CNA Week 2

The "4 As" of Dementia

=Amnesia - Difficulty remembering; memory loss - Short-term memory in early stages • Provide lots of reminders; introduce self each time; structured routine - Long-term memory in later stages • Living in pass; easy to embarrass and upset - Validation therapy =Aphasia - Difficulty speaking - Expressive - Receptive - Source of stress and frustration =Agnosia - Difficulty recognizing information obtained through the five senses - Unable to recognize objects - Unable to recognize danger - Unable to recognize people (family, friends, staff, self) =Apraxia - Difficulty coordinating steps needed to complete task • ADLs • Eating - Allow person to do what they can - Coaching - Hand-over-hand cueing - Never rush the person

• Which of the following is very important to develop when working with individuals with developmental disabilities? A.Communication B.Understanding of limitations C.Best way to educate D.Close friendships

A. Communication • Many people with developmental disabilities have difficulty communicating. The nursing assistant needs to observe and find out which method is the best way to communicate. Without adequate communication, it will be very difficult and challenging to be able to understand the individual's limitations, way to educate, or develop a close friendship.

• Some stress is necessary to protect us from harm. A.True B.False

A. True • Stress is the result from any change from the normal routine. For example, the stress of meeting a wild bear on a walking trail will encourage us react in a way which will protect ourselves.

• Most individuals with developmental disabilities have intellectual as well as physical challenges. A.True B.False

A. True • The majority of the types of developmental disabilities have varying degrees of intellectual and physical challenges for the individual to overcome.

• A person with dementia may exhibit some unacceptable behaviors. Some of these behaviors may be related to which of the following? A.Unable to communicate effectively B.Wanting to do their own thing C.Not understanding the policies of the facility D.Does not understand that the actions are not allowed

A. Unable to communicate effectively •An individual with dementia may act inappropriately not realizing that what he or she is doing is unacceptable due to the loss of understanding and inability to function normally. Their attempt to communicate is misunderstood and they will act out.

• A person with dementia may feel frightened or threatened when trying to perform basic activities. What can you as a nursing assistant do to assist the person? A.Do the activity for the person B.Break the task down into small steps C.Ask the family to assist D.Wait until the person is ready to assist

B. Break the task down into small steps •Allowing the person with dementia to do as much as possible on his or her own is very important; however, since they cannot remember how to do things, breaking the task down into small steps and assisting the individual is the best approach.

• The majority of mental illnesses are untreatable and these patients or residents are placed in special homes to protect themselves. A.True B.False

B. False • Many mental illnesses, just like physical illnesses, can be successfully managed with medications, psychiatric counseling or both.

• Usually if an individual has not developed a mental illness by the time they are elderly, then they will not develop one at all. A.True B.False

B. False • The unique losses and challenges that face the elderly may trigger a mental illness. For example, clinical depression is very common among elderly people.

• The main difference between dementia and delirium is that dementia is temporary. A.True B.False

B. False •Delirium is a temporary state of confusion. It is a symptom of an underlying disorder, such as an infection or reaction to medication. Dementia is a chronic, permanent condition which results in loss of function.

• Special education programs can provide which of the following: A.Social skills B.Life skills C.Self-care skills D.All of the above

D. All of the above • Special education programs are focused on the individual's needs and covers a wide range of topics such as self-care skills, life skills, and social skills.

• Working with individuals with dementia can be very trying but also rewarding. If you find yourself become frustrated while caring for an individual with dementia, which of the following might you do? A.Ensure the individual is safe and walk away for a moment B.Talk to the nurse C.Ask for reassignment for a few days D.All of the above

D. All of the above •All the choices - ensuring the individual is safe and walking away; talking to your nurse; and asking for a short-term reassignment - are all acceptable ways of dealing with the frustration that can occur when assisting individuals with dementia. It must be remembered that they cannot control what is happening to them and if they could truly communicate with you, they would let you know that they are just as frustrated!

What is a Developmental Disability?

• A developmental disability is a permanent disability that affects a person before he reaches adulthood (i.e., before 19 to 22 years of age) and interferes with the person's ability to achieve developmental milestones • A developmental disability may be: - Congenital (something a child is born with) OR - Acquired (occurring after birth, as a result of trauma or illness) - May affect intellectual function, physical function, or both

What is Mental Illness?

• A mental illness is a disorder that affects a person's mind, causing the person to - Act in unusual ways - Experience emotional difficulties - Or both • In many societies and cultures, mental illness is viewed as something to be ashamed of • A mentally ill person's odd behavior may be frightening to those who do not understand it

Eating Disorders: Binge-Eating

• A person who binge-eats will eat large amounts of food without purging • The need to continue eating is excessive • The person will become obese • A person who binge-eats may develop various weightrelated health disorders - Cardiovascular disease - Diabetes - Hypertension

Meeting the Physical Needs of a Person With a Developmental Disability

• A person with a developmental disability has the same physical needs as everyone else - Assisting the person with activities of daily living (ADLs) • Depending on the severity and type of disability, the person may need assistance with ADLs • As with any patient or resident, helping a person achieve the greatest possible level of independence is the best type of assistance that you can give • A person with a developmental disability has the same physical needs as everyone else - Assisting with rehabilitation • Physical therapy or respiratory therapy may be needed to help the person maintain levels of function or to treat accompanying illnesses • As a nursing assistant, you may play a very important role in helping the person with physical rehabilitation

Types of Developmental Disabilities: Autism

• A person with autism has extreme difficulty communicating and relating to other people and surroundings • Boys are affected more often than girls • A person with autism may seem very withdrawn, like he is in his "own world" (auto- means "self") • The person may have lengthy or extreme tantrums, or show aggressive or violent behavior that can result in self-injury • Other disorders, such as intellectual disability and seizure disorders, may accompany autism...however, many people with autism have average or above average intelligence

Eating Disorders: Bulimia Nervosa

• A person with bulimia nervosa regularly eats huge amounts of food (binging) and then induces vomiting or uses laxatives to rid the body of the food before it is digested (purging) • A person with bulimia nervosa often is of normal weight for her age and height • A person with bulimia nervosa is extremely focused on her body weight and shape, and believes that she is excessively overweight

Types of Developmental Disabilities: Intellectual Disability

• A person with intellectual disability has below-average intellectual functioning and problems with adaptive skills - Intellectual functioning is the ability to reason, think, and understand - Adaptive skills are skills needed to live and work, such as communication skills, social skills, and self-care skills • An intellectual disabled person has an intelligence quotient (IQ) score of less than 70 points and limited adaptive skills in two or more areas • Mild intellectual disability - Most people with intellectual disability fall into this category - Mild intellectual disability may go unnoticed until a child begins school, and starts having trouble with reading or solving math problems - With special education, a person with mild intellectual disability is usually able to achieve a third- to sixth-grade learning level and master the skills needed for socially appropriate behavior - Vocational (job) training is useful • Moderate intellectual disability - People with moderate intellectual disability have delays in both motor (manual) skills and speech development - With special education, a person with moderate intellectual disability is usually able to learn self-care skills, communication skills, and safety habits - However, academically, she will probably not progress beyond a second-grade learning level - The person may also have trouble learning socially appropriate behavior • Severe intellectual disability - With special education, people with severe intellectual disability are able to learn some communication and basic self-care skills, such as how to feed themselves - A person with severe intellectual disability can usually learn to walk, if he does not have other physical disabilities • Profound intellectual disability - People with profound intellectual disability have minimal function in all developmental areas, physical and mental - These people need complete assistance with their activities of daily living (ADLs), and constant supervision to provide for their safety • Many people with intellectual disability need guidance with "appropriate" methods of displaying their love and affection to other people • Adults with intellectual disability may function mentally at the level of a 7- or 8-year-old but will experience the same hormonal changes and sexual drives as everyone else and may not understand what is happening; these physical drives may be very confusing • Because people with intellectual disability tend to be very trusting, and because they are not able to understand what is happening to them, they are often targets of sexual abuse • Education and guidance from caregivers is very important to help a person with intellectual disability learn about appropriate touch and sexual behavior • In addition, caregivers must protect the person from sexual abuse - As a nursing assistant, you must be especially observant for signs of sexual abuse when caring for a person with intellectual disability - Any observations you make or suspicions that you have should be reported to the nurse immediately • One of the great rewards that you will experience as a nursing assistant is the satisfaction of helping a person with intellectual disability to feel loved, and allowing her to express love back to you

Anxiety Disorder: Phobias

• A phobia is an excessive, abnormal fear of an object or situation • Phobias can be incredibly disabling for the person affected by them • The person will do anything to avoid the thing she is afraid of, to the point where she may be unable to do something as simple as leaving the house • There are three main groups of phobias: - Simple phobia - Social phobia - Agoraphobia • Simple phobias are the most common type • A person with a simple phobia is abnormally afraid of a specific thing, for example: - Dogs or cats - Insects - Heights - Water - Flying in an airplane • Social phobias involve a fear of being humiliated or embarrassed in front of other people • Social phobias may be related to: - Feelings of inferiority - Low self-esteem • Social phobias may cause a person to: - Drop out of school - Avoid making friends - Remain unemployed • Agoraphobia is the fear of having a panic attack in a place from which there is no easy escape, and where help is not available • For example, a person may be intensely afraid of having a panic attack in an elevator or on a crowded bus

Recording and Reporting Vital Signs

• Accuracy is important: many people rely on these measurements to make decisions about the person's care • Always ask for assistance if having difficulties; it is not a sign of failure, but could indicate something is wrong with your patient or resident • Report an abnormal measurement immediately

Anxiety Disorders

• Anxiety is a feeling of uneasiness, dread, apprehension, or worry • Anxiety is a normal feeling that we have in response to situations that are threatening to our body, lifestyle, values, or loved ones • A certain level of anxiety is normal and may actually lead us to do something positive about a bad or potentially dangerous situation • But too much anxiety or prolonged periods of anxiety can make it hard for us to function or cope with everyday situations • Feelings of anxiety can cause many physical signs and symptoms, such as: - Sleeplessness - Restlessness - Fatigue - Changes in appetite - Increased heart rate and blood pressure - Irritability - Difficulty thinking clearly

Mood Disorders: Bipolar Disorder

• Bipolar disorder (manic depression) is a mental health disorder that causes mood swings • Periods of excessive happiness and excitement that may cause the person to engage in impulsive or reckless behavior (mania) are followed by... • Periods of excessive sadness and hopelessness (depression) • Experts believe that bipolar disorder is caused by chemical imbalances in the brain that affect a person's moods

Withdrawal Signs and Symptoms

• Body tremors • Mental status and mood changes • Delirium • Hallucinations • Restlessness • Anxiety and fear • Insomnia • Nausea and vomiting • Sweating • Heart palpitations and rapid pulse • Seizures

Types of Developmental Disabilities: Cerebral Palsy

• Cerebral palsy is caused by damage to the cerebrum, the part of the brain involved with motor control • Cerebral palsy has many possible causes - Physical brain deformity - Conditions that interfere with the flow of oxygen to the baby's brain before, during, or shortly after birth • One type of cerebral palsy causes spasms and shortening of the muscles - The affected joints may develop contractures - If the hands and arms are affected, the person may be unable to perform self-care skills like feeding, bathing, or dressing - If the feet and legs are affected, the person may be unable to walk • The second type of cerebral palsy causes involuntary movements of the arms, legs, and upper body - Facial and tongue muscles may also be involved, making the person appear to be chewing constantly • Varying degrees of intellectual disability may also accompany the physical disabilities associated with cerebral palsy

Mood Disorders: Clinical Depression

• Clinical depression is one of the most common mental illnesses • It affects more than 19 million Americans each year • Some research indicates that a family history of clinical depression increases a person's risk of developing this mental illness • Women seem to experience clinical depression about twice as much as men do • Clinical depression is also the most frequently treated mental illness among elderly people • Several factors can lead to the development of clinical depression, including: - Chemical imbalances in the brain - Low self-esteem and poor coping skills - Hormonal changes, such as those that affect women during pregnancy, menstruation, childbirth, and menopause - Medications • Signs and symptoms: - A person who is depressed loses interest in activities that she usually finds pleasurable or fulfilling, such as: • Eating • Working • Socializing with friends • Pursuing hobbies - The person may feel sad or anxious - The person may cry frequently • Many people who are depressed have problems with sleeping. The person may: - Sleep too much - Sleep not enough • The person may be restless or irritable • Instead of being grateful when someone tries to help, the person may become angry and defensive • The person may have feelings of guilt and worthlessness • The person may struggle with thoughts of death or suicide • Physical complaints (e.g., of pain or a digestive disorder) are also common among people who are depressed • Prompt treatment is needed to help a clinically depressed person return to an enjoyable, productive life

Common Anxiety Disorders

• Common anxiety disorders include: - Panic disorder - Obsessive-compulsive disorder - Phobias: • Simple phobias • Social phobias • Agoraphobia

Common Causes of Developmental Disabilities

• Congenital (present at birth) - Genetic (inherited) disorders - Consumption of alcohol, drugs, or other toxic substances during pregnancy - Infections during pregnancy, such as German measles (rubella) or HIV - Poor nutrition during pregnancy - Conditions that deprive the baby of oxygen • Acquired (occurring after birth) - Birth trauma - Head injury - Near-drowning - Poisoning

Mood Disorders: Depression

• Depression is a feeling of excessive sadness or hopelessness • Many events in life, such as the loss of a loved one, can cause temporary feelings of intense sadness and hopelessness • In a person with good mental health, the painful emotions of an event-related depression go away over time • Sometimes, short-term treatment with medication or counseling may be needed to help the person through the crisis • Some people, however, experience intense feelings of sadness and hopelessness that do not go away, even with time • These feelings may or may not be brought on by a sad event, such as the death of a loved one • When depression is severe and persistent, it is called clinical depression

Types of Developmental Disabilities: Down Syndrome

• Down syndrome is a developmental disability that is the result of a genetic disorder - Normally, each of our body's cells contains 23 pairs of chromosomes, for a total of 46 - A person with Down syndrome has one extra chromosome • People with Down syndrome have some degree of intellectual disability and muscle weakness • In addition, they have certain characteristic physical features - Eyelid folds that give the eyes an almond-shaped appearance - A large tongue in a small mouth - Square hands with short, stubby fingers - A small, wide nose and small ears - Short stature and a wide, short neck • Many people with Down syndrome are also born with heart defects that require corrective surgery or medication • Frequent respiratory tract infections are also common among people with Down syndrome, due to muscle weakness (which affects the muscles used for breathing) and a compromised immune system • Many people with Down syndrome live independently and hold down jobs • Children with Down syndrome are usually raised in their own homes with their families • Once a person with Down syndrome reaches adulthood, the person may continue to live with family members, or he may choose to move to a group home • Group homes allow a person with Down syndrome to live independently within a supervised and supportive environment

Stress: How Much is Too Much?

• Each person has a limit to the amount of stress that she can effectively deal with at any given time • Fatigue, illness, and everyday stress sometimes affect our ability to cope well with change • Many times, stress does not come from a single source - A person may be able to cope fairly well with one type of stress, such as the loss of a job... - But when other stresses, such as a sick child, are added, the person may reach his "breaking point"

Caring for a Person With Mental Illness

• Even if you choose to work in a facility that does not specifically care for people with mental illness, you may care for people who have or develop mental illness • Think about the stresses a person in a health care facility experiences: - He may have fears of being disabled or disfigured from illness or injury - He is separated from loved ones and in an unfamiliar place - He may be worried about the loss of a job and income - He may be worried about his current and future health • Any of these additional emotional stresses can push a person toward mental illness if he has poor or ineffective coping mechanisms • Elderly people are particularly at risk for mental illness - They face the loss of spouses, friends, and sometimes children, often within a short period of time - They face retirement, which can lead to a loss of structure, routine, and the sense of identity that their jobs gave them - They may face worries about money, especially if they are living on a fixed income - They face the loss of physical abilities and independence, either as a result of illness or the normal process of aging - They may feel that they are a burden to their families - They may fear the need to move to a long-term care facility, because of the associated loss of independence • Listening and observation skills are very important when you care for a person with mental illness • Be aware of comments or actions that may indicate that a person is thinking about suicide, and report your observations immediately to the nurse • When you notice a change in a patient's or resident's behavior or mental status and report this change to the nurse, you are taking the first step toward making sure the person gets the help he needs • The health care team will work to determine the cause of the person's change in behavior, which will lead to prompt treatment

Types of Developmental Disabilities: Fetal Alcohol Syndrome

• Fetal alcohol syndrome is a combination of physical and intellectual problems that affect a child whose mother consumed alcohol during pregnancy • The degree of disability seems to depend on the amount of alcohol the mother drank during her pregnancy, as well as on how frequently she drank • Babies born with fetal alcohol syndrome are usually smaller than normal and have intellectual disabilities, behavioral problems, learning difficulties, and facial deformities • Although the disabilities caused by fetal alcohol syndrome are permanent, special education and therapy can help to maximize the person's abilities

Types of Developmental Disabilities: Fragile X Syndrome

• Fragile X syndrome is the most commonly inherited type of intellectual disability caused by a defect in the X chromosome • Fragile X syndrome is more common and usually more severe in boys, as compared with girls • People who have fragile X syndrome are usually moderately to severely intellectual disability and may have physical characteristics such as: - Large, cupped ears - A slim build - Wide-set, somewhat squinting eyes - Velvet-like skin • They usually have delayed speech and communication skills • They may be hyperactive, and prone to "mood swings" • They may be autistic • Special education helps people with fragile X syndrome learn self-care and behavior skills - A calm, structured environment that keeps distractions and disturbances to a minimum is useful when caring for a person with fragile X syndrome • Unfortunately, because the syndrome has only recently been identified as a developmental disorder, more research is still needed to determine the most effective methods of caring for people with this disability

Concerns for Long-Term Care - Elderly

• In an older person, a physical problem can cause behavior that may be similar to that seen in people with mental illness • Never just assume that your elderly patient or resident is just "entering his second childhood" or becoming senile • The person may have a serious mental or physical problem that needs to be treated • Examples of physical problems that can cause an elderly person to appear to be mentally ill include: - Nervous system disorders - Kidney disorders - Chronic illnesses, such as hypertension and diabetes - Hypothyroidism - Anemia - Early signs of dementia - Infections - Dehydration - Side effects of many medications • If you work in a facility that specializes in caring for mentally ill people, special methods of recording and reporting may be used • Know what is expected of you and how to report and record according to facility policy • When reporting and recording subjective information about patients and residents with mental illnesses, be very careful to: - Use the person's own words - Avoid adding your own opinions or judgments • Certain phrases or words may have special meaning for a particular person • To accurately gauge the person's mental status, the health care team will need to know exactly what the person said

What is Body Temperature?

• It is the difference between heat produced and heat lost by the body • Body heat is produced as a normal process of metabolism • Body temperature is regulated by the thermoregulatory center located in the brain

Mental Stress

• Life events that cause mental stress include: - Getting married - Getting divorced - Starting a new job - Having a baby - Losing a loved one • For most of us, stress is a constant in our lives

Special Education

• Mainstreaming - Children with developmental disabilities go to public school alongside friends and classmates who have no disabilities - Mainstreaming benefits children with developmental disabilities by making them feel less isolated and giving them higher self-esteem and better social skills - Mainstreaming also benefits children who are not disabled by making them aware that people with disabilities are just like they are, except that they need extra help to do certain things • Special educational programs are focused on the individual's needs and cover a wide range of topics, such as - Self-care skills (e.g., eating or dressing) - Life skills (e.g., counting money) - Social skills (e.g., understanding appropriate behavior and "limits") - Vocational skills: focuses on teaching work skills that help people with disabilities become less dependent on others for their care

Positive Coping Mechanisms

• Many people rely on positive coping mechanisms, such as: - Exercise - Prayer - Meditation - Getting together with friends - Engaging in a hobby

Communicating With a Person With a Developmental Disability

• Many people with developmental disabilities have difficulty communicating with other people • When caring for a person with a developmental disability: - Ask family members what communication techniques work best with the person - Use simple words and short phrases - Perhaps the most useful communication method is that of a touch, a smile, or a kind word, all of which transmit the message of your care and compassion for the person • Because many people with severe developmental disabilities have difficulty communicating, they may be unable to tell you if they are experiencing pain or discomfort • Learn to watch for small, subtle changes in your patients or residents, such as changes in behavior, eating habits, or sleeping habits: changes like these may be a sign that the person is ill • Because you will most likely be the member of the health care team who spends the most time with the person, you will likely be the first to notice that "something is not quite right" • Always be sure to report your observations to the nurse

Assisting With ADLs

• Mental illness may affect a person's ability to eat, sleep, rest, or manage routine grooming and hygiene • People with mental illnesses will need different levels of assistance with their ADLs, depending on the severity of their disorders • Always help to promote the person's independence by allowing the person to provide as much of his own selfcare as possible • Some mental illnesses affect a person's ability to think through the steps of routine care. You may need to gently remind the person of what step comes next

Mood Disorders

• Mood disorders affect how a person feels emotionally • Common types - Depression - Bipolar disorder (manic depression)

Mental Illness and the Role of Media

• Movies, television, and books have contributed to the popular image of mentally ill people as - Crazy - Violent - Out of control • Some people who are mentally ill may behave in violent or dangerous ways, but most do not • There are many different types of mental illness, and mental illness varies in severity from person to person

Anxiety Disorder: Obsessive-Compulsive Disorder

• Obsessive-compulsive disorder is an anxiety disorder that causes a person to suffer intensely from recurrent unwanted thoughts (obsessions) • The obsessions are usually associated with rituals that the person cannot control (compulsions) • The rituals may include actions such as: - Hand washing - Counting - Checking • The rituals are repeated over and over in hopes that the obsessive thoughts will go away • Not performing the rituals increases a person's level of anxiety • When it is severe, obsessive-compulsive disorder takes over the person's life • The person becomes unable to perform the tasks that are associated with normal daily activities, because of his obsessions and compulsions

Negative Coping Mechanisms

• Other people rely on negative coping mechanisms, such as: - Nail biting - Pacing - Overeating or not eating enough - Smoking - Abusing drugs or alcohol • Initially, these behaviors may help the person to reduce stress, but over time, they place the person at risk for serious physical problems, mental problems, or both

Defense Mechanisms

• Our bodies are "programmed" to try and return to a state of balance • When a person is under stress, the mind may try to return the person to a state of emotional balance by using defense mechanisms • Defense mechanisms are methods of dealing with stress that "just happen"...usually the person is not even aware that he is using them • Defense mechanisms help to protect us from emotionally traumatic events • Compensation: to make up for a loss by "filling in" or "substituting" something else - For example, a person who feels lonely may eat too much (substituting food for affection) • Conversion: changing one thing into another - For example, a person who is depressed (an emotional problem) may develop a stomach ache (a physical problem) • Denial: refusing to believe something that is true, especially if the truth is unpleasant - For example, a person who has been diagnosed with cancer may truly believe that the doctor has made the wrong diagnosis, and that she does not have cancer • Displacement: shifting an emotion from one person to another who is less threatening - For example, a resident who is angry with her daughter for moving her to a long-term care facility—and who is afraid of expressing this anger because she fears the daughter will abandon her—may take her anger out on the nursing assistant instead • Projection: blaming someone else for your own uncomfortable or unacceptable actions or feelings - For example, a resident may accuse a nursing assistant of breaking a vase when in fact, the resident actually broke the vase herself • Rationalization: making excuses or creating acceptable reasons for poor behaviors or actions - For example, a student who does not study for a test and then fails it may tell herself that the reason she failed is because the teacher is "too hard" • Regression: to turn back to a former or earlier state - For example, an older child who is hospitalized begins to suck his thumb • Repression (suppression): the refusal to remember or think about a frightening or painful memory - For example, a person who was a victim of a terrible accident or crime may not be able to remember the event

Anxiety Disorder: Panic Disorder

• Panic is a sudden, overpowering fright • A person with a panic disorder has terrifying episodes or "panic attacks," during which she experiences: - Extreme anxiety - Feelings of intense fear • A person who is having a "panic attack" usually also has physical signs and symptoms, such as - Chest or abdominal pain - A rapid heart beat - Shortness of breath - Dizziness • These symptoms may be very similar to those of a heart attack or other severe physical illness • Panic attacks can be very brief, or they may last for some time • Some people will experience these attacks rarely while others will have them quite often • It is important to remember that even though the physical symptoms may not be a sign of a serious physical condition, they are no less real and frightening to the person who is experiencing them

Eating Disorders: Anorexia Nervosa

• People with anorexia nervosa see themselves as very overweight, even though they are excessively thin • Anorexia (loss of appetite) is a key feature of this disorder • The person simply does not eat enough food • She will skip meals, take tiny portions at meal times, or make excuses for why she cannot eat • She may only allow herself to eat small amounts of very "safe" low-calorie foods • Many people with anorexia nervosa exercise excessively

Concerns for Long-Term Care

• People with developmental disabilities are living longer • May experience the results of aging sooner, starting in middle-age • They may require more care • Elderly parents are no longer able to care for their child • Moving to a long-term care facility is traumatic for the whole family - Individual leaving the familiar, safe environment - Family members are worried about the individual

Special Needs of People With Developmental Disabilities

• People with developmental disabilities have the same physical and emotional needs as everyone else • For example: - They need good nutrition - Plenty of exercise - The sense of well-being that comes from feeling loved and cared for • However, many people with disabilities have additional, special needs as well

Factors Affecting Body Temperature

• Physical or emotional stress • Environmental temperature • Time of the day • Age • Gender

Anxiety Disorder: PTSD

• Post-traumatic stress disorder (PTSD) • After experiencing overwhelming traumatic event (combat, natural disaster, serious injury, criminal assault, rape, death of another person) - Symptoms: flashbacks, panic attacks, nightmares, depression, increased anxiety • Substance abuse and alcohol abuse common, if not treated

Emotional Needs

• Reassurance, love, and acceptance are vital for everyone's well-being, and especially for those with disabilities that can make them appear or feel "different" • One notable way in which people with developmental disabilities gain self-esteem is through the Special Olympics - A sporting event established to promote the physical and emotional health of people with developmental disabilities - The participants are matched for their competitions according to their level of physical and intellectual ability - Their motto is: "Let me win, but if I cannot win, let me be brave in my attempt." - The Special Olympics and other events also help to meet a person with a developmental disability's social needs

Schizophrenia

• Schizophrenia can be a very disabling form of mental illness • It tends to run in families and may have a genetic basis • Schizophrenia may be mild or severe • A person with severe schizophrenia that is untreated may be a danger to himself, or to others • A person with schizophrenia has trouble determining what is real and what is imaginary • He may suffer from delusions, or false ideas • For example, the person may believe that: - He or she is someone famous - Someone is spying on him or her - Someone is trying to steal his or her belongings • A person may experience hallucinations, or episodes where he or she: - Sees - Feels - Hears - Smells or - Tastes something that does not really exist • For example: - The person may hear voices in his head telling him to perform a certain act • The person's thinking and speech becomes disordered • He may switch from one topic to another during a conversation • He may make up new words or patterns of speech • The person may say or do very strange things, making it hard for him to function normally in social situations • A schizophrenic person's behavior is often very frightening and confusing to others

Mental Health

• Simply put, mental health is the absence of mental illness • One of the main qualities of mental health is a state of emotional balance • Physical health is related to the body's ability to make adjustments to maintain a state of physical balance, or homeostasis • Similarly, mental health is characterized by a person's ability to make adjustments to maintain a state of emotional balance

Types of Developmental Disabilities: Hydrocephalus

• Sometimes called "water on the brain," results from a build-up of cerebrospinal fluid (CSF) • Many cases of hydrocephalus are congenital • When hydrocephalus occurs in a child younger than 2 years, the child's head often enlarges, because the bones of the skull have not yet fused together • Whether the hydrocephalus is congenital or acquired, it is often treated by surgically inserting a tube (called a shunt) that allows the fluid to drain from the brain to another part of the person's body

When are Vital Signs Taken?

• Specified on nursing care plan or doctor's orders - Long-term care facility: once daily or weekly, and as needed - Hospital: every shift or every few hours, and as needed • Within the nursing assistant's scope of practice to take vital signs whenever he or she thinks it is warranted

Types of Developmental Disabilities: Spina Bifida

• Spina bifida is a congenital defect of the spinal column • Normally, the vertebrae enclose the spinal cord, protecting it from harm • In a person with spina bifida, the vertebrae do not close properly during development, leaving the spinal cord exposed • As with other developmental disabilities, spina bifida varies in severity • Some people with spina bifida have only a slight bone deformity that is not even visible on the outside of the body, except for possibly a dimple or tuft of hair on the back • Other people have more severe deformities that result in the meninges, the spinal cord, or both bulging through a large opening on the back

Effects of Stress on Our System

• Stress that is not managed properly can affect a person's physical health, as well as his mental health • For example, not being able to manage stress can put a person at risk for - Cardiovascular problems, such as a heart attack - Digestive disorders, such as ulcers

Physical Stress

• Stress, which results from any change from the normal routine, affects a person's ability to maintain a state of balance • Changes that affect us physically, such as illness or disability, cause physical stress

Substance Abuse Disorders and Addiction

• Substance abuse disorders and addictions involve excessive or inappropriate use of drugs (prescription and recreational), alcohol or inhalants • Can develop physical dependency • Can experience physical (tremors, delirium) and emotional (anxiety) effects • Addiction: - Physical need for substance that results in withdrawal signs and symptoms when quit taking the substance • Withdrawal: - Emotional and physical reaction that occurs when use is discontinued • Alcohol most often abused by older people • Withdrawal signs and symptoms depend on substance, how frequently used and how much is consumed

Protection of Rights

• The Americans with Disabilities Act - Ensures that people who have disabilities are treated the same as those without disabilities, by guaranteeing people with disabilities access to public education, employment, and public places such as parks, restaurants, and transportation • The Arc of the United States - An organization that promotes the rights of people with intellectual disabilities

Depression and the Older Person

• The incidence of depression increases with age • Elderly people are less likely to seek treatment for this disorder • Many older people who are depressed feel that their depression is just part of getting older, but this is not true! • If you will be working with older patients or residents, pay attention to changes in their behaviors or moods that may indicate clinical depression • By reporting these observations to the nurse, you play an important role in helping to ensure that the person receives treatment that will help him feel better

Signs of Stress

• The mentally ill cannot cope effectively with stress and may become unable to: - Work - Care for their children - Make simple decisions - Think clearly, or even provide their own self-care • A mentally ill person may need medication, counseling, or support groups to help regain emotional balance

Types of Mental Illness

• The more common mental illnesses include: - Anxiety disorders - Mood disorders - Schizophrenia - Substance abuse disorders and addiction - Eating disorders

Eating Disorders

• The most commonly known eating disorders are: - Anorexia nervosa - Bulimia nervosa - Binge-eating • All eating disorders involve serious and potentially fatal changes in eating behavior, such as: - Reducing the amount of food eaten to almost nothing - Severe overeating • Eating disorders cause many physical problems, including kidney failure and serious heart problems that can lead to death • Like people with other mental illnesses, people with eating disorders cannot voluntarily control their impulses, and they need treatment to help them learn to eat normally again • Eating disorders usually start during adolescence or early adulthood • Women are at higher risk than men for developing an eating disorder • Many people who suffer from depression or anxiety disorders also suffer from eating disorders

Signs of Excessive Stress

• The person may: - Cry - Sleep excessively or be unable to sleep - Have difficulty concentrating - Feel depressed for a time • Most people with good mental health are able to eventually overcome these feelings and regain their emotional balance

Treatment of Mental Illness

• The word psychiatric comes from the Greek words psyche (the soul) and iatreia (healing) - A psychiatrist is a medical doctor (MD) trained in diagnosing and treating mental illness; allowed to prescribe medications - A psychologist, while not a medical doctor (PhD), has education and training that allows counseling services to help people with mental illness; is not allowed to prescribe medications • Depending on the person's situation, he may need the services of a psychiatrist, a psychologist, or both • With treatment, many people with mental illnesses are able to lead happy, productive lives • Dramatically changed over the last 50 years • In the past, mentally ill people were usually sent to special hospitals ("mental institutions"), where they were given large doses of medications to keep them quiet and sedated • Techniques such as electro-shock therapy (passing electricity through the brain to cause a seizure) and lobotomy (surgical removal of part of the brain) were used frequently, often with little success • Now we know more about why mental illnesses occur and how they should be treated - Medications are used to restore the brain's chemical balance. Rather than simply sedating the person into submission, these new medications help the person to act and think more "normally" - And electro-shock therapy, while still used in some cases, is used much more effectively • Treatment is important because with treatment, many people with mental illness are able to lead happy, productive lives. Without treatment, they may suffer needlessly and may even be at risk for suicide

Causes of Mental Illness

• There are many different types of mental illness, and many different causes - Some types of mental illness run in families (i.e., they are inherited) - Others result from chemical imbalances in the chemicals called neurotransmitters - Some mental illnesses may be caused by a person's environment (e.g., a person who is abused by a family member may develop ineffective coping or defense mechanisms that lead to mental illness)

Treatment Facilities for the Mentally Ill

• Treatment facilities for people with mental health disorders differ in purpose • Some facilities provide a form of long-term care for mentally ill people who cannot function on their own and need assistance with activities of daily living (ADLs) and safety • Other facilities specialize in acute care services and provide care to a person who is experiencing a mental crisis that may result in: - Attempted suicide - Drug overdose - Danger to others • After the crisis phase has passed, the person may be able to return home and receive treatment on an outpatient basis • Outpatient mental health clinics see people on a regular basis and offer services such as: - Counseling - Medication - Support groups • They may even help the person to obtain: - Education - Job training - Employment

Tell a Nurse

• Various signs and symptoms which should be reported to the nurse - Change in appetite - Change in sleep pattern - Restlessness, pacing or unusual "handling" of items - Inability to concentrate - Crying for long periods or frequently - Loss of interest in daily activities - Loss of interest in socializing - Inability to focus during a conversation or unwillingness to make conversation - Unusual mood or behavior changes - Fatigue or irritability - Expressions of feelings of hopelessness or helplessness - Expressions of a desire to die

Coping Mechanisms

• What do you do when you start to feel overwhelmed or "stressed out"? • Over time, many people come to know what they can do to make themselves feel better when they start to feel overwhelmed by life's pressures • These conscious and deliberate ways of dealing with stress are called coping mechanisms

Vital Signs

• What is a vital sign? - Vital signs are key measurements that provide essential information about overall health status - How fast heart is beating, internal temperature of body, and rate of breathing • What do vital signs indicate? - How well the body is functioning - A change in a vital sign may indicate a response to illness or injury

Caring for a Person With a Developmental Disability: What Should You Do?

• When working with a person who has a developmental disability, the care that you provide must be specific to the person's abilities and disabilities • Learn as much as you can about each person in your care • Focusing on each person's abilities, whether developmentally disabled or not, will help you to provide the standard of care that each of your patients or residents needs from you

Caring for a Person With a Developmental Disability

• You may have many opportunities to care for people with developmental disabilities, in many different health care settings: - In a hospital, may care for a person with a developmental disability while he is receiving treatment for an acute health problem - In a home health care agency or in a long-term care facility, you may have the opportunity to form a longer-lasting relationship - In a day care center that specializes in the care of people with developmental disabilities, you may provide care for adults or children while their families work - In a long-term care facility, you may provide care for an individual because the family is no longer able to care for them adequately

Types of Behaviors: Pacing

•A person with dementia may pace back and forth - May have a physical need that is not being met (e.g., the person may be hungry or need to use the bathroom) - In response to a noisy, over-stimulating environment, or feeling scared or lost •Try to figure out what is causing the behavior, and take steps to relieve the cause of the behavior •Sometimes there is nothing to do but to let the person pace •Take the person to a safe place (e.g., a fenced-in garden) and walk alongside him or her until the behavior has run its course

Assisting With Bathing

•Bath time can be a very frightening time •May not remember what a bath or shower is, or why needs to take one •The sound of running water, the bright lights, and the shiny surfaces in the tub room can be very upsetting •Being naked makes the person feel exposed and vulnerable •The person may be very afraid of falling •May become agitated when hears "time to take a bath." If this is the case, try to avoid the word "bath." •Instead, say "Let's go freshen up" or "It's time for an activity you will enjoy" •If the person seems very agitated, you might try singing to the person •Singing can have a very calming effect on people with dementia •Bath time will generally go more smoothly if prepare the tub room in advance •Make sure that the room is warm, fill the tub ahead of time so does not become frightened by the sound of the running water •Put a folded towel on the shower chair for comfort •Allow the person to wear robe as long as possible, consider draping a bath blanket or towel over shoulders while bathing •The bath blanket or towel will make the person feel less exposed and also provide some warmth •Hand the person a washcloth and let the person assist as much as possible

Assisting With Elimination

•Can present many problems for the person with dementia •May forget where the bathroom is, or fail to recognize the toilet •What should you do? - Sometimes, the person will have an accident because he is unable to move the necessary clothing out of the way fast enough - Taking the person to the bathroom on a regular schedule (e.g., every 2 hours) can help, as can helping the person to select clothing with fasteners that are easy to manage - If a person suddenly seems to be having a lot of accidents, report this to the nurse - The person may have a medical problem, such as a urinary tract infection, that needs to be addressed

Effects of Caring for the Person With Dementia on the Caregiver

•Caring for people with dementia is very important work •The difference you make in the lives of the person with dementia, as well as those of her family members, is significant •Can take its toll, physically and emotionally -Prone to outbursts of anger, become agitated very easily -On any given day, may be cursed at, spit on, slapped, hit, scratched, or pinched -Develop a fondness for the residents, can be very difficult when a resident has a "bad day" and that affection is not returned! -Behaviors can be very annoying, because they are repetitious -It is not always easy to figure out what you can do to make the behavior stop, and until a solution is found, the behavior can really try your patience •If feel yourself becoming overwhelmed, take a deep breath and remind yourself that a person with dementia cannot be held responsible for her actions •If you still feel angry, make sure that the person is safe and walk away •Ask a co-worker or the nurse for help with the person •Sometimes you may need to ask to be assigned to another resident for a while •If your frustration or anger moves you to the point of actually causing a resident physical harm - You will lose your job (as well as all chances of future employment in the health care field) - You may even be punished by a court of law for abuse •To provide the best care to your residents, you need to care for yourself

Types of Behaviors: Delusions and Hallucinations

•Delusions - A delusion is a false belief. For example, a person with dementia may think that she is someone she is not, such as the Queen of England. - Do not try to correct the person...this will only upset her...it would be like someone telling you that you are not who you think you are! - Try to redirect the conversation. For example, you might say, "Tell me about your day" or "Would you like to take a walk now?" •Hallucinations - A hallucination is seeing, hearing, tasting, or smelling something that is not really there - Common in people with dementia. For example, a person with dementia may tell you that there is a cat in the hallway or insects on the bed - If a person is hallucinating, reassure the person. For example, you might tell the person that you will ask the cat to leave, or go through the motion of sweeping the bugs off the bed - Then, gently redirect the person's attention

What is Dementia?

•Dementia is the permanent and progressive loss of the ability to think and remember, caused by damage to the brain tissue •A person with dementia experiences: -Problems with memory, especially short-term memory -Difficulty putting thoughts together and understanding concepts -Problems with judgment (the person is not able to make good decisions) -Disorientation (the person is not oriented to person, place, or time) -An inability to manage activities of daily living (ADLs)

Dementia Versus Delirium

•Dementia must not be confused with delirium, which is a temporary state of confusion •Delirium is a symptom of an underlying disorder, such as an infection, or a side effect of a medication -Once the underlying disorder is treated or the medication is stopped, the delirium goes away -In some cases, the person may die if the underlying cause of the delirium is not identified and treated

Types of Behaviors: Repetition (Perseveration)

•Doing the same thing over and over •For example - The person might repeat the same phrase or question constantly - She might constantly move a piece of cloth around on a coffee table, as if dusting •Behaviors are usually not physically harmful, may be a sign the person is bored •Very annoying to caregivers and other residents •Distract the person by going for a walk, or get involved in an activity such as looking through a magazine, may help to break the cycle

Stages of Dementia

•Early stage - Begins to experience memory loss - Person is aware of memory changes, becomes fearful, anxious, or depressed - May become angry at other people •Middle stage - Difficulty communicating - Difficulty recognizing familiar people and things - Difficulty remembering steps necessary to complete familiar tasks - Personality changes; behaving differently - Incontinence •Late stage - Loses ability to walk and sit independently - Becomes bedridden - No longer able to speak, swallow, or smile - Totally incontinent of urine and feces - Death

Four Major Causes of Dementia

•Four of the most common types of dementia are: = Alzheimer's disease •Alzheimer's disease is the most common type of dementia, accounting for more than 60% of cases of dementia •More than 5 million people in the United States have Alzheimer's disease •If no cure is found, it is estimated that 11 to 16 million people will have the disease by the year 2050 •Alzheimer's disease usually occurs in people older than 65 years •However, people as young as 40 years may also get the disease •The risk for developing increases with age, people 85 years and older are at highest risk •Alzheimer's disease is a leading cause of death •Exact cause is unknown •Researchers have identified a number of risk factors - Age - Family history - Serious head trauma - Heart disease (hypertension, high blood cholesterol levels, diabetes) = Vascular (multi-infarct) dementia •Damage to the blood vessels that supply the brain can affect the delivery of oxygen to the brain tissue •Mental functions are lost because multiple areas of the brain tissue die due to lack of adequate oxygen and nutrients •Thought to be the cause of dementia in approximately 20% to 25% of people with dementia, can coexist with other types of dementia •Most often affects people between the ages of 55 and 75 years, most commonly in 70 years old •It is more common in men than in women •Conditions that put a person at risk for developing vascular dementia include: - A history of myocardial infarction (heart attack) - Hypertension (high blood pressure) - Diabetes mellitus - Peripheral vascular disease - Transient ischemic attacks (TIAs) - Obesity - Smoking - High blood cholesterol levels •Symptoms may appear suddenly and they may vary from person to person, depending on which areas of the brain are affected •Like Alzheimer's disease, vascular dementia is irreversible and incurable •Keeping blood pressure, blood glucose, and blood cholesterol levels within normal limits can help to slow the progression = Lewy body dementia •Symptoms are a result of the abnormal buildup of protein bodies in the brain •Affects thinking, movement, and memory •Develop problems controlling body movements •Tend to experience visual hallucinations •May be alert and capable one day and confused and in need of help with ADL the next day = Frontotemporal dementia •Result of damage to frontal and temporal lobes of the brain •Affects personality, behavior, language, and memory •Onset seen between the ages of 40 and 65 years

Types of Behaviors: Rummaging

•Go through drawers or closets, searching for an item that he is never able to find •Ask the person what he is trying to find, and offer help in finding it •Rummage through other residents' belongings or every single drawer in his own dresser, it may be necessary to make certain areas "offlimits" by locking them •Special drawer or a box filled with small personal items that he can rummage through

Assisting With Dressing

•Have trouble selecting an outfit to wear •Often want to wear the same clothes every day •What should you do? -Limiting the number of outfits to choose from; asking family to purchase several identical outfits can help to solve these problems -To help make dressing less frustrating for the person, select articles of clothing that are simple, rather than complex

Assisting With Eating

•It may be difficult to get a person with dementia to focus on eating at meal times •May forget why she is at the table, or become distracted by others at the table •A quiet setting and limited food choices can help, will not recognize eating utensils or forget how to use them •Remind the person how to eat by placing your hand over the person's hand - Together, you bring the fork or spoon with the bite of food to the person's mouth •If the person cannot focus long enough to eat a proper meal, try offering the person "finger foods" such as sandwiches, cut-up vegetables or fruits, or a stuffed baked potato •A plastic cup with a lid and a straw or a spout can help to ensure that the person drinks enough fluids •Advanced stages of dementia eventually lose the ability to eat independently •Most of the food placed in the mouth just comes right back out again •Tongue-thrust motions are common in the late stages •A special syringe with a nozzle-shaped tip is used for feeding instead of a spoon •The syringe is used to place the semi-liquid food further back in the mouth so can swallow it more easily •The food is given slowly in small amounts to prevent choking •Using a feeding syringe may allow the person with advanced Alzheimer's disease to continue taking food by mouth for a longer period of time, instead of through a feeding tube

Reality Orientation

•Many years ago, caregivers used a technique called reality orientation with people with dementia •Based on the idea that it is important to bring the person back to the "here and now" by constantly orienting the person to time, place, people, and things •If the person was given enough information to stay on track, then he could be brought back to the present •Is useful for people who are experiencing temporary confusion that is reversible and treatable (i.e., delirium), it is not an effective technique with dementia

Types of Behaviors: Inappropriate Sexual Behaviors

•May attempt to get into bed with a resident who is not her spouse •Masturbate or undress in a public area, such as the dining room •Must take measures to stop inappropriate sexual behaviors, especially if making unwelcome sexual advances toward another person -Gently, but firmly, lead the person back to room and redirect attention by introducing another activity •Although OBRA specifically says that a resident of a long-term care facility must be allowed to fulfill her sexual needs with another consenting resident, another resident with dementia is not able to give that consent •You have a responsibility to protect all of the residents of the facility from unwelcome sexual advances

Meeting the Emotional Needs of a Person With Dementia: Activity Therapy

•Need to exercise their minds •Still can become bored •Activities may be planned for a group of residents, or just for one resident •There are many different types of activities that a person with dementia can enjoy: - Creative activities (flower arranging, painting, baking) - Intellectual activities (looking at a book of photographs, reading the newspaper aloud together, attending a play) - Social activities (hosting a tea party, going on a picnic) - Physical activities (taking a walk, participating in a group exercise class) •When planning an activity, take care to choose one that relates to the former interests and abilities of the person or people who will be participating in it

Types of Behaviors: Agitation

•Often become very upset and excited •May pace, shout, or strike out at caregivers or other residents •Unable communicate effectively with others, so they express themselves through behavior •Many things can cause agitation, including pain or an infection, an unmet physical need (e.g., hunger, a full bladder, or lack of sleep), or a noisy environment

Types of Behaviors: Catastrophic Reactions

•Over-react to something that would cause a healthy person minimal or no stress •For example, may become very agitated or begin to scream or sob loudly when you try to give him a bath •Often occur when the person feels threatened •For example, the person may feel that his privacy is being threatened when you attempt to give him a bath •Feeling overwhelmed •For example, a ringing telephone in a room where the television is on and people are talking might be too much for a person with dementia to handle

Types of Behaviors: Wandering

•People with dementia may stray away from home •It is very dangerous because the person is confused and disoriented - Might get lost, walk into the path of an oncoming car, or drown in a body of water, such as a lake or river - May not be dressed appropriately to be outside •Wandering cannot be stopped, many long-term care facilities have developed ways to allow residents to wander safely -Outside courtyards with high fencing, allow the resident to wander outside within the safe environment of the facility - May also wear a bracelet or an anklet that will set off an alarm if tries to leave through a doorway that leads to an unsafe area - Alarm sounds, staff members are alerted and can guide the person back to safety

Meeting the Emotional Needs of a Person With Dementia

•Several approaches are taken to help meet the emotional needs of a person with dementia - Reminiscence therapy - Activity therapy

Validation Therapy

•Stresses the importance of acknowledging the person's reality •Rather than correcting the person, attempt to distract and redirect the conversation whenever possible •For example, change the course of the conversation by encouraging the person to talk about things from her past •Pay special attention to the words, phrases, and body language that the person uses, better understand what the person is trying to communicate •What the person is saying may seem like nonsense to you, but there may be important meaning behind the words •Validation therapy protects the feelings of the person with dementia •Helps the caregiver to understand what the person with dementia is experiencing

Meeting the Emotional Needs of a Person With Dementia: Reminiscence Therapy

•To reminisce means to remember •In reminiscence therapy, the person with dementia is encouraged to remember and share experiences from his past with others •For example -If a person with dementia insists that she needs to go see her mother (who has been dead for years), you might say, "What does your mother look like?" or "Tell me about a favorite food that your mother used to make when you were growing up"

Caring for the Person With Late-Stage Dementia

•Unable to walk - Risks: pressure ulcers, contractures, pneumonia •Unable to swallow - Feeding tubes; depends on advance directives •Comfort care -Oxygen therapy •Care for someone who is dying •Care of the family

Managing Difficult Behaviors

•When caring for a person with dementia who is demonstrating a particular behavior, you must use your observation skills to try and answer the following questions: - What is the behavior? - Whom is the behavior associated with? - When does the behavior occur? - Where does the behavior occur? - Why is the behavior occurring?

Meeting the Physical Needs

•When helping a person with ADLs, there are several general things to do to make the task at hand go more smoothly: - Speak clearly, in a calm tone of voice - Remind the person at each step what she needs to do next - Use hand gestures in addition to spoken instructions - Plan for the procedure in advance - Keep to a regular schedule

Types of Behaviors: Sundowning

•Worsening of a person's behavioral symptoms in the late afternoon and evening, as the sun goes down •For example, the person may become more agitated, restless, and confused in the evening hours, and may have trouble getting to sleep •Exact cause unknown -Might be brought on by fatigue, especially if the person frequently wanders, paces, or engages in other repetitious behavior of a physical nature -Occurs because the person cannot see as well in the evening hours, when the sun starts to go down •Not being able to see well can increase the person's confusion and agitation •Turning on lights earlier in the evening may help to prevent or reduce sundowning behavior