Week 2 - Long Term Care Flashcards
Describe some physiological effects of aging.
Decreased bone density Lowered immune system Decrease in mentation thinner skin Slower metabolism lower muscle and higher fat content
How does ageing change life views and goals?
Getting prepared for the empty nest
Preparing for LTC or moving to a retirement home
losing friends
Describe how the WHO describes how ageing shifts relationships, goals, etc.
Older adults tend to select fewer and more meanginful goals and activities
Older age may be a stimulus for a shift from materialistic perspectives to more transcendent ones
Desrcribe how the typical trajectory toward death has occured.
Years ago people lived and then there was a precipitous drop to death
Now, we see more of a gradual decline with ups and downs
Why do clients move to LTC?
unable to care for themselves
- e.g. incontinence issues, frail, care needs exceed support they have, mobility issues, kids unable to care for them
What do you risk losing with old age or transition to LTC?
Independence, privacy, connectedness
Who regulates LTC facilities?
MOHLTC
What is the difference between a retirement home and LTC?
Retirement home – more independent, can do a lot of things autonomously, but unable or unwilling to live at home; still have support here – can have PSWs bathe them, but they only for 45 minutes a day for the full 7 days – maximum time allotment
LTC home – need around the clock, more intensive care
Is it easier to move to LTC from home or from the hospital?
Much easier to move to LTC from home
If assessed at home and the forms are complete, which states this patient is not fit to return home – go to critical status – need a bed now
In the hospital, they are still safe – less critical to move them
Describe the process of getting into LTC.
o CCAC or LHIN does an assessment – approved
o Get to choose up to 5 homes and whichever of those homes comes up first, you have to take it
o If you elect not to take that home, kicked out of the system, and need a whole new assessment
o RN or physician can do the assessment, usually an RN – see what supports are needed and applicability to LTC
Ontario’s LTC residents - 2018
- 9/10 residents have _________ impairment; 2 out of 3 have been diagnosed with ____
- Over the past 5 years, the proportion of residents needing ________ support with ADLs increased from 77% to 85%
- 46% exhibit some level of ________ behaviour
- 61% take ___ or more prescription medications
- 38% need monitoring for a(n) ________ medical condition
cognitive AD complete aggressive 10 acute
What is the typical LTC patient?
Cognitive abilities have decreased, needs lots of ADL support, polypharmacy, and most likely AD or other dementia
What is the wait list for long-stay beds in ontario?
What is the average time to placement in LTC?
34 000
143 days
What are the 10 myths of LTC?
- I’ll lose my “skills”
- Backwater of nursing
- Easy and slow paced
- Pay is bad
- Spinning my wheels
- Patients go there to die
- No bedside care
- Not the gold standard of care
- Isolating
- Not fulfilling
What skills, if any, may one lose if entering LTC?
IV and venupuncture skills
Leadership - Relationships and Trusts (RNAO):
- Maintain an ____ _____ policy and post times of availability
- Practice management by walking around and _______ time on the unit
- _____-__ at meetings and open forums to hear issues and concerns and what’s going on in peoples lives to foster _________ and provide ________
- Communicate support to staff by determining and clarifying what staff expects of _______
- providing ongoing _______ feedback for a job well done
- Build a network of advisors and informants who will provide an honest and unbiased perspective when seeking information and advice
open door spending check-in relationships, support leaders informal
more effective and responsive way to honour each person’s uniqueness and to provide people what they need for their own health and healing
SBN
What kind of activities promote QOL, autonomy and dignity in LTC patients?
Activities with young children
Asking the family what type of foods the patient prefers
How can a family be included in care?
Implement them in decisions
Inform family of progress
Give the family the option to help with care
What is on the nurse’s radar for LTC clients?
Constipation, continence, falls, pain, pressure ulcers, 3 Ds, End-of-life care, oral health
The RNAO, in working with the 3 Ds, suggests that the nurse’s role is to assess for all 3 conditions within the context of the following tenets of care.
Know the person
relate effectively
recognize retained abilities
manipulate the environment
For the following descriptions, discern which of the 3 Ds is being described.
A - Memory changes from baseline B- Decline in function C - Anhedonia D - Vegetative changes, such as sleep and nutrition E - Abrupt onset F - Memory impairment
A - delirium B - dementia C - depression D - Depression E - Delirium F - dementia
For the following descriptions, discern which of the 3 Ds is being described.
A - Lack of eye contact B - Aphasia, Apraxia, agnosia C - Disorganized thinking D - consciousness altered E - Alterations in executive functioning (e.g. planning) F - Decreased self-care
A - depression B - dementia C - Delirium D - delirium E - dementia F - depression
For the following descriptions, discern which of the 3 Ds is being described.
A - Fluctuating course
B - inattention
C - Vague physical symptoms
D - Feelings of sadness/depression
A - delirium
B - delirium
C - depression
D - depression
Difficulty with the motor planning to perform tasks or movements when asked
Apraxia
Inability to interpret sensations and recognize things
Agnosia
When considering dementia, what is important to rule out?
Other reversible causes of cognitive decline
What are the important risk factors that should be urgently attended to when worrying about delirium?
Hearing/visual defecits Dehydration Sleep disturbances Cognitive impairment ↓mobility/immobility
