Copyright © 2008 Delmar Learning. All rights reserved. Unit 33 Care of the Elderly and Chronically...

Copyright © 2008 Delmar Learning. All rights reserved.

Unit 33

Care of the

Elderly and Chronically Ill


Objectives

• Spell and define terms.• List the federal requirements for nursing

assistants working in long-term care facilities.

• Identify the expected changes of aging.


Objectives

• Identify residents who are at risk of malnutrition and list measures to promote adequate food intake.

• Explain why elderly individuals are at risk of dehydration and list nursing assistant actions to prevent dehydration.


Objectives

• List the actions a nursing assistant can take to prevent infections in the long-term care facility.

• Define delirium. List potential causes and signs and symptoms of delirium to report.


Objectives

• Recognize unsafe conditions in the long-term care facility.

• Describe actions to use when working with residents who have dementia.

• Describe the management of wandering residents.


Introduction

• Many individuals require continuing health care.

• These individuals are frequently elderly. • This is because as people age, their

risk of acquiring a chronic disease increases.


Introduction

• Persons of any age who are chronically ill or severely injured may require long-term care.


Types of Long-Term Care Facilities

• Many types of facilities provide health care for persons with ongoing medical problems:– Assisted living– Intermediate care – Skilled care


Long-Term Care Population

• People living in a long-term care facility are usually called residents.

• This is because the facility is considered their home as well as a place to receive health care.


Legislation Affecting Long-Term Care

• Nursing Home Reform Act– Federal legislation mandating

improvements in the quality of long-term care


Legislation Affecting Long-Term Care

• Result of the Omnibus Budget Reconciliation Act of 1987 (OBRA)– Each state is responsible for implementing

this legislation


Role of the Nursing Assistant in a Skilled Care Facility

• As in the acute care facility:– The nursing assistant in a skilled care

facility carries out the procedures as taught– Assisting in the health care of residents

under the direct supervision of a nurse


Role of the Nursing Assistant in a Skilled Care Facility

• Basic physical care and special procedures are provided to help residents reach their maximum degree of well-being


Role of the Nursing Assistant in a Long-Term Care Facility

• Nursing assistants provide 75 percent to 80 percent of the care in long-term care facilities– They come to know the residents well



• Nursing assistants are the eyes and ears of the nurses– Nurses depend on assistants to report

important changes, findings, and observations.



• Inform the nurse promptly if a resident’s normal or usual condition changes.


Art and Science of Nursing

• Nursing is both an art and a science:– The science is doing tasks in the way you

were taught– Each step of the procedures you do has a

scientific rationale that is supported by nursing research

– Being caring and compassionate in doing your work is the art



• Never get so busy with technical tasks that you forget the caring and compassion.



• Caring and compassion are as important or more important than the science– It humanizes the care you give to the

residents

• Caring and compassion are the essence of nursing assistant care


Effects of Aging

• Many residents in the long-term care facility– Are advanced in age and have one or

more chronic or debilitating conditions

• Some are mentally alert• Others are confused and disoriented


Nutritional Needs

• Malnutrition– A problem for the aged because the older

person may become progressively apathetic toward food


Nutritional Needs

• Malnutrition can and does occur in long-term care facility residents– Despite the fact that a balanced diet is

served and nutritional supplements are available


Nursing Assistant Actions

• Meal time is a very busy time in the long-term care facility– Especially on the day shift, when two

meals are served

• Do not get so busy that you overlook residents who are having difficulty eating or who are not eating.


Residents Receiving Tube Feedings

• Tube feedings– Common treatments in the long-term care

facility– Residents receiving tube feedings are at

nutritional risk


Residents Receiving Tube Feedings

• Tube feedings– Their medical needs sometimes change– Tube-feeding formula and fluid orders must

be adjusted to keep up with their bodies’ demands


Hydration Needs

• Like malnutrition, dehydration can and does occur in long-term care facility residents.

• This is partially due to decreased thirst in the elderly.

• Some residents deliberately avoid fluids because they fear incontinence.


Hydration Needs

• Offer and encourage residents to drink a beverage they like each time you are in their rooms.


Preventing Infections in Residents

• There are no additional or special infection control techniques in long-term care facilities

• Section 4 – Provides instruction on all infection control

procedures– These should be performed in nursing

homes


Signs of Infection

• Signs and symptoms of infection are often the same in the elderly as they are in younger persons, however:– Elderly persons may not run a fever

because of aging changes– Below normal temperature or hypothermia

may indicate sepsis• Very serious systemic infection


Signs of Infection

• Inform the nurse of residents with an abnormally low temperature

• Monitor the resident closely


Delirium

• Mental confusion – Is not a normal aging change and is often

caused by reversible conditions

• Delirium – Acute confusional state caused by

reversible medical problems


Keeping Residents Safe

• Each year– An estimated 30 to 50 percent of all

nursing home residents fall

• The risk and incidence of falls increase with age.


Keeping Residents Safe

• Caregivers often recognize these aging changes but fail to associate them with an increased risk for falls.


Exercise and Recreational Needs

• Residents in long-term care facilities – Need the stimulation of planned recreation

and exercise

• The types of activities must be carefully tailored to the needs and abilities of the residents.


Exercise and Recreational Needs

• Health care workers in these facilities– Responsible for coordinating this aspect of

care


General Hygiene

• Cleanliness of the skin is essential– But a full daily bath for the older person is

neither necessary nor advisable– In fact, most elderly are reluctant to bathe

daily


General Hygiene

• Hygiene also includes care of:– Hands and feet– Hair– Facial hair– Mouth– Eyes, ears, and nose


Mental Changes

• Mental deterioration is not a normal part of aging

• As people age– Risk of mental deterioration increases

• Mental deterioration– May stem from physical or emotional

causes


Caring for Residents with Dementia

• You will care for many residents with dementia in the long-term care facility

• Dementia is not a disease in itself– It is a group of symptoms seen in a number

of different diseases– Dementia is a permanent condition that is

not related to acute physical problems


Special Problems

• Some special problems include:– Wandering and pacing– Agitation, anxiety, and catastrophic

reactions– Sundowning– Pillaging and hoarding


Special Problems

• Some special therapies include:– Reality orientation– Reminiscing– Validation therapy– Music therapy– Animal-assisted therapy


The Velveteen Rabbit

This is a conversation between two stuffed animals: “What is REAL?” asked the Rabbit one day, when they were

lying side by side. “Does it mean having things that buzz inside you and a stick-out handle?”

“REAL isn’t how you are made,” said the Skin Horse. “It’s a thing that happens to you. When a child loves you for a long, long time, not just to play with, but REALLY loves you, then you become REAL.”

“Does it hurt?” asked the Rabbit.“Sometimes,” said the Skin Horse, for he was always truthful.

“When you are REAL you don’t mind being hurt.”


The Velveteen Rabbit

“Does it happen all at once, like being wound up,” he asked, “or bit by bit?”

“It doesn’t happen all at once, like being wound up,” said the Skin Horse. “You become. It takes a long time. That’s why it doesn’t often happen to people who break easily, or have sharp edges, or who have to be carefully kept. Generally, by the time you are REAL, most of your hair has been loved off, and your eyes drop out and you get loose in the joints and very shabby. But these things don’t matter at all, because once you are REAL you can’t be ugly, except to people who don’t understand.”

Williams Margery. (1880-1944. Public domain.) The Velveteen Rabbit. New York, Doubleday. Online. http://www.gutenberg.org

Copyright © 2008 Delmar Learning. All rights reserved. Unit 33 Care of the Elderly and Chronically...

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Transcript of Copyright © 2008 Delmar Learning. All rights reserved. Unit 33 Care of the Elderly and Chronically...