Cognitive

Assisting the Patient with Cognitive Impairment
Lesson Plan and Speaking Notes

Just imagine, a strange woman barges into your house uninvited. She mutters something you don't understand, and starts rummaging through your personal possessions. Then, she comes toward you. How frightening. This will never happen to me, you're probably thinking. Well, what I've just described is how a confused patient might interpret the nursing assistant entering her room to assist her with morning care. We want to consider how the world looks and feels to a patient with cognitive impairment, and we want to learn to communicate effectively to enhance the patient's quality of life.

Facts about Cognitive Impairments

Causes of:
Dementia
Alzheimer's
Stroke

Types of:
Memory Problem
Impaired Decision-making

Cognitive Impairment Affects:

Communication

Ability to perform Activities of Daily Living

Effects all areas of the patient's life: appetite, socialization, mobility, independence, dignity

Changes in the patient's cognitive status can indicate a variety of serious problems, such as urinary tract infection or dehydration.

Goals for Patients with Cognitive Impairments:

Maintain the patient's safety

Improve or maintain the patient's independence in Activities of Daily Living

Promote the best communication possible, so the patient's needs and desires are met

Promote the patient's happiness

Improve or maintain the patient's ability to socialize with others

Promote the patient's dignity

Memory Problems

Two Kinds:
Short term memory problem - cannot recall after 5 minutes
Long term memory problem - cannot recall long past

Examples - Cannot Recall:
Time, place, or person
Current season or year
Location of room
Meal times
Family or staff names or faces

What are some examples of memory problems you have observed in patients?

Interventions for Patients with Cognitive Impairments Fall into Three Main Categories:

Communication
Assisting with the Activities of Daily Living
Altering the patient's environment

Communication

Introduce yourself and call patient by name with each interaction

Allow patient ample time to absorb and respond to information

Assisting with the Activities of Daily Living

Follow the same routine with patient's care each day

Explain all procedures and treatments to patient

The more stability there is in the patient's routine, the less confusing it will be to the patient.

Altering the Patient's Environment

Provide clock, calendar, and family photos in patient's room

Avoid changes in patient's environment

What are some other interventions you think would help patients with memory problems?

Goals for Patients with Memory Problems

Patient will demonstrate ability to remember names of family and staff members

Patient will demonstrate ability to remember mealtimes

Impaired Decision-making

Have you ever had trouble making a decision? Think for a few moments about the last time you had trouble making up your mind about something. How did it make you feel?

Impaired decision-making is very stressful for the patient, and affects his safety and autonomy.

Types of Decision-making Problems
Slow in making decisions
Unable to make decisions
Makes bad decisions
Becomes agitated or frustrated when confronted with decisions

What are some examples of impaired decision-making you have observed in patients?

Interventions for Patients with Decision-making Problems

Communication

Offer patient two simple choices to reduce the stress of decision making and increase patient's sense of autonomy

Allow patient ample time to absorb and respond to information

Assisting with the Activities of Daily Living

Follow the same routine with patient's care each day

Altering the Patient's Environment

Provide a calm, therapeutic environment and structured routine

Avoid changes in patient's environment

What are some other interventions you think would help patients with impaired decision-making?

Observe the patient's behavior, actions, appearance, and environment for signs of deteriorating cognitive ability.

You should observe the patient for changes in cognitive status, and report to the charge nurse any changes in the patient's ability to:
Remember
Make decisions
Follow directions
Perform simple tasks

Also report to the charge nurse any changes in the patient's:
Level of consciousness
Response to stimuli
Basic reaction time
Level of basic awareness

We need to deal with each patient as an individual with unique needs.

Every patient with cognitive impairment has a care plan for that specific problem. You should be aware of what that is, and you should be familiar with all the goals and interventions.

The care plan should match what is on the Nursing Assistant Assignment sheet, and it should match what is actually going on with the patient. If it doesn't, you need to let the charge nurse know.

Besides bringing to the nurse's attention what doesn't match, you can also make suggestions for the care plan about what you think works well with the patient and what doesn't. We need your ideas to share with the entire staff.

You will often be the first person to notice changes in the patient's cognitive status since you are in such frequent and close contact with the patient.