Chapter 3. Understanding Residents

psychosocial needs

needs that involve social interaction, emotions, intellect, and spirituality

6 psychological needs

love/affection, acceptance, safety, independence, contact, self-reliance

when psychosocial needs not met

anger, depression, withdrawal, stress, fear, agression

Maslow's Hierarchy of Needs

(level 1) Physiological Needs, (level 2) Safety and Security, (level 3) Love and Affection, (level 4) Self Esteem, (level 5) Self Actualization

guidelines for resident sexuality in long-term care

-people have sexual; needs throughout their lives

-knock on pt rooms and wait

-provide privacy if you encounter a sexual situation

-be open and nonjudgemental

-respect pt sexual orientation

-do not view elderly as cute or disgusting

If you see sexual abuse between two residents...

-remove resident from the situation and take them to a safe place.

-report to nurse immediately.

-not all residents can consent so it's important to protect them.

spiritual needs guidelines

-learn about their religion

-respect their decisions

-encourage participation in religious services

-respect all religious items

-read religious materials out loud if asked

-never try to change their beliefs or express judgment, or interference with their practices

Holistic Care

care that provides for the well-being of the whole person and meets not only physical needs, but also social, emotional, and mental needs

A loss of independence can cause

Poor self-image, Anger, Feelings of helplessness, sadness, and hopelessness, Feelings of uselessness, Increased dependence, Depression.

NAs promote independence by

- encourage pt to do as much as possible themselves no matter how long it takes

- remain patient

- allow residents to make choices (what to wear, when to wake up, etc)

Physical activity has the following positive effects:

- reducse risk of illness

-imporves mood, body function, appetite

Inactivity can cause

loss of self-esteem, depression, boredome, UTI, skin breakdown, pressure ulcers, etc

family types

Nuclear

Extended

Blended

Single parent

families participate in care of resident in following ways

-help to make decisions

-communicate with care team

-assist with dying residents

during family visits, NAs must

-provide privacy

-report the effects of visit on resident after

-be respectful and understanding as families are likely experiencing big adjustments

infancy

-birth to 12 months

Toddlerhood

1-3 years, speak, gain coordination and bladder control

preschool

-3-6, develop social skils

school-age

5-10

adolescence

10-13, experience growing sense of identity

adolescent

13-19, puberty

young adulthood

19-40, select career and mate

Middle Adulthood

40-65, physical changes to aging

late adulthood

56 and older, retire, many changes, loss of physical health, lose friends

Developmental Disabilities

Disabilities that are present at birth or emerge during childhood that restrict physical or mental ability.

important points about intelectial disabilities

-not a disease

-below average mental functioning

-limit ability to live independently

-have the same emotional and physical needs as others

guidelines for caring for pt with intelectual disability

-treat them like adults

-encourage them

apathy

lack of interest

major depressive disorder

a type of depression that causes withdrawal, lack of energy, and loss of interest in activities, as well as other symptoms; also called major depression.

bipolar disorder

a type of depression that causes a person to swing from periods of deep depression to periods of extreme activity; also called manic-depressive illness

anxiety

uneasiness or fear, often about a situation or condition

phobia

intense fear of or aversion to

obsessive-compulsive disorder (OCD)

an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions)

Post-Traumatic Stress Disorder (PTSD)

an anxiety disorder caused by a traumatic experience

Schizophrenia

a psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression

Hallucinations

false sensory experiences

Delusions

false beliefs

Psychotherapy

a method of treating mental illness that involves talking about one's problems with mental health professionals

caring for residents that are mentally ill

-observe pt for changes and report

-support their family and friends

-encourage them to do as much as they can themselves

-remember that mental illness can be treated

-report: changes in ability, mood changes, self-harm comments, real or imagined symptoms, failure to take meds, situations that provoke certain reactions (people or events)

ALWAYS REPORT

suicidal thoughts/tendencies/jokes from residents. Anything in their room could be used as a weapon towards themselves.

intellectual disability and mental illness

are not the same thing

terminal illness

a disease or condition that will eventually cause death

grief

deep distress or sorrow over a loss

5 stages of dying

1. Denial: refusal to believe one is dying

2. Anger: "why me?"

3. Bargaining: "Yes me, but..."

4. Depression: the need to mourn and review life

5. Acceptance

not everyone goes through all these stages or in this order

living will

a document that outlines the medical care a person wants, or does not want, in case he or she becomes unable to make those decisions.

durable power or attorney

you designate some person to make medical decisions on your behalf if you are not able to. often next of kin

DNR

(Do Not Resuscitate) A type of advance directive that tells medical professionals not to perform CPR if a person's heartbeat or breathing stops.

when an advance directive is in place...

-NAs may be asked to continue to monitor vital signs and report readings to the nurse

-Comfort measures, such as pain medication, will continue to be used

-Depending on the details of the advance directive, CPR and extraordinary measures may be prohibited

-You are STILL providing them care but you must always honor the advance directive no matter your personal feelings.

guidelines for caring for dying residents

-keep lighting low, hearing is last sense to leave

-mouthcare every two hours

-skin kept clean and dry, wrinkle free sheets

-pain relief is critical, observe for signs of pain

-make their environment comfortable even if pt is unaware of their surroundings

-emotional and spiritual support: family members, volunteers to listen to them and provide support

-help with the family's physical comfort

Signs of approaching death

-Blurred and failing vision

-unfocused eyes

-impaired speech

-diminished sense of touch

-loss of movement, muscle tone, and feeling

-rising body temperature or below normal temperature

-decreasing blood pressure

-weak pulse that is abnormally slow or rapid.

-cheyne-stoke breathing

-rattling/gurgling sounds when breathing

-cold pale skin

-perspiration

postmortem care

care of the body after death.

Postmortem care guidelines for NA

-Rigor mortis may make the body difficult to move.

-Talk to the nurse if you need assistance.

-Bathe the body gently.

-Place drainage pads where needed.

-Do not remove tubes or other equipment.

-Put in dentures IF instructed by the nurse but clean them no matter what.

-Close the eyes.

-position the body flat and put pillow under head

-follow facility policy on personal items

-open windows to air room and straighten up the room

-respect family wishes

-document procedure

Hospice Care

holistic, compassionate care given to dying people and their families

Palliative Care

care that focuses on the comfort and dignity of the person rather than on curing him or her

guidelines for hospice work

-be a good listener

-respect privacy and independence

-be sensitive to individual needs

-be aware of your own feelings

-recognize stress and take a break when needed