1. Chapter 3 NA Understanding Your Residents

2. Basic human physical needs
Food and water
Protection and shelter
Activity
Sleep and rest
Safety
Comfort, especially freedom from pain

3. Basic Human Psychosocial Needs
Love and affection
Acceptance from others
Security
Self-reliance and independence in daily living
Contact with other people (take time to talk with residents)
Success and self-esteem

4. Stress and frustration can occur when basic needs are not met.
This can lead to fear, anxiety, anger, aggression, withdrawal, indifference and depression.

5. Maslow’s Hierarchy of Needs
Physical needs must be met before psychosocial needs can be met.
(in order of importance according to Maslow)
1st Physical needs: oxygen, water, food, elimination, rest
2nd safety and security: shelter, clothing, protection from harm, stability
3rd need for love: feeling loved, accepted, belonging
4th need for self esteem: achievement, belief in one’s own worth and value
5th need for self-actualization: the need to learn, create, realize one’s own potential

6. Spiritual and sexual needs
Do not make judgments, do not try to push your beliefs on residents
Residents have the right to choose how they express their sexuality. The ability or urge do not end due to age or admission to a care facility.
Honor privacy

7. Holistic care Caring for the whole person, mind and body
Example: taking the time to talk with your residents while helping them bathe, meets physical need and psychosocial need

8. Normal changes of aging
Skin is thinner, drier, more fragile, less elastic
Muscles weaken, lose tone
Bones become more brittle
Sensitivity decreases, responses and reflexes slow
Short-term memory loss
Senses weaken

9. More normal changes
Heart works less efficiently, oxygen in the blood decreases
Appetite decreases
Digestion takes longer
Urinary elimination is more frequent
Hormone level decreases
Immunity weakens
Lifestyle changes occur

10. NOT normal changes Signs of depression Can’t think logically
Poor nutrition
Shortness of breath
Incontinence
And more….

11. Dying residents- Grief process (Kubler-Ross)
Five stages:
Denial
Anger
Bargaining
Depression
Acceptance

12. Common signs of approaching death
Blurred or failing vision, unfocused eyes
Reduce glare, put favorite objects where the resident can see them, put call light in reach
Impaired speech
Diminished sense of touch, loss of movement, muscle tone and feeling
speak in a normal tone, talk to the person without expecting an answer.
Observe for signs of pain, report them. Frequent changes of position, back massage, mouth care, body alignment. Lubricate the mouth with lip balm.
Temperature change
Decreasing b/p, weak pulse that is either rapid or abnormally slow
Cold, pale skin

13. More common signs of death
Mottling (bruised looking), spotting or blotching of skin from poor circulation
Keep sheets wrinkle free, reposition often
Perspiration
Bath often, change sheets and clothes for comfort
Disorientation, confusion
Listen, report any comments about fear, give emotional and spiritual support, don’t deny
Incontinence
Keep skin clean and dry, given bed bathes and incontinence care as needed
A “rattling” or ‘gurgling” sound while breathing
Slow, irregular respirations or rapid, shallow respirations, called Cheyne-Stokes respirations.

14. Postmortem care Care of the body after death.
(Be sensitive to the needs of the family, they may wish to sit at the bedside to say goodbye or stay a while. Allow them to do so. Offer support as needed.)
Bathe the body gently
Place drainage pads where needed often under the head or perineum
Do not remove any tubes or equipment
Put dentures back in the mouth and close it.
Close the eyes carefully
Position the body on the back, legs straight, fold arms across the abdomen. Put a small pillow under the head.
Follow policy about removal of jewelry, have a witness if removed or given to a family member, document it.
Funeral home will come and then remove the body
Strip the bed after the body has been removed, straighten up
Document

15. Hospice Special care that a dying person needs
Holistic approach- treats physical, emotional, spiritual and social needs compassionately.
Goal is palliative care- comfort and dignity of the resident focusing on pain relief and comfort.