Dementia is the loss of cognitive function and social function caused by changes in the brain (Chapter 30). (Cognitive relates to knowledge.) Memory and the ability to think and reason are lost. Persons with dementia are confused and disoriented. Their awareness of surroundings is reduced. They may not understand what is happening to and around them. Judgment is poor. They no longer know what is safe and what are dangers. They may access closets, cupboards, or other unsafe and unlocked areas. They may eat or drink cleaning products, drugs, or poisons. Accidents and injuries are great risks.

Identifying the Person

Each person has different treatments, therapies, and activity limits. Life and health are threatened if the wrong care is given.

The person may receive an identification (ID) bracelet when admitted to the agency (Fig. 9-1). The bracelet has the person’s name, room and bed number, birth date, age, doctor, and other identifying information.

You use the bracelet to identify the person before giving care. The assignment sheet states what care to give. To identify the person:

• Compare identifying information on the assignment sheet with that on the ID bracelet (Fig. 9-2). Carefully check the information. Some people have the same first and last names. For example, John Smith is a very common name.

FIGURE 9-2 The ID bracelet is checked against the assignment sheet to accurately identify the person.

• Use at least 2 identifiers. An identifier cannot be the person’s room or bed number. Some agencies require that the person state and spell his or her name and give his or her birth date. Others require using the person’s ID number. Always follow agency policy.

• Call the person by name when checking the ID bracelet. This is a courtesy given as you touch the person and before giving care. Just calling the person by name is not enough to identify him or her. Confused, disoriented, drowsy, hard-of-hearing, or distracted persons may answer to any name.

See Focus on Communication: Identifying the Person.

See Promoting Safety and Comfort: Identifying the Person.

Focus on Communication

Identifying the Person

To identify the person, call the person by name. Ask to see his or her ID bracelet. For example: “Hello, Mr. Hall. May I see your ID bracelet?” Then ask for 2 identifiers. You can say: “Please tell me your full name and birth date.” Compare the identifiers with the information on the ID bracelet and your assignment sheet.

For some persons, identifying themselves is annoying. The person may say: “Do I have to say it again? You know who I am.” Be polite. Explain why you check the person’s identity. You can say: “It is important to check so I give care to the right person. It is for your safety.” Thank the person. Use his or her title and name. For example: “Thank you, Mr. Green.”

Identifying Nursing Center Residents

Alert and oriented residents may choose not to wear ID bracelets. This is noted on the person’s care plan. Follow center policy and the care plan to identify the person.

Some nursing centers have photo ID systems (Fig. 9-3). The person’s photo is taken on admission. Then it is placed in the person’s medical record. If your center uses such a system, learn to use it safely.

FIGURE 9-3 The person’s photo is at the head-board. Her name is under the photo. The nursing assistant uses the photo to identify the person.

Preventing Burns

Smoking, spilled hot liquids, electrical items, and very hot water (sinks, tubs, showers) are common causes of burns. To prevent burns:

• Assist with eating and drinking as needed. Spilled hot food or fluids can cause burns.

• Be careful when carrying hot food and fluids, especially when near patients or residents.

• Keep hot food and fluids away from counter and table edges.

• Do not pour hot liquids near a person.

• Turn on cold water first, then hot water. Turn off hot water first, then cold water.

• Measure bath or shower water temperature (Chapter 16). Check it before a person gets into the tub or shower.

• Check for “hot spots” in bath water. Move your hand back and forth.

• Do not let the person sleep with a heating pad or an electric blanket.

• Follow safety guidelines when applying heat and cold (Chapter 24).

• Provide safety measures for persons who smoke.

• Be sure people smoke only in smoking areas.

• Do not leave smoking materials at the bedside.

• Supervise the smoking of persons who cannot protect themselves.

• Do not allow smoking in bed.

• Do not allow smoking where oxygen is used or stored (Chapter 26).

• Be alert to ashes that may fall onto a person.

Preventing Poisoning

A poison is any substance harmful to the body when ingested, inhaled, injected, or absorbed through the skin. Drugs and household products are common poisons. Poisoning in adults may be from carelessness, confusion, or poor vision when reading labels. To prevent poisoning:

• Make sure patients and residents cannot reach hazardous materials (p. 106).

• Follow agency policy for storing personal care items. Shampoo, mouthwash, lotion, perfume, and deodorant are examples. These products are harmful when swallowed.

• Keep harmful products in their original containers.

• Leave the original label on harmful products.

• Read all labels carefully before using a product.

Preventing Suffocation

Suffocation is when breathing stops from the lack of oxygen. Death occurs if the person does not start breathing. Common causes include choking, drowning, inhaling gas or smoke, strangulation, and electrical shock (p. 105).

Measures to prevent suffocation are listed in Box 9-1. Clear the airway if the person is choking.

Box 9-1 Preventing Suffocation

• Cut food into small, bite-sized pieces for persons who cannot do so themselves.

• Make sure dentures fit properly and are in place.

• Make sure the person can chew and swallow the food served.

• Report loose teeth or dentures.

• Check the care plan for swallowing problems before serving food (including snacks) or fluids. The person may ask for something that he or she cannot swallow.

• Tell the nurse at once if the person has swallowing problems.

• Do not give oral foods or fluids to persons with feeding tubes (Chapter 20).

• Follow aspiration precautions (Chapter 20).

• Do not leave a person unattended in a bathtub or shower.

• Move all persons from the area if you smell smoke.

• Position the person in bed properly (Chapter 15).

• Use bed rails correctly (Chapter 10).

• Use restraints correctly (Chapter 11).

• Prevent entrapment in the bed system (Chapter 15).

• Do not use power strips for care equipment.

• See “Preventing Equipment Accidents” (p. 104).

Choking

Foreign bodies can obstruct the airway. This is called choking or foreign-body airway obstruction (FBAO). Air cannot pass through the airways into the lungs. The body does not get enough oxygen. Death can result.

Choking often occurs during eating. A large, poorly chewed piece of meat is the most common cause. Laughing and talking while eating also are common causes. So is excessive alcohol intake.

Unconscious persons can choke. Common causes are aspiration of vomitus and the tongue falling back into the airway.

Foreign bodies can cause mild or severe airway obstruction. With mild airway obstruction, some air moves in and out of the lungs. The person is conscious and usually can speak. Often forceful coughing can remove the object. Breathing may sound like wheezing between coughs. For mild airway obstruction:

• Stay with the person.

• Encourage the person to keep coughing to expel the object.

• Do not interrupt the person’s efforts to clear the airway. If the person is breathing and coughing, abdominal thrusts are not needed.

• If the obstruction persists, call for help.

A person with severe airway obstruction has difficulty breathing. Air does not move in and out of the lungs. The person may not be able to breathe, speak, or cough. If able to cough, the cough is of poor quality. When the person tries to inhale, there is no noise or a high-pitched noise. The person may appear pale and cyanotic (bluish color).

The conscious person clutches at the throat (Fig. 9-4). Clutching at the throat is often called the “universal sign of choking.” The conscious person is very frightened. If the obstruction is not removed, the person will die. Severe airway obstruction is an emergency.