21 COGNITIVEDISORDERS 531
action. For example, the client may get angry and
yell at the nurse for no discernible reason. The nurse
can leave the client for about 5 or 10 minutes then
return without referring to the previous outburst.
The client may have little or no memory of the inci-
dent and may be pleased to see the nurse on his or
her return.
Going alongmeans providing emotional re-
assurance to clients without correcting their misper-
ception or delusion. The nurse does not engage in delu-
sional ideas or reinforce them, but he or she does not
deny or confront their existence. For example, a client
is fretful, repeatedly saying, “I’m so worried about the
children. I hope they’re OK,”and speaking as though
his adult children were small and needed protection.
The nurse could reassure the client by saying, “There’s
no need to worry; the children are just fine”(going
along), which is likely to calm the client. The nurse
has responded effectively to the client’s worry without
addressing the reality of the client’s concern. Going
along is a specific intervention for clients with demen-
tia and should not be used with those experiencing
delusions whose conditions are expected to improve.
The nurse can use reframing techniques to offer
clients different points of view or explanations for sit-
uations or events. Because of their perceptual difficul-
ties and confusion, clients frequently interpret envi-
ronmental stimuli as threatening. Loud noises often
frighten and agitate them. For example, one client
may interpret another’s yelling as a direct personal
threat. The nurse can provide an alternative explana-
tion such as “That lady has many family problems,
and she yells sometimes because she’s frustrated”(re-
framing). Alternative explanations often reassure
clients with dementia, who become less frightened
and agitated (Allen-Burge et al., 1999).◗ CAREGIVEREDUCATION: DEMENTIA
- To help clients cope with memory loss and confusion, encourage them to follow their usual routine and
habits of bathing, and dressing rather than imposing new ones. - Because safety from injury is a risk for clients with dementia, caregivers should encourage as much indepen-
dence as possible for the client in performing self-care responsibilities but should provide support when client
engages in potentially dangerous activities such as cooking or bathing. For example, sit in the kitchen and
chat with the client while he or she is cooking or sit outside the door while the client is bathing rather than
doing it for him or her. - Clients who are bored, alone, and not engaged in any activities tend to become more agitated and irritable.
Try to encourage clients to participate in activities of interest. - Clients with dementia frequently believe their physical safety is jeopardized and may feel threatened or suspi-
cious and paranoid. These feelings can lead to agitated or erratic behavior and compromise the client’s safety.
Avoid direct confrontation of the client’s fears or paranoia, but try to anticipate and eliminate the environmen-
tal triggers that cause them such as the presence of strangers, changes in the daily routine, or impaired
memory. - Monitor food and fluid intake to ensure that clients are getting adequate fluid and nutrition because these
clients often eat poorly, have a limited appetite, are distracted at mealtime, or do not respond to normal cues
when thirsty. Independence in eating and drinking should be encouraged as much as possible. Try to avoid
feeding the client until this becomes necessary. Sit with the client at meals to provide cues to continue eating,
try to minimize noise and undue distraction, prepare desirable and nutritious snacks and food that the client
can eat without the use of utensils such as sandwiches or fresh fruit. - Promote proper bowel elimination patterns by giving increased fluids and fiber or prompts as needed.
Remind the client to urinate, but try to avoid initiating use of the bathroom. For clients who are incontinent,
sanitary pads or adult diapers should be used but should be checked frequently and changed promptly
when soiled to avoid infection, skin irritation, and unpleasant odors. - Promote an adequate balance of rest and activity in the client’s daily routine by encouraging and assisting
client to engage in mild physical activity such as walking, which helps the client feel better, stimulates bowel
elimination, and helps the client sleep better at night. Client needs to rest during the day at intervals but
should be discouraged from extensive daytime napping, which may interfere with adequate sleep at night. - Monitor chronic health problems carefully, have the client visit a physician regularly, and inform all physi-
cians and health care providers about all medications taken including over-the-counter medications, dietary
supplements, and herbal preparations. - Check with the physician before taking any nonprescription preparation; make sure the client avoids alcohol
and recreational drugs. - Monitor your own health and needs for socialization, recreation, and respite from the caregiver role to avoid
or diminish caregiver role strain.