as prescribed. take measures to avoid these triggers. Many people who Provide good mouth care. Breathing through the have been diagnosed with asthma also take medication mouth and supplemental oxygen therapy can make on a regular basis to prevent asthma attacks. However, mouth tissues dry and uncomfortable. when an asthma attack does occur, it can be very frightening for the person. Signs of an asthma attack Follow the guidelines in Box 18-1 for caring for a include wheezing; rapid, shallow breathing (or difficulty person who is receiving oxygen therapy. breathing); sweating; and an inability to talk. Obtain pulse oximetry readings as requested or specified in the person’s care plan. (Pulse oximetry A person who has been diagnosed with asthma may readings are often taken along with the person’s vital take two forms of medication. Long-term control sign measurements.) A pulse oximeter is a device medications are taken every day, whether the person that is clipped to the fingertip to measure the oxygen has symptoms or not. These medications help prevent level of the blood (Figure 18-4). asthma attacks. A person who is experiencing an acute Provide a portable commode when the person asthma attack may also need to take a quick-relief (or needs it. Sometimes using the commode is easier rescue) medication to open the airways right away. than getting to the bathroom when the person needs Both long-term control medications and quick-relief to conserve energy or has shortness of breath. A medications may be given through an inhaler or orally. commode is also more comfortable than a bedpan. Offer small, frequent meals to reduce fatigue associated with eating and help ensure that the person receives adequate nutrition. Encourage the person to cough to help clear air passages of excess mucus. To promote infection control and maintain the person’s dignity, keep tissues and trash containers within the person’s reach. Raise the head of the bed for comfort. Asthma Asthma is an illness in which certain substances or conditions, called triggers, cause inflammation and constriction of the airways, making breathing difficult. Common triggers include exercise, temperature extremes, Figure 18-4 A pulse oximeter is placed on the person’s fingertip to allergies, irritants (such as dust, smoke or pollution), measure the oxygen level in the person’s blood. Box 18-1 Nurse Assistant DO’s and DON’Ts Caring for a Person Who Is Receiving Oxygen Therapy DO check regularly to see that tubes are amount of oxygen that the person DO take precautions to prevent fire in place and not kinked. is supposed to receive (the flow rate) and make sure that others do the same. is specified by the person’s primary Oxygen therapy raises the amount of DO provide good skin care around the care provider. oxygen in the surrounding air, which nose, cheeks and ears if the person is increases the risk for a fire. receiving oxygen through a nasal cannula DO tell the nurse if the flow rate on the (a device with two prongs that is inserted flowmeter does not match the ordered DO ensure that Oxygen in Use signs are into the nostrils). The cannula and tubing flow rate. prominently displayed according to your can put pressure on the skin in these employer’s policy. DON’T remove the person’s cannula to areas and cause skin breakdown. provide care, unless you are instructed to DON’T adjust the flow rate. Oxygen by the nurse. is considered a medication, and the Chapter 18 | Providing Care for People with Specific Illnesses | 301  techniques and check to make sure that he uses NEUROLOGICAL CONDITIONS them properly. Chronic conditions of the nervous system include Offer small, frequent meals and snacks. People with Parkinson’s disease, multiple sclerosis (MS), stroke and Parkinson’s disease usually lose weight because spinal cord injury. they become tired before they finish a meal. They may also be embarrassed by spilling food or by how slowly they eat, and they may lose interest in eating. Parkinson’s Disease Be aware that Parkinson’s disease can affect the Parkinson’s disease is one of the most common nervous muscles used for speech, which makes it difficult for system disorders affecting older adults. In Parkinson’s the person to express herself. Be patient and give disease, a brain chemical called dopamine is not the person time to respond to a question or request. produced in adequate amounts. Dopamine is needed When appropriate, asking questions that can be for proper functioning of the nerves that control answered with a simple “yes” or “no” may make it movement. As a result, communication between the easier for the person to express herself. brain and the nerves that control muscle movement is Provide emotional support. disrupted. A person with Parkinson’s disease has muscle tremors (shaking or repetitive motions of the muscles), especially in the hands. The tremors are worse when Multiple Sclerosis the person is resting and decrease when the person Multiple sclerosis (MS) is a chronic disease that attempts movement. As the disorder gets worse over gradually destroys the protective coating on the nerves time, muscles become weak and stiff. The person may in the brain and spinal cord. This condition creates a shuffle and lean forward during walking, and it can be situation similar to a short circuit or crossed wire. Nerves difficult for the person to stop suddenly once he is cannot communicate with each other or with the brain. walking. These factors put the person at risk for falling. A person with MS may have difficulty walking; loss of As the muscles of the face are affected, the person may balance; muscle tremors and muscle weakness; feelings have trouble chewing and swallowing, and he may drool. of numbness, tingling and burning; vision problems; Speech may also be affected; the person may speak in a speech problems (such as slurred speech); bowel and low tone without much variation. The person may lose the bladder problems; pain; and overwhelming fatigue. Late ability to smile, frown or show other facial expressions. in the disease, the person may become paralyzed. The When you provide care for a person who has person may experience periods of remission, with no Parkinson’s disease, focus your care on promoting symptoms, but then the symptoms return and are much safety, independence, good nutrition and mobility. Care worse. There is no cure for MS. strategies for a person with Parkinson’s disease include When you care for a person with MS, encourage the the following: person to do as much for herself as possible to maintain Avoid rushing the person. Muscle tremors increase independence. As always, focus on what the person when the person becomes anxious. can do rather than what she cannot do. Encourage the person to do active range-of-motion exercises when Encourage the person to use assistive devices as possible, or help her with range-of-motion exercises needed. Be patient and allow the person to take the according to her care plan, to prevent contractures and time that she needs. maintain joint mobility. Encourage the person to exercise within his capabilities and according to his care plan. Activity can help prevent worsening of stiffness and balance Stroke problems. Frequent rest periods can help the person avoid becoming too tired or frustrated. A stroke (cerebrovascular accident [CVA]) occurs when blood flow to a part of the brain is interrupted, which When the person is walking, remind her to take big results in death of brain cells. A stroke can also be steps. A person with Parkinson’s disease has to caused by bleeding into brain tissue. A stroke can cause make a conscious effort to do what comes naturally hemiplegia (paralysis on one side) or hemiparesis to people who can control their movements. (weakness on one side). The person may have a Use a high toilet or elevated toilet seat set on top of decreased sense of pain, touch and temperature on the a regular toilet seat. This can make it easier for the affected side. In addition, the person may have difficulty person to sit down on, and get up from, the toilet. swallowing (Figure 18-5). Other effects of stroke may Many people with Parkinson’s disease work with a include aphasia (difficulty speaking, reading or writing), speech therapist to learn safe techniques for eating vision impairments, and bowel or bladder incontinence and swallowing. Remind the person to use these (or both). 302 | | Nurse Assistant Training  repositioning schedule and using positioning aids to support weak or paralyzed limbs and ensure good body alignment. Supervise the person while she eats. If the person cannot eat independently, always put food on the side of the mouth that is not affected by paralysis. Make sure that no food is left in the person’s mouth after the meal is finished to lower the person’s risk of choking. Make sure that the person sits up to eat so that she can swallow food more easily. As when assisting a person with Parkinson’s disease to eat, be aware of the techniques the person has learned from the speech therapist, and help the person practice these techniques while eating. Because the person may drool on the paralyzed side and her skin may become irritated, keep her face clean Figure 18-5 A person who has had a stroke may work with a speech-language therapist to learn techniques that will help her and dry. If ordered, apply a protective skin cream. to swallow without choking. Supervise the person while he shaves. The person may miss spots that he cannot feel, or he may cut himself and not feel it. Depending on the area of the brain damaged by the stroke, the person may have trouble forming words or Help the person walk, according to the physical understanding the meaning of words. If the person has therapist’s directions. The person may need a walker trouble forming words, allow the person extra time to or cane to steady herself. express her thoughts. The person may rely heavily on Put articles that the person needs, such as the nonverbal forms of expression (such as body language person’s method for calling for help, eyeglasses, or gestures) or pointing to pictures to communicate with hearing aid, telephone and a glass of water, within others. As appropriate, ask “yes” or “no” questions to reach on his unaffected side. make it easier for the person to respond. If the person has trouble understanding the meaning of words, speak slowly and clearly in a normal tone of voice. Choose Spinal Cord Injury simple words rather than complex ones, and speak in Messages to and from the brain travel through the simple, direct sentences (for example, “Mr. Lewis, please spinal cord. Spinal cord injuries often occur suddenly, sit here” instead of “Mr. Lewis, could you please sit as a result of trauma (for example, a motor vehicle crash down?”). Use hand gestures (such as patting the seat or diving accident). Spinal cord injuries can cause of the chair), pictures or written messages to help the paralysis (the loss of movement and sensation) below person understand your meaning. the level of the injury. Paraplegia is paralysis that affects both legs and the lower trunk and can result from When you provide care for a person who has had a injury to the lower spinal cord (for example, at waist level stroke, encourage her to do as much as possible for or below). Quadriplegia is paralysis that affects both herself. If the dominant side of her body is affected, she arms, the trunk and both legs. An injury in the neck or may have to relearn how to do activities using her other upper spinal cord can result in quadriplegia. Depending side. Encourage the person to use assistive devices for on the location of the damage to the spinal cord, as well eating, mouth care and other activities to maintain her as the severity of the injury, the person may experience: independence. In addition: Loss of sensation in the affected body parts. Encourage the person to do active-assistive range-of-motion exercises or assist the person with Loss of movement in the affected body parts. passive range-of-motion exercises, according to the Loss of bladder control, bowel control or both. person’s care plan. Loss of the ability to breathe without Be aware that the person’s sense of touch may be mechanical assistance. affected. He may be unable to recognize pain and Loss of sensation puts the person at risk for injuring the temperature and will be unaware of how his affected affected body parts, and loss of movement can affect body parts are positioned. Take measures to keep the person’s ability to manage some tasks. When you the person safe. provide care for someone with a spinal cord injury, focus Follow measures on the person’s care plan designed on promoting safety and independence. Follow the to prevent pressure ulcers, such as following a person’s care plan concerning care measures such as Chapter 18 | Providing Care for People with Specific Illnesses | 303 schedules for repositioning and toileting. Remember the shakiness; sudden changes in behavior (for example, principles that you learned about providing restorative combativeness, argumentativeness, aggression or care. Physical rehabilitation from a spinal cord injury can anger); cool, clammy skin; and headache. be long and difficult, so providing emotional support and Hyperglycemia can result from eating too much encouragement is important. food, taking too little medication, exercising less than usual, or from physical or emotional stress. The signs and symptoms of hyperglycemia are similar to those of undiagnosed diabetes (for example, excessive DIABETES thirst and urination). The person’s pulse may be rapid and weak, the person may have a headache, and the Diabetes, sometimes called diabetes mellitus, is a person’s breath may have a fruity or sweet odor. disorder characterized by the body’s inability to process glucose (sugar) in the bloodstream. Normally, an organ Severe hypoglycemia or hyperglycemia can result in called the pancreas secretes insulin, a hormone that seizures and loss of consciousness and is life-threatening. causes glucose to be moved from the bloodstream into A person with diabetes needs to monitor her blood the cells, where it is used for energy. In a person with glucose levels regularly. The person may use a diabetes, either the pancreas fails to make insulin or glucometer, which tests a drop of blood drawn from the body’s cells are unable to respond to insulin. Either the person’s finger, or the person may test the urine situation causes glucose levels in the bloodstream to for glucose using a chemically treated strip of paper. increase. As a result of the high levels of glucose in the If you are expected to perform blood or urine glucose bloodstream, the person may develop symptoms such monitoring for a person in your care, the nurse will show as excessive thirst, increased urination, chronic fatigue, you how. When assisting with blood glucose monitoring, blurred vision, and slow healing of wounds or infections. take standard precautions and dispose of the lancet (the small device used to prick the skin) in a sharps container. ELDER CARE NOTE. In an older person, falling and dehydration could be early signs of General care measures for a person with diabetes undiagnosed diabetes and high blood include the following: glucose levels. Serve meals and snacks on time, and report to the nurse if the person does not finish the meal or snack If the glucose levels are not controlled, the person can (Figure 18-6). develop severe complications, including heart disease, Provide good foot care. Examine the person’s blindness, kidney failure and nerve damage. The person feet each day for small cuts or breaks in the skin is also at higher risk for increased blood pressure (Figure 18-7). In people who have diabetes, cuts and stroke. Circulatory problems and nerve damage do not heal well because of decreased circulation, associated with high blood glucose levels may delay and even the smallest cut can become badly healing of injuries to the lower legs and feet, which can infected. The sensation of touch may also be necessitate amputation (surgical removal) of a toe, the impaired, and a person with diabetes may not foot or the lower leg. A person with diabetes may manage the condition with insulin injections or oral medications. Diet and exercise play an important role as well. To keep blood glucose levels within an acceptable range, food intake, exercise and medication must be balanced. A person with diabetes must follow a well-balanced diet, with limited sweets and fats. The timing of meals, relative to exercise and medication, is important as well. If food intake, exercise and medication are not in balance, the person may develop hypoglycemia (excessively low blood glucose levels) or hyperglycemia (excessively high blood glucose levels). Hypoglycemia can result if a person misses a meal or snack, eats too little food, exercises more than usual, vomits or takes too much medication. A person who is experiencing hypoglycemia Figure 18-6 The timing of meals and snacks is important for a person may experience symptoms such as dizziness; with diabetes. 304 | | Nurse Assistant Training  condition, such as diabetes. Acute kidney failure may be reversible, but chronic kidney failure is not. When waste products accumulate in the body, they produce symptoms such as: Fatigue, weakness and confusion. Puffiness around the eyes and swelling in the hands and feet. Muscle twitching or cramping. Nausea, vomiting and an unpleasant taste in the mouth, which often lead to decreased food intake. Itching skin that is often severe. High blood pressure. A person with kidney failure often needs dialysis, a treatment that replaces the function of the kidneys by Figure 18-7 A person with diabetes often has poor circulation and may removing waste products and excess fluid from the body. not realize that her shoes do not fit properly until a sore develops. To detect early signs of trouble, regularly inspect the tops and bottoms of There are different types of dialysis. Peritoneal dialysis her feet for red or sore areas. involves injecting a solution through the abdominal wall and then withdrawing it after a period of time. feel an injury. Inform the nurse when the person’s Hemodialysis uses a machine to clean the blood of toenails need to be cut. waste products. Dialysis treatments take several hours Assist the person with exercise as needed. Exercise and may be done a few times a week. improves circulation and helps the person maintain When you provide care for a person with kidney failure, a healthy body weight, both of which are key for focus on the following things: people with diabetes. Carefully monitor and report the person’s food and fluid intake. Observations Into Action! Plan care to conserve the person’s energy and to provide periods of rest. Be aware that after dialysis, When you care for a person with diabetes, be sure to it is common for the person to feel very tired, and report the following to the nurse right away: the person may need more assistance than on { Any change in the usual amount of exercise, nondialysis days. activity or stress in the person’s life Take increased care to prevent infections. If the { The person does not eat all or part of a person is on dialysis, pay special attention to meal or snack keeping the access site (for either peritoneal dialysis { The person vomits or hemodialysis) clean and dry. { The person has signs of hypoglycemia (for Provide good skin care. example, dizziness, shakiness, behavioral Obtain vital sign and weight measurements changes, clammy skin, headache) according to the person’s care plan. If the person { The person has signs of hyperglycemia (for receives hemodialysis, avoid measuring blood example, excessive thirst and urination, pressure in the arm where the access site for the sweet-smelling breath, rapid pulse) hemodialysis is located. { The person’s blood glucose monitoring test results are high or low { The person has a cut or wound on the foot, CANCER or the person’s toenails need trimming Cancer is the abnormal growth of new cells that crowd out or destroy other body tissues. A tumor (a solid mass of tissue) can be noncancerous (benign) or cancerous KIDNEY FAILURE (malignant). Benign tumors usually grow slowly and do not spread to other areas of the body. Malignant tumors Kidney (renal) failure is the inability of the kidneys to can spread, or metastasize, to other parts of the body. filter waste products from the blood. Kidney failure can be the result of an acute disease (such as poisoning Cancer can affect almost any organ in the body. The or a severe infection) or a complication of a chronic outcome of the disease depends on the type of cancer, Chapter 18 | Providing Care for People with Specific Illnesses | 305 how early the cancer was detected and many other special rinses or sprays according to the person’s factors. Although signs and symptoms differ according care plan. to the type of cancer, the American Cancer Society has The drugs used for chemotherapy can affect the identified seven general signs and symptoms that may person’s sense of smell and taste so that nothing be early signs of cancer: seems appetizing. A person being treated with A change in bowel or bladder habits chemotherapy or radiation may also experience nausea, vomiting, diarrhea and painful mouth sores A sore that does not heal that can make eating difficult. Still, it is important Unusual bleeding or discharge for the person to receive adequate nutrition. Offer Unusual lumps small snacks of nutritious, appealing foods (such Indigestion or difficulty swallowing as milkshakes or fruit smoothies) frequently. If the A change in a mole or wart person requests a special food, try to accommodate the request. A persistent cough or hoarseness Chemotherapy can cause people to become very Any of these signs warrants further medical investigation. sensitive to certain smells. Even scents that would Cancer is treated in different ways, depending normally be considered pleasant can become on the kind of cancer, the location and whether the offensive, so take steps to eliminate odors that the cancer has spread. Some cancers are treated with person finds offensive. surgery. Chemotherapy (the use of drugs to stop The drugs used for chemotherapy are excreted in the or slow the growth of cancer cells), radiation (the person’s urine, feces and vomit for 48 to 72 hours use of high-energy X-rays to destroy cancer cells) or after treatment. To protect yourself from exposure to both may be used instead of or in addition to surgery. these drugs when contact with body fluids is likely, A person undergoing chemotherapy or radiation put on two pairs of gloves. therapy may experience unpleasant side effects. The Help the person with grooming routines to promote drugs used for chemotherapy are powerful and affect self-esteem. Some people who experience hair loss all of the systems in a person’s body. As a result, as a result of treatment may wish to wear a scarf, the person may experience nausea, diarrhea, loss of wig or hat until the hair grows back. appetite, hair loss and extremely dry skin. Radiation Exercise is beneficial for the person and should therapy can also have unpleasant side effects, be encouraged when the person feels up to it. including skin burns, fatigue and possibly nausea, Be aware that the person may experience vomiting and hair loss. extreme fatigue after chemotherapy or radiation When you provide care for a person who is being treated treatment, however. Plan care to allow for for cancer: periods of rest, and encourage the person to take naps as needed. Provide emotional support. If the cancer is newly diagnosed, the person may be very worried about Pain is common, as a result of either the cancer or the effects of treatment, whether the treatment will the treatment. Frequently ask the person about pain be successful and what the future holds. Although and report any complaints of pain or discomfort to many cancers are treatable and many people with the nurse. cancer recover fully, some people in your care with Provide good skin care. cancer may be coming to terms with the fact that their cancer is terminal. The emotional support that you provide during these times will be a great help What precautions will you take while and comfort to the person. providing care for Mr. Trainer, who is undergoing chemotherapy treatments? Remember that infection control is extremely What special care needs will you anticipate important. Chemotherapy and radiation affect a that Mr. Trainer might have? person’s immune system and put the person at higher risk for infections. If you have a contagious illness such as a cold or the flu, ask to be temporarily reassigned to limit your exposure to the person until you recover fully. HIV/AIDS Provide good mouth care to promote comfort Acquired immunodeficiency syndrome (AIDS) is a and prevent infection. Treatments such as condition that results from human immunodeficiency radiation and chemotherapy can make the mouth virus (HIV) infection. HIV infection is passed from one dry and may cause painful sores in the mouth. Use person to another primarily through unprotected sexual 306 | | Nurse Assistant Training contact and blood-to-blood contact through needles Weight loss. and syringes. In addition, infected pregnant women can Memory loss or confusion. pass HIV to their babies during pregnancy or delivery, Pain and difficulty when moving. as well as through breast-feeding. By the time a person with HIV develops AIDS, his When a person is exposed to HIV, the virus enters immune system is very damaged and the person is no the body, multiplies in the blood and other organs longer able to fight off other infections. This makes the and damages the immune system. The person can person vulnerable to opportunistic infections (infections be infected with HIV for many years without showing that healthy people can resist or control), such as any signs or symptoms of AIDS. As a person’s HIV pneumocystis pneumonia (PCP). The person may also infection worsens and the immune system weakens, the develop cancers rarely found among people with healthy person may begin to experience signs and symptoms, body defenses, such as Kaposi’s sarcoma (which causes including: red or purplish spots on the skin) and invasive cervical Yeast infections (candidiasis) in the mouth cancer. (called thrush) or in other areas of the body, You may be afraid to care for a person with HIV/AIDS. such as the vagina. Knowing the facts about how HIV/AIDS is transmitted Repeated episodes of diarrhea. can help to relieve some of those fears (Table 18-1). Dry cough or shortness of breath. Practice standard precautions when you provide care Swelling in the glands that does not go away. for someone who has HIV/AIDS, just as you practice standard precautions when you provide care for anyone. Fatigue. You do not have to do anything differently when caring Fevers that occur again and again. for a person with HIV/AIDS. You can safely touch, help Night sweats. and hug the person, as well as laugh and talk with her. Table 18-1 Myths About HIV/AIDS Myth Fact You can get HIV through casual contact HIV is not transmitted through casual contact. The virus does not live (shaking hands, hugging, using a toilet, drinking long outside of the body. from the same glass). You can get HIV by breathing the air after an infected HIV is not an airborne or food-borne virus. person coughs or sneezes, or by sharing food with the person. Only homosexuals are at risk for HIV infection. Any person, regardless of sexual orientation, can get HIV as a result of unprotected sexual activity. Men cannot get HIV from women. Any person, regardless of gender, can get HIV as a result of unprotected sexual activity. You can get HIV through receiving donated blood Stringent policies for HIV screening and testing of blood transfusion or organs. products and donated organs have been in place in the United States since 1985, making the U.S. supply of donated blood and organs among the safest in the world. You can get HIV through donating blood. Donating blood does not put a person at risk for becoming infected with HIV. Sterile procedures and disposable equipment are used when collecting blood. Each needle is used only once. There are medications that can cure HIV/AIDS. There are medications that can delay the progression of the disease, but currently, there is no cure for HIV/AIDS. Adapted from the Centers for Disease Control and Prevention: HIV Transmission. http://www.cdc.gov/hiv/resources/qa/ transmission.htm Chapter 18 | Providing Care for People with Specific Illnesses | 307 Care measures for the person with HIV/AIDS include ELDER CARE NOTE. Depression is a taking steps to relieve uncomfortable symptoms and common problem in older adults. Older adults protecting the person from opportunistic infections. experience many life changes that can trigger A person who has AIDS is particularly susceptible to a bout of depression, such as the deaths of infection caused by contact with people who have friends and family members and the loss contagious illnesses, foods that have not been handled of independence as a result of a decline in safely and pets. Prevent the person from being exposed physical abilities. As a result, people often to people who are ill with contagious illnesses, such as a assume that depression is just part of getting cold or the flu. Practice good infection control measures, old and that the depression must be accepted. including the safe handling of food. Finally, be aware that However, this is not true! If you think that an the person should not perform pet care activities that older person in your care is showing signs involve possible contact with animal stool (for example, of depression, report your concerns to the cleaning litter boxes or bird cages, or changing the water nurse so that the person can be assessed and in fish tanks). treatment, if needed, can be initiated. The person may also require a great deal of emotional support and compassion. People who used to be close When you provide care for a person with depression, to the person may stop coming to visit when they learn focus on maintaining her safety and increasing her self- of the person’s diagnosis (for example, because they esteem. To accomplish this: do not understand how the virus is transmitted and are Encourage independence to promote feelings of afraid of getting the disease themselves, or because self-worth. they do not approve of behaviors that may have led to Give the person appropriate positive feedback and the person getting the infection). Because HIV/AIDS is reinforce her accomplishments. a terminal condition, the person may have many worries Work with the person to set simple, attainable goals. about what the future holds. As with each person in your Be sure to praise her when she meets the goals. care, be a good listener and practice the five principles of caregiving. Listen when the person expresses sadness, and allow the person to cry (Figure 18-8). Because the person’s energy level is low, schedule MENTAL HEALTH CONDITIONS rest periods throughout the day. Monitor the person’s food intake to make sure that Mental health conditions affect a person’s emotions and nutrition is adequate. thoughts. There are many different types of mental health disorders. Two common types of mental health disorders Provide fluids frequently, because the person may are depression and anxiety disorders. not drink enough fluids on her own. Report all complaints of pain so that her symptoms do not get overlooked. Depression Depression is a persistent feeling of sadness. A person who is experiencing depression loses interest in activities that used to give him pleasure. He may say that he feels sad, empty, helpless or hopeless, and he may complain of feeling very tired all the time. He may have crying spells. A person who is depressed may eat or sleep too much or too little. The person may be irritable or angry. Sometimes depression will cause physical complaints, such as headaches, stomaches or backaches. An extremely depressed person may talk about or try to commit suicide (the act of deliberately taking one’s own life). Depression can be triggered by an event (such as the death of a spouse or having to give up one’s home to move to a nursing home) but often is not related to a single event. Signs of depression may be similar to those of a physical illness, and often the person is treated for the physical illness while the depression Figure 18-8 Listening is an important skill when caring for a person who goes untreated. is depressed. 308 | | Nurse Assistant Training  Encourage the person to use a prescribed hearing obsessions, the person feels that he must engage aid or eyeglasses so that she is more in touch with in certain rituals (called compulsions). Performing the world around her. these rituals helps reduce the person’s anxiety. Encourage the person to participate in activities, However, performing these rituals may interfere with especially those that involve contact with other the person’s ability to function and live a normal life. people and those that are physical (as much as she Post-traumatic stress disorder. Post-traumatic can). Avoid overly stressful or tiring activities. stress disorder is a type of anxiety disorder that is Take all comments about suicidal thoughts seriously brought on by experiencing a life-threatening event. and report them to the nurse right away. For example, veterans returning from war, people who survive natural disasters or terrorist attacks, and people who have been victims of rape or abuse are at risk for Observations Into Action! developing post-traumatic stress disorder. The person may not be able to stop thinking about the event and A person with untreated depression may try to may have flashbacks and recurrent nightmares. commit suicide or talk about committing suicide or When caring for a person with an anxiety disorder, wanting to die. Take all such actions and comments learn what causes the person’s anxiety to increase, seriously and report them to the nurse right away. and try to avoid those situations. For example, making Do not conclude that a suicide threat or attempt is basic decisions can be difficult for a person with an just a way to get attention. Also report any of the anxiety disorder. Offering two or three choices, instead following observations to the nurse: of multiple choices, can help limit the person’s anxiety. { The person shows a dramatic change When caring for a person with an anxiety disorder, in mood or behavior, such as increased continuity of care is important. Communicate to the withdrawal or a very excited, elevated mood. nurse what strategies work well for minimizing the { The person hoards medication or purchases person’s anxiety, so that these strategies can be included a gun or other weapon. in the person’s care plan for all members of the health { The person gives away belongings. care team to use when caring for the person. { The person increases her use of alcohol. { The person becomes preoccupied with inner thoughts. CHECK YOUR UNDERSTANDING { The person becomes secretive. Questions for Review ELDER CARE NOTE. Older men, especially those who are without a partner (because of 1. A person with arthritis should be encouraged to: death or divorce), have a higher rate of suicide a. Avoid the pain by not moving. than any other group. b. Take cold showers to reduce swelling of joints. c. Exercise strenuously to keep joints flexible. Anxiety Disorders d. Do active or passive range-of-motion Anxiety is a feeling of unease, dread or worry. At exercises regularly. times, we all experience periods of anxiety, but usually 2. A person with chronic heart failure generally is this anxiety is only temporary. A person with an most comfortable when: anxiety disorder experiences anxiety that continues to build and will not go away, until the person can no a. Lying flat. longer function. Examples of specific types of anxiety b. Sitting up. disorders include: c. Lying on the left side. Panic disorder. The person experiences episodes d. Lying on the right side. of intense anxiety and fear, commonly called 3. A person with diabetes: panic attacks. The emotional symptoms are often accompanied by physical symptoms such as chest a. Needs to eat extra sugar and protein to maintain or abdominal pain, dizziness, shortness of breath or her strength. racing heartbeat. b. May have reduced sensation in his feet. Obsessive-compulsive disorder. A person c. Needs to eliminate exercise completely. with obsessive-compulsive disorder has recurrent d. Needs to have the nurse assistant cut his toenails unwanted thoughts (called obsessions). To calm the daily so that they do not become too long. Chapter 18 | Providing Care for People with Specific Illnesses | 309 Providing Care for C H A PT E R People with Cognitive Changes and Dementia 19 After reading this chapter, you will have the information needed to: Describe different types of cognitive changes, including age-related memory impairment, mild cognitive impairment, dementia and delirium. Describe the course of illness for people with dementia and list common symptoms that occur in each stage. Goals Identify common mental health symptoms often experienced by those with dementia. Describe appropriate care measures to meet the needs of people with dementia over the course of the illness. Identify the issues specific to caring for those with dementia, including the display of challenging behaviors. Continued on next page Chapter 19 | Providing Care for People with Cognitive Changes and Dementia | 311  Continued from previous page Discuss effective communication techniques to use when caring for people Goals with dementia. Discuss the needs of those who provide care for those with dementia, including family members and nurse assistants. Key Terms: cognition delirium aphasia hallucinations age-related memory amnesia expressive aphasia delusions impairment short-term memory receptive aphasia paranoia mild cognitive impairment long-term memory agnosia catastrophic reaction dementia validation therapy apraxia Normal Age-Related Changes Today you meet Mrs. Elizabeth Davis for the first time, as she is on her way home after spending As we age, changes occur that affect how the body the day with her husband, Will, who was just admitted functions. These changes affect all organs and to Morningside Nursing Home because of dementia. processes in the body, including the brain and thinking Tearfully, Mrs. Davis shares with you that her husband processes. Many older people complain about the is nothing like he used to be. “He was such a charming, forgetfulness that occurs with aging. Forgetfulness fun-loving, thoughtful husband and family man,” she happens because of the gradual loss of brain cells and says. “He worked hard to make a good life for us. We a decrease in the chemicals that help the brain to work. were so looking forward to his retirement, so that we As a result, it becomes harder to remember or recall could travel and spend time with our grandchildren.” things. For example, a person may remember a piece But, she continues, “We didn’t get much of a chance. of news but cannot recall when or how she heard it. Or A few months after Will retired, I started noticing perhaps the person remembers who told her the news increasing problems. He became very forgetful and but cannot immediately recall that person’s name— increasingly confused. I started finding odd things like even if it is a close friend! Frequently that forgotten mail in the freezer and gardening tools in the pantry! information just pops into mind a few hours later. And, I found that he was making lots of mistakes Other examples of normal forgetfulness are misplacing handling our money. This was really concerning to commonly used items, such as keys or eyeglasses, or me, because Will was an accountant for 40 years.” You having a word on the tip of the tongue and being unable give Mrs. Davis a tissue and she dabs at her eyes. She to say it. Although it may take a little longer for older says, “I feel so guilty for placing him here, but I am so people to learn something new (such as the features of tired and I just don’t know what else to do. As things a new cell phone), they are capable of learning. Such got worse, Will was picked up by the police twice experiences may be annoying, but they do not interfere because he got so lost while driving. I took his car keys with the ability to carry out normal activities of life. away, but twice I found him wandering through the These types of changes are known as age-related neighborhood on foot. It got to the point where I felt I memory impairments. had to watch him every minute to make sure he didn’t get himself in trouble.” You hand Mrs. Davis another tissue and tell her that she can be sure her husband Mild Cognitive Impairment will be well cared for at Morningside. Cognitive impairment refers to changes in thinking processes (such as memory, reasoning, judgment and language) that are caused by disease or injury. People with mild cognitive impairment demonstrate TYPES OF COGNITIVE CHANGES problems with memory and thinking that are noticeable Cognition is the term used to describe thinking to others but are not severe enough to interfere with processes, which include memory, reasoning, judgment daily life. Problems are worse than those associated and language. with age-related memory impairment, but are not severe 312 | | Nurse Assistant Training enough to indicate dementia. Some people with mild memory and thinking. Dementia is not a specific disease. cognitive impairment remain stable without experiencing Rather, there are many different types of dementia. further decline; however all people with this condition The most common types are summarized in Table 19-1. are at increased risk for developing dementia. Although variations exist among the types of dementia, they are similar enough that the only way to tell what type of dementia a person has is by examining the Dementia person’s brain after the person dies, during an autopsy. Dementia is a term that is used to describe the group Often, autopsy shows that a person had more than one of symptoms that occur with a progressive decline in type of dementia. A person’s specific symptoms depend Table 19-1 Types of Dementia Type of Dementia Cause Characteristics General Information Alzheimer’s disease Plaques (abnormal Progressive memory loss; Accounts for more than 50% of sticky clumps of difficulties thinking, problem all dementias amyloid, a protein) solving and performing Lasts on average 8 to 12 years and tangles (twisted familiar tasks Usually occurs after age 60, protein fibers within Problems recognizing with risk increasing with nerve cells) build up people and objects advanced age; however, a rare in the brain. Together, Loss of language skills form (early-onset Alzheimer’s they cause cell death Personality changes disease) can occur between and ultimately destroy the ages of 30 and 60 years the brain tissue. Lewy body dementia Abnormal protein Has features of both Second-most-common cause deposits, called Lewy Parkinson’s disease and of dementia bodies, occur in the Alzheimer’s disease: Affects men slightly more brain, and throughout problems with motor than women the gray matter movement, memory, Generally occurs between the covering of the brain. language and ages of 50 and 85 years, but thought processes can occur earlier Possible alternating periods of confusion and periods of alertness and orientation Vivid visual hallucinations common; also possible delusions (fixed, false beliefs), or acting out of dreams Vascular dementia Blood supply to the Type and severity of About as common as Lewy brain is impaired symptoms depend on the body dementia because of damaged area of the brain that has Rarely occurs before blood vessels, which been damaged age 65; increasing likelihood deprive the brain Problems with memory, with advanced age tissue of nutrients confusion, thinking Has the same risk factors and oxygen. processes and as heart attack and stroke problem solving (history of heart problems, Can occur suddenly Unsteady gait strokes, mini-strokes, high with a total blockage Restlessness cholesterol, high blood of a blood vessel Urge to urinate or difficulty pressure, diabetes, smoking) (as in a stroke), or over time because of passing urine Depression gradual closing off of a vessel. Continued on next page Chapter 19 | Providing Care for People with Cognitive Changes and Dementia | 313 Table 19-1 Types of Dementia Continued Type of Dementia Cause Characteristics General Information Frontotemporal Damage to the front Language difficulties: Accounts for 10 to 20 percent dementia part of the brain occurs. trouble naming things and of all dementias misuse of words Lasts from 2 to 20 years, Impulsive, inappropriate with people living 8 years, on behavior and lack of average, after symptoms start concern for others Generally affects people in Increased irritability, their 50s and 60s decreased judgment Possible apathy (loss of interest and motivation) Memory generally spared until later in the disease on what areas of the brain are damaged and how much the person of all memories, personality and abilities—the damage there is (Figure 19-1). things that make up the very essence of an individual. Most forms of dementia affect older people. The diseases Most people with dementia whom you will care for that cause dementia last for years and ultimately lead will have Alzheimer’s disease, the most common type to death. As brain cells become damaged, the person of dementia. Table 19-2 provides an overview of the gradually loses the ability to remember, to think and to changes that occur over the years as Alzheimer’s use language. Physical abilities are lost, and the person disease runs its course. becomes totally dependent on others for care. Despite Early stage. In the early stages of Alzheimer’s widespread research, there is still no cure for dementia. disease, changes occur very gradually and may not Some medications have helped slow the progression be immediately noticeable to others. When they of symptoms, but they do not work for everyone, they do become noticeable, many people misinterpret are not useful in all forms of dementia and they do not them as normal changes of aging. Often those in prevent decline from occurring. Dementia ultimately robs