Chapter 3 NA Understanding Your Residents

Basic human physical needs Food and water Protection and shelter Activity Sleep and rest Safety Comfort, especially freedom from pain

Basic Human Psychosocial Needs Love and affection Acceptance from others Security Self-reliance and independence in daily living Contact with other people (take time to talk with residents) Success and self-esteem

Stress and frustration can occur when basic needs are not met. This can lead to fear, anxiety, anger, aggression, withdrawal, indifference and depression.

Maslow’s Hierarchy of Needs Physical needs must be met before psychosocial needs can be met. (in order of importance according to Maslow) 1st Physical needs: oxygen, water, food, elimination, rest 2nd safety and security: shelter, clothing, protection from harm, stability 3rd need for love: feeling loved, accepted, belonging 4th need for self esteem: achievement, belief in one’s own worth and value 5th need for self-actualization: the need to learn, create, realize one’s own potential

Spiritual and sexual needs Do not make judgments, do not try to push your beliefs on residents Residents have the right to choose how they express their sexuality. The ability or urge do not end due to age or admission to a care facility. Honor privacy

Holistic care Caring for the whole person, mind and body Example: taking the time to talk with your residents while helping them bathe, meets physical need and psychosocial need

Normal changes of aging Skin is thinner, drier, more fragile, less elastic Muscles weaken, lose tone Bones become more brittle Sensitivity decreases, responses and reflexes slow Short-term memory loss Senses weaken

More normal changes Heart works less efficiently, oxygen in the blood decreases Appetite decreases Digestion takes longer Urinary elimination is more frequent Hormone level decreases Immunity weakens Lifestyle changes occur

NOT normal changes Signs of depression Can’t think logically Poor nutrition Shortness of breath Incontinence And more….

Dying residents- Grief process (Kubler-Ross) Five stages: Denial Anger Bargaining Depression Acceptance

Common signs of approaching death Blurred or failing vision, unfocused eyes Reduce glare, put favorite objects where the resident can see them, put call light in reach Impaired speech Diminished sense of touch, loss of movement, muscle tone and feeling speak in a normal tone, talk to the person without expecting an answer. Observe for signs of pain, report them. Frequent changes of position, back massage, mouth care, body alignment. Lubricate the mouth with lip balm. Temperature change Decreasing b/p, weak pulse that is either rapid or abnormally slow Cold, pale skin

More common signs of death Mottling (bruised looking), spotting or blotching of skin from poor circulation Keep sheets wrinkle free, reposition often Perspiration Bath often, change sheets and clothes for comfort Disorientation, confusion Listen, report any comments about fear, give emotional and spiritual support, don’t deny Incontinence Keep skin clean and dry, given bed bathes and incontinence care as needed A “rattling” or ‘gurgling” sound while breathing Slow, irregular respirations or rapid, shallow respirations, called Cheyne-Stokes respirations.

Postmortem care Care of the body after death. (Be sensitive to the needs of the family, they may wish to sit at the bedside to say goodbye or stay a while. Allow them to do so. Offer support as needed.) Bathe the body gently Place drainage pads where needed often under the head or perineum Do not remove any tubes or equipment Put dentures back in the mouth and close it. Close the eyes carefully Position the body on the back, legs straight, fold arms across the abdomen. Put a small pillow under the head. Follow policy about removal of jewelry, have a witness if removed or given to a family member, document it. Funeral home will come and then remove the body Strip the bed after the body has been removed, straighten up Document

Hospice Special care that a dying person needs Holistic approach- treats physical, emotional, spiritual and social needs compassionately. Goal is palliative care- comfort and dignity of the resident focusing on pain relief and comfort.