dementia in general hospital

Nursing role in dementia care Dementia challenge in general hospital communication challenge in dementia

Report
Alzheimer Challenge in
General Hospital
Dr Amira El Baqary
Doctorate of Nursing
[email protected]
Scotland
Personal Motive
The man who was drowning in the ICU
Definition of Dementia
Do you consider dementia a part of the ageing
process ?
Discussion
Dementia definition
Dementia is a general term that reflects the
declining of cognitive functions
Dementia= without Mind
Facts about dementia
O Dementia doesn't mean memory loss
O Dementia affects all cognitive functions not
only memory
Facts about dementia
O Dementia is a progressive disease , it starts
and it never stop untill it affects all brain
functions
O Dementia lead to death
Facts and figures
Facts and figures
Facts and figures
Prevalence of dementia
25%
20%
15%
10%
Prevalance of
Dementia
5%
0%
Over 65 Y Over 85 Y
Why dementia
O All previous facts suggest that nurses will meet
dementia patients more frequently
O It is proven that dementia patients struggle in
general hospitals since their ability to
communicate or express needs become
impaired
O Therefore, basic knowledge about dementia is
core knowledge for nurses and care assistants
in general hospitals
Prevalence of dementia
Dementia affects 5% of people aged 65 years
and 20% of over 80 years
This fact suggests that dementia awareness is
a core knowledge for society and care workers
as well
Dementia types
O Alzheimer (around 70% of dementia is due
to Alzheimer's disease)
O Vascular dementia
O Other types (head injuries, accidents, lwey
body dementia)
Pathophysiology
In Alzheimer dementia, plaques and
tangles appear and affect the function
of nervous cells
Shrinking Brain cells
Can you see the differences in the two
pictures….
Warning signs of Alzheimer's
O Memory loss that affects daily life
O Difficulty in planning for simple routine tasks
O Getting lost in familiar places
Warning signs of Alzheimer's
O
confusion and irritability
O Mood swing without apparent cause
O Inability to manage financial issues
Warning signs of Alzheimer's
O Difficulty in translating visual images
O Can’t find words to complete the sentences
O isolation and depression
O Putting things in wrong places (milk in the
oven, clothes in the fridge…)
The challenge of Dementia in
general hospital
O Reviewing previous signs of dementia can
you discuss what would be the struggle of
dementia patient in general hospital?
O If a patient suffer from dementia in a
general ward and the patient has pain and
can’t express it..what would be the signs of
pain? How the nurse can recognise it?
The challenge of Dementia in
general hospital
Patient with dementia in general hospital
suffer with the following:
O Longer stay in-patient wards
O Their needs sometimes ignored or not met
O Difficult communication with health care
provider in the hospital busy environment
Video about dementia
http://www.youtube.com/watch?v=UxfAxP7jyHw
Signs to Alzheimer's Disease
Memory problems
Declining memory abilities that is apparent in
forgetting not only names but also function of
things…e.g the use of cupboard , spoon,
table..
Mode change
Patient feels lonliness, depression, anxieties
and confusion (lost in his own house)
wandering
Wandering appears particular in timing of usual tasks..
E.g time to pick children from school, time used to go
to
Deteriorate language
O Deteriorating language is a barrier of
communication for patients and prevents
dementia patient from expressing their
needs or feelings
Impaired judgment
Dementia affect thinking and judgment and
make patient unable to make right decisions
even for minor things such as choosing clothes
appropriate to weather
Dementia patient is vulnerable
Dementia makes the person weak, forgetful
and confused. The picture from a care home
where the patient was subject to drag lifting
and maltreatment and was unable to express
it
Impaired vision
Patient suffer from impaired vision, inability to
translate pictures and sometimes visual
hallucinations, this reflect on patient mood
through fear and anxiety
Impaired vision
Narrowing the scope of vision is very common
with dementia. therefore you should face the
patient during talking and never come from his
side
Impaired vision
Patient become unable to translate his
surrounding e.g. if the bathroom is all while ,
patient will not be able to differentiate the sink
from the toilet or will think the the floor is full
of water or wet
Fear
Fear in dementia is due to different factors
such as memory problems (patient can’t
recognize his surrounding)
‘’Want to go home’’
It is common to hear dementia patient say ‘’I
want to go to my home’’ while he is already
home. During analysis of this sentence it was
revealed that patients describe their own
homes during childhood and can’t recognize
their current homes where they lived their
whole life…. In many cases patients tried to
escape or were subject to be locked inside !!
Mood changes
Can you think why this could happen?
Incontinence
Incontinence is very common with dementia
and consider one of the factors that lead to
deterioration of patient mood and increase
anxiety
Discussion
What do you think of this picture…what would
be the reaction of people live with this patient
in your opinion? Can you predict what they will
do?
Faineance and dementia
Difficulty managing finance …anyone here
witnessed example of this before?
This point requires legal guardian in a specific
stage of dementia after assessment
Dementia and mirrors
In many cases the patient can’t recognize his
picture in a mirror, this cause fear and anxiety
to patient and it is better to remove mirrors
from patient’s room
Sun downing syndrome
A mix of irritability, cry and negative feelings
that is common in dementia patients by the
time of sun set. This syndrome is not
scientifically explained but requires attention
Sun downing syndrome
During sun set time it is better to close the
curtains, increase the inside light and start
activities such as music television, tea and
cake
Video
http://www.youtube.com/watch?v=8Z5m0sY1RA
How to fight
dementia
Healthy life style
Healthy life style
O Observe blood pressure and blood glucose
O Avoid overweight and obesity
O Exercise and waling daily
Smoking cessation
O For preserving excellent brain functions,
smoking should be avoided
Planning care for
dementia
Personalized Care Plan
(1)
Assessment
(2)
Care plan
(3)
Review
Personalized Care Plan
O Each patient goes the dementia journey
differently than other patients
O Plan of care should be tailored to patient’s
condition, level of education, previous job,
hobbies….
Personalized Care Plan
O Life story work … you need to know your
patient very well to be able to plan care for
him
O Respecting differences, culture is a key for
successful planning of care .
O Dementia affects most physical and
cognitive functions hence it needs to be well
understood
Assessment
O Assessment includes physical and cognitive
functions to be able to recognize patient
needs
O Assessment of level of independence and
activities of daily living ADL is important
Assessment
O Assessment also includes assessment of
quality and quantity of food and fluids that
patient have per day
Assessment
O Physical assessment also include skin
assessment, detecting skin breakdown,
bruises, injuries, nail care, hair care, ….
O Remember patient can’t depend on himself
in many occasions
Care planning
O That consider physical care, psychological
reassurance, and planning activities for
patients
Environment modification
O Dementia patient can easily fall, so they
need clear way for walking
O Small tables and wires complicate patient
life and make it difficult to be self
dependent
Environment modification
O In case the patient will be transferred to a
care home , family members can transfer his
familiar parts of furniture , albums, chairs
with him
Evaluation
O Evaluation of care need to be continues
process for dementia patients to detect
deterioration or improvement
Problem-based learning
scenario
Mr. Hazem is 74 years admitted to internal
medicine department for treatment of diabetic
foot. Mr. Hazem blood pressure was 160/100,
pulse 92, blood glucose 320. Mr Hazem is
suffering from dementia since 1 year and has
difficulty in communication, becomes forgetful,
aggressive, sometimes he starts to cry without
apparent reason to nursing team. Can you
plan patient cantered care plan for this patient
Late stage of
Dementia Care
Loss of physical movement
O Patient become dependent even in minor
tasks such as moving, walking …
Discussion
O Can you suggest different aspects of care for
immobile patient ?
Late stage dementia
O Difficulty in swallowing
O Incontinence
O Inability to communicate
O Loss of consciousness
Range of motion exercise
active and passive ROM is advised through
the day
Music and Dementia
Can you see
the
differences
Nutrition and dementia
O Sometimes patients suffer from anorexia, it
is preferred to provide soft food,
sandwiches, fruits or juice. Assessment of
patient food preference is core aspect of
patient care
Aids and adaptations
O Care givers need to consider aids required
for patients to facilitate their lives such as
walking cans, eyeglasses
Purposeful
activities with
dementia
Memory books
O Is a very engaging experience to remember
significant events in patients’ lives,
Gardening
O Gardening and caring for plant is considered
a self rewarding experience and proved
positive impact on patients.
Walking
Walking patients outside has a very positive
impact on patient’s psychological state
Feeding animals
O Pet therapy is very common with dementia,
many care homes in the UK allow animals to
be present for dementia patients to
decrease stress and anxiety
Video
‘’Darkness in the afternoon’’ 17 minutes video
produced by the Dementia Service Developing
Centre in String University. A true experience of
dementia
Facebook page
This page is part of the national dementia
awareness project in Egypt
https://www.facebook.com/dementiaegypt/?f
ref=photo
https://m.facebook.com/dementiaegypt/
Facebook page
Post test
O

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