Long-Term Care Midterm Flashcards
True or False? It is estimated that 50% of the population has activity limitations related to one or more chronic illnesses.
True
Chronic health condition
any impairment or deviation from the normal that is permanent, causes some disability and often requires a long period of care (on-going)
Does chronic health conditions interfere one’s daily activities?
yes
List the most prevalent chronic conditions among seniors 65+:
- arthritis and rheumatism
- high blood pressure
- stroke
- chronic pain
- heart disease
- cataracts
- diabetes
- COPD
- asthma
- depression
- heart disease
- stroke
- COPD
- high blood pressure
- diabetes
- arthritis and rheumatism
- asthma
- chronic pain
- cataracts
- depression
What factors affect a senior’s function?
- acute illness
- psychosocial factors
- environmental conditions
- age-related changes
- development of a new chronic illness
- existing chronic illness
- adverse effects of medication and other treatments
Identify effects other than physical of a chronic condition.
- fatigue
- depression
- zest for life is gone
- each action takes lots of energy
True or false? Only seniors are allowed to be admitted into a long term care facility.
False. Any individual of any age is allowed if they have a chronic health problem or disability
What is the goal of a long term care facility?
provide a normal home-like environment while teaching the patient to become as independent as possible
Name the types of long term care facilities.
- personal care homes
- rehabilitation centers
- mental health centers
- drug and alcohol treatment centres
Why do patients enter a rehabilitation center?
- after a period of treatment in an acute-care hospital
- to assist in restoring normal levels of functioning to be able to care for themselves again
- patient has good potential for recovery
Identify the staff in a rehabilitation center
- physical therapist
- occupational therapist
- nurse
Why do patients enter a mental health center?
- specializes in providing care for psychiatric disorders
- upon discharge, patient may live in group home
What are the common concerns of people with chronic conditions?
- loss of control
- increased dependency
- strangers providing intimate care
- pain
- financial stress
- loss of relationships, love, approval
- loss of former roles
- heightened sense of mortality, uncertainty of future
- change in living arrangements
True or false? All chronically ill individuals must find ways to cope
True, otherwise you’ve given up
How does coping help?
- manage distress
- restore sense of worth
- maintain relationships
- generate hope and fulfillment
Summarize Miller’s coping tasks
- Striving to feel normal
- Modifying routines and lifestyles
- Obtaining knowledge and skill for continuing self-care
- Maintaining a positive concept of self
- Adjusting to altered social relationships
- Grieving over the losses of chronic illness
- Dealing with role change
- Handling physical discomfort
- Complying with the prescribed regimen
- Confronting the inevitability of one’s own death
- Dealing with social stigma
- Maintaining a feeling of being in control
- Maintaining hope
How is striving to feel normal accomplished?
- covering up
- keeping up
- pacing
True or false? Must allow the chronic disease to become the person’s identity.
False
How can a chronic illness lead to social isolation and loneliness?
- depleted energy reserve
- poor self-concept
- feelings of unworthiness
- physically unable to participate in social events
Identify the losses a chronically ill individual may experience.
- physical abilities
- familiar routines
- self-esteem and self-confidence
- role performance
- relationships
- possessions
- lifestyle
- financial security
True or false? Hope for life and the will to live is related to having something and someone to live for.
True
Discuss the role of the health care aide when caring for patients with chronic health conditions.
- Supportive care provider
- good and bad days
- type, amount and frequency of lifelong support will vary
- encourage coping strategies
- do not talk about patient in their presence
- allow expression and concerns
- alert of psychological state of patient
- realistic hope
- respect and accept individuals
- encourage social interaction and participation - Promoting sense of control
- involve them in decision making
- allow to choose between two alternatives
- knock on door and ask permission to enter
- call light accessible - Facilitating maximal ability and independence
- encourage independence
- ensure access to assistive devices and personal effects
- be patient
- environment adaptable to sensory loss and mobility needs
True or false? The majority of patients who need long-term care are older.
True.
True or false? Living longer decreases the likelihood for the development of a chronic health problem or permanent disability.
False. Living longer increases the likelihood for the development of a chronic health problem or permanent disability.
Chronic Obstructive Pulmonary Disease (COPD): Facts
- leading cause of death in North America
- blocks breathing airways
- most common form is chronic bronchitis and emphysema
- cause in 80 to 90% of cases is smoking, exposure to chemical fumes and organic dusts
Chronic bronchitis
- most common form of chronic obstructive pulmonary disorder
- airways narrow and plugged with mucus
Emphysema
- most common form of chronic obstructive pulmonary disorder
- enlargement and destruction of air sacs in lungs
Chronic Obstructive Pulmonary Disease (COPD): symptoms and cure
- shortness of breath, coughing, wheezing
- progresses slowly and worsens over time, no cure, permanent
- controlled by: stop smoking, promote energy conservation, avoid cold air, eat healthy, lose weight, avoid infected people, exercise, medication, oxygen therapy and breathing exercises
Chronic Obstructive Pulmonary Disease (COPD): medication
- pills, liquids, inhalers
- bronchodilators, steroids, antibiotics
Chronic Obstructive Pulmonary Disease (COPD): breathing exercises
Pursed Lip Breathing:
-breath slowly through nose for 1 count, purse lips, breathe out slowly through pursed lips for 2 counts, repeat until no longer short of breath
Diaphragmatic Breathing:
-put one hand on upper chest and other on abdomen just above waist, breath in slowly through nose so only one hand rises, breath out slowly through pursed lips
Stroke: Facts
- fourth leading cause of death in Canada (16000 die)
- more women die than men
- 40000 to 50000 strokes each year
- 300000 live with effects
- after age 55, risk of stroke doubles every 10 years
- 10% severely disabled and require long-term care
- bleeding or blockage of blood vessel in brain causing it to die and stop functioning
Stroke: Warning signs
- Dizziness
- Headache
- Trouble speaking
- Vision problems
- Weakness
Stroke: what to do
- turn them on their affected side
- bend head without flexing neck
- loosen tight clothes
- call 911
- keep the person awake
- be calm and reassure
True or false? The right side of the brain controls the functions of the right side of the body.
False. The right side of the brain controls the left side of the body.
Stroke: Effects to right brain damage
- loss of hand, arm, leg or body control on left side (hemiplegia)
- left sided neglect
- space and perception deficits
- tends to minimize problems
- rapid movements and short attention span
- impulsive
- impaired judgement and time concepts
Stroke: Effects of left brain damage
- loss of hand, arm, leg or body control on right side (hemiplegia)
- impaired speech and language
- impaired right and left decimation
- slow performance
- aware of deficits therefore more prone to depression
- impaired comprehension especially language and math
Stroke: Treatment
- begin immediately
- goal to stop further damage to brain and maintain/restore ability
Stroke: Care measures of the health care aide
Dealing with communication difficulties:
-speak slowly and clearly, pausing between sentences, repeat or rephrase
-use gestures, facial expressions, pictures
-ask for communication tips used by therapist
Dealing with sensory-perceptual deficits:
-remind patient to check the position of their affected arm or leg
-encourage the client to look for objects towards the affected side
Dealing with emotional problems:
-be patient and understanding
-focus on patient’s accomplishments and strengths
Parkinson’s disease: Facts
- shaking palsy
- progressive movement disorder affecting part of the brain controlling voluntary movement
- affects men and women over 50 years
- parts of body affected and how badly depends from person to person
Parkinson’s disease: Symptoms
- tremors
- stiffness and rigidity of limbs and trunks
- slowness of movement
- gait or balance problems
- swallowing
- constipation
- sleep problems
- depression
- lack of facial expression
Parkinson’s disease: list difficulties that could result from the symptoms and how a health care aide can help
- difficulty with buttons and snaps on clothing ; choose clothing without buttons or zippers or Velcro
- difficulty opening doors; keep door open when patient is moving around
- difficulty walking; provide walking devices to help out
- difficulty writing; help to write letters for example
Parkinson’s disease: Symptoms that would affect an individual’s ability to interact with others
- lack of facial expression
- dementia (not remembering who the person is)
- emotional changes
- slurred speech (difficulty understanding)
- talking too fast
Parkinson’s disease: Cure and minimizing effects
- no cure
- use of medications
- exercise
- activity
- rest
- diet, increasing calories since weight loss is common
- positive attitude, keep calm and keep trying
Multiple sclerosis: Facts
- MS
- chronic, degenerative disease of the nervous system
- body attacks itself, causing damage to brain nerves and spinal cord, interfering with normal nerve signal
- cause severe disability
- does not shorten life
- 50 000 Canadians have MS
- more likely in women and in colder parts of world
- begins in young adulthood
Multiple sclerosis: Symptoms
- double vision, blind spots, blurred vision
- extreme fatigue
- loss of balance, dizziness, difficulty walking, clumsiness
- muscle weakness and stiffness
- tingling, numbness, burning feeling
- sensitivity to heat
- difficulty speaking
- difficulty swallowing
- tend to come and go
Multiple sclerosis: Factors contributing to returning symptoms
- infections
- warm weather
- fatigue
- stress
- anxiety
Multiple sclerosis: Practical tips offered by the MS Society of Canada
- beat the heat: dress lightly, eat cool foods, use fans, air conditioning, take cool baths/showers
- safety in the home: place regularly used items within reach, use microwave instead of oven, wear rubber gloves when using dishes, sit down when showering, use rubber bath mat, turn cold water on first, use night lights, keep floor free of obstacles, wear well fitting shoes, use handrails
Multiple sclerosis: Role of the health care aide
- ensure items are within reach
- provide bell nearby in case patient needs help
- ensure floors are free of obstacles
Arthritis: Facts
- wearing down of cartilage in joints
- men and women affected but in different ways (women in hands, knees, ankles and feet; men in hips, wrist and spine)
Arthritis: Osteoarthritis and Rheumatoid arthritis
Osteoarthritis: breakdown of the cartilage that covers and protects the ends of bones; indicated by joint pain, swelling and stiffness
Rheumatoid arthritis: inflammation of the lining of joints or internal organs; painful and restrict movement
Arthritis: Symptoms
- swelling
- redness
- heat
- pain
- decreased mobility
Arthritis: Interventions of the health care aide
- alternating rest with activity
- encourage maintenance of independence
- hot/cold therapy
- protect and position joints
- pillows should never be placed under knees
Arthritis: Interventions (others not by health care aide)
- regular individualized exercise program
- medication
- weight reduction
- relaxation therapy
- surgery (hip and knee replacements)
Spinal cord injuries: Facts
- 36000 Canadians living with this
- majority caused by motor vehicle accidents, then falls, medical conditions, diving and sport injuries
- experienced by young people, usually young men
- part of spinal cord is damaged determines amount of paralysis
Spinal cord injuries: Paraplegia and quadriplegia
paraplegia: paralysis from the waist down
quadriplegia: paralysis of all four limbs and trunk; neck down
Spinal cord injuries: Adverse effects
- skin
- muscles
- cardiovascular system
- respiratory system
- digestive system
- urinary system
- reproductive system
- nervous system
- skin: loss of touch, pressure, ability to perspire
- muscles: muscles that are not used waste away
- cardiovascular system: low blood pressure, decreased mobility increases risk of blood clots
- respiratory system: if respiratory muscles are affected there can be shallow breathing and difficulty coughing
- digestive system: slowed activity leads to constipation
- urinary system: loss of control over voiding, increased risk of kidney and bladder stones
- reproductive system: loss of pleasurable sensations, inability to achieve erection, loss of reproductive ability in males only
- nervous system: loss of sensation, loss of awareness of location of body parts
Spinal cord injuries: Health care aide roles
- keep skin clean
- avoid burns
- assist with ADLs
- follow care plan
- prevent falls
- use bed rails
- keep call bell within reach
- check temperature of bath water, heat applications and food
- turn and reposition patient at least every two hours
- maintain good alignment
- prevent pressure ulcers
- assist with transfers
- give emotional support
Spinal cord injuries: Autonomic dysreflexia
- life-threatening emergency
- extremely high blood pressure
- overreaction to stimuli for skin, bowel, and bladder
- headache, goosebumps, intense sweating, stuffy nose
- raise the person’s head to lower blood pressure, find and remove the cause like un-kink the catheter tubing and notify supervisor immediately
Heart disease: Facts
- number one killer in Canada
- most costly for health care system
- chances to get it increases as you age
Heart disease: Heart attack (myocardial infarction): Facts
- lack of blood supply to heart muscle that leads to damage and can longer perform its function
- 75000 heart attacks per year
Heart disease: Heart attack (myocardial infarction): Symptoms
- chest pain
- pain radiates to left arm, neck and jaw
- irregular, weak pulse
- lightheadedness
- difficulty breathing or shortness of breath
- pale, cool, clammy skin
- intense perspiration
- fear, anxiety
Heart disease: Heart attack (myocardial infarction): Actions to be taken
- call 911
- have person stop all activity and lie down in whatever comfortable position
- if person takes nitroglycerin, give usual dose
- get them to chew ASA tablet (aspirin)
- if unresponsive, start CPR
Heart disease: Congestive heart failure: Facts
- failed to pump, so blood backing up into the lungs and body cells aren’t getting enough blood
- results in heart attack
Heart disease: Congestive heart failure: Symptoms
- difficulty breathing
- bluish tinge around lips
- lung congestion
- spitting up of frothy blood tinged sputum
- restlessness and anxiety
- swelling of feet, hands, legs
- weight gain
- weakness and fatigue
- dizziness and confusion
- chest pain
Heart disease: Congestive heart failure: Role of health care aide
- documenting and reporting dietary intake and fluid intake and output
- maintain oxygen
- position patient in Fowler’s or semi-Fowler’s for easier breathing
- maintain bedrest or limited activity program
- restrict fluids
- assisting with transfers and ambulation
- measure daily weight
- apply elastic stockings to reduce leg swelling
Diabetes Mellitus: Facts
- chronic disease and leading cause of death
- body can’t store and use sugar, processes using insulin
- does not make enough or can’t use insulin
- can slowly damage both large and small blood vessels
Diabetes Mellitus: Type 1
- occurs most often in children and young adults, -pancreas does not produce insulin which leads to severe hyperglycemia,
- need daily insulin injections
Diabetes Mellitus: Type 2
- develops in adulthood
- most common type
- pancreas does not produce enough insulin or can’t use it properly
- treated by diet, exercise and oral medications
Diabetes Mellitus: Gestational diabetes
- develops during pregnancy
- disappears after baby is born
- at risk for developing type 2 later in life
Diabetes Mellitus: Symptoms
- unusual thirst
- frequent urination
- unusual weight loss
- extreme fatigue or lack of energy
- blurred vision
- frequent or recurring infections
- cuts and bruises that are slow to heal
- tingling or numbness in hands or feet
Diabetes Mellitus: Treatment
- no cure
- manage diet, exercise and medication
- use blood glucose monitor each day
Diabetes Mellitus: Hyperglycemia (high blood sugar)
causes: undiagnosed diabetes, not enough insulin or medication, overeating, little exercise, stress
symptoms: tiredness, hunger, thirst, low blood pressure, frequent urination, leg cramps, dry itchy skin, headache
Diabetes Mellitus: Hypoglycemia (low blood pressure)
causes: too much insulin or medication, omitting or delaying a meal/snack, eating little food, too much exercise, vomiting
symptoms: weakness, sweating, headache, faintness, low blood pressure, rapid pulse, changes in vision, unconsciousness
Diabetes Mellitus: Two emergency situations
1) insulin shock: when patient receives too much insulin or miss a meal or engage in too much physical activity
2) diabetic coma: when patient does not receive enough insulin or under stress or suffering from infection
Diabetes Mellitus: Role of health care aide
- bathe or shower daily
- examine skin for bruises, cuts or cracks
- wear comfortable, well-fitting shoes
- avoid stockings
- avoid crossing knees
- cut toe nails straight across
- do not use hot water bottles or ice packs
Cancer: Facts
- when cell division is out of control of abnormal cells
- 2nd leading cause of death in Canada
- one in three canadians will develop it in lifetime
- most happen after age of 65
- women=breast, colorectal and lung cancer
- men=prostate, colorectal and lung cancer
- leading cause of death is lung cancer for both sexes
Define tumour
new growth of abnormal cells
Define benign tumour
non-cancerous tumour
Define malignant tumour
cancerous tumour
Define metastasis
spread of cancer to other body parts
Cancer: Causes
- exact causes not known
- tobacco use (30% of fatal cancers)
- poor diet (20% of fatal cancers)
- workplace hazards, family history, alcohol use, sexual activity, sunlight, drugs
Cancer: Symptoms
- thickening or lump in breast or other part of body
- change in wart or mole
- sore that does not heal
- nagging cough
- changes in bowel or bladder habits
- indigestion or difficulty swallowing
- unexplained changes in weight
- unusual bleeding or discharge
Cancer: Treatment methods
- surgery (localized, malignant tissue removed)
- radiation therapy (localized, destroys all living cells using high energy rays to tumour)
- chemotherapy (drugs that kill cancer cells and normal cells)
Cancer: Role of health care aide
- allow rest time
- assist with ADLs
- provide food and cut into small pieces
- keep skin clean, avoid lotions and powders
- change person’s position on bed every two hours
- do not remove any radiation markings on skin
- provide plenty of fluids
- provide frequent mouth and lip care
- help select hair covering
- properly position person, give back rubs, cold or hot packs
Cancer: Side effects of treaments
- fatigue
- loss of appetite
- skin breakdown, reddened and irritated
- hair loss
- fear, anger and depression
- nausea and vomiting
- sore and dry throat
Pressure ulcers: Facts
- blood supply to skin is interrupted by pressure especially for those in wheelchairs, unable to move, underweight, overweight, elderly
- occur where little fat is between the skin and bone
Pressure ulcers: stages of skin breakdown
1) skin is red, colour does not return to normal when skin relieved of pressure
2) skin cracks, blisters or peels, shallow crater
3) skin is gone, tissue exposed and damaged, drainage from an area
4) muscle and bone exposed/damaged, drainage
Pressure ulcers: Prevention
- reposition patients every 2 hours
- use pillows for support
- position in 30-degree lateral position
- use proper lifting, positioning and transferring techniques to prevent shearing and friction
- do not raise head more than 30 degrees
- minimize exposure of skin to moisture
Pressure ulcers: Protective devices
1) bed cradle: metal frame placed on bed over client to prevent sheets from exerting pressure on feet and legs
2) elbow protectors: made of foam, rubber or sheepskin to prevent friction between bed and elbow
3) heel elevators: pillows or cushions to raise heels off of bed
4) special beds/mattresses: air, gel, foam beds to allow client to float to distribute weight of body and lessen pressure
Falls and fractures: Facts
- leading cause of accidental deaths and hospitalization in elderly
- cost Canadian taxpayers three million dollars per year
- cause of hip fractures
- can lead to dependence on others, loss of autonomy, confusion, immobilization and depression
Falls and fractures: Factors
- age-related changes (muscle weakness, gait problems)
- medical conditions
- medication effects (sedation)
- psychological impairments
- environmental (hazards in facilities like wet floors, poor lighting, incorrect bed height, poor fitting wheelchairs)
Falls and fractures: Safety measures to prevent falls
- report frayed, torn, bumpy carpets and loose floorboards
- don’t leave items on stairs or hallways
- use nonslip rugs and mats in showers
- always put on brakes of wheelchairs and beds when placing client
- check on client often
- use bed rails if asked by supervisor
Falls and fractures: Role of the health care aide
- identify and report all fall risk concerns to supervisor
- make living environment safer for residents
- exercise programs to improve balance, strength, walking
- assess for any adverse effects of medication
- provide hip pads
- use alarm devices to notify staff when resident tries to get out of bed unattended
- do not use restraints as fall prevention
Falls and fractures: What to do if someone falls?
- stay with person, call for help
- do not move them until examined
- remove object that caused the fall
- keep patient calm, warm and comfortable
True or false? Older people are more prone to fractures because their bones have less calcium and not as strong.
True. Fractures=broken bones, usually hips or wrists are most common fractures
Falls and fractures: Symptoms
- pain
- swelling
- limb bent or out of position
- bruising or bleeding
Swallowing difficulties: Causes
- Parkinson’s disease, Multiple sclerosis, stroke
- muscle and nerve damage
- uncoordinated tongue
- facial muscle weakness
- inability to chew
- excessive or insufficient saliva
Swallowing difficulties: Role of health care aide
- sit upright when eating and 30 min after eating
- take small bites
- place and chew on strong side of mouth
- do not talk when chewing
- brush teeth and rinse after each meal
- know Heimlich maneuver if choking
Constipation: Facts
- build of fecal material in large intestine not easily passed through rectum (movement slows down)
- common in elderly and chronically ill
Constipation: Causes
- decreased fluid intake
- inactivity
- inadequate diet
- medications
- certain diseases
- ignoring need of bowel movement
Constipation: Role of health care aide
- cover patient
- do not rush them
- assist client to toilet or warm bedpan
- provide privacy
- dispose of stools promptly
- position in normal sitting position
- report any unusual changes to supervisor
Constipation: Symptoms
- abdominal discomfort
- fullness feeling
- increased gas
- large stools causing pain
Urinary incontinence: Facts and role of health care aide
- inability to control passage of urine
- report any unusual changes t supervisor
- provided fluids
- monitor client’s routine
- put in normal position
- warm bedpan
- provide privacy
- put running water, TV or radio on to mask urination sounds
Identify factors that affect cognitive function in old age.
- decreased blood flow to the brain
- mental health disorders
- altered sensory function
- poor physical health
- medications
What are the most common cognitive disorders in older adults?
1) depression
2) delirium
3) dementia
Differentiate between delirium and dementia.
Delirium: temporary state of acute mental confusion that comes on suddenly, not a disease of nervous system
Dementia: gradual onset, progressive and irreversible progressive loss of brain functions, group of illness involving memory, behaviour, learning and communication, starts slow then slowly gets worse
Delirium: Causes
1) physiological (dehydration, stroke, medication) 2)psychological (stress, depression, pain) 3)environmental (noise, sleep deprivation, sensory deprivation) conditions
Delirium: Symptoms
- disorientation
- short attention span
- memory loss
- slurred speech
- impaired judgement
- personality changes
- misperceptions, illusions, hallucinations
- insomnia
Delirium: Role of health care aide
- be calm, quiet, friendly, use simple communication
- ensure doors locked, alarms in place, do not use restraints
- do treatments and activities early in the day, ensure nutrition, keep rooms well lit
- ensure client wears glasses, reassure, use touch
- provide ADLs
Alzheimer’s disease: Facts
- don’t know what causes it or how to stop it
- not a normal part of aging
- affects both men and women, more common in older people
- slow developing, degenerative brain disease
- starts with forgetting recent events or tasks and leads to confusion, behaviour changes, difficulty communication, and can no longer care for themselves
- half live in the community and half live in institutions
- age and family history play role, environment, abnormality in immune system
Alzheimer’s disease: Symptoms
- memory loss
- difficulty performing tasks
- problems with language
- disorientation
- poor judgment
- problems with abstract thinking
- misplacing things
- changes in mood or behaviour
- changes in personality
- loss of initiative
Alzheimer’s disease: Stages
1) primary stage
- memory loss
2) middle stage
- urinary and fecal incontinence
- impairments to language, motor activity and object recognition
3) final stage
- incapable of remembering, communicating or performing self care
* rate of decline and specific problems are unique to each individual
True or false? Doctors use “probable Alzheimer’s disease”
True, because there is no conclusive test that exists, you can only eliminate other possible causes
Dementia: Role of the health care aide: General guidelines
- be consistent and keep routine
- keep it simple and talk slowly and clearly
- eliminate distractions
- respect privacy
- promote independence and self-esteem
- reduce chance of failure
- avoid confrontation and do not argue
- be patient
- never force an activity
- allow right of choice
Dementia: Role of the health care aide: Meal time
- plan well balanced diet and offer favourite foods
- prepare food for eating
- for those who have difficulty using utensils give finger foods
- create calm environment
- simplify the table
- use simple directions
- watch for signs of choking
- NEVER force food
Dementia: Role of the health care aide: Grooming
- ensure quiet environment
- collect all needed supplies ahead of time
- break tasks into simple steps
- suggest electric shver
- simple hairstyle
- schedule occasional visit to hairstylist
- offer handi-wipes
Dementia: Role of the health care aide: Bathing
- determine best time for bath
- ensure privacy
- make bathroom warm
- prepare for bath ahead of time
- help person relax
- use mats, grab bars for safety in bathtub
Dementia: Role of the health care aide: Dressing
- select easy to put on clothes
- put labels on drawers for clothes to be easy to find
- offer limited choices
- limit amount of clothing in closet
- select appropriate clothing for weather
- order clothing in reverse order for person to put on
- buy duplicates of favourite outfits
Dementia: Role of the health care aide: Toileting
- ensure bathroom door clearly marked
- schedule toilet break first thing in the morning, before bed
- watch for cues
- coloured toilet for those who have difficulty seeing
- provide privacy
- ensure cleaning of perineal area
- discourage fluid intake before bed
- provide disposable undergarments
Dementia: Role of the health care aide: Leisure and recreation
- offer a variety of activities
- never force person to join into activity
- keep it simple
- never focus more on activity than person
- discontinue activity if person becomes upset
- never presume older adults are like children
- keep duration of activity around 20-30 minutes due to short attention span
- activity must have a good chance of success
- keep a routine
- be creative and flexible
ex) listening to music, helping with housework, grooming pets, looking at photo albums, exercising, folding cloths, sorting mail
Dementia: Role of the health care aide: Communication and dementia
- don’t correct
- feelings get hurt
- speak slowly
- ignore off-hand remarks
- don’t argue
- be patient
- ask what they want, don’t assume
Dementia: Reality orientation vs validation therapy
- reality orientation (only useful in early stages): used to help disorient patients to regain connections to environment, time and themselves. ex) marking days off calendar, setting a person’s watch to correct time, pointing out who you are and who the person is
- validation therapy (used in later stages): feelings and memories of individual is acknowledged and affirmed whether they are true or not, preserve person’s dignity
Identify factors that contribute to challenging behaviours in people with dementia.
- physical changes in the brain
- impaired hearing, fatigue, pain
- emotional like depression
- environment like excessive stimulation, clutter
- psychological like high expectation, communication difficulties
Identify effective strategies to use when responding to challenging behaviors: Altered sleep patterns
- keep person active during the day
- discourage nap times
- avoid caffeine
- use night lights
- encourage walks
Identify effective strategies to use when responding to challenging behaviors: Wandering
- reassure and distract the person
- move locks on outside of doors
- disguise doors with paint or wallpaper
- ensure regular walks and exercise
- ask neighbors to call if see person on street unaccompanied
- ensure identification on patient
Identify effective strategies to use when responding to challenging behaviors: Restlessness
- distract the person
- calm the person with music or touch
- consider pacing as form of exercise
- look for patter and arrange to be with person at that time
Identify effective strategies to use when responding to challenging behaviors: Repetitive actions
- do nothing if behaviour not harmful
- think of ways to use repeated action (folding clothes)
- change the subject
- stay calm
Identify effective strategies to use when responding to challenging behaviors: Suspicion
- provide comfort and reassurance
- do not argue or reason with person
- don’t take accusations personally
- distract with another activity
Identify effective strategies to use when responding to challenging behaviors: Sexual behaviour
- don’t judge or scold
- provide affection
- look for unrelated needs
- distract with other activities
- stay calm
- provide privacy
Identify effective strategies to use when responding to challenging behaviors: Aggression
- be calm and reassuring
- look for immediate cause
- give space to cool down
- distract with other activity
- leave if your safety is threatened
- way of communication and not an intent to cause harm
What is the quote of PIECES workshop? And what does the workshop consist of?
“a practical, effective approach to change and continuous improvement”
- approach to understand and enhance care for individuals with complex physical and cognitive health needs and behavioural changes
- supportive care strategies for older persons at risk and aggressive behaviour (client centered approach)
What does PIECES stand for?
P-physical I-intellectual E-emotional C-capabilities E-environment S-social *cornerstones of philosophy and care of PIECES approach
What is the PIECES philosophy?
- person-centered, evidence-based and humanistic care
- health is beyond absence of disease and includes quality of life, independence and self-determination
- prevention of problems and early intervention
- care and service available where older person resides (relocation avoided)
- provide common set of values, common language for communicating and comprehensive approach for thinking through problems
What are the PIECES goals?
1) comprehensive and best practices approach to assessment and care planning
2) risk management (increases detection of risk and identification of supports to address it)
3) implementation of current and emerging best practices
4) interdisciplinary care (helps minimize unnecessary disability)
5) integration and collaborative care (shared care)
