8.1 Care Impaired Overview

8.1 Care Impaired Overview

On the Ohio State Tested Nurse Aide (STNA) exam, the "Care of the Cognitively Impaired" content area tests how you care for residents with dementia, Alzheimer's disease, and the behaviors that come with cognitive loss. The written knowledge test, administered by D&S Diversified Technologies (D&SDT/Headmaster), has 79 multiple-choice questions in 90 minutes, and you must score 70% or better (about 55 correct) to pass. Cognitive-care items reliably appear, so master the distinctions below.

The three D's: dementia, delirium, depression

A classic exam trap is confusing these. The stem gives you onset and reversibility clues.

When a resident with stable dementia becomes suddenly more confused, do not assume the dementia "got worse." That is a change in condition (often delirium from a urinary tract infection or dehydration) and you report it to the nurse immediately.

Alzheimer's disease basics

Alzheimer's is the most common cause of dementia. It is progressive and irreversible, moving from early (forgetfulness, repeating questions), to middle (wandering, agitation, needing help with activities of daily living), to late (incontinence, loss of speech, total dependence). The STNA's job is to maintain dignity, safety, and the highest level of function the resident still has.

Behaviors are communication

Wandering, agitation, rummaging, and sundowning (increased confusion and restlessness in late afternoon/evening) are not deliberate misbehavior. They usually signal an unmet need: pain, hunger, full bladder, fatigue, fear, or overstimulation. The competent STNA asks, "What is this behavior telling me?" rather than trying to stop it.

Core communication rules

These show up repeatedly in question stems as the correct action:

• Approach from the front, make eye contact, identify yourself, and call the resident by name.
• Speak calmly and slowly in short sentences; give one instruction at a time.
• Ask yes/no questions rather than open-ended choices when comprehension is low.
• Do not argue, quiz, reason, or correct a confused resident; it causes agitation.
• Keep routines consistent; familiarity reduces anxiety.

Reversible causes you must never miss

Because delirium is treatable, the STNA's observations can be life-saving. Report any of these to the nurse: new or increased confusion, fever, decreased urine output or foul-smelling urine (UTI), poor fluid intake, a recent fall, or a new medication. A confused resident cannot reliably report symptoms, so your eyes and documentation are the early-warning system.

Person-centered care is the framework

Ohio long-term-care expects person-centered care: the resident's history, preferences, and routines guide the care, not the other way around. Knowing a resident was a teacher, a farmer, or a mother of six gives you reminiscence material and redirection topics. A care plan that honors lifelong habits (a morning coffee, a favorite hymn, going to bed early) prevents far more behavior than any reactive technique.

Common terms you should be able to define

Worked example

Stem: "A resident with Alzheimer's keeps trying to leave, saying she must 'pick up the children from school.'" The wrong answer corrects her ("Your children are grown"). The right answer validates the feeling and redirects: acknowledge her concern ("You're a devoted mother"), then guide her to a calming, familiar activity such as folding laundry or looking at photos. Correcting her resets her grief and fear each time; validating it preserves her dignity and lowers agitation. This validate-then-redirect pattern is the single most tested action in the entire domain, so practice recognizing it in many disguises.

Safety and supervision baseline

Cognitive impairment multiplies safety risk, and many exam items pair dementia with a hazard. Residents with dementia are at high risk for falls, elopement, choking, burns, and ingesting non-food items. The STNA maintains a clutter-free, well-lit path, keeps the call light and personal items within reach, uses non-skid footwear, checks water temperature before bathing, and keeps hazardous products (cleaners, medications, sharps) locked away. Supervision is continuous: a resident who seems calm can wander or fall within minutes. When you leave the room, ensure the resident is in a safe position with needs met.

Reporting near-misses and hazards to the nurse is part of the role, because preventing one fall protects far more than reacting to an injury afterward. Tie every behavior response back to safety: the calmest redirection still fails if the resident is left near an unlocked stairwell or a too-hot bath.