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cna skills lol my name is Anna roads I'm a registered dietitian
today we're going to be discussing probably Havers often encountered
countered with a client who has dementia when
when you're trying to feed them will also be discussing interventions that
might be useful cna skills
in counteracting these problems clients with dementia
are at high risk for poor nutrition and for weight loss
they can be quite difficult to feed or tone courage to eat
some recent research has shown that people with Alzheimer's disease actually
need more calories cna skills
than the same people up the same age however due to their disease processes
day often forget to eat don't realize they're hungry
have trouble using utensils are resistant to being
cna skills sad can't sit still long enough to complete an entire meal
or may not remember how to chew or swallow
health care givers we want to keep our client is independent as possible
and yet we also need to ensure that they are eating
we also need to remember treat our clients cna skills
will our memory losses with respect and dignity
and to speak to them as they are adults
its often easy to me talk to a client's
as if they're a two-year-old because they're acting like it
I'll but we have to remember that they are adults
join us in the dining room while we observed
a caregiver serving some clients watch the first two beach scenario cna training skills
where the caregiver ignores the problem behavior are actually contributes to it
than the fact that scene where he will be intervening appropriately
the first scene will be showing distractions
often our client with dementia will be distracted by other people cna skills
bob by playing with non-food items or food items
on noise can be a distraction or given too many choices
in this foreseen see if you can pick out of some other problem
you
cna skill you know
now watch the caregiver
interact more appropriately up
he might all move a client 2 I'll quieter area
or not place arm to clients next to each other so they can't be
job touching each other remove items that are distracting I
a client with dementia doesn't need an attractive centerpiece on the table
have quiet music you soft voices
in the dining the and I'll cna skills
limit choices %ah don't ask them numerous questions give them one or two
choices
yeah ended in this incident how are you today
good I'm
John are you today had why it to get there we had
that as the rigid as yeah I
right thing I just imagine today we're
you here rugby gladly pay
came in at all people need you want black cna skill
okay me the next problem behavior can be inappropriate actions
a client job maybe jumping up and down from the table are banging on the table
might be mixing their foods together or arm
eating non edible food items frequently a client with dementia will
hide food fell you have put it in a pocket or
put it in a parse I'll they might be eating
non finger foods with their fingers all up some clients will only drink for
liquids or
only eat one food item or near the food item all over their face
see what abut caregivers
doing in this first scenario
all
one all Motlop cna skills
him 11 warm
one my all mall
here you sit down now
red she's all all down
officer in that scene the caregiver was not very effective was he
just kind of ignored the situation up
a better way to handle things would be if you have a client who is impatient
banging on the table constantly getting up cna skills
try to feed them first give them their food immediately
I'll again up if client is eating
non edible items were playing with things remove those items from the table
up if they're hiding food up asked to hold that food for them if they're
not willing for you to do that don't force them to
but then possibly remember later on to get that food back from them
up when they go back to their homes hop if a client
job is having trouble abuse improper utensils help
guide of Cup to put up for them he'll say
know mister Jones you might want to use your four let me put this in your right
hand cna training skills
of for making food together arm
of a one food item at a time this frequently works with
with patients who are confused stake if they can know what to do with one food
item
they get three or four they get confused
now watch where the caregivers using some interventions to
to get the meal time to go more smoothly my
Paul word a my
port here
my him Richard cna skills
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human cna training videos skills
spent are you today
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showing them how to repair all K
the here all day
period all something
area the headline cna training video skills
on one when you get there John
and I C and whatever
thanks
sorry today
good Shari'a of your problem
our behavior with a confused client maybe that they just stepped
and don't know what to do with the phone or they may refuse to open their mouth
up often you'll see someone just
stay I date they don't even know how to initiate
mealtime or client may be falling asleep at the wheel
hi may actually put their head is into their plate he'll be seeing a scene
are now where where the caregivers not very effective cna skills
in any of these manners fashion and think about what you would do
differently
if you with a caregiver this
gonna this man come on
come on wake up honey 1g
man is a really good mind he did
wanted or needed this day
a boy mine one
time this year money today
the caregiver was not very patient was he he certainly didn't spend any time
trying to get this client to eat
of some things that you might do that are more effective
first thing would be to to wake your client gently if they are asleep
treat them as a person talk to them
let them know what's its mealtime when you do try to get them tiiiii might need
to queue them which means cna skills
say pick you for up pick your spoon up now now playing
the arms phone up to your mouth you might even need to be say
now sure your phone sometimes you need to assist
with what's called a hand on hand technique and that is actually taking
your hand
placing it over the client's hand holding the spawn
putting the food into they're putting spoon into the food
and then bring it up sometimes she'll do that two or three times
and then the client will be able to continue doing it themselves
sometimes you have to do that the entire meal that's still better than actually
feeding the client himself because it is getting them to use their own muscles
have a client's clamping their mouth shut and singing to not want to eat
there several techniques that can be used
you can just say open your mouth now and see if that works
if not you might strokes your cheek or stock under their care and and they
might cna skills
open their mouth that way never grab their mouth
and for sale just gently stroked her cheek
and it might work if that doesn't work
you might need to bring this phone up to your clients let
frequently once the spoon had slipped their mouth fell open
if that doesn't work if they've absolutely
clamp them all shot you are not going to force them to eat
but you bite continue to try or wait a few minutes and then come back and try
those same techniques
now sit back and watch and see if the
caregiver does a better job this time them
this man wait no
hi
money now
here
I'm Cohen know you're busy period under today
with a good
his injury day
hey y'all cna skills
a good mashed potatoes
here then i right here in China
i'm happier minor
banner here now banana real
you got it
PO
and the last problem that will be discussing is when a client has
difficulty feeding themselves for inability to feed himself
and this happens as
arm as the dementia progresses often
a client might have trouble using their utensils they might not remember
how to use them or on
they're unaware that there even there the other thing clients might do
is just pick up an entire piece %uh me you're an entire roll
and stick it in their mouth and try to chill and
up fifth can be caused by a couple of things one
if if they unsuccessfully been able to cut their food they may just
give up failed just eat it hor
not being aware of their utensils at all they might just stop this is how I eat
that could have been a very unsafe situation
with the client putting in tyre piece of meat miss now
I'm trying to chill it I of the caregiver was not observed the client
client could have been choking cna skills
some techniques to use
when wanna clients having difficulty in
using utensils would be to just saw first-born
most foods can be eaten with us fallin in if they only have one choice
they'll be able to use it if a client is actually having physical difficulty
holding the utensils
or if for some reason they can't
bend to their rest or anything like that you may need to get the occupational
therapy department involved
up occupational therapists arm
can provide up what's called adaptive equipment
om different
sometimes I'll put troops on arm the utensils or ID title might be bent
so they don't have to bend their wrists of have all sorts of equipment
job and techniques to have are are
client I'll be able to feed themselves that will be discussed a little further
and cna skills
in another tape of but it's important to know that with
with trouble with utensils there are ways around that to keep the client
self feeding again
if a client just cannot use utensil or AQAP
he may need to feed them but prior to feeding you should again try to hand
over hand technique
are sometimes that is an of to
get the client to feed themselves are you can do that with the utensils as he
explained before
or are with a cop you can actually physically place your clients hands on
the cup
you put your hands over and bring the cup up to their mile
any anytime you can get the client to be using their
own all muscles
it's much better and it might just
trigger their mind hell yes this is what I'm supposed to be doing
another thing that's very important is
all you need to be cutting up your clients food and making sure that
they're safe
home that way if they keep the peace food up
and put it in the mall it won't be a large piece of meat it would just be a
tiny piece
as as the caregiver you need to be
observing as much as possible to keep
thing safe to keep your client able to cna skills
keep himself if possible that if they're not able to feed themselves
you're there to help now watch
arm and see what the caregiver does in this situation dont
renewing their here shuttles
you need here me happier all okay
we have %um here
asserted
you
all their here anyway
now we're going to discuss the caregivers responsibilities
in mealtime our preparation
for the dementia patient again
we've gone over this in the past but it it's worth repeating
up need to start with washing your hands
tell the client that its mealtime and
what's being served keen probably will need to say
not just that it's mail time but it's lunchtime
missus charms and today we are having cna skills
green beans mashed potatoes and
roast chicken head you might wanna interspersed something like doesn't that
sound good
archie hungry you need to try to get the client in the mood for
eating and wash their hands brush 30
I take them to the bathroom if they say they don't wanna go you
may want to take them anyway up because frequently
a client with dimension is not going to tell up
make sure that the clothes are dry and that they're appropriately dressed
you would not want to be sitting in what clothing while you were eating
some 8 make sure that there's are dry
at the client seeded No upright position to prevent aspiration
make sure that their chair back is straight place a close protector on them
let them know what you're doing
and don't call it a BM using the word bid is
is kinda om demeaning to them and much you can say is
misses chance but I put this close protector on you to keep your clothes
clean
if a client does not want something going
over their head keep cross but we do wanna keep keep them covered up because
chances are they will be spilling make sure that they're
going to receive the correct tray and you do this by looking at the tray card
and her client's name tag with the dementia client is probably not
best to rely on asking them what their name s because
many people will agree to whatever you say if you say are you missus jones
they'll say yes cna skills
are you missus smith health say yes to that also
so you really do need to be looking at they are
name and and tell you
definitely know who they are make sure that they're receiving the proper diet
it's your responsibility to know all what
food is appropriate for for which diet your client is not going to be able to
say to you I'm on a low salt diet
I shouldn't have that sausage you're going to need to do that yourself
take the photo of the tray and place it in front of the client
and you do this because it's more home-like at home you would not be
sitting with the tray at the table that
looks more like fast food we want to keep our settings says
at home like as possible Cup foods into bite-size pieces
and make make sure that everything is
easily eat he'll need to butter the cna skills bread
you'll need to open all cartons om open rappers
of assume that your clients can't do that season the foods
to enhance the flavor *** people who would be able to answer you could ask
would you like your eggs salted pepper I'll
if they can't om all you don't know what they like you can either ask another
a caregiver that might know that person more for
more familiarly or season at cna skills
up just slightly season it is maybe you would want it done
make sure that all the items are within
clients reach so that they can
of reached adolescent male that they can reach a cup of coffee
some clients will find too many things confusing
and they need maybe to have one item at a time
might need to have only their mashed potatoes on
plate are only their green beans if
if they're getting two or three beverages they get one at a time
during the meal time one chipset on the client strays up
if you are not assigned to feed a specific client still need to be
monitoring the dining
what this means is you walk around ob
the different tables and if you see clients who aren't eating
you PQ them encourage them to eat someone's not eating
ask why they're not a do they not like the full do they want something
different cna kills
maybe they need help getting started once they get started take
finish all eating themselves
up encourage socialization that might stimulate
someone's appetite you can get your clients
of talking about the whole don't distract them by
talking about a football game talking about something else the
keep I'll food focused in food or are
related are as the patient gets more
to mitad demented as the the process is going along
they may not be able to participate conversation they may need to
focused solely on the task at hand which is eating
and I'll often people might need to be at a table where there's only one or two
people at the table because anyone else around them
is distracting them wanna keep
%uh in dining room environment quiet and call
don't wanna have loud music playing if there's
TV in the dining room it's probably not appropriate to have it on
all but want to keep things very call
feeding clients he watched trial allow the client to
feed themselves as much as possible so if you know that someone can handle a
piece of bread
you might start with the bread left them up hold the board themselves
let them know what their eating often
arm with dementia they might look at the food but it doesn't quite process
you need to let them know you might remind them again this is lunchtime
and you're having a bowl of soup the for
a try verbally killing your clients missus sholls cna training videos
pick your spoon up put it into the carrots
bring it up to your mouth that might be enough to get someone started eating
or you might need to remind them to keep eating
or gently wake them up if the falling asleep birthday getting distracted
looking away bring them back to to the plate
if you're going to be actually physically
being someone you need to be sitting and being at level
and that that's for two reasons one of
if you're standing above them and feeling the stone is coming in at the
wrong angle and it would be easier for them to aspirate
the other is secure towering over them
cue not sitting in and communicating with them
and and you need to be sitting and and cna training skills
in talking to them
don't rush you need to feed the client
at their own pace might take them a very long time to chill a bite
hop if they're prone to holding food in their mouths you need to be aware of
that
very important with dementia clients to give them one
or two bites food at the most and then give them a sip of something to drink
and that should help if they do have any residual
food hop that will help bring it I bring it back down
feed food separately don't mix them together
you wouldn't want to eat your green beans mixed with your ice cream can skills
he wanna keep the food subplot sometimes with the dementia client
nixon foods together maybe the only way
to get them up to eat that would be indicated on their patient care plan
and that would only be used in specific om
situations typically you would not mix that builds together cna skills video
hop you might need to remind your client
true and to swallow sometimes people get the food in her mouth and they won't
remember it
or they can't remember what to do with sometimes
on if someone's having trouble arms swallowing
and its due to their demand sure that they're forgetting TE
that it's not due to a physical stalin problem cna skills videos
rubbing their neck like this will stimulate the Swale
and again you do it very chip and you would say
house follow missus schott while you're doing that
need to be up spring for any difficulty in swallowing
clients with dementia are at a much greater risk for choking on food and
fluids and other people cna skills
and that's partly because they're not consistent in what they're doing
y los following mechanisms are somewhat automated
we don't have to think about as as the
client is getting more and more dementia their abilities to swallow our
declining watch for poaching are pocketing
food that's where they get the food they make sure what up than you might think
that followed it
but if their cheek is getting bigger and bigger
like bad there they're not following up their
their pocket up
if after feeding arm someone their voice gets
Gergely here have watery sounding home
or that coffee after they eat or drink that is an indication that there's
following and that would be
a situation where you'd want to let the nurse now hot you need to report and
record how much the client is
eat when you're done eating and report to the nurse
any unusual behavior or or information
sometimes the client who normally eat well suddenly seem shy forgot
howdy and and that can happen with dementia
hi then you need to let the nurse know that of
report your supervisor any change in appetite
intake if someone is vomiting if they're having difficulty eating after
complaining of nausea
anything out of the ordinary needs to be reported to your supervisor
if a client our 8 poorly at that me
his supervisor now they might need to have a job
staff offer to them that afternoon strictly someone doesn't eat well
at that may also take something an hour or two later
need to be aware of which appear over our clients are
are receiving diabetic or up special diets
those people in particular the nurse will need to know how much they be
also all most facilities will cna skills
have a record of how much every client eats
a specially other clients with dementia because they aren't able to
tell their fitfully not even able to say they're hungry between meals
are so those people have on have food intakes
and input and output records %um to follow those according
to of the policy of your facility
feet clients mealtimes is is a big portion of your day and there's a
there's a lot of steps involved
but it can be a very fun and rewarding time also it's a time where you
is that and get interact with with your client cna training videos skills
ob cannot rushing around doing things but you get said and treat them as
I'll as people I help you joi
I'm feeling your clients is as you continue on your training
home cna skills