Nurse Aide I: Mental Health, End-of-Life, Aging, and Restraints
Mental Health and Mental Illness
Mental health is the ability to adjust to everyday stresses; mental illness is a disturbance affecting thinking, emotion, or behavior.
Mood Disorders: Includes Major Depression, Dysthymia, and Bipolar Disorder.
Anxiety Disorders: Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), Panic Disorder, Post-Traumatic Stress Disorder (PTSD), and Social Anxiety Disorder.
Psychotic Disorders: Includes Schizophrenia, Schizoaffective Disorder, and Delusional Disorder.
De-escalation Techniques: Maintain a distance of , identify behavioral triggers, use a low monotonous voice, and acknowledge the resident's reality.
End-of-Life Care and Death
Advance Care Planning: Includes Advance Directives such as the Living Will and Durable Health Care Power of Attorney.
Do Not Resuscitate (DNR) Order: A medical order instructing that CPR not be performed; must be honored by nurse aides.
Palliative and Hospice Care: Focuses on comfort and dignity for terminal conditions, typically involving a life expectancy of < 6\,\text{months}.
Signs of Impending Death: Cheyne-Stokes breathing, "death rattle," mottling of extremities, and sensory decline (hearing is the last sense to be lost).
Five Stages of Grief (Kubler-Ross): Denial, Anger, Bargaining, Depression, and Acceptance; a sixth stage, Meaning, involves finding value in the life lived.
Postmortem Care: Position the body supine with legs straight and arms over the abdomen; provide privacy and perineal care.
Psychological Effects of Aging
Maslow's Hierarchy of Needs: Progression from Physiological and Safety needs to Love and Belonging, Self-Esteem, and Self-Actualization.
OBRA (Omnibus Budget Reconciliation Act): Federal regulation protecting resident rights and quality of life in nursing homes.
Defense Mechanisms: Unconscious coping behaviors including Projection, Rationalization, Denial, Compensation, Displacement, Daydreaming, Identification, and Sublimation.
Relocation Stress: Impact depends on the degree of choice, preparation, and number of additional losses experienced by the resident.
Restraint Elimination and Use
Definitions: Restraints can be physical or chemical; unnecessary use for discipline or convenience is considered false imprisonment.
Legal Framework: Regulated by the Code of Federal Regulations (CFR), Safe Medical Devices Act (SMDA), and North Carolina Administrative Code.
Clinical Requirements: Restraints require a doctor's order and must be the least restrictive method.
Nurse Aide Monitoring: Observe residents every ; release restraints every for at least to provide basic care.
Safety: Leave - of slack and pad bony areas during application.
Dementia and Alzheimer's Disease
Definitions: Dementia involves progressive cognitive deficits; Alzheimer's Disease is the most common cause.
Delirium: A sudden, severe, and usually reversible state of confusion often caused by acute illness.
Alzheimer's Stages: Early (Mild), Middle (Moderate), and Late (Severe, requiring care).
Behavioral Management: All behavior has meaning; address issues like sundowning, wandering, and catastrophic reactions by identifying triggers and redirecting.
Care Philosophy: Utilize Person-Centered Care and Activity-Based Care focused on meaningful engagement.
Mental health refers to an individual's emotional, psychological, and social well-being, enabling them to cope with the stresses of everyday life. In contrast, mental illness is manifested through disturbances in thinking, emotion, or behavior, significantly impeding daily functioning.
Mood Disorders: This category encompasses a range of conditions such as Major Depressive Disorder, characterized by persistent sadness and loss of interest; Dysthymia (Persistent Depressive Disorder), a chronic form of depression lasting for at least two years; and Bipolar Disorder, which involves alternating episodes of depression and mania, resulting in extreme mood changes.
Anxiety Disorders: These include Generalized Anxiety Disorder (GAD), marked by excessive, uncontrollable worry; Obsessive-Compulsive Disorder (OCD), where individuals experience intrusive thoughts and compulsive behaviors; Panic Disorder, characterized by unexpected panic attacks; Post-Traumatic Stress Disorder (PTSD), often following traumatic events; and Social Anxiety Disorder, which involves intense fear of social situations.
Psychotic Disorders: This group includes conditions like Schizophrenia, which affects the way a person thinks, feels, and behaves, often causing delusions and hallucinations; Schizoaffective Disorder, which combines features of both schizophrenia and mood disorders; and Delusional Disorder, where individuals experience persistent delusions without the major symptoms of schizophrenia.
De-escalation Techniques: When working with individuals experiencing mental health crises, effective de-escalation techniques are crucial. These include maintaining a distance of at least to ensure personal space, identifying and addressing behavioral triggers, employing a low tone and monotonous voice to promote calmness, and acknowledging the individual's reality to validate their feelings and experiences.