Care of a Confused Client

Care of a Confused Client

TABLE OF CONTENTS

QUESTIONS ………………………………………………………………………………………………………………… 3

INTRODUCTION …………………………………………………………………………………………………………. 4

ANSWERS …………………………………………………………………………………………………………………….. 5

BIBLIOGRAPHY ………………………………………………………………………………………………………….. 10

CARE OF A CONFUSED CLIENT

1.- Development of a client profile and assessment of individual client need.

2.- Determine the level of assistance required to complete activities of daily living.

3.- Maintaining a safe environment.

4.- Promote client involvement in social events and therapies.

5.- Mobility including falls and pressure area care.

6.- Effective verbal and written communication with client and healthcare team.

7.- Assist clients with activities of daily living.

8.- Promote the rights of the client to dignity, privacy, independence, positive self image.

INTRODUCTION

The purpose of this assignment of the module Care Skills FETAC Level 5 Major Award is to expose the knowledge, skills and competencies acquired by the learner on the subject of caring, specifically in care of a confused client.

Many people forget someone’s name or lose things from time to time. This kind of forgetfulness is normal. But forgetting how to get home or ask questions again and again may be signs of a problem.

Confusion is a common problem in persons over 65 years of age. They may have forgotten how to perform well-learned skills such as dressing themselves or language problems. Also, orientation, visual or motor problems. It may be a symptom of delirium or dementia.

Delirium is a transient global disorder of cognition and consciousness. Causes of delirium include metabolic disorders, infections and medications.

Dementia is characterized by a decline in intellectual functioning to the extent that patients are unable to perform their usual daily activities. Dementia include illnesses as Alzheimer’s disease, vascular dementia, central nervous system trauma.

The philosophy of this assignment is to show that caring involves not only the giving of physical care, also the giving of emotional support and understanding to the resident and family and the ability to encourage the person to gain independence.

The methodology of this assignment combines class and tutor notes; research on internet and the library; and the appropriate legislation.

This is the case of Matthew and his health care assistant Emma.

Emma arrived at Mr. and Mrs. Haselt’s home in April and got the following ananmesis of Mr. Haselt from his wife.

Matthew has been married with his wife Anna for 48 years, both are 70 years old. They have two children living in the same town.

Matthew a retired history teacher began to noticed that he was having problems remembering friends’ names and phone numbers one year ago.

Anna has been aware of her husband’s progressive cognitive decline, including forgetting current news from last night’s newspaper or confusing their children’s names. Anna states that problems seem to exacerbate with the time. He seems easily agitated, his sleep habits are jumbled; and he has long periods of wakefulness in the nighttime.

They decided to go to the doctor. The Haselts was referred to a neurologist for evaluation. The doctor makes to Matthew differents evaluations and diagnostic testing, such as:

The Mini-Mental State Examination (MMSE) evaluates the cognitive domains of orientation, registration, attention, memory and language. Less than 24 is considered abnormal. This is not diagnostic of dementia or delirium, but it does reflect the severity of cognitive impairment.

The Short Portable Mental Status Questionnaire (SPMSQ) assesses the cognitive domains of orientation, mathematics skill and both short- and long-term memory. Between 3 – 4 errors is considered a mild intellectual impairment.

Mr. Haselt scored 21 points on the MMSE and 4 errors on the SPMSQ.

The neurologist diagnosed dementia due to Alzheimer’s disease (stage 2).

Mr Haselt intends to remain in his home for as long as he can, so they decided to hire a healthcare assistant, Emma, to help them.

Emma explained Ann Alzheimer’s disease is the most common form of dementia. The confusion and the loss of functional ability are caused by brain cell death (tangles) and interruption in communication of brain cells (amyloid plaques).

The symptoms and progression begin slowly and worsen in each of the four stages of the disease. Symptoms may vary in clients; some clients progress quickly through each stage, whereas others may live for years without completely deteriorating.

Stage 1, mild dementia, Matthew may appear normal. He can function with minimal assistance and supervision, and usually is still living at home.

Stage 2, moderate dementia, Matthew will continue in good physical health but memory loss is apparent.

Stage 3, severe dementia, Matthew will not function alone and becomes increasingly more dependent on caregiver. This stage involves greater mental deterioration and decline in motor ability.

Stage 4, the terminal stage, Matthew will becomes totally dependent upon others for care and will develops severe physical problems. Death usually occurs due to complications of immobility or respiratory infections.

On the first day of work Emma spends the day with Matthew and identified some hazards at the house. Later on, she proposes the following objectives:

• To provide a safe environment:

– Remove rugs, extension cords and anything that can cause trip and fall. Avoid rearranging the furniture.

– Install handrails to prevent falls.

– Install locks on cabinets that contain medicine, dangerous utensils and controls on the oven and stove.

– Labeling drawers with their contents.

– Provide extra lighting in dark areas, especially a night-light in the bathroom.

– Install raised bars to help them get on and off the toilet.

– It is important for Matthew to carry appropriate identification at all times including his name, address and an emergency contact number. For example, an identity bracelet.

• To participate in out-of-home activities.

– The Hastle’s and their sons attend the weekly local support group meetings for Alzheimer’s disease and related disorders.

– Matthew has to go physiotherapy three times a week. While Ann will visit her friends.

– Matthew receives visit at home and also goes to the Community center every Tuesday.

• To avoid any kind of injury, such as bedsores, she recommends to Ann buying a air-filled mattress. Also to use cushions to protect bony areas and Emma inspect Matthew’s skin daily.

• To resolve Matthew communications problems:

Sometimes it is difficult to Matthew to find words, understand, write, read or express emotions. This inability to comprehend and process information distresses him. Emma tells the family to follow these tips for communicate with Matthew:

­- Stand in front of Matthew and look into his eyes.

– Use simple and direct directions.

– Stay calm and allow time for Matthew to understand and respond.

– Remember that Matthew still have feelings and emotions even though they may not always understand what you are saying.

– Use positive body language and touch because this is an important part of communication.

– Emma does with Matthew repetitive hand activities to keep Mathew’s mind and hands busy. She uses a “rummage box” filled with soft things like washcloths and balls of yarn. Also, she uses games and large print playing cards.

• To establish and maintain a daily routine to perform daily activities, such as bathing , grooming, feeding, dressing, drug delivery in an orderly, accurate and establishing schedules. It may help to Matthew to maintain and even improve his skills, giving greater security and autonomy.

• To do the grooming and hygiene activities:

– Emma choose the mornings for Matthew personal care as he seems calmer in the morning.

– Make sure there is enough warmth and light in the bathroom

– Play classical music because as it seems to relax and sooth Matthew.

• To manage Matthew’s eating and nutrition needs:

– Offer snacks, drinks and meals regularly, perhaps trying 5-6 small meals a day.

– Serve one course at a time.

– Serve foods that are familiar to Matthew.

– Demonstrate chewing if this seems to be a problem, and eat with Matthew so he can copy her.

– Consider nutrition supplements, particularly in later stages of dementia when he will tend to lose a lot of weight.

– When Emma is not at home, she has prepared a blackboard with hours and foods that Ann will have to give Matthew.

• To manage Matthew’s incontinence needs:

– Watches for non-verbal clues such as pulling on clothes and increased agitation, and when this happens, she uses short, simple words to suggest Matthew go to the toilet.

– Buy clothing with elastic and velcro waistbands so Matthew can easily remove and put it back on again.

• To achieve 7 uninterrupted hours of sleep at night:

– Do exercise with Matthew. For example, walk with Matthew and Ann in the mornings; exercies at home.

– Not drinking too much caffeine.

– Try that Matthew does not feel too cold or too hot.

Ann and her sons are very happy with Emma because she always treated Mathew with dignity and respect. She displayed empathy and interest to Matthew. She knew his past, likes, and dislikes. She always introduced herself, called Mathew by his name. Spokes softly, in a low-pitched voice. Emma explained each task by providing short, one-step directions. Showed Matthew how to begin a specific task such as, brushing hair. Emma spent time encouraging Matthew to talk about his family and past experiences. Emma always asked Matthew what he wanted to wear, sometimes he answered and elegy, his gray suit, others simply smiled but always went out into the street with great elegance.

Emma was with Matthew until the last moments of his life providing spiritual and paliative care. She adapted her work to the changes that this disease caused Matthew.

She will always remember what Mattheer told her about his illness:

Alzheimer’s disease acts as a thief memory. First, the disease robs my daily memory; then it undermines my ability to reason, learn, speak and act, until eventually wrest me the most basic human capabilities.

I know this will be a long way to go but I will be good company and I will be careful.

BIBLIOGRAPHY

• Creative Training (2013) ‘Creative Training Student Manual’, Naas: Creative Training.

• Dementia (2014) Caring for someone with dementia. PDF [Online]. Available: http://www.myagedcare.gov.au/caring-someone-particular-need/caring-someone-dementia [Accessed 27 November 2014].

• National Center of Continuing Education (2014) Confused about confusion. [Online]. Available: https://www.nursece.com/courses/71-confused-about-confusion [Accessed 28 November 2014].

• Nursing Care Plan (2014) A client with AD. PDF [Online]. Available: wps.prenhall.com/wps/media/objects/737/755395/alzheimers_disease.pdf [Accessed 26 November 2014].
• Myagedcare (2014) Caring for the client who is confused or mentally ill [Online]. Available: https://dese.mo.gov/sites/default/files/CIHA_ch6.pdf [Accessed 28 November 2014].
• RNAO, Nursing Best Practice Guidelines (2014) Interventions for delirium. [Online]. Available: http://pda.rnao.ca/content/interventions-delirium#top [Accessed 28 November 2014].

• American Family Physician (2014) Diagnostic Approach to the Confused Elderly Patient [Online], available: http://www.aafp.org/afp/1998/0315/p1358.html#afp19980315p1358-t7 [accessed 26 November 2014].

• Health Information and Quality Authority (2014) National Quality Standards for Residential Care Settings for Older People in Ireland [Online], available: http://hiqa.ie [accessed 26 November 2014].