Miss Information Communication Case

Presentation 87 year-old female with dementia who is now routinely upset with caregivers 87 year-old female with dementia who is now routinely upset with caregivers Aphasic Aphasic Usually combative with ADL cares Usually combative with ADL cares Angry at not going home in the late afternoon/early evening Angry at not going home in the late afternoon/early evening Frustrated easily when trying to speak to staff Frustrated easily when trying to speak to staff

Medical History Arthritis pain Arthritis pain Heartburn Heartburn Right knee replacement Right knee replacement High blood pressure High blood pressure Constipation Constipation Incontinence Incontinence Depression Depression Skin cancer in the past Skin cancer in the past Hysterectomy Hysterectomy

Medications Acetaminophen (Tylenol) Acetaminophen (Tylenol) Ultram (Tramadol) Ultram (Tramadol) Prilosec Prilosec Lasix Lasix Metoprolol Metoprolol Potassium Potassium Effexor Effexor Senna, colace, fleets enema Senna, colace, fleets enema

Assessment All laboratories normal All laboratories normal Gait remains stable Gait remains stable No increased pain complaints No increased pain complaints Appetite good Appetite good Sleeps well overnight Sleeps well overnight Naps in the afternoon Naps in the afternoon Attends activities the do not involve participation (singers, e.g.) Attends activities the do not involve participation (singers, e.g.)

Assessment Mood screens are positive Mood screens are positive However these are difficult to interpret due to aphasia However these are difficult to interpret due to aphasia More context is given to the provider More context is given to the provider No weepiness No weepiness No anxiety No anxiety Agitation focused on interactions with staff Agitation focused on interactions with staff She seems more functional than her cognitive screens would imply She seems more functional than her cognitive screens would imply

Nursing Management Nursing staff conveys their plan to provider: Nursing staff conveys their plan to provider: Communication is the key Communication is the key Slow, step-by-step instructions Slow, step-by-step instructions Make a series of photographs into a book showing common wants/needs Make a series of photographs into a book showing common wants/needs A person dressing, eating, bathing, etc. A person dressing, eating, bathing, etc. Make a series of written questions as well Make a series of written questions as well Use visual pain scales Use visual pain scales Employ several caregivers in assessing depression Employ several caregivers in assessing depression Especially those providing the most care Especially those providing the most care

Nursing Management Nursing staff plan Nursing staff plan Pay attention to her distress when she becomes agitated at the end of the day Pay attention to her distress when she becomes agitated at the end of the day Will engage her in activities prior to the later afternoon to help reduce her distress Will engage her in activities prior to the later afternoon to help reduce her distress Especially those that involve a minimum of verbal input from her Especially those that involve a minimum of verbal input from her Remove her from areas in the late afternoon where she can see employees come and go at shift change, end of the day Remove her from areas in the late afternoon where she can see employees come and go at shift change, end of the day

Outcome Plan provides the provider more information Plan provides the provider more information Reduced likelihood of added or changed doses of medication Reduced likelihood of added or changed doses of medication Provided universal framework for caregivers to manage the problem Provided universal framework for caregivers to manage the problem Led to fewer episodes of afternoon distress Led to fewer episodes of afternoon distress More successful toileting, bathing, dressing More successful toileting, bathing, dressing As long as guidelines followed As long as guidelines followed Care plan placed in her chart and MAR for all to see Care plan placed in her chart and MAR for all to see Reduced distress of caregivers as well Reduced distress of caregivers as well