Chapter 3: Understanding Your Residents

Psychosocial needs:
Needs having to do with social interaction, Emotions, Intellect and Spirituality

A human being has six basic physical needs:

Food and Water Protection and shelter Activity Sleep and rest Safety Comfort, freedom from pain

A human being has the following psychosocial needs:

Love and affection Acceptance by others Security Self-reliance and independence in daily living Interaction with other people Success and self-esteem

Maslows Hierarchy of needs:

Masturbation:

To touch or rub sexual organs in order to give oneself or

another person sexual pleasure

Remember:

People continue to have sexual needs through their lives Humans express their sexuality through different behaviors Knock & wait for a response before entering residents room Provide privacy if you encounter a sexual situation Do not judge any sexual behavior you see Honor Do Not Disturb signs.

As an NA you can help your residents with Spiritual needs:

Learn about their religion Assist with practices Encourage participation in religious services if they are religious Respect all religious items Report requests to see clergy to nurse Get to know residents priest, rabbi, or minister Allow privacy for clergy visits If asked, read religious material aloud Refer resident to spiritual resources if requested

You should never:

Try to change someones religion Tell a resident his/her belief or religion is wrong Express judgment join religious group Insist that a resident join religious activities Interfere with religious practices
Holistic Care:

A type of care that involves considering a whole system, such as

a whole person, rather than dividing the system into parts

Residents may encounter these problems due to lack of independence:

Poor self-image Anger Feeling of helplessness, sadness, and

hopelessness Feeling uselessness Increased dependance Depression

As a NA you can promote independence in these ways:

Encourage residents to do as much as possible for themselves

no matter how long it takes Be patient Allow residents to make choices

Cultural Diversity:

The variety of people with varied backgrounds and

experiences who live and work together in the world

Culture plays a part in determining all of these things:

Language Religion Food Preferences Degree of comfort with touch

Physical activity has the following benets:

Lessens the risk of illness Relieves symptoms of depression Improves mood and concentration Improves body function Lowers risk of falls Improves sleep Improves ability to cope with stress Increase energy Increases appetite

Inactivity and immobility can cause many problems for residents?

Depression Boredom Pneumonia Urinary tract infection Constipation Blood Clots

There are many types of families:

Single-parent families Nuclear families Blended families Multigenerational families Extended families Unmarried couples Same-sex couples

Families play an important role in the care of residents.

Making care decisions Communicating with the care team Providing support and encouragement Connecting to the outside world Giving assurance

Stages of development include:

Infancy (birth to 12 months):

Grow and develop quickly Development is from head down

Toddlers (1 to 3 years):

Formerly dependent, now gain independence and body control Learn to speak, gain coordination, bladder and bowel control May have tantrums or whine to get their way

Stages of development include:

The Preschool stage (3 to 6 years): More social relationships Play cooperatively and learn language Know right from wrong School-Age (6 to 12 years):

Cognitive development Get along with others in peer groups Develop a conscience and self-esteem

Stages of development include: Puberty & Adolescence (12 to 18 years): Secondary sex characteristics appear Reproductive organs begin to function Concern for body & peer acceptance Changing moods Interacting with opposite sex Young Adulthood (18 to 40 Years): Select a career Select and live with a mate Raise children Develop satisfying sex life

Stages of development include:

Middle Adulthood (40 to 65 years): More comfortable and stable May have mid-life crisis

Late Adulthood (65 years and older):

Many physical and psychosocial changes Loss of physical health Loss of friends and jobs

Ageism: Prejudice towards, stereotyping of, and/or discrimination against older persons or the elderly Remember these facts about aging: People have many different capabilities Stereotypes are false Older persons are usually active Aging is a normal process, not a disease Aging persons need to adjust to change They do not need to be dependent

Aging brings many normal changes:

Thinner, drier more fragile, and less elastic skin Weaker muscles Bones more brittle Sensitivity of nerve endings in skin decreases Responses and reexes slow Short-term memory loss Changes in senses Less efcient hearts Oxygen in blood decreases Decreases appetite More frequent elimination Weakened immunity

Developmental Disabilities: Disabilities that are present at birth or emerge during childhood that restrict physical or mental ability Remember the following information on mental retardation: Most common developmental disorder Not a disease or psychiatric illness Below-average mental functioning May have limited ability to live independently Have the same emotional and physical needs of others

There are special care guidelines for residents with developmental disabilities:

Treat adult residents as adults Praise and encourage often Help teach ADLs by dividing a task into smaller units Promote independence Encourage social interaction Repeat words you use to make sure they understand Be patient

Apathy:
A lack of interest

Major depression:
A major type of mental illness that may cause a person to lose interest in everything once cared about

Bipolar disorder:
Type of mental illness that causes a person to swing from deep depression to extreme activity

Anxiety:
Uneasiness or fear, often about a situation or condition

Phobias:
Intense form of anxiety

Claustrophobia:
The fear of being in a conned space.

Obsessive compulsive disorder:

Disorder in which a person uses obsessive behavior to cope with anxiety

Post-traumatic stress disorder:

Anxiety-related disorder caused by a traumatic experience

Remember these guidelines for caring for mentally ill residents:

Observe for changes in condition or ability Support resident, family and friends Encourage resident to do as much for himself as possible Remember that mental illness can be treated

Denial: Anger:

Refusal to believe one is dying why me?

Bargaining: just let me live until..... Depression: need to mourn & review ones life Acceptance: Preparing for death

Durable power of attorney for healthcare:

A signed, dated & witnessed paper that appoints someone else to make the medical decisions for a person in the even he or she becomes unable to do so

Living will:
A document that states the medical care a person wants, or does not want, in case he or she becomes unable to make those decisions for him or herself

Do-not-resuscitate (DNR):
An order that tells medical professionals not to perform CPR.

All of these factors inuence feelings and attitudes about death:

Experience with death Personality type Religious beliefs Cultural background

Cheyne-Stokes respirations: Slow, irregular respirations or rapid, shallow respirations The following are signs of approaching death:

Blurred vision that gradually fails Unfocused eyes Impaired speech Diminished sense of touch Rising or lowered body temperature Decreasing blood pressure Weak pulse that is abnormally slow or rapid Rattling or gurgling sound as person breathes Cold, pale skin Perspiration Disorientation or confusion

Keep these guidelines in mind as you care for dying residents: Diminished senses Care of mouth and nose Skin care Comfort Environment Emotional and spiritual support

Postmortem care: Care of the body after death Remember these guidelines for postmortem care:

Rigor Mortis may make the body difcult to move Bathe the body gently Place drainage pads where needed Do not remove tubes or other equipment Put in dentures if instructed by the nurse Close eyes Position body properly Follow facility policy on personal items Strip the bed after body is gone Respect wishes of the family and friends Document procedure properly

Palliative care:

Care that focuses on the comfort and dignity of the

person, rather than on curing him or her

Hospice care:

Special care that focuses on the dignity and comfort of a dying

person