Module 11 - Cognitive Impairment

ASSIGNMENT - 1

1] Bayo Ogundipe
2] Joseph George
3] Kanwal Aziz Amjad
4] Oladipupo Ogunlade

DATE 13 DEC 2022

1) Cognitive impairment can disrupt the person’s ability to participate in their ADL’s. List three
examples of specific difficulties with ADL’s that could arise, and then provide one action the PSW
could implement to support and assist the client to promote autonomy and dignity with the task.

Cognitive impairment is when a person has trouble memorizing, learning new things, concentrating,
or making decisions that disturb their ordinary life. Cognitive impairment ranges from mild to severe.
Cognitive impaired person may have difficulty in performing skills such as Eating, Bathing or
showering, Grooming, Walking, Dressing and undressing, Transfers, Toileting.

1) ADL task: Dressing

PSW support: As a PSW, I will support my client in different stages such as:
 Encourage choice in the selection of dresses.
 Assist as required but allow client to direct the activity.
 Offer comfortable clothes with elastic waistbands and Velcro closures.
 Limit choices but encourage involvement in the choice of dress.
 Assist closely but encourage individuality.
 Limit choices, select dresses and set them out.
 Select comfortable clothing that is easy to wash.
 Practice simple, one-step commands and gestures.
 Encourage as much individuality as possible.

2) ADL task: Eating

PSW support: As a PSW, I will support my client in different stages such as:
 Enquire about food preferences.
 Request the person to help with meal preparation and meal arrangement.
 Offer adaptive tools if needed.
 Provide support as needed.
 Ask for food preferences.
 Arrange the meal before serving.
 Open packages, uncover serving dish.
 Offer adaptive equipment as needed.
 Observe closely.
 Ask for food preferences.
 Fully set up meal before serving.
 Provide adaptive equipment as needed.
 Monitor closely and be ready to provide feeding support.
 Offer liquids on a regular schedule.
 Allow time adequately to finish eating.
3) ADL task: Toileting
PSW support: As a PSW, I will support my client in different stages such as:
  Monitor and support as needed.
 Encourage fluids even though more bathroom visits may be required.
 Ask frequently if the client needs to use the bathroom.
 Provide close assistance, mainly with transfers.
 Label bathroom door for easy identification.
 Offer toileting on a systematic schedule.
 Expect both bowel and bladder incontinence requiring over-all care.
 Set up timed toileting schedule.

2) Mr. Heron is a 78-year-old client of the agency you are employed with. He lives in a
retirement home but is supported by your agency two mornings each week. He has been a
client of yours for a month. Mr. Heron’s forgetfulness is progressing slowly, but he remains a
person with precise ideas and preferences regarding how things should be done. Mr. Heron’s
occupation was a high school principal. He held that position for over thirty years. He is
married and has two adult children and five grandchildren.

Three times in the last two weeks when you have visited Mr. Heron you have found him
hovering near the elevator in his building. He has appeared slightly agitated and has not
been fully dressed. Today you find him in the same location wearing a suit jacket with no
shirt underneath, and he seems particularly upset. He says to you, “The train is
leaving and I’ve got to be on it or I will be late for school.”

a) How might Mr. Heron’s personality and past experiences influence the behaviour
you witness today? (2 marks)

Dementia can affect a person's personality and habits, which may lead to changes in behaviour.
For example, they may no longer be able to do things they enjoy or follow their interests
without help, or they may experience symptoms of depression. Behavior changes for many
reasons. In dementia, it is usually because the person is losing neurons (cells) in parts of the
brain. The behavior changes we see often depend on which part of the brain is losing cells.
Dementia modifies how a person responds to their environment. They may become angry and
irritated because they cannot follow what is going on. Noise, crowds, conversation and activity
may be over-stimulating and too hard to process or understand.

b) What actions or verbal direction might you do or suggest in order to make Mr.
Heron more comfortable? (2 marks)

 Recognize what is the cause of this behavior change.

 Stand-in an attitude of acceptance.
 Be calm and patient, don’t argue.
  Tell him directly even his cognitive capacity is reduced.
 Get his attention and stand very near to him to maintain eye contact.
 Speak clearly
 Accept what they are saying.

3)Why is depression often mistaken for dementia? (1 mark)

The symptoms of depression are often mistaken for dementia. It is not easy to define the
symptoms because many people with dementia develop signs of depression, such as feelings of
low self-esteem and confidence, tearfulness and appetite, concentration and memory
problems.

4) Using the three stages of dementia, explain how you would support your client with their
meal times and eating in each of the stages. (3 marks)

Mild Stage: In earlier stages of dementia, my client may be able to eat a meal without
problems. However, preparation with multiple steps, like assembling a sandwich or making a
salad, may be too difficult. Simpler meals that don’t require assembling may be best.

Moderate Stage: As the disease advances into middle stages, my client may become “messy” at
meal time, playing with or picking at food. Using utensils gets harder. Appetite begins to
decrease. It’s possible that appetite issues in the middle stages are related to frustration in a
person unable to self-feed.

Severe Stage: During late-stage dementia, your loved one will eventually need to be manually
fed. If you are doing the feeding, alternate a solid food with a sip of liquid. Other tips:

5) A client you are assigned by your home care agency has been diagnosed with Alzheimer’s
Disease – Stage 2. List five safety concerns you would have in the client’s home. (5 marks)

Kitchen

 Install childproof door latches on storage cabinets and drawers designated for breakable
or dangerous items. Lock away all household cleaning products, matches, knives,
scissors, blades, small appliances, and anything valuable.
 If prescription or nonprescription drugs are kept in the kitchen, store them in a locked
cabinet.
 Remove scatter rugs and foam pads from the floor.
 Install safety knobs and an automatic shut-off switch on the stove.
  Do not use or store flammable liquids in the kitchen. Lock them in the garage or in an
outside storage unit.
 Keep a night-light in the kitchen.
 Remove or secure the family "junk drawer." A person with Alzheimer's may eat small
items such as matches, hardware, erasers, plastics, etc.
 Remove artificial fruits and vegetables or food-shaped kitchen magnets, which might
appear to be edible.
 Insert a drain trap in the kitchen sink to catch anything that may otherwise become lost
or clog the plumbing.
 Consider disconnecting the garbage disposal. People with Alzheimer's may place objects
or their own hands in the disposal.

Bedroom

 Anticipate the reasons a person with Alzheimer's disease might get out of bed, such as
hunger, thirst, going to the bathroom, restlessness, and pain. Try to meet these needs
by offering food and fluids and scheduling ample toileting.
 Use a night-light.
 Use a monitoring device (like those used for infants) to alert you to any sounds
indicating a fall or other need for help. This also is an effective device for bathrooms.
 Remove scatter rugs and throw rugs.
 Remove portable space heaters. If you use portable fans, be sure that objects cannot be
placed in the blades.
 Be cautious when using electric mattress pads, electric blankets, electric sheets, and
heating pads, all of which can cause burns and fires. Keep controls out of reach.
 If the person with Alzheimer's disease is at risk of falling out of bed, place mats next to
the bed, as long as they do not create a greater risk of accident.
 Use transfer or mobility aids.
 If you are considering using a hospital-type bed with rails and/or wheels, read the Food
and Drug Administration's safety information.

Bathroom

 Do not leave a severely impaired person with Alzheimer's alone in the bathroom.
 Remove the lock from the bathroom door to prevent the person with Alzheimer's from
getting locked inside.
 Place nonskid adhesive strips, decals, or mats in the tub and shower. If the bathroom is
uncarpeted, consider placing these strips next to the tub, toilet, and sink.
 Use washable wall-to-wall bathroom carpeting to prevent slipping on wet tile floors.
 Use a raised toilet seat with handrails, or install grab bars beside the toilet.
 Install grab bars in the tub/shower. A grab bar in contrasting color to the wall is easier to
see.
 Use a foam rubber faucet cover (often used for small children) in the tub to prevent
serious injury should the person with Alzheimer's fall.
  Use a plastic shower stool and a hand-held shower head to make bathing easier.
 In the shower, tub, and sink, use a single faucet that mixes hot and cold water to avoid
burns.
 Set the water heater at 120°F to avoid scalding tap water.
 Insert drain traps in sinks to catch small items that may be lost or flushed down the
drain.
 Store medications (prescription and nonprescription) in a locked cabinet. Check
medication dates and dispose of outdated medications.
 Remove cleaning products from under the sink, or lock them away.
 Use a night-light.
 Remove small electrical appliances from the bathroom. Cover electrical outlets.
 If a man with Alzheimer's disease uses an electric razor, have him use a mirror outside
the bathroom to avoid water contact.

Living Room

 Clear electrical cords from all areas where people walk.

 Remove scatter rugs or throw rugs. Repair or replace torn carpet.
 Place decals at eye level on sliding glass doors, picture windows, or furniture with large
glass panels to identify the glass pane.
 Do not leave the person with Alzheimer's disease alone with an open fire in the
fireplace. Consider alternative heating sources.
 Keep matches and cigarette lighters out of reach.
 Keep the remote controls for the television, DVD player, and stereo system out of sight.

Laundry Room

 Keep the door to the laundry room locked if possible.

 Lock all laundry products in a cabinet. Laundry detergent pods can be fatal if eaten by
accident.
 Remove large knobs from the washer and dryer if the person with Alzheimer's tampers
with machinery.
 Close and latch the doors and lids to the washer and dryer to prevent objects from being
placed in the machines.

6) Mrs. Green is a client of your agency. She has been diagnosed with multi-infarct
(vascular) dementia. She has been assessed to be in the first stage and is only mildly
forgetful the majority of the time. She is most comfortable when she gets the answers she
needs, although she may forget them in a short period of time. Today she asks you, “Have
you seen my daughter? I haven’t seen her in a very long time.” You know that Mrs. Green’s
daughter visits on a regular basis but you are unsure as to when she was last in.

a) What is dementia?
Dementia is the loss of cognitive functioning such as thinking, memorizing, and reasoning to an
extent that it interferes with a person's daily life and activities.

b) What is meant by multi-infarct dementia?

Multi-infarct dementia is a loss of memory, thinking, judgment, or other mental skills caused by
a series of strokes. A stroke occurs when blood flow to a portion of the brain is impassable for a
short time. If blood flow stops for too long then brain cells die.

c) How might Mrs. Green’s forgetfulness interfere with her safety needs?

Mrs. Green's forgetfulness might interfere with her safety needs as she might end up
forgetting her daily activities, and end up harming herself.

d) Considering effective communication techniques, how would you respond to Mrs.

Green?

I will respond like, yes you are right Mrs. Green. I didn’t see your daughter for a long time
too and:

 Try to address Mrs. Green directly.

 Gain Mrs. Green's attention by maintaining eye contact.
 Speak distinctly
 Help orient the patient.
 Consider having familiar person present at first.
 Support and reassure Mrs. Green.
 Acknowledge when responses are correct.
 Use simple, direct wording.

e) Explain how this approach would be helpful.

Positive communication can help a person with dementia sustain their dignity and self-esteem.
It helps them to keep a sense of self, sustain relationships and maintain their quality of life.
Even as communicating becomes more challenging, there are lots of ways to communicate
meaningfully together.

7) “When a resident is cognitively impaired, does it really matter whether he/she is

attractively dressed? Are we just trying to make an impression on visitors and other
residents? If the confused resident doesn’t know or care how he/she is dressed, why should
we? It’s not bothering him/her.”
It really matters, particularly if a person with dementia can maintain his/her appearance can
promote positive self-esteem. It also helps them to express who we are and. Besides, it is
significant for an individual to maintain good personal hygiene, as it helps to prevent them from
infections. Maintaining the appearance that slips away for one with Alzheimer’s or dementia.

8) You have been assigned a client with a diagnosis of schizophrenia. At the time of their
in-home assessment, the client was well controlled on medication and had excellent
outside support from social work and family who live in the area. Desiring to be prepared
for any change that could potentially occur from non-compliance with their medication
regime, what are three signs that you would take note of that your client may be in
mental health crisis? (3 marks)

Schizophrenia is a serious mental disorder in which people interpret reality abnormally. The
three signs that I would take note is; hallucinations, delusions, and extremely disordered
thinking and behavior that weakens daily functioning.
a) Delusions - Delusions occur in most people with schizophrenia. These are false beliefs that
are not based in reality. For example, you think that you're being harmed or harassed; certain
gestures or comments are directed at you; you have exceptional ability or fame; another person
is in love with you; or a major catastrophe is about to occur.
b) Hallucinations - These usually involve seeing or hearing things that don't exist. Hallucinations
can be in any of the senses, but hearing voices is the most common hallucination.
c) Extremely disorganized or abnormal behavior - This may show in a number of ways, from
childlike silliness to unpredictable agitation. Behavior isn't focused on a goal, so it's hard to do
tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a
complete lack of response, or useless and excessive movement.

9) “The elderly is not at risk of committing suicide.” Do you agree or disagree?

 I disagree
Explain your answer: (2 marks)
There are a few factors that put older adults at risk of suicide, factors that can put stress on
one’s mental health and possibly lead to thoughts of suicide. Experiences of loss such as loss of
health, loved ones, physical mobility and independence. Major life changes such as retirement,
change in financial status, a transition into care facilities. Fewer relationships and connections
as loved ones have passed away. Also, older adults are more likely to live alone because of the
feeling of being a burden to loved ones. Chronic illness and pain.

10) Define: (4 marks)

a) Affective disorder: Affective disorders are the set of psychiatric disorders called mood
disorders. Affective disorders are illnesses that affect the way you think and feel. The symptoms
may be quite severe. In most cases, they won't go away on their own.
Give one example: Depression and bipolar disorder also called manic depression or bipolar
affective disorder. Bipolar disorder is sometimes called manic-depressive illness. That's because
it causes extreme mood swings.

b) Anxiety disorder: An anxiety disorder is a type of mental health condition. If you have an
anxiety disorder, you may respond to certain things and situations with fear and dread. You
may also experience physical signs of anxiety, such as a pounding heart and sweating
Give one example: generalized anxiety disorder, social anxiety disorder or social phobia,
specific phobias.