How about a little Continuing Education Credit for you?

This is the post-test portion of one of the learning activities I wrote at work for my staff members. Thought you may find it interesting. There is a learning guide to accompany but it took up too much blogspace to include here... also sorry about some of the formatting glitches when I posted this.


Pain in Confused Elders Self Study for CNA’s Name:________________________
1 hr credit Learning Activity Portion (Post test) date:__________________________

Please read the information below and complete the questions for credit. Return to Ruth’s mailbox. Thanks.

My name is Nadia. I am 67 years old. Well, actually, I can’t talk to you or tell you my name; I have dementia and also, I am originally from Brazil; I converse in a mixture of languages and you can’t quite understand me. I mumble. But if I could talk to you, I would tell you this: I hurt! My pain is nearly killing me. I don’t understand why I hurt and I wish I could get some help! But I can’t tell you that, so you will have to take my verbal and non verbal cues, and put the picture together.

What verbal or non verbal cues would you expect to see from someone like Nadia, that could help you guess that she is in pain? Circle any cues that you think are possible.

Moaning- grimacing -crying- rubbing an arm or other part of body-
Frowning -appears frightened -aggressive when approached -irritable -
Restless- wringing hands -resists cares -not sleeping well -not eating well
Withdrawn- more confused that usual- trying to elope(new behavior) -guarded

You noticed many of these behaviors in Nadia and reported them to the nurse, who reported them to the doctor, who has seen Nadia. He concluded from history and current information that Nadia is suffering from poorly controlled Rheumatoid Arthritis pain. You learned this today in report. You are thinking about what you can do to help Nadia, since you are a caring and loving staff member and you hate to think that she is in such horrible distress. You decide that when you notice she seems to be in pain you should:

(Circle all that apply)
Y Tell the nurse right away
Y Make sure you take care of her basic needs (like toileting)
Y Totally avoid Nadia because you can’t stand her wailing
Y Sit with her, give her a hug, offer assurance if at all possible
Y React to her in a calm manner, avoid rushing while with her
Y Use the skills that seem to have worked with Nadia in the recent past

If you tell the nurse right away, you could expect what to happen?

Y The nurse will likely assess the pain level and then decide what to do for Nadia.
Y You know that Nadia has a prn pain medication ordered. You expect the nurse to perhaps
give her this.




In addition to Dementia, Nadia has a few other limitations. One of them is that she is wheelchair bound (cannot get up by herself) and needs you to help her reposition, transfer and move. She requires one assist to reposition in chair or bed and two assist to transfer. How could this affect her comfort level?

Y She is more likely to get stiff and sore, since she cannot move by herself.
Y It is harder to meet her needs on some shifts and at certain times.
Y This does not affect Nadia’s comfort level. She can sit in her chair for long hours on end
without pain. Can’t everyone?
Y I would be certain to look at pressure areas often as she is also at risk for painful sores if
she cannot move, besides becoming stiff from lack of movement.

Nadia has been referred to the restorative program for help with range of motion, since it is getting harder and harder for her to complete activities. You are really happy about this. You know that the assistance and attention will help Nadia in what ways?

Y She is likely to retain more function for a longer time.
Y She probably will enjoy the personal one-to-one time with a caregiver.
Y Frequent movement may decrease pain for her.


Nadia initially enjoyed the ROM exercises and the attention, but recently has begun to resist them, shows agitation, and hits out at the caregiver providing them. She then seems to reclude to an area by herself and cry. From these verbal and non-verbal cues, you begin to wonder about what?

(Choose the one most likely answer)
Y Nadia doesn’t like her caregiver anymore.
Y Nadia doesn’t like the exercises anymore.
Y The exercises are causing pain for Nadia.

You talked with the nurse about the changes you noticed in Nadia’s behavior. The nurse was really glad that you explained to her what you had seen, and asked you to let her know at least ½ hr before the next ROM exercises. You do so, and the nurse gives Nadia the prn pain medication. This becomes the common practice as you notice that Nadia once again enjoys the ROM exercises she is doing. Great job helping your resident!

Based on what you know about her, is Nadia at risk for a fall?

Probably yes, because:



Probably no, because:




I felt this learning activity was enjoyable and helpful. yes no no opinion
I like this format better than the previous self study formats. yes no either is ok