Published on March 5, 2014
NATCEP Day Thirty Three
Objectives Define depression Identify signs and symptoms Describe possible causes Identifies the nurse aide’s role and responsibility in caring for the resident with depression Possible interventions
Definition An emotional disorder that involves the body, mood, and thoughts. The person loses interest in daily activities. Most commonly overlooked disorder in the elderly Misdiagnosised as a cognitive disorder Can mimic physical illness
Signs & Symptoms Sadness Inactivity Difficulty thinking Problems concentrating Feelings of despair Problems sleeping Changes in appetite Fatigue Agitation Withdrawn Thoughts of death or suicide Pain Irritability
Causes Death of family or friends Loss of health Loss of body functions Loss of independence Loneliness/boredom Medications – side effect Lose of purpose
Nurse Aide Roles/Responsibilities Recognize signs & symptoms Report observations to nurse Maintain safety Follow care plan
Nurse Aide Roles/Responsibilities Don’t make light of or ignore resident comments or behaviors Suicidal? Suicide Precautions according to policy Observant for clues of attempts ○ High risk categories include 75 years of age and older Recent diagnosis of terminal illness Unrelieved chronic pain Sudden loss of spouse Elderly with recent multiple losses
Possible Interventions One on One interaction Activities Learn the resident’s preferences and habits
NATCEP Day Thirty Three
Objectives Identify possible causes of confusion Identify symptoms that indicate a resident may be confused Discuss implications of confusion for the resident Identify ways in which some of the causes of confusion may be minimized Identify behaviors hat may be seen Describe appropriate therapeutic interventions
Possible Causes of Confusion Medical issues Chronic illnesses Surgery & injury Degenerative brain diseases – Alzheimers, dementia, arteriosclerosis Poor nutrition Poor fluid intake Medication Reaction Combo of meds Social Isolation Hearing & Vision Loss Changes in the usual environment
Symptoms of Confusion Does not know self or others Talks incoherently Forgetful Does not pay attention Does not understand when someone else is speaking Sleep disorders Hallucinates – visual or auditory Hostile/combative SUNDOWNING
Implications The resident may be Frightened, unhappy, bewildered or angry Unaware of environment – doesn’t recognize danger Reduced contact with others Less self expression Less independence Insecure Verbal or physical aggression Socially inappropriate behavior
Ways to reduce confusion Treat medical condition Improve nutrition & hydration Change prescribed medications Encouraging socialization Avoid overstimulation Calm, relaxed and peaceful setting Hearing aids and glasses
Behaviors Combative Withdrawn Socially inappropriate Verbal or physical aggression Wandering Abnormal sexual behavior Repetitive behaviors Catastrophic reactions
Therapeutic Interventions Reality orientation to maintain reality contact Reminiscing = life review Validation therapy Focuses on responding to the affect or emotion expressed by the patient rather than the actual content, which may be distorted. Rather than correct and attempt to reorient a disoriented person, positive reinforcement is continually given. Helps them feel more secure and oriented within their own reality
Therapeutic Interventions Begin conversation by identifying yourself Do not ask if they remember you Eye level with eye contact Pleasant facial expression Place hand on resident’s arm or hand unless it causes agitation Control background noise – be sure they can hear you Lower tone of voice Short, common words; short, simple sentences Give resident time to respond One question at a time – if need to repeat, say same way Ask resident to do only one task at a time
Therapeutic Interventions Dementia: eventually unable to understand verbal communication Use pictures and point, touch, or hand the resident items Demonstrate an action when you want resident to complete a task Resident may use word substitutes Consistent – find out what they mean & use yourself Avoid abstract, common expressions “You can hop into bed now” Repeat resident’s last words to help stay on track during conversation Do not try to “make” resident understand = agitation Use nonverbal praise freely and always respect resident’s feelings
1. NATCEP Day Thirty Three 2. Objectives Define depression Identify signs and symptoms Describe possible causes Identifies the nurse aide’s…
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