Lecture Week 2: Communication Flashcards

Question

What is the communication process?

Answer 1

How can communication be broken or damaged : consists of: - referent -Sender -Message -Channel -Receiver Feedback: stress, busy, environment, interpersonal variables (consider contextual factors)

Answer 2

: it’s not just what you say; being aware of one's own thinking Communication: 55% body language (can completely change how a phrase is perceived by another) 38% tone '' 7% actual spoken word

Answer 3

written, oral, or sign language - Vocabulary - Pacing - Tone - Brevity - Timing - Relevance

Answer 4

meaning: definition denotative connotative: assigned meaning

Answer 5

personal appearance, facial expression, posture & gait, eye contact, touch, gestures & sound, personal space nonverbal communication can: Reinforce, supplement, or undermine verbal communication

Answer 6

Intimate space: 0 - 1.5 ft Personal: 1.5 - 4 ft Social: 4 - 12 ft Public: 12+ ft

Answer 7

Courtesy Use of names Trustworthiness Autonomy and responsibility Assertiveness - “I” language - “I feel ____ about ____ because _____”

Answer 8

Helping: Client narrative and client collaboration Family relationships Interprofessional collaboration Community relationships

Answer 9

- Asking personal questions - Giving personal opinions - Changing the subject - Automatic responses - False reassurance - Sympathy - Asking for explanations: “why?” - Approval or disapproval - Defensive responses - Passive or aggressive responses - Arguing **Ineffective communications = poor outcomes**

Answer 10

Paraphrase, give patient space to clarify, avoid invalidating, making promises, making comments, automatic response, false reassurance, avoid ignoring the non-verbal, share observations, summarize, provide information. ex. 1 During a long conversation your client expresses concerns about pain, quality of life and becoming a burden to their partner “During our conversation you have expressed concerns regarding…” ex. 2 A client is assisted by the nurse to sit up in bed. The client grimaces ‘Are you experiencing pain when you sit up in bed?” “I noticed you grimaced, is this painful?” ex. 3 “I won’t ever be able to use this electric wheelchair!” How are they feeling about it? “You are concerned that you won’t be able to use the devices on your new wheelchair?”

Answer 11

Strategy for active listening S: sit facing the patient O: open posture L: lean forward E: eye contact R: relax

Answer 12

Open-ended questions: gives pt space to answer; more broad When do they work? When are they not so great? “How may I help you?” Close-ended questions: limited answers; yes or no When do they work? When are they not so great? “Can I help you?

Answer 13

Aphasia: inability to produce/understand language - Cannot speak clearly - Cognitively impaired - Hearing impaired - Visually impaired - Touch - Unresponsive - Speak a different language

Answer 14

Adjusting/tailoring healthcare delivery to meet the specific needs of individuals of specific age groups: considerations: - Physical or psychosocial - Function impacted by disease and disability - Decreased homeostasis - Lack of standard norms - Altered manifestations and response

Answer 15

Truth: structural and physiological changes within the brain are normal with again Symptoms such as disorientation, loss of language skills, loss of the ability to calculate, and poor judgement are not normal changes with aging – can indicate that something is wrong

Answer 16

confused/disoriented Visual hallucinations (auditory – less common) Difficulty thinking/focusing attention Behavior or personality is different than usual day/nights are mixed up Drift between asleep and awake More alert or more tired Older persons tend to experience hypoactive delirium – making it harder to recognize – it might seem like depression

Answer 17

1. The interrelation between physical and psychological aspect of aging 2. The effects of disease and disability on functional status 3. The decreased efficiency of homeostasis mechanisms 4. The lack of standard for health and illness normas 5. Altered manifestations of an responses to specific disease (atypical signs and symptoms)

Answer 18

- Longer life and medical history and the potential complexity of that history - Rest periods or conduction of assessment in several sessions due to reduced energy and limited endurance experienced by some frail older persons

Answer 19

1. Identify how the older person wishes to be addressed (use culturally appropriate titles) 2. Assess the health-related beliefs and practices of the older person 3. Know the beliefs and practices of the older person’s culture group with regard to spatial requirements, eye contact, and touch, and use them to establish rapport

Answer 20

Changes in mental status Falls Dehydration Decrease of appetite Loss of function Dizziness Incontinence Mental status commonly changes as a result of disease and psychological issues, but more often in relation to drug toxicity or adverse drug events. Falls are complex events and careful investigation is necessary to find out whether it has environmental causes or is the symptom of a new-onset illness; such illnesses include cardiac, respiratory, musculoskeletal, neurological, urological, and sensory disorders. Dehydration is common in the older populations because the thirst response is reduced, resulting in less water intake, and because less free water is available as a consequence of decreased muscle mass. Vomiting and Diarrhea can accompany the onset of an acute illness and older persons are then at risk for further dehydration. Decrease of appetite is a common symptom with the onset of pneumonia, heart failure, and urinary tract infection. Loss of functional ability occurs either in a subtle manner over time or suddenly, depending on the underlying cause. Thyroid disease, infection, cardiac or pulmonary conditions, metabolic disturbances, and anemia are common causes of functional decline, so nurses need to identify them early and notify healthcare providers so that proper treatment can be initiated Dizziness is a common sign of various acute illnesses, including anemia, arrhythmia, infection, myocardial infarction, stroke, and brain tumour. Urinary incontinence (new-onset) is often associated with a urinary tract infection, but it can also be a symptom of an electrolyte abnormality or adverse drug event

Answer 21

1. Timely detection of these cardinal signs of illness 2. Focus on finding underlying causes because of mistaken assumptions about normal aging Many health challenges can coexist, adding difficulty to isolating the causes of symptoms.

Answer 22

Delirium: or acute confusional state, is a potentially reversible cognitive impairment that often has a physiological cause. Physiological causes of delirium include, but are not limited to, too many medications, dehydration, malnutrition, infection, pain, and stress. Delirium in older persons sometimes accompanies systemic infections and may be the presenting symptom for pneumonia or urinary tract infections. Delirium may also have environmental causes (e.g. sensory deprivation, unfamiliarity with surroundings) or psychosocial causes (e.g. emotional distress, pain). Delirium may occur in any setting, older people within the acute care setting is especially at risk due to predisposing factors (psychological, psychosocial, and environmental) in combination with the medical conditions that led to hospital admission Older people with dementia are at higher risk of experiencing delirium The onset of delirium is typically sudden, and symptoms and severity fluctuate rapidly. Since delirium can fluctuate throughout the 24-hour period, it is important for nurses to conduct frequent assessments. Confusion assessment method positive “Out of track” Delirium is an acute, reversible state of disorientation, inattention, and confusion Rapid onset (hours - days) Increased prevalence with age and more likely to occur in acute care settings) Medical emergency**

Answer 23

Dementia: is an umbrella term for a variety of diseases that cause irreversible changes in the brain; broad term for a set of symptoms affecting the brain 5 major classifications of dementia: Alzheimer’s disease Diffuse Lewy body disease Frontotemporal dementia Creutzfeldt-Jakob dementia Vascular dementia

Answer 24

Symptoms: Loss of memory, judgement, reasoning Changes in mood, behaviour, and communication abilities Deterioration of cognitive function leads to a decline in the ability to perform basic and instrumental ADLs. Unlike delirium, dementia is characterized by progressive, irreversible cerebral dysfunction. Due to the close resemblance of delirium to dementia, the presence of delirium must be ruled out whenever dementia is suspected.

Answer 25

Alzheimer's

Answer 26

Delirium is a medical emergency. It is characterized by acute and fluctuating onset of confusion, disturbances in attention, disorganized thinking, and/or decline in consciousness. It can coexist with dementia. Older people with dementia have a higher risk of delirium. Sudden onset–it lasts hours to days. Often it is reversible with treatment of the underlying cause. Often it fluctuates over a 24-hour period and can be worse at night. Fluctuations in alertness, cognition, perceptions, and thinking occur. The person may have misperceptions and delusions. Fluctuations in emotions occur, with outbursts, anger, crying, and/or feeling fearful. Sleep may be disturbed, but there is no set pattern. Hyperactive: agitation, restlessness, hallucinations Hypoactive: unarousable, very sleepy Mixed: combinations of hyper and hypoactive manifestations. Confusion Assessment Method (CAM) If the person has features 1 and 2 plus either 3 or 4 they are positive for delirium. Presence of acute onset and fluctuating course and Inattention and either Disorganized thinking or Altered level of consciousness Notify the physician—delirium is considered a medical emergency. Determine and treat the underlying cause of the delirium (e.g. urinary tract infection, reaction to medication.

Answer 27

Dementia is a gradual and progressive decline in mental processing ability that affects short-term memory, language, judgement, reasoning, and abstract thinking. It eventually affects long-term memory and the ability to perform familiar tasks. Some types of dementia are associated with changes in mood and behaviour. Gradual deterioration occurs over months to years. It has slow, chronic progression and is irreversible. Cognitive decline with problems in memory occurs plus one or more of the following: apraxia, agnosia, and/or executive functioning. The person may have paranoia and delusions of theft, and some types of dementia include hallucinations. The person is depressed, especially in early stages. Apathy occurs. Sleep may be disturbed, with a pattern in disturbance. Wandering with exit seeking. Agitation The person is withdrawn (which may be related to an existing depression). Folstein’s Mini Mental Status Exam measures cognitive functioning. A score of 23 or lower is indicative of cognitive impairment. Management of behaviours should focus on nonpharmaceutical interventions.

Answer 28

Depression is a term used to describe the presence of a cluster of depressive symptoms on most days, most of the time, for at least 2 weeks, and when the intensity of the symptoms is out of the ordinary for that person. It is a biologically based illness that affects a person’s thoughts, feelings, behaviour, and even their physical health. Recent unexplained changes in mood persist for at least 2 weeks. Usually, it is reversible with treatment. Often it is worse in the morning. Reduced memory, concentration, and thinking occur, along with low self-esteem. The person may have delusions of poverty, feel guilt, and complain of somatic symptoms. The person has a depressed mood with decreased interest in or experiences of pleasure. Changes in appetite occur, with possible suicidal ideation and/or feelings of hopelessness. Sleep is disturbed, with early morning waking. Hyperactive: agitated Hypoactive: withdrawn, decreased motivation and interest. Geriatric Depression Scale (GDS) Interpretation of the 15 GDS screen: Less than or equal to 4 = no depression 5-7 = borderline depression Greater than 7 = probable depression Refer patient to a physician if there is suicidal risk. Refer to geriatric outreach teams.

Answer 29

If the client is CAM+ complete PRISME P: pain, psychosocial R: restraint, retention I: infection, impaction, impaired cognition, intake-oral S: sleep disturbance, sensory change, social isolation M: medication, metabolic, mobility E: environment

Answer 30

Why does delirium happen? Infection: causes inflammation – confusion in the older adult Low sodium: cell swelling – confusion

Answer 31

Impaction: dehydration, nausea, irritation, constipation can lead to bowel perforation Poor outcomes can lead to falls/injury Increase L.O.S Death

Answer 32

**Find and treat underlying cause** Include family and friends Keep the clients routine as simple as possible Keep the environment calm – reduce distractions Encourage healthy eating and promote drinking fluids Keep sentences short and simple Ensure patient ahs their glasses, hearing aids, etc Do not argue with patients (hallucinations)

Answer 33

Memory loss affecting day-to-day abilities Difficulty performing familiar tasks (ADLs) Problems with language Disorientation in time and space Impaired judgement Problem with abstract thinking Misplacing things Changes in mood/behaviour Changes in personality

Answer 34

cognitive impairment

Answer 35

- Identify yourself (“My name is… I’m here to help you get into your wheelchair”) - Approach the person from the front - Move slowly; maintain eye contact - Address the person by name; speak slowly and clearly - Present one idea at a time - Repeat/rephrase responses to clarify what the client is trying to tell you - Ask “yes” or “no” questions and allow time for a response - Back up your words with actions using gestures - Listen actively/acknowledge the person’s emotional state - Touching too roughly or quickly could cause increased stress

Answer 36

Vascular dementia

Answer 37

Alzheimer's

Answer 38

:A mood disorder characterized by feelings of sadness and despair 2 or more weeks Not a normal part of aging

Answer 39

Alzheimer's: age, genetics, general health Vascular dementia: heart disease, diabetes, hypertension, high cholesterol Lewy body: age, gender (men), family history of LBD or Parkinsons

Answer 40

Health challenges Chronic disease Chronic pain Loss Social isolation Changes in independence

Answer 41

ADLs Loses interest Feelings of worthlessness and sadness Sleep changes Nutrition changes Physical symptoms Lethargy Difficulty concentrated Spends more time alone Suicide

Answer 42

GDS – geriatric depression scale

Answer 43

Diet Exercise Manage stress Avoid drugs and alcohol Medication (antidepressants) Suicide risk -Suicidal risk assessment -Report to instructor/RN -Refer to resources

Answer 44

A: gradual decline V: rapid decline LB: gradual decline

Answer 45

Question, persuade, respond QPR is a technique used to recognize the signs that someone is at risk of suicide and offer hope. 1) Question: Recognize the warning signs of suicidal thoughts and behaviors. 2) Persuade: Convince the individual to seek help. 3) Refer: Direct the person to appropriate resources for professional help23.

Answer 46

Onset: insidious (months to years) Course: progressive Duration: months to years Consciousness: usually clear Attention: normal except in severe dementia Psychomotor changes: often normal, impaired as progresses Reversibility: irreversible

Answer 47

Onset: acute (hours to days) Course: fluctuating Duration: hours to weeks Consciousness: altered Attention: impaired Psychomotor changes: increased or decreased Reversibility: usually

Answer 48

Onset: insidious (weeks to months) Course: may be chronic Duration: months to years Consciousness: clear Attention: may be decreased Psychomotor changes: may be slowed in severe cases Reversibility: usually