Class 7 - Age-related Communication and Grief
COMMUNICATIONS
Lesson Topics
Patient Observations
Age-related patient assessment
Grief cycle
P.I.E.C.E.S
Mental Status
Importance of visual assessment in providing information.
Abnormal findings include:
Drowsiness
Excitability
Obtundation: Insensitive to painful stimuli.
Stupor: State of lethargy with possible unresponsiveness.
Coma: Profound unconsciousness.
Levels of Alertness
A: Alert
V: Responds to Verbal stimuli
P: Responds to Physical stimuli
U: Unresponsive
Motor Activity
Typically, individuals without physical disabilities exhibit good balance and mobility.
Abnormal findings may include:
Ataxia: Uncoordinated movement.
Paralysis
Restlessness
Agitation
Bizarre body postures/movements
Immobility
Appearance
Indicators of potential abuse/neglect:
Inappropriately dressed for the weather or poor hygiene.
General appearance should reflect:
Age
Lifestyle
Occupation
Socioeconomic group
Environmental conditions
Breath and Body Odors
Can indicate underlying conditions/illnesses:
Alcohol/Mouthwash: Intoxication.
Acetone: Hyperglycemia.
Feces: Bowel obstructions.
Ammonia: Kidney/bladder issues.
Facial Expressions
Reveal emotions such as:
Fear
Anxiety
Pain
Anger
Withdrawal
Important to observe changes during assessment.
Mood and Speech
Should be contextually appropriate.
Abnormal findings include:
Unusual happiness
Indifference
Mood swings
Hallucinations.
Assess:
Quantity, rate, and fluency of speech.
Abnormal findings include:
Aphasia: Loss of speech.
Dysphonia: Abnormal voice.
Dysarthria: Poorly articulated speech.
Thought, Attention, and Perception
Patients should be oriented to:
Person
Place
Time
Healthy thoughts and perceptions are logical, relevant, and coherent.
Abnormal findings include:
Hallucinations
Obsessions
Inability to focus.
Use questions to check orientation.
AGE-RELATED ASSESSMENTS
Communicating and Assessing Different Age Groups
Paramedics must adapt communication for:
Infants
Toddlers
Preschoolers
School Age Kids
Teenagers
Adults
Seniors
Infants and Caregivers
Calls involving infants are often distressing; paramount to remain calm.
May involve two patients: the infant and the caregiver.
Maintain body temperature during physical exams.
Infants (Birth – 1 Year)
Constantly in motion; limp presentation indicates sickness.
Characteristics include:
Strong cry
Belly breathers
Poor skin color, nasal flaring, accessory muscle use indicate difficulty breathing.
Toddlers (1-3 Years)
Explain assessments in simple terms; make them fun.
Avoid separation from parent/caregiver; build rapport through play.
Preschoolers (3-5 Years)
Able to express discomfort but have varying fears.
Use of equipment may ease fear; importance of gentle communication.
School-Age Kids (5-12 Years)
Growing rational thought; can provide history accurately.
Maintain reassuring tone; explain assessments in detail.
Teenagers (13-18 Years)
Capable of understanding situations; more like adults.
Concerns about privacy and body image; involve them in decision-making.
Adults
Communication can be hindered by:
Alcohol/drug use
Mental illness
Developmental delays
Language barriers.
Seniors
Treat with respect; identify how they prefer to be addressed.
Speak slowly; provide assistance with aids as needed.
Listening skills and reassurance are crucial for effective communication.
GRIEF CYCLE
Key Points
Individual responses to grief vary.
Ethnicity, beliefs, and culture play a significant role in grief processing.
Kubler-Ross Grief Cycle
Stages:
Shock
Denial
Anger
Bargaining
Depression
Testing
Acceptance
P.I.E.C.E.S
Assessing Patients with Confusion/Dementia/Delirium
What is P.I.E.C.E.S?
A non-pharmacological assessment tool used to identify causes of behavioral symptoms in dementia.
P: Physical
I: Intellectual
E: Emotional
C: Capabilities
E: Environment
S: Social/support network
Physical Health
Monitor patients for changes during assessment for reassurance.
Dementia is a progressive decline in mental function.
Delirium
Caused by acute stress, medications, or environmental changes.
Symptoms include restlessness and confusion; requires careful history-taking.
I WATCH DEATH (Causes of Delirium)
Infections
Withdrawal
Acute metabolic crises
Toxins/drugs
CNS pathology
Hypoxia
Deficiencies
Endocrine issues
Acute vascular problems
Trauma
Heavy metals
Physical Health in Elderly
Chronic pain is common; may require tailored pain management due to medication effects.
Intellectual Ability
Affected by neurological diseases and mental conditions; 7 As of altered intellect.
Amnesia
Inability to Recollect
Short-term and long-term memory distinctions.
Considerations in daily living; constant reassurance needed.
Other Cognitive Considerations
Aphasia
Impairs language abilities and comprehension; various types exist:
Expressive
Receptive
Anomic
Global
Apathy
Lack of interest; differs from depression as patients require social interaction.
Altered Perception
Inaccurate reality discernment; may confuse illusions with hallucinations.
Agnosia
Loss of recognition and inability to interpret sensations; may create frustration.
Apraxia
Inability to execute tasks; frustration in performing everyday activities.
Anosognosia
Denial of illness severity; may ignore medication needs.
Emotional Adjustments
Changes in environment can increase anxiety or behavioral issues.
Capabilities
Assess typical abilities and encourage independence with supportive tools.
Environmental Factors
Observe living conditions; ensure safety and comfort.
Social Factors
Patients with dementia need social interaction; mitigating loneliness is essential.