CARE OF THE RESIDENT WITH

DEPRESSION

NATCEP Day Thirty Three

Objectives

Define depression Identify signs and symptoms Describe possible causes Identifies the nurse aide’s role and

responsibility in caring for the resident with depression

Possible interventions

Definition

An emotional disorder that involves the body, mood, and thoughts. The person loses interest in daily activities.

Most commonly overlooked disorder in the elderlyMisdiagnosised as a cognitive disorderCan mimic physical illness

Signs & Symptoms Sadness Inactivity Difficulty thinking Problems concentrating Feelings of despair Problems sleeping Changes in appetite Fatigue Agitation Withdrawn Thoughts of death or suicide Pain Irritability

Causes Death of family or friends Loss of health Loss of body functions Loss of independence Loneliness/boredom Medications – side effect Lose of purpose

Nurse Aide Roles/Responsibilities

Recognize signs & symptoms Report observations to nurse Maintain safety Follow care plan

Nurse Aide Roles/Responsibilities

Don’t make light of or ignore resident comments or behaviorsSuicidal? Suicide Precautions according to policyObservant for clues of attempts

○ High risk categories include75 years of age and olderRecent diagnosis of terminal illnessUnrelieved chronic painSudden loss of spouseElderly with recent multiple losses

Possible Interventions

One on One interaction Activities Learn the resident’s preferences and habits

CARE OF THE CONFUSED RESIDENT

NATCEP Day Thirty Three

Objectives

Identify possible causes of confusion Identify symptoms that indicate a resident

may be confused Discuss implications of confusion for the

resident Identify ways in which some of the causes

of confusion may be minimized Identify behaviors hat may be seen Describe appropriate therapeutic

interventions

Possible Causes of Confusion Medical issues

Chronic illnessesSurgery & injuryDegenerative brain diseases – Alzheimers, dementia,

arteriosclerosis Poor nutrition Poor fluid intake Medication

ReactionCombo of meds

Social Isolation Hearing & Vision Loss Changes in the usual environment

Symptoms of Confusion Does not know self or others Talks incoherently Forgetful Does not pay attention Does not understand when someone else is

speaking Sleep disorders Hallucinates – visual or auditory Hostile/combative SUNDOWNING

Implications

The resident may beFrightened, unhappy, bewildered or angryUnaware of environment – doesn’t

recognize dangerReduced contact with othersLess self expressionLess independenceInsecureVerbal or physical aggressionSocially inappropriate behavior

Ways to reduce confusion Treat medical condition Improve nutrition & hydration Change prescribed medications Encouraging socialization Avoid overstimulation Calm, relaxed and peaceful setting Hearing aids and glasses

Behaviors

Combative Withdrawn Socially inappropriate Verbal or physical aggression Wandering Abnormal sexual behavior Repetitive behaviors Catastrophic reactions

Therapeutic Interventions Reality orientation to maintain reality contact Reminiscing = life review Validation therapy

Focuses on responding to the affect or emotion expressed by the patient rather than the actual content, which may be distorted. Rather than correct and attempt to reorient a disoriented person, positive reinforcement is continually given.

Helps them feel more secure and oriented within their own reality

Therapeutic Interventions Begin conversation by identifying yourself

Do not ask if they remember you Eye level with eye contact Pleasant facial expression Place hand on resident’s arm or hand unless it causes

agitation Control background noise – be sure they can hear you Lower tone of voice Short, common words; short, simple sentences Give resident time to respond One question at a time – if need to repeat, say same way Ask resident to do only one task at a time

Therapeutic Interventions Dementia: eventually unable to understand verbal

communication Use pictures and point, touch, or hand the resident itemsDemonstrate an action when you want resident to complete a task

Resident may use word substitutesConsistent – find out what they mean & use yourself

Avoid abstract, common expressions“You can hop into bed now”

Repeat resident’s last words to help stay on track during conversation

Do not try to “make” resident understand = agitation Use nonverbal praise freely and always respect resident’s

feelings