Exam 5 Chapters 9, 39-41

Dementia: the permanent and progessive loss of mental functions (thinking, reasoning & remembering) caused by damage to the brain tissue Person w dementia: 1) problems with memory, especially short term memory 2)difficulties communicating 3) problems with judgement (unable to make good decisions) 4) disorientation; person,place,or time 5) inability to manage activities of daily living -​ Symptoms appear over a period of several months-few years -​ Live 8 to 10 years after first symptoms appear -​ Medications are available to slow the process but NO cure -​ 5% of older adults suffer with dementia Delirium: TEMPORARY state of confusion. Is a systom of an underlying disorder, such as infection, nutritonal deficiencies or a side effect of medication What are the 3 major stages of Dementia and what are the symptoms/signs associated with each stage? 1. Early Stage -begins to experience memory loss -may become fearful, angry, nervous because of these memory changes 2. Middle Stage -difficulty communicating -difficulty recognizing familiar people and things -difficulty remembering the steps that are necessary to complete familiar tasks (ex: getting dressed) -personality may change; may begin to behave differently (often in challenging ways) -begins to experience incontinence (inability to hold urine in the bladder) 3. Late Stage -loses the ability to walk and sit independently and eventually becomes bedridden -no longer able to speak, swallow, or smile -becomes totally incontinent or urine and feces -the person dies What are the 4 most common causes of Dementia? 1. Alzheimer's Disease 2. Vascular Dementia 3. Lewy Body Dementia 4. Frontotemporal Dementia Alzheimer's Disease: The most common type of Dementia (60% of all cases); characterized by the permanent and progressive loss of the ability to think and remember caused by damage to the brain Alzheimer's Disease usually occurs when in people? People older than 65 years (however people as young as 40 years may also get the disease) At what age are people at the highest risk for developing Alzheimer's Disease? Because the risk increases with age, people 85 years and older are at the highest risk How was Alzheimer's Disease named? It was named after Alois Alzheimer, German doctor who discovered the disease in 1906. What did Doctor Alzheimer discover about his patient who died showing unusual mental changes and behaviors? He performed an autopsy on her and found that certain areas of her brain seemed soft and shrunken. In addition, he saw abnormal deposits of protein (plaques/ tangles), especially in parts of the brain that function in memory. Plaques & Tangles: Abnormal protein deposits found in the brain What effect does plaques/ tangles have on neurons within the brain? They affect the ability of the nerve cells in the brain to communicate with each other. The neurons start to die. As a result, the brain shrinks in size, and brain activity decreases. What is the cause of Alzheimer's Disease? Researches do not know what exactly causes it What is the most significant risk factor for developing Alzheimer's Disease ? Age What are some other risk factors for developing Alzheimer's Disease ? 1. Family History 2. Those who have had serious head trauma 3. Heart Diseases (such as Hypertension, Hypercholesterolemia, Diabetes) What may contribute to the onset of Vascular (Multi-Infarct) Dementia? Damage to the blood vessels that supply the brain which affect the delivery of oxygen to the brain tissue Vascular (Multi-Infarct) Dementia A type of Dementia caused by the loss of function in multiple areas of the brain due to tissue death caused by a lack of adequate oxygen and nutrients (20%-25% of people with dementia) Infarction: Death of tissue due to lack of oxygen and nutrients MID (Multi-Infarct Dementia) most often affects people between the ages of what? 55 to 75 years (most commonly occurring in people who are 70 years old). T/F- MID is more common among women than men. FALSE- more common among men What are some conditions that put a person at risk for developing Vascular Dementia? 1. History of a myocardial infarction 2. Hypertension 3. Diabetes Mellitus 4. Peripheral Vascular Disease 5. Transient Ischemic Attacks 6. Obesity 7. Smoking 8. Hypercholesterolemia What can a person do to slow the progression of the irreversible and incurable Vascular Dementia? Keep the person's blood pressure, blood glucose, and blood cholesterol levels within normal limits Lewy Body Dementia A disorder characterized by the build-up of abnormal protein deposits (Lewy bodies) in areas of the brain that are responsible for thinking and movement; in addition to a progressive decline in mental abilities, also have problems controlling body movement similar to those seen in people with Parkinson's Disease, visual hallucinations, and distinct changes in mental alertness (20% of all cases of Dementia) Frontotemporal Dementia A disorder characterized by damage to the frontal and temporal lobes of the brain; in addition to a progressive decline in mental abilities, may have extreme changes in behavior and personality, and difficulties with language, or both (5% of all cases of Dementia) Which area of the brain is responsible for personality and behavior? Frontal Lobe Which area of the brain is responsible for language? Temporal (Broca's- speech function; Wernicke's- understanding language) T/F- Caring for a person with Frontotemporal Dementia can be particularly challenging because the disease may cause the person to say or do things that are socially inappropriate or they lack motivation and energy. TRUE When does memory loss begin with Frontotemporal Dementia? Unlike other forms of Dementia, memory is often spared until later in the disease process What are the "4 A's" of Dementia? 1. Amnesia (difficulty remembering) 2. Aphasia (difficulty speaking or understanding language) 3. Agnosia (difficulty recognizing information obtained using the five senses) 4. Apraxia (difficulty coordinating the steps needed to complete a task) During the early stage of Dementia, memory loss generally only affects what? Short-Term Memory What may be some actions/reactions of a person with short-term memory loss? 1. Accuse others of larceny (because they cannot remember where they put their belongings) 2. Ask for a meal after they have eaten (they do not remember eating) 3. Stop in the middle of a task (they have forgotten what they were doing) 4. Ask the same question over and over again (they cannot remember asking the question and cannot remember the answer you gave them) T/F- If you insist that what the Long-Term Memory Loss resident believes to be true is not real, they will not lose their trust in you since you are only trying to help them. FALSE-they will lose trust in you! (Instead use validation therapy) Validation Therapy: A technique used for interacting with people who have dementia, in which the caregiver acknowledges the person's reality; rather than correcting the person, the caregiver attempts to distract the person and redirect the conversation whenever possible Validation Therapy does what for the resident and what for the caregiver? Resident- protects the feelings and beliefs of the person with dementia and helps the person to retains sense of self-worth and dignity Caregiver- helps understand what the person with dementia is experiencing When does a person begin to experience aphasia? During the Middle Stage of dementia What is the difference between expressive aphasia and receptive aphasia? Expressive- difficulty using words Receptive- difficulty understand words If you cannot understand a resident with expressive aphasia (ex: "my twig had a cap and the nose was had indeed!"), how should you respond? Respond to the mood or feeling that the person is conveying through their body language or tone of voice How can you convey a message to a resident with receptive aphasia? (ex: asking the person to go to the dining room with you) Using gestures may help the person to understand the message (ex: pointing toward the dining room or pretend to pick up a fork and eat) What must a caregiver be very careful of when caring for people with agnosia? To keep cleaning solutions, personal care items, medications, equipment, and other potentially dangerous items in a secure place What are some common behaviors in people with Dementia? 1. Wandering 2. Pacing 3. Repetition 4. Rummaging 5. Delusions and Hallucinations 6. Agitation 7. Catastrophic Reactions 8. Sundowning 9. Inappropriate Sexual Behaviors T/F- A resident who tends to wander may wear a bracelet or an anklet that will set off an alarm if the resident tries to leave the facility through a doorway that leads to an unsafe area. TRUE Why might a resident with dementia pace back and forth? Often, the person is pacing because they have a physical need that is not being met (ex: hungry or need to use the toilet), or in response to a noisy, overstimulating environment, or because they are feeling lost or scared. Perseveration The inappropriate and constant repetition of a phrase or act; often seen in people with dementia (Can be a sign that the person is bored) Delusions A belief or impression that is firmly believed despite being contradicted by what is generally accepted as reality or rational argument; typically a symptom of dementia Hallucination Seeing, hearing, tasting, or smeeling something that is really not there; typically a symptom of dementia People with dementia often lose the ability to communicate effectively with others, so how do they express themselves? Through behavior What may cause agitation? 1. Pain 2. Infection 3. Unmet physical need 4. Noisy environment Catastrophic Reaction An extreme reaction to a situation that would normally cause minimal or no stress; often seen in people with dementia When do catastrophic reactions usually occur? When the person feel threatened or overwhelmed Sundowning The worsening of a person's behavioral symptoms in the late afternoon and evening, as the sun goes down Why do people think sundowning occurs? Some people think it is brought on by fatigue, while other think it occurs because the person cannot see as well once the sun has gone down, increasing confusion and agitation OBRA states that a resident of a long-term care facility must be allowed to fulfill their sexual needs with another consenting resident. How can this be a problem with residents that have dementia? A resident with dementia is not able to give consent Why is it important to try and determine the cause of difficult behavior, rather than just accepting it as a normal part of the person's dementia process? Because a change in the person's behavior might be the first and only sign of a medical problem. Reality Orientation Based on the idea that it is important to bring the person back to the "here and now" by constantly orienting the person to the time, place, people, and things. Which type of patient should you use Reality Orientation on? Delirium When helping a person with dementia with their ADLs, what are some general things you can do to make the task go more smoothly? 1. Speak clearly, in a calm tone of voice (also consider gently resting one of your hands on the person's arm or hand). 2. Remind the person at each step what they need to do next. 3. Use hand gestures in addition to spoken language 4. Plan for procedures in advance 5. Keep a regular schedule What are some things that a CNA can do in order to make bathing go more smoothly with a person with dementia? 1. Avoid saying "bath", instead say "Let's go freshen up" 2. Try singing if the person is agitated 3. Prepare the tub room in advance 4. Make sure the room is warm 5. Place a folded towel on the shower chair for comfort 6. Allow the person to wear their robe for as long as possible 7. Draping a bath towel over the person while they are bathing 8. Hand the person a washcloth and let the person assist as much as possible What are some things that a CNA can do in order to make dressing go more smoothly with a person with dementia? 1. Limiting the number of outfits the person has to choose from 2. Asking family members to purchase several identical outfits for the person 3. Select articles of clothing that are simple rather than complex What are some things that a CNA can do in order to make eating go more smoothly with a person with dementia? 1. A quiet setting 2. Limited food choices 3. Remind the person how to eat (by placing your hand over the person's hand then together bring the fork with the food to the person's mouth; make sure they are chewing and then swallowing, many people just keep the food in their cheeks) 4. Offer finger foods 5. Feeding Syringe (Advanced Dementia) What are some things that a CNA can do in order to make going to the bathroom go more smoothly with a person with dementia? 1. Taking the person to the bathroom on a regular schedule (ex: every 2 hours) 2. Helping the person select clothing with fasteners that are easy to manage What are the 4 types of therapy used for emotional needs in people with dementia? 1. Reminiscence Therapy 2. Activity Therapy 3. Music Therapy 4. Pet Therapy Reminiscence Therapy A technique used for interacting with people who have dementia, in which the person with dementia is encouraged to remember and share experiences from his or her past with others (ex: A person is talking about her mother that is going to visit her, but she has really been dead for 20 years. The CNA may say, "What was your favorite food your mother used to make for you?" Activity Therapy A technique used for interacting with people who have dementia, in which some form of activity (creative, intellectual, social, physical) is used Engaging in activities helps the person with dementia feel what? Useful and gives them a sense of purpose and accomplishment What are some activities a person with dementia can enjoy? 1. Creative activities (ex: painting) 2. Intellectual activities (ex: reading the newspaper,word search) 3. Social activities (ex: tea party, bingo) 4. Physical activities (ex: group exercise class) *Take care to choose an activity that relates to the former interests and abilities of the person or people Music Therapy A technique used for interacting with people who have dementia, in which music is used to benefit people. What effects do our bodies have when listening to music we like? 1. Our heart and respiratory rates slow 2. BP drops Pet Therapy A technique used for interacting with people who have dementia, in which people spend time with companion animals which can be very calming Immobility (seen in late dementia patients) puts the person at risk for problems such as what? 1. Pressure Ulcers 2. Contractures (a condition of shortening and hardening of muscles, tendons, or other tissue) 3. Pneumonia What is usually the final phase of the disease before death occurs? When the person loses the ability to swallow, affecting their ability to eat (Look at Advanced Directive to see if Feeding Tube should be used or go to the person's Health Care Agent for directions) I. Introduction to Rehabilitation and Restorative Care ●​ Rehabilitation: The process of helping a person with a disability return to their highest level of physical, emotional, or economic function. It involves treatment, education, and prevention of further disability. ●​ Restorative Care: The care provided by the healthcare team that supports the rehabilitation effort. It aims to help individuals regain or maintain their highest level of function, independence, and well-being. ●​ Key Concept: Many diseases and injuries can leave a person with a disability. Disabilities can be physical, emotional, or both, and can be temporary or permanent. II. The Rehabilitation Team ●​ A team of healthcare professionals works together to provide comprehensive rehabilitation and restorative care. ●​ Team Members and Their Roles: ○​ Nurse/Rehabilitation Nurse: Develops a nursing care plan, manages and directs the person's rehabilitation program, teaches the person self-care measures, administers medications, and monitors complications. ○​ Occupational Therapist (OT): Helps the person learn or maintain skills needed for daily activities (ADLs) such as eating, dressing, grooming, and bathing. Focuses on fine motor skills and using assistive devices. ○​ Physical Therapist (PT): Helps the person regain or maintain strength, endurance, coordination, posture, and flexibility. Focuses on gross motor skills and mobility. ○​ Speech-Language Pathologist (SLP): Helps the person relearn to speak, communicate, chew, and swallow. Addresses speech, language, and cognitive disorders affecting communication. ○​ Dietitian: Assesses nutritional needs and plans meals to promote healing and health. ○​ Psychologist: Helps the person cope with the emotional and psychological aspects of disability. ○​ Social Worker: Helps with financial and housing issues, and community resources. ○​ Prosthetist: Fits the patient or resident with prosthetic devices (artificial limbs). ○​ Orthotist: Fits the patient or resident with supportive devices (braces or supports). ○​ Neuropsychologist: Helps the person regain or maintain cognitive skills. ○​ Nursing Assistant: Plays a key role in supporting the rehabilitation effort, providing restorative care, and encouraging residents. III. Settings for Rehabilitation ●​ Rehabilitation services can be provided in various settings: ○​ Specialized rehabilitation facilities: Offer comprehensive services for individuals with complex needs. ○​ Hospitals (Acute Care): Rehabilitation begins early after an injury or illness to prevent complications and promote recovery. ○​ Subacute Care Facilities: Bridge the gap between acute care and long-term care, providing intensive rehabilitation. ○​ Long-term Care Facilities: Provide ongoing restorative care to maintain function and prevent decline. ○​ Home: Rehabilitation can occur at home, promoting independence in a familiar environment. IV. Phases of Rehabilitation Rehabilitation typically takes place in three phases: 1.​ Acute Phase:​ ○​ Begins immediately after an injury or illness (first 24-48 hours). ○​ Focuses on preventing complications and maintaining existing function. ○​ Healthcare team keeps the person comfortable, maintains body alignment, and performs range-of-motion exercises. ○​ Nursing assistants play a vital role in assisting with basic care and monitoring the person's condition. 2.​ Subacute Phase:​ ○​ The person's condition has stabilized, and they can tolerate more activity. ○​ Focuses on regaining lost function and improving physical abilities. ○​ Includes more intensive therapy, such as physical, occupational, and speech therapy. ○​ Nursing assistants assist with ADLs and encourage independence. 3.​ Chronic Phase:​ ○​ For individuals with long-term disabilities. ○​ Focuses on maintaining the highest possible level of function, preventing further complications, and adapting to the disability. ○​ May involve ongoing therapy and the use of assistive devices. ○​ Nursing assistants support the person in maintaining their independence and quality of life. V. Factors Affecting Rehabilitation Effort ●​ The person's attitude and coping skills: A positive outlook and strong desire to improve significantly impact the success of rehabilitation. ●​ The person's family members and caregivers: Support from loved ones is crucial for encouragement and assistance. ●​ The person's overall health status: Underlying health conditions, pain, and complications can affect progress. ●​ The person's age: Younger individuals may recover more quickly than older individuals. VI. Types of Rehabilitation ●​ Physical Rehabilitation: Focuses on regaining physical function and may involve specialized therapists. ●​ Occupational Therapy (OT): Helps individuals perform ADLs and use assistive devices. ●​ Physical Therapy (PT): Focuses on improving strength, endurance, coordination, balance, and mobility. ●​ Speech-Language Pathology (SLP): Addresses communication, chewing, and swallowing difficulties. ●​ Vocational Rehabilitation: Helps individuals return to work or find new employment after a disability. ●​ Emotional Rehabilitation: Addresses the emotional and psychological impact of disability, helping individuals cope with feelings of anger, frustration, and depression. VII. Specific Rehabilitation Measures ●​ Integumentary System: Rehabilitation related to the skin, especially for individuals with chronic wounds or mobility issues. ●​ Musculoskeletal System: Focuses on regaining and maintaining muscle function, range of motion, and preventing complications like contractures. Involves physical therapy, assistive devices, and prosthetic devices. ●​ Cardiovascular System: Rehabilitation for individuals with heart conditions, focusing on improving cardiovascular fitness, managing medications, and lifestyle changes. ●​ Nervous System: Rehabilitation for people with neurological disorders, focusing on regaining neurological function and managing symptoms. ●​ Digestive, Urinary, and Reproductive Systems: Rehabilitation measures can address issues like incontinence and sexual health. ●​ Endocrine System: Rehabilitation for conditions affecting the endocrine system, such as diabetes mellitus. VIII. Guidelines Box 39-1: Assisting With Rehabilitation and Restorative Care What You Do: ●​ Monitor the person's emotional status: Look for signs of frustration, discouragement, and depression. ●​ Focus on the person's abilities and celebrate all successes: Even small achievements can boost morale. ●​ Encourage and reassure the person, but be realistic: Set achievable goals and do not compare the person with others. ●​ Give the person the time they need to complete a task: Be patient and offer assistance only as needed. ●​ Be empathetic, but do not pity the person: Understand their feelings without feeling sorry for them. ●​ If you find yourself feeling frustrated with a patient or resident who is struggling, talk to the nurse: Seek guidance and support. Why You Do It: ●​ Special techniques are being used: Understand the purpose of each task to help the person. ●​ Working to regain or maintain function is a long, difficult, and painful process: Patients experience frustration and discouragement. Your encouragement can help them cope. ●​ Achieving small goals gives the person an emotional boost: This keeps them motivated. ●​ Each person will have individual responses: Progress varies for everyone. ●​ When you pity someone, it means you recognize their loss: Empathy helps you understand their feelings and build trust. ●​ If you let the person's frustration and anger affect you, you may not be able to provide the person with the best care possible: It's important to maintain professional objectivity. IX. Helping Hands and a Caring Heart: Focus on Humanistic Health Care ●​ ●​ ●​ ●​ ●​ Disability can lead to feelings of helplessness, fear, and frustration. Empathy and understanding are crucial. Focus on the person's abilities and potential, not their limitations. Encourage self-esteem and independence. A holistic approach considering the person's emotional needs is vital. X. Tell the Nurse! (Reporting Observations) Report the following observations to the nurse immediately: ●​ A supportive device or assistive device is broken or not working properly. ●​ The person has a change in vital signs during or after the rehabilitation or restorative care activity. ●​ The person has pain, swelling, redness, or signs of inflammation around supportive devices or prosthetic devices. ●​ The person is showing signs of depression or excessive frustration, such as crying, withdrawal, anger, or talk of suicide. ●​ The person is having excessive difficulty with a new rehabilitation technique or treatment. XI. Key Vocabulary ●​ Mobility: The ability to move freely and easily. ●​ Rehabilitation: The process of restoring a person to the highest possible level of physical, emotional, and economic function. ●​ Restorative Care: Nursing care that helps persons regain their health, strength, and independence. ●​ Supportive Devices: Equipment used to support a body part, prevent injury, or improve function (e.g., leg brace, wrist support). ●​ Assistive Devices: Tools or equipment that help individuals perform tasks they might otherwise have difficulty with (e.g., walker, cane, crutches, swivel spoon, cup holder, buttonhole, long-handled shoehorn). ●​ Prosthetic Devices: Artificial body parts that replace missing limbs or organs (e.g., artificial arm, artificial leg). ●​ Frailty: A state of increased vulnerability to adverse health outcomes due to age-related decline in physiological reserves. I. Key Concepts & Definitions ●​ Developmental Disability: A permanent disability that affects a person before adulthood (age 22) and interferes with the person's ability to achieve or maintain economic self-sufficiency, live independently, or participate fully in community life. These disabilities often involve mental or physical function, or both. ●​ Special Needs: The physical and emotional needs that people with developmental disabilities have, which may include good nutrition, plenty of exercise, and the sense of well-being. They often require ongoing assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). ●​ Mainstreaming: Benefits children with developmental disabilities by making them feel less isolated. ●​ Self-Care: The ability to provide for one's own needs. For individuals with developmental disabilities, achieving self-care may require significant assistance. ●​ Quality of Life: For people with developmental disabilities, this includes having a say in their own care, being treated with dignity, and having opportunities for social interaction and recreation. II. Types of Developmental Disabilities The chapter discusses several types of developmental disabilities, often involving intellectual and/or physical limitations: ●​ Intellectual Disabilities:​ ○​ Definition: A person with an intellectual disability has certain limitations in intellectual functioning and adaptive skills (skills needed to function in daily life). They may learn at a slower pace and have difficulty with social skills, self-care, and problem-solving. ○​ Mild Intellectual Disability: IQ of 50-70. Able to live independently with some support, learn vocational skills, and often achieve academic skills up to a sixth-grade level. ○​ Moderate Intellectual Disability: IQ of 35-49. May learn speech and communication skills, but often need supervision. Can live in supervised group homes. ○​ Severe Intellectual Disability: IQ of 20-34. May learn some communication and basic self-care, but often require significant assistance with ADLs. ○​ Profound Intellectual Disability: IQ below 20. Require total care, often unable to communicate or provide for their safety. ●​ Down Syndrome:​ ○​ Definition: A developmental disability that is the result of a genetic disorder, specifically an extra chromosome 21. ○​ Characteristics: Typically short stature, flat facial features, a short wide neck, small hands and feet, wide-set eyes, and upward slanting eyelids. May have heart defects, respiratory problems, digestive issues, and increased risk of infections. Many have mild to moderate intellectual disability. ●​ Autism Spectrum Disorder (ASD):​ ○​ Definition: A neurological disorder that affects a person's ability to communicate and interact with others. It is a spectrum disorder, meaning it varies widely in severity. ○​ Characteristics: Challenges with social interaction and communication, repetitive behaviors, difficulty with changes in routine, and sensitivity to sensory input. Some individuals may have exceptional abilities in specific areas. ●​ Cerebral Palsy:​ ○​ Definition: A motor disorder caused by damage to the cerebrum (part of the brain) before, during, or shortly after birth. This damage affects the brain's ability to control movement and posture. ○​ Characteristics: Vary widely depending on the extent and location of brain damage. May include spasticity (stiff muscles), involuntary movements, balance and coordination problems, and difficulty with fine motor skills. Can also impact speech, vision, and intellectual abilities. ●​ Fragile X Syndrome:​ ○​ Definition: The most common inherited intellectual disability, caused by a defect in the X chromosome. ○​ Characteristics: More common and severe in males. May cause intellectual disability, behavioral problems (e.g., hyperactivity, anxiety), and physical features (e.g., long face, large ears). ●​ Fetal Alcohol Spectrum Disorder (FASD):​ ○​ Definition: A group of conditions that can occur in a person whose mother drank alcohol during pregnancy. ○​ Characteristics: Can include physical defects, intellectual disabilities, and problems with behavior and learning. ●​ Spina Bifida:​ ○​ Definition: A developmental congenital disorder caused by the incomplete closing of the backbone and membranes around the spinal cord. It is a type of neural tube defect. ○​ Characteristics: Can range from mild to severe, affecting mobility, bowel and bladder control, and sometimes intellectual development. Often requires surgery. ●​ Hydrocephalus:​ ○​ Definition: Results from a buildup of cerebrospinal fluid (CSF) in the ventricles of the brain. The excess fluid can put pressure on the brain, causing damage. ○​ Characteristics: Enlarged head in infants, vomiting, irritability, seizures, and developmental delays. Often requires a shunt to drain excess fluid. III. Common Causes of Developmental Disabilities The chapter identifies various factors that can contribute to developmental disabilities, often occurring before or around birth: ●​ Congenital (Present at Birth):​ ○​ Genetic or Chromosome Abnormalities: Such as Down syndrome, Fragile X syndrome. ○​ Consumption of Alcohol or Drugs during Pregnancy: Leading to conditions like Fetal Alcohol Spectrum Disorders. ○​ Certain Infections During Pregnancy: Rubella, Herpes, Cytomegalovirus (CMV), Zika Virus. ○​ Poor Nutrition during Pregnancy. ○​ Conditions that Deprive the Baby of Oxygen. ●​ Acquired (Occurring After Birth):​ ○​ ○​ ○​ ○​ ○​ Birth Trauma. Head Injury. Near-drowning. Poisoning. Severe infections: Meningitis, encephalitis. IV. The Nursing Assistant's Role in Caring for People with Developmental Disabilities The nursing assistant (NA) plays a crucial role in providing holistic care and support to individuals with developmental disabilities. This includes: ●​ Promoting Independence and Self-Care:​ ○​ Assisting with Activities of Daily Living (ADLs) such as bathing, dressing, eating, and toileting, while encouraging as much independence as possible. ○​ Providing opportunities for residents to make choices and participate in their own care decisions. ○​ Teaching new skills and reinforcing learned ones. ●​ Communication:​ ○​ Using clear, simple language and short sentences. ○​ ○​ ○​ ○​ ○​ ○​ Speaking slowly and clearly. Being patient and allowing time for responses. Using non-verbal cues (gestures, facial expressions) as needed. Paying attention to resident's non-verbal communication. Reporting any changes in communication abilities. Recognizing that some individuals may communicate differently (e.g., using picture boards, sign language). ●​ Meeting Physical Needs:​ ○​ Assisting with mobility and transfers, using proper body mechanics and assistive devices. ○​ Helping with exercise and range of motion to prevent complications. ○​ Ensuring proper nutrition and hydration, assisting with feeding as needed. ○​ Providing skin care to prevent pressure ulcers, especially for those with limited mobility. ○​ Assisting with bladder and bowel management. ○​ Monitoring vital signs and reporting any changes. ○​ Being aware of physical changes that may indicate discomfort or illness (e.g., grimacing, moaning). ●​ Meeting Emotional and Social Needs:​ ○​ Treating individuals with respect and dignity, regardless of their intellectual or physical abilities. ○​ Providing opportunities for social interaction and participation in activities they enjoy. ○​ Encouraging participation in recreational and social events, such as those offered by the Special Olympics. ○​ Promoting emotional well-being by providing a supportive and understanding environment. ○​ Recognizing and reporting signs of abuse or neglect. ●​ Assisting with Rehabilitation and Therapies:​ ○​ Following the care plan developed by therapists (physical, occupational, speech). ○​ Assisting with exercises and adaptive equipment. ○​ Reinforcing therapy goals in daily care. ●​ Observing and Reporting:​ ○​ Carefully observing changes in the resident's physical condition, behavior, mood, or abilities. (exs: person who usually has no trouble walking starts having falls 2. Seems more confused or disoriented 3. Gentle person becomes more aggressive) ○​ Promptly reporting observations to the nurse, including any signs of pain, illness, or distress. Or signs of physical, sexual or emotional abuse ○​ Change in vital signs, especially body temp or pulse rythm ○​ Persons skin is red or swollen ●​ Promoting Rights:​ ○​ Understanding and upholding the rights of individuals with disabilities, including the right to make choices, be treated with respect, and live in the least restrictive environment possible. ○​ Advocating for the resident's needs and preferences. ●​ Long-Term Care:​ ○​ Recognizing that developmental disabilities are lifelong conditions, and care needs may change over time. ○​ Providing consistent and compassionate care, fostering a trusting relationship with the resident and their family. 1. Defining Mental Illness ●​ Mental Illness: A disturbance in the ability to cope with or adjust to stress; behavior and function are impaired; a disease affecting how a person thinks, feels, and behaves, and how they cope with daily life. It is not an emotional problem or character flaw. 2. Qualities of Good Mental Health ●​ The text primarily focuses on mental illness and associated challenges. However, good mental health can be inferred as the opposite of the characteristics of mental illness, including: ○​ The ability to cope with and adjust to stress effectively. ○​ Functioning well in daily life (e.g., in work, relationships, self-care). ○​ Maintaining emotional balance. ○​ Having a sense of well-being and purpose. ○​ Engaging in activities that promote physical and mental health. 3. Methods People Use to Cope Effectively with Stress (Coping Mechanisms) ●​ Coping Mechanisms: Actions or strategies people use to manage stress and emotional challenges. These can be healthy or unhealthy. ○​ Effective Coping Mechanisms: ■​ Enjoying a hobby or relaxing (e.g., reading, listening to music). ■​ Playing, exercising, or meditating. ■​ Getting together with friends. ■​ Talking about problems and feelings. ■​ Knowing what you can and cannot change. ■​ Making yourself feel better when you start to feel bad. ■​ Asking for help. ■​ Using spiritual resources (e.g., prayer). ○​ Less Effective/Unhealthy Coping Mechanisms: ■​ Displacement (shifting an emotion from one person to another). ■​ Projection (blaming another person). ■​ Rationalization (making excuses). ■​ Denial (refusing to believe something true). ■​ Repression (suppressing memories). ■​ Maladaptive Coping Mechanisms (often leading to further problems): ■​ Nail biting, pacing, excessive sleep, overeating, smoking, or abusing drugs and alcohol. ■​ Ignoring physical problems. 4. Possible Causes of Mental Illness ●​ Factors Contributing to Mental Illness: ○​ Inability to cope or adjust to stress. ○​ Chemical imbalance in the brain. ○​ Physical illness or disability. ○​ Inheritance (genetics). ○​ Abuse of alcohol and drugs. ○​ Life events (e.g., trauma, loss, prolonged stress). ○​ Changes in brain structure or chemistry. ○​ Environmental factors (e.g., isolation, poverty). 5. Different Treatments for Mental Illness ●​ Treatment Approaches: ○​ Psychotherapy: "Talk therapy" with a psychologist or psychiatrist. ○​ Drug Therapy (Medication): Prescribed by a physician (psychiatrist) to manage symptoms (e.g., antidepressants, antipsychotics). ○​ Cognitive Behavioral Therapy (CBT): Focuses on changing negative thought patterns and behaviors. ○​ Electroconvulsive Therapy (ECT): Used in severe cases, especially for depression. ○​ Support Groups: Provide a sense of community and shared experience. ○​ Community Mental Health Centers: Offer a variety of services, including therapy, medication management, and support. ○​ Inpatient Treatment: For severe cases requiring hospitalization. 6. Common Mental Illnesses in Healthcare Settings ●​ Anxiety Disorders: Characterized by worry, fear, and apprehension. ○​ Panic Disorder: Sudden, overwhelming fright or terror, with physical symptoms like chest pain, rapid heartbeat, and shortness of breath ("panic attacks"). ○​ Phobias: An excessive, abnormal fear of an object or situation. ○​ Obsessive-Compulsive Disorder (OCD): Recurrent unwanted thoughts (obsessions) and repetitive behaviors (compulsions). ○​ Post-Traumatic Stress Disorder (PTSD): Develops after experiencing or witnessing a traumatic event; symptoms include flashbacks, nightmares, and severe anxiety. ●​ Mood Disorders: Affect a person's feelings, emotions, and mood. ○​ Depression: Prolonged or excessive sadness, hopelessness, loss of interest in activities, fatigue, and suicidal thoughts. ○​ Bipolar Disorder: Episodes of intense mood swings, from extreme happiness (mania) to severe depression. ●​ Schizophrenia: A severe, chronic mental illness characterized by disorganized thoughts, hallucinations (seeing or hearing things that aren't there), delusions (false beliefs), and impaired social functioning. ●​ Eating Disorders: ○​ Anorexia Nervosa: Intense fear of gaining weight, distorted body image, and severe restriction of food intake, leading to extreme weight loss. ○​ Bulimia Nervosa: Repeated episodes of binge eating followed by compensatory behaviors like purging (vomiting, laxative use), excessive exercise, or fasting. ○​ Binge-Eating Disorder: Repeated episodes of eating large amounts of food, often quickly and to the point of discomfort, accompanied by feelings of lack of control, shame, or guilt, without compensatory behaviors. ●​ Substance Use Disorders: Compulsive use of a substance (e.g., alcohol, illicit drugs, prescription medications) despite harmful consequences, leading to physical, social, and psychological problems. Characterized by tolerance and withdrawal symptoms. 7. Special Concerns Related to Healthcare Settings and Aging Affecting Mental Health ●​ Healthcare Settings: ○​ Withdrawal: Emotional and social detachment in response to illness or stress. ○​ Physical Illness: Can contribute to or worsen mental health disorders. ○​ Medications: Some medications can affect mental state or interact with mental health drugs. ○​ Loss of Control/Independence: Being in a healthcare setting can lead to feelings of helplessness, contributing to anxiety or depression. ●​ Aging and Mental Health: ○​ Increased Risk: Older people are at higher risk for mental health disorders due to physical illness, loss of independence, social isolation, and grief. ○​ Cognitive Decline: Mental health can be affected by conditions like dementia or Alzheimer's. ○​ Losses Associated with Aging: ■​ Loss of physical or mental ability/independence. ■​ Loss of spouse, friends, and family. ■​ Loss of income and financial security. ■​ Loss of identity and purpose (e.g., retirement). ■​ Loss of structure or schedule. ○​ Depression in Older Adults: Often missed or mistaken for normal aging; common causes include chronic illness, pain, and side effects of medications. 8. Responsibilities of the Nursing Assistant When Caring for Patients and Residents with Mental Health Disorders ●​ General Principles: ○​ Observe and Report: Note and report any changes in mood, behavior, or physical signs to the nurse immediately. This is crucial for early intervention. ○​ Provide a Safe Environment: Ensure the person's safety and the safety of others. ○​ Maintain Dignity and Respect: Treat individuals with respect, regardless of their mental health status. ○​ Promote Independence: Encourage the person to do as much as they can for themselves. ○​ Show Empathy and Understanding: Try to understand the person's feelings and perspectives. ●​ Specific Responsibilities: ○​ Assisting with Activities of Daily Living (ADLs): Help with personal care, hygiene, and nutrition while promoting independence. ○​ Communication: ■​ Listen actively and patiently. ■​ Use clear, simple language. ■​ Be honest and trustworthy. ■​ Avoid arguing or criticizing. ■​ Do not make promises you cannot keep. ■​ Be aware of non-verbal cues. ○​ Observations to Report (Signs and Symptoms of Mental Illness): ■​ Physical Signs: Changes in appetite, sleep patterns, hygiene, restlessness, tremors, rapid pulse, sweating, dry mouth, changes in weight. ■​ Behavioral Signs: Social withdrawal, aggression, agitation, paranoia, hallucinations, delusions, refusal to eat or take medication, unkempt appearance, self-harm gestures, repetitive behaviors (e.g., pacing), inappropriate dress. ■​ Emotional Signs: Sadness, hopelessness, anxiety, irritability, anger, euphoria, apathy, excessive worry, lack of interest in activities, suicidal thoughts, crying. ■​ Communication Changes: Rapid or slow speech, incoherent speech, rambling, difficulty concentrating, inability to make eye contact, making threats. ■​ Cognitive Changes: Confusion, disorientation, memory problems, difficulty making decisions. ○​ Managing Challenging Behaviors: ■​ Report any changes immediately. ■​ Follow the care plan. ■​ Maintain a calm and professional demeanor. ■​ Protect the person and others from harm. ■​ Be aware of triggers. ■​ Do not argue with or contradict delusions/hallucinations. ■​ Offer reassurance and support. ○​ Promoting Mental Well-being: ■​ Encourage participation in activities. ■​ Provide opportunities for social interaction. ■​ Support healthy coping mechanisms. ■​ Help maintain a routine. ■​ Offer comfort and reassurance. I. Understanding Dementia ●​ What is Dementia?​ ○​ A permanent and progressive loss of mental functions. ○​ Caused by damage to brain cells, which in turn affects a person's ability to think, remember, and communicate. ○​ Often involves problems with: ■​ Memory (especially short-term). ■​ Communicating. ■​ Judgment (person is not able to make good decisions). ■​ Disorientation (person not oriented to person, place, or time). ■​ Inability to manage activities of daily living (ADLs). ○​ Typically has a gradual onset, with symptoms appearing over months to years. ○​ Progresses through three major stages (early, middle, late). ○​ Not a normal part of aging. ○​ Different from delirium (sudden onset, temporary, reversible, can be caused by nutritional deficiencies or side effects of medication). Delirium goes away when the underlying cause is treated. ●​ The "Four As" of Dementia (page 126 and 123):​ ○​ Amnesia: Memory loss (short-term, then long-term). ■​ Examples: Not remembering recent events, forgetting where items are placed, repeating questions. ○​ Aphasia: Language difficulties. ■​ Types: ■​ Expressive Aphasia: Difficulty finding the right words, speaking clearly, making sense when speaking. ■​ Receptive Aphasia: Difficulty understanding what is being said, responding appropriately to questions or directions. ○​ Agnosia: Inability to recognize sensory input (objects, people, sounds, smells, etc.). ■​ Example: Not knowing what a pencil is for. ○​ Apraxia: Difficulty performing purposeful movements. ■​ Example: Difficulty with dressing, eating, or walking. ●​ Stages of Dementia (Box 9-1, page 123):​ ○​ Early Stage: ■​ Begins with experience memory loss (recent events). ■​ Person may become fearful, anxious, or depressed. ■​ May become angry at others. ○​ Middle Stage: ■​ Difficulty communicating (using words, understanding both written and spoken language). ■​ Difficulty recognizing familiar people and things. ■​ Difficulty remembering tasks. ■​ Personality may change. ■​ May begin to behave differently (wandering, incontinence). ○​ Late Stage: ■​ Loses the ability to walk and sit independently. ■​ Eventually becomes bedridden. ■​ No longer able to speak, swallow, or eat. ■​ Totally incontinent of urine and feces. ■​ Person dies. ●​ Causes of Dementia (page 124):​ ○​ Many different diseases can cause dementia. ○​ Alzheimer's Disease (most common cause, over 60% of cases): ■​ Progressive, degenerative brain disease. ■​ No cure, death is inevitable. ■​ Linked to plaques and tangles in the brain (Fig. 9-1). ○​ Vascular Dementia: ■​ Caused by damage to blood vessels that supply the brain. ■​ Often results from stroke or transient ischemic attacks (TIAs). ■​ Risk factors: heart disease, high blood pressure, diabetes, obesity, smoking, high blood cholesterol levels. ○​ Lewy Body Dementia: ■​ Caused by abnormal protein deposits in the brain. ■​ Symptoms include sleep disturbances, visual hallucinations, and fluctuating alertness. ○​ Frontotemporal Dementia: ■​ Damage to the frontal and temporal lobes of the brain. ■​ Affects personality, behavior, and language. ■​ Person may be impulsive or display inappropriate social behaviors. ○​ Other causes mentioned (briefly): Huntington's disease. II. Behaviors Associated with Dementia ●​ Common Behaviors: ○​ Wandering: Person moves about without purpose or direction. ■​ Risks: Getting lost, injury, exposure to elements. ■​ Management: Secure environment (fenced areas), identification bracelets, regular checks. ○​ Pacing: Person walks back and forth in the same area. ○​ Repetition/Perseveration: Person does the same thing over and over. ○​ ○​ ○​ ○​ ○​ ○​ ○​ ○​ ■​ Examples: Repeating words, questions, actions. ■​ Management: Redirecting, distracting with new activities. Rummaging: Person searches through drawers or items. ■​ Management: Provide a designated rummage drawer/box with safe items. Delusions: False beliefs (e.g., believing they are someone else, thinking family is trying to harm them). Hallucinations: Seeing, hearing, tasting, or smelling things that are not there. Agitation: Person is restless, upset, or uneasy. ■​ Causes: Unmet needs (pain, hunger, full bladder), overstimulation, fear, anxiety. Catastrophic Reactions: An extreme emotional or physical reaction to a minor event. ■​ Examples: Screaming, crying, hitting. ■​ Management: Remove the person from the stressful situation, identify triggers. Sundowning: Increased agitation, confusion, and restlessness in the late afternoon/evening. ■​ Management: Maintain routine, adequate lighting, avoid overstimulation in the evening. Inappropriate Sexual Behaviors: Unwanted sexual advances or exposure. ■​ Management: Redirect, ensure privacy, consult with the care team. Managing Difficult Behaviors: ■​ Nursing assistants observe to try and figure out the underlying cause of behavior. ■​ If the cause is determined, actions can be taken to stop the behavior. ■​ A change in a person's behavior is often a sign of an unmet physical or emotional need. ■​ Key: Identify triggers and provide appropriate interventions. III. Caring for a Person with Dementia (Guidelines Box 9-1, pages 133-134) ●​ Meeting the Physical Needs:​ ○​ ADLs: As the person's dementia gets worse, they need more help with ADLs such as eating, bathing, dressing, and toileting. ○​ Maintaining a calm, structured environment. ○​ Approaching the person with dementia slowly and announcing yourself before touching them. ○​ Bathing: ■​ Can be a frightening experience. ■​ Avoid rush, bright lights, loud noises. ■​ Make the person feel exposed and vulnerable. ■​ If the person is very agitated, try again later. ■​ Offer "it's time for a bath" instead of "do you want to take a bath?" ■​ Use calming techniques like singing or talking softly. ■​ Prepare everything beforehand; fill tub before bringing the person in. ■​ Ensure the water temperature is comfortable. ■​ Allow the person to wear their robe or towel for as long as possible. ■​ Allow person to help as much as possible with dressing and bathing. ○​ Dressing: ■​ Many people have trouble selecting clothes. ■​ Limit choices, lay out clothes in order. ■​ Choose comfortable, easy-to-manage clothing (e.g., elastic waistbands, zippers instead of buttons). ○​ Eating: ■​ May have difficulty focusing, get distracted. ■​ Provide a quiet setting. ■​ Limit food choices. ■​ May forget how to eat; use hand-over-hand assistance. ■​ Person may swallow slowly or "pocket" food. ■​ Feeding Spoons: May be used to feed pureed food (Fig 9-9). ■​ Offer "finger foods" (sandwiches, cut-up vegetables, fruit). ■​ Use a sippy cup or a spout on a regular cup. ■​ Ensure the person chews and swallows. ■​ Allow ample time for meals. ○​ Elimination: ■​ May forget where the bathroom is or fail to recognize the urge to eliminate. ■​ Establish a regular schedule for toileting (e.g., every 2 hours). ■​ Report any changes in elimination or signs of urinary tract infection to the nurse. ○​ Maintaining person's dignity and self-esteem. ●​ Meeting the Emotional and Social Needs:​ ○​ Communication Strategies: ■​ Speak clearly, in a calm tone of voice. ■​ Consider gently resting one of your hands on the person's arm or hand. ■​ Repeat information using different words/phrases. ■​ Use simple, direct sentences. ■​ Avoid "reality orientation" if it causes distress (page 132). Instead, validate feelings. ■​ Maintain eye contact. ■​ Use gestures and visual cues. ■​ Avoid arguing or disagreeing with the person. ■​ Be patient and allow time for response. ■​ Do not embarrass or rush the person. ■​ Focus on feelings rather than facts. ■​ When asking a person with dementia to do something, use short words and short sentences. Avoid negative words. Put only one instruction at a time. ■​ Give a person with dementia enough time to respond to questions and directions. ■​ "Listen" to the person by paying attention to body language and observation skills. ■​ People with dementia often become clumsy and fall. Protect the person from physical injury. ○​ Validation Therapy: ■​ A communication technique that helps understand what is "real" for the person with dementia, and does not try to correct them. ■​ Acknowledge and validate the person's feelings and emotions, even if their perception of reality is different. ■​ Do not argue or try to correct them if they are disoriented. ■​ Example: If a person says they want to go home, ask about "home" rather than reminding them they are already home. ○​ Reminiscence Therapy: ■​ Discussing past events, people, and places. ■​ Can help with short-term memory loss by focusing on long-term memories. ○​ Activities: Activity therapy, music therapy, and pet therapy are used to help meet their emotional needs. ○​ Protecting from harm: Dementia often causes poor judgment; protect the person from harm. ○​ Allowing for independence: Help the person maintain independence for as long as possible by using visual cues (e.g., large clock, pictures, labels). For a person who keeps trying to walk out the front door, apply a "stop" sign to the inside of the door. ○​ Managing difficult behaviors: Be creative and do not give up. ○​ Handling emotional stress: When you become tired and frustrated, take time out. It's important for the caregiver to manage their own feelings and stress. ●​ Role of the Caregiver:​ ○​ Nursing assistants play a vital role in observing, identifying causes of behavior, and implementing care plans. ○​ Caring for a person with dementia is demanding and stressful. ○​ Dementia is a terrible disease that is devastating for both the person and their family. ○​ Effects on the Caregiver (page 137): ■​ Caring for people with dementia is very important work, but can also make caregivers ill. ■​ Caregivers often experience emotional distress, exhaustion, and fatigue. ■​ May feel frustrated or angry. ■​ ■​ ■​ ■​ It is crucial for caregivers to protect their own health and well-being. Do not feel responsible for the person's illness or behaviors. Ask for help from the care team. Managing stress and maintaining good health are essential for caregivers. IV. Important Concepts ●​ Reality Orientation vs. Validation Therapy (Page 132): ○​ Reality Orientation: Designed to keep disoriented people aware of person, place, and time. May increase agitation if person is severely confused. ○​ Validation Therapy: Accepting and validating the person's feelings and emotions, even if their perception of reality is different. Often more effective for people with advanced dementia. ●​ Differentiating Delirium from Dementia (Page 123 and 124): ○​ Delirium: Sudden onset, temporary, reversible. Caused by underlying conditions (e.g., infection, dehydration, medication side effects). ○​ Dementia: Gradual onset, progressive, permanent. ○​ Always report changes in mental status to the nurse.