1. Signs, Symptoms, & Observing Changes Training The Center for Life Enrichment Resource: MTTP Student Manual

2. Observing Changes As an employee of TCLE, you spend a lot of time with the individuals in your care. Because of this, you are one of the most important advocates responsible for communicating the preferences and needs of individuals in your care You are the best person to notice when changes occur in the individual’s physical condition or in their usual ways of behaving Some changes may be sudden and drastic, while others are more subtle

3. Objective Signs Objective signs are observable/measurable information that you can document about another person The changes you see in an individual’s appearance, behavior, and bodily functions are objective signs They can be seen, heard, felt, smelled, or measured For example, you may: ▫ See or hear a person crying or moaning ▫ Feel an individual’s skin as warm or cold ▫ See that the individual has vomited ▫ See that an individual has a change in bowel habits ▫ Hear an individual slurring his speech ▫ Measure an individual’s temperature or weight ▫ See that an individual’s eating habits have changed

4. Subjective Symptoms The changes that you cannot see, but that are experienced and/or reported by the individual are subjective symptoms An individual may verbally tell you of changes he/she perceives or may use nonverbal behavior to express these changes For example, the individual may complain of: ▫ Pain ▫ Itching ▫ Dizziness ▫ Feeling upset or worried ▫ Weakness ▫ Loss of appetite ▫ Nausea

5. Objective Signs & Subjective Symptoms When an individual reports a symptom to you, you should not only report the symptom but also look for other signs. ▫ For example, if an individual reports that he is dizzy (symptom), a sign would be if he held onto furniture to help steady himself There are times when you might have to observe an individual’s nonverbal behavior and report these behaviors to assist in detecting symptoms ▫ For example, what might these signs indicate?  Holding one’s head  Pointing toward part of the body  Limping  Restlessness  Pacing

6. Changes in Physical Condition To observe correctly, you must notice any and all changes that occur in the individual’s physical condition To accurately detect changes, you must be familiar with the individual’s daily patterns, baseline behaviors, and health status To detect changes, be alert to: ▫ A change in body weight ▫ Urinary patterns change (e.g. frequency or incontinence) ▫ Constipation, diarrhea, or other change in bowel habits ▫ Loss of appetite ▫ Change in walking/gait or balance ▫ Change in ability to perform activities of daily living (ADLs) e.g. put on coat, wash hands, etc. ▫ Change in eating pattern ▫ Change in cognition (process of knowing/thinking) and/or memory ▫ Change in temperature, pulse, respiratory (breathing) rate, and/or blood pressure

7. Changes in Behavior In identifying changes in an individual’s behavior, it is necessary to first learn what is usual or baseline for that individual Compare his or her present behaviors to the usual behaviors that the individual has shown in the past For individuals with dementia or behavioral problems, it becomes especially important to know what their “usual” behavior pattern was like before receiving any medications to target behavior Behavioral changes may present as: ▫ Emotional changes (e.g. mood, withdrawn, anger, etc.) ▫ Change in sleep patterns ▫ Change in level of activity ▫ Changes in ability to communicate ▫ Changes in socialization with others ▫ Change in level of consciousness (e.g. lethargy, hyperactivity, drowsiness, etc.) ▫ Increased irritability ▫ Increased pacing ▫ Increased or decreased resistance to care ▫ Change in level of cooperativeness ▫ Mental changes (e.g. memory, ability to concentrate, etc.)

8. Your Role is Very Important! While only the Healthcare Professional (HCP) can order medication, your reported observations and descriptions of physical and behavioral changes contribute to the information that the HCP uses in planning treatment Because you are the person in closest contact with the individual experiencing physical and behavioral changes, it is your responsibility to observe, describe and report signs and symptoms to your supervisor and/or the delegating nurse right away!

9. Contact Info Nurse’s Office at TCLE  301-373-8100 *821 (office) Ann Kline, Quality Assurance Director, TCLE  301-373-8100 *830 (office) Know your immediate supervisor’s contact info! Have access to emergency contact numbers for the individuals in your care!

10. Be Well Informed! It is important that you read the Individual Plan (IP) and health record of each individual in your care Pay close attention to the recommendations from all health care professionals, including the delegating nurse at TCLE You are responsible for reviewing and implementing the individual’s Nursing Care Plan (NCP) You are responsible for asking questions if you don’t understand