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

2. Copyright © 2008 Delmar Learning. All rights reserved. Objectives Spell and define terms. List the federal requirements for nursing assistants working in long-term care facilities. Identify the expected changes of aging.

3. Copyright © 2008 Delmar Learning. All rights reserved. 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.

4. Copyright © 2008 Delmar Learning. All rights reserved. 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.

5. Copyright © 2008 Delmar Learning. All rights reserved. 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.

6. Copyright © 2008 Delmar Learning. All rights reserved. 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.

7. Copyright © 2008 Delmar Learning. All rights reserved. Introduction Persons of any age who are chronically ill or severely injured may require long- term care.

8. Copyright © 2008 Delmar Learning. All rights reserved. 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

9. Copyright © 2008 Delmar Learning. All rights reserved. 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.

10. Copyright © 2008 Delmar Learning. All rights reserved. Legislation Affecting Long-Term Care Nursing Home Reform Act –Federal legislation mandating improvements in the quality of long-term care

11. Copyright © 2008 Delmar Learning. All rights reserved. Legislation Affecting Long-Term Care Result of the Omnibus Budget Reconciliation Act of 1987 (OBRA) –Each state is responsible for implementing this legislation

12. Copyright © 2008 Delmar Learning. All rights reserved. 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

13. Copyright © 2008 Delmar Learning. All rights reserved. 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

14. Copyright © 2008 Delmar Learning. All rights reserved. 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

15. Copyright © 2008 Delmar Learning. All rights reserved. Role of the Nursing Assistant in a Long-Term Care Facility Nursing assistants are the eyes and ears of the nurses –Nurses depend on assistants to report important changes, findings, and observations.

16. Copyright © 2008 Delmar Learning. All rights reserved. Role of the Nursing Assistant in a Long-Term Care Facility Inform the nurse promptly if a resident’s normal or usual condition changes.

17. Copyright © 2008 Delmar Learning. All rights reserved. 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

18. Copyright © 2008 Delmar Learning. All rights reserved. Art and Science of Nursing Never get so busy with technical tasks that you forget the caring and compassion.

19. Copyright © 2008 Delmar Learning. All rights reserved. Art and Science of Nursing 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

20. Copyright © 2008 Delmar Learning. All rights reserved. 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

21. Copyright © 2008 Delmar Learning. All rights reserved. Nutritional Needs Malnutrition –A problem for the aged because the older person may become progressively apathetic toward food

22. Copyright © 2008 Delmar Learning. All rights reserved. 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

23. Copyright © 2008 Delmar Learning. All rights reserved. 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.

24. Copyright © 2008 Delmar Learning. All rights reserved. Residents Receiving Tube Feedings Tube feedings –Common treatments in the long-term care facility –Residents receiving tube feedings are at nutritional risk

25. Copyright © 2008 Delmar Learning. All rights reserved. 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

26. Copyright © 2008 Delmar Learning. All rights reserved. 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.

27. Copyright © 2008 Delmar Learning. All rights reserved. Hydration Needs Offer and encourage residents to drink a beverage they like each time you are in their rooms.

28. Copyright © 2008 Delmar Learning. All rights reserved. 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

29. Copyright © 2008 Delmar Learning. All rights reserved. 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

30. Copyright © 2008 Delmar Learning. All rights reserved. Signs of Infection Inform the nurse of residents with an abnormally low temperature Monitor the resident closely

31. Copyright © 2008 Delmar Learning. All rights reserved. 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

32. Copyright © 2008 Delmar Learning. All rights reserved. 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.

33. Copyright © 2008 Delmar Learning. All rights reserved. Keeping Residents Safe Caregivers often recognize these aging changes but fail to associate them with an increased risk for falls.

34. Copyright © 2008 Delmar Learning. All rights reserved. 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.

35. Copyright © 2008 Delmar Learning. All rights reserved. Exercise and Recreational Needs Health care workers in these facilities –Responsible for coordinating this aspect of care

36. Copyright © 2008 Delmar Learning. All rights reserved. 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

37. Copyright © 2008 Delmar Learning. All rights reserved. General Hygiene Hygiene also includes care of: –Hands and feet –Hair –Facial hair –Mouth –Eyes, ears, and nose

38. Copyright © 2008 Delmar Learning. All rights reserved. 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

39. Copyright © 2008 Delmar Learning. All rights reserved. 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

40. Copyright © 2008 Delmar Learning. All rights reserved. Special Problems Some special problems include: –Wandering and pacing –Agitation, anxiety, and catastrophic reactions –Sundowning –Pillaging and hoarding

41. Copyright © 2008 Delmar Learning. All rights reserved. Special Problems Some special therapies include: –Reality orientation –Reminiscing –Validation therapy –Music therapy –Animal-assisted therapy

42. Copyright © 2008 Delmar Learning. All rights reserved. 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.”

43. Copyright © 2008 Delmar Learning. All rights reserved. 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