Caring for clients with delirium or dementia

As a nursing assistant, you will be caring for clients that have either delirium or dementia. You need to be familiar with these diseases and what you can do to provide the best care to your clients.

Both delirium and dementia lead to a decline in various mental functions, including memory, thinking, language, behavior, mood, and personality. Delirium has a sudden onset, while the onset of dementia is gradual.

Delirium occurs as a consequence of an underlying condition, like an infection, medication toxicity, a recent surgery, or serious illness, and signs and symptoms often fluctuate, meaning they come and go.

On the other hand, dementia is caused by structural changes in the brain; it progressively gets worse over time. Delirium can last hours or weeks, and it is reversible when the underlying cause is addressed promptly.

Okay, let’s take a closer look at delirium, which is a medical emergency and must be recognized and treated promptly.

As a nursing assistant, you might notice your client isn’t their usual self, which could signal the onset of delirium.

You might notice client behaviors, like disorientation, where they don't know where they are or what day it is, or they might have difficulty concentrating.

Their level of activity will often fluctuate between agitated, angry, and aggressive to being drowsy, withdrawn, and depressed.

Their speech may not make sense; they could experience hallucinations, which means they see, hear, or even smell things that are not actually real but are very real to them; or they could experience delusions, where they believe things that are not true.

Now, there are some general considerations to keep in mind when caring for a client with delirium. First, it’s really important to keep your client safe.

Check the nurse and client’s care plan for interventions, such as creating a calm environment by reducing environmental noise; reorienting the client to person, place, time, and procedures; and ensuring they have their glasses and hearing aids as needed to avoid sensory deprivation.

Restraints should be avoided. Some clients respond to music therapy or other relaxation techniques, such as massage or warm blankets.

When communicating to the client, remember to speak in a clear, calm voice using short, simple sentences. Encouraging family members to visit and bring in familiar objects or photographs can also be helpful.

Finally, you could be asked to assist with client care, such as pain management; maintaining skin integrity; promoting nutrition, hydration, and sleep; and assisting with mobility as tolerated.

Okay, let’s switch gears and talk about dementia. Τhere are some behaviors commonly exhibited by clients with dementia.

These include wandering and getting lost; restlessness, or the constant need to move around or pace back and forth; repetitive speech or actions, rummaging or hiding things; and agitation, where the client becomes excessively upset.

Other common behaviors include catastrophic reactions, meaning that they react excessively to something seemingly trivial; sundowning, meaning that symptoms of confusion or loss of orientation may intensify late in the afternoon or evening; as well as inappropriate sexual behavior.

Also, clients with dementia can have delusions; hallucinations; as well as abnormal motor behavior, like resting tremors, stiff and slow movements, and limited facial expressions.

These behaviors can be triggered by various physical and emotional causes. First of all, the client’s room can be overwhelming due to loud noises and excessive decorations, or it can be too big or too small for the client.

Also, clients can feel uncomfortable and insecure when they’re in a new environment, such as a hospital or a long-term care facility.

A person can also exhibit strange behaviors when they’re asked to perform a new or complicated task.

Finally, these behaviors can be the person’s way to communicate a physical need, such as hunger, thirst, and need to use the bathroom, or an emotional need, such as missing their family.

It’s very important to find and address the underlying cause instead of accepting them as normal for a client with dementia. Many times, a change in a client’s behavior may be the first sign of a new medical problem.

For instance, a client that develops a new urinary tract infection can become more agitated or seem restless as the only sign. Observe the client and try to understand the reason behind the behavior they’re exhibiting.

Keep track of when and where the behavior occurs and the situation and condition that triggers it. Remember to report your observations to the nurse and document them.

When caring for a client with dementia, there are some common care tips you need to remember. First, it is important to help maintain a safe and comfortable environment in order to avoid overwhelming the client and triggering behaviors, such as wandering.

Also, clients with dementia often have hearing problems, so when entering the client’s room, don’t forget to knock and announce yourself before touching the client to avoid startling them.

Try to speak clearly and use a calm tone of voice. Another important tip is to use simple words and short sentences that a person with dementia can process.

Also, consider holding the person’s arm when interacting with them to show affection and fondness. It can also be helpful to use hand gestures to better communicate an instruction.

Avoid negatively phrased commands such as, “Don’t do that;” instead, use positive instructions, like, “Please do that,” which are easier to follow.

Also, give them time to respond or follow your command. As dementia progresses and the client’s oral skills deteriorate, observe their body language closely to understand them better.

It’s also important to avoid arguing with and upsetting the client. People with dementia also have emotional needs so help them feel safe, appreciated, and show them affection.

People with dementia can show vastly different behavior from day to day, making it difficult to work with them. So, you have to persist and be patient with them.

It’s also essential to allow them to participate in their daily activities and personal care as much as possible because this will boost their self-esteem and well-being.

When providing personal care for a client with dementia, collect all the necessary supplies in advance in order to complete the task quickly and efficiently without rushing the procedure.

It’s also important to encourage them to continue activities that they used to enjoy, provided they can do so safely. Also, help them stay oriented in time and place by using visual cues, such as a calendar or a large clock in the resident’s unit.

Also, try to maintain a regular schedule in order to reduce stress and confusion. At all times, keep an eye on the client and protect them from falling, wandering, or leaving the healthcare facility.

Okay, when caring for a client with dementia, a technique that can be used is validation therapy. With this approach, you accept the client’s reality and divert the conversation by encouraging them to talk about events from the past that they remember better.

For example, you can sit down with the client and ask them to tell you stories about their partner, distracting them from wanting to leave the healthcare facility. This way, you protect the person’s feelings, understand their needs, and gain their trust.

Alright, now, when assisting with personal care procedures or grooming, there are some specific considerations to keep in mind.

Let’s start with bathing, which can be upsetting for a client with dementia. In order to reduce the stress, tell the client, “It’s time to freshen up,” and avoid using the word “bath.”

Watch out for a slippery bathtub or bathroom floor; place a non-slip mat and secure it to prevent a fall. Check the water to make sure the temperature is safe and comfortable for the client.

Encourage them to participate as much as possible. At all times, respect the client’s privacy and modesty by remembering to close the room’s door, all window covers, and ensuring the client is properly covered.

Clients with dementia will also require assistance with dressing and undressing. Some clients will only need minimal assistance, like help selecting clothes, while others will require your assistance for the entire procedure of dressing and undressing.

If the client seems to have trouble choosing clothes, provide limited choices to make the decision easier.