Special Concerns

CW 107.1 Special
– Dementia
and
Care Concerns – Mental Illness
Dementia and
Mental Illnesses
 Objectives
At the end of this unit the student will be able to:
• Explain the difference between dementia and delirium.
• Describe the three major stages of dementia.
• Describe four major causes of dementia.
• Define mental illness
• Identify and describe qualities that signify good mental
health.
• Identify coping methods for stress.
• Compare four models of stress as they relate to nursing
practice.
 Objectives
• Describe the four “As” of dementia: amnesia, aphasia,
agnosia, and apraxia.
• Describe behaviors that are common in patient’s with
dementia.
• Identify strategies for assisting patient’s suffering from
dementia.
• Describe special care measures that are taken to help
maintain quality of life of a patient with dementia.
• Describe the effects of caring for a patient with
dementia on the caregiver, and strategies for coping.
 Objectives
• Discuss the limitations of homeostatic control.
• Describe how adaptation occurs in each of the five
dimensions.
• Describe two forms of local physiological adaptation.
• Describe the three phases of the general adaptation
syndrome.
• Identify behaviors that are responses to stress.
• Identify the most common ego-defense mechanisms that are
responses to stress.
• Explain the effects of prolonged stress on each of the five
dimensions of a patient’s functioning.
 Objectives
• Describe stress management techniques that nursing personnel
can implement to assist patient’s and themselves.
• Describe techniques of crisis intervention.
• Describe possible causes of mental illness.
• Describe the various treatments that are available for patient’s
with mental illness.
• Describe common mental illnesses that are encountered during
patient care.
• Describe special concerns related to health care facilities and
aging that may affect a person’s mental health.
• Describe the responsibilities of the PCT when caring for
mentally ill patients.
 What is Dementia?
• Dementia is a
permanent and
progressive loss of
mental function
caused by damage to
the brain.
 Dementia
• Dementia has a very gradual onset, with
symptoms appearing over a period of several
months or a few years.
• On average a person diagnosed with dementia
will live 8-10 years after the onset of symptoms.
• There is no cure for dementia, although there
are medications available to slow the
progression.
 Dementia vs Delirium
• Dementia should not be confused with
delirium, which is a temporary state of
confusion.
• Delirium is a symptom of an underlying
disorder or condition.
• Delirium can be caused by infections, various
disease processes, and even medications.
 Stages of Dementia
Early Stage
• Patient experiences memory loss.
• The patient is aware of the memory changes
and may become fearful, anxious, angry or
depressed.
 Stages of Dementia
Middle Stage
• The patient begins to have difficulty
communicating.
• They may have difficulty using words, recognizing
words spoken or both; recognizing familiar people
and items; remembering the steps that are
necessary to complete familiar tasks; experience
personality changes; and incontinence.
 Stages of Dementia
Late Stage
• Patient may lose the ability to walk and sit
independently; no longer able to speak,
swallow, or smile; experiences bladder and
bowel incontinence.
• This stage culminates in death of the patient.
 Causes of Dementia
• There are various diseases and conditions that can cause
dementia.
• Some neurological diseases such as Parkinson’s and
Huntington’s disease have been associated with the
development of dementia.
• Dementia has been associated with infectious disorders
such as HIV/AIDS, syphilis, and “mad cow” disease.
• Four of the most common causes of dementia are
Alzheimer’s disease, vascular dementia, Lewy Body
dementia, and Frontotemporal dementia.
 Alzheimer’s Disease
• Alzheimer’s disease is the most common cause of
dementia and is the leading cause of death. More than
5 million people in the United States have Alzheimer’s
disease and it is estimated that this number will grow
to 11-16 million by the year 2050 if no cure is found.
• This is a progressive disease that is usually diagnosed in
patient’s 65+ years, however there are occurrences of
the disease in people as young as 40 years old.
Patient’s 85+ years are at the highest risk for
development of Alzheimer’s disease.
 Alzheimer’s Disease
• The disease is named after Alois Alzheimer, a
German physician who discovered the disease in
1906. He performed an autopsy on one of his
patient’s who died that had exhibited unusual
mental changes and behaviors. The autopsy
revealed that certain areas of the brain were sunken,
soft, and had abnormal protein deposits especially
in the part of the brain that affected memory. He
called the abnormal deposits plaques and tangles.
 Alzheimer’s Disease
• Researchers still do not understand what causes
Alzheimer’s disease, but risk factors have been
identified and include:
• Age (the most significant)
• Family history (if more than one family member has
developed the disease, the risk increases)
• Status Post (S/P) head trauma
• High risk factors for heart disease including
hypertension, hypercholesterolemia, and diabetes.
 Vascular Dementia
• Vascular dementia is caused by damage to the
blood vessels that supply the brain, and affects
the delivery of oxygen to the brain tissue.
• Mental functions are lost because multiple areas
of the brain tissue die due to inadequate
oxygenation.
• Vascular dementia is suspected to be the cause of
20-25% people with dementia, and can coexist
with other forms of dementia.
 Vascular Dementia
• This form of dementia
often occurs in people
between the ages of 55
– 75 years old, and is
more common in men
than women.
 Vascular Dementia
• Risk factors for the development of vascular dementia
include:
• History of myocardial infarction
• Hypertension
• Diabetes mellitus
• Peripheral vascular disease
• Transient ischemic attacks
• Obesity
• Smoking
• Hypercholesterolemia
 Vascular Dementia
• Symptoms may appear suddenly and may vary from
person to person depending on which area of the
brain is affected.
• Vascular dementia is irreversible and has no cure.
• Maintaining hypertension, blood glucose, and
cholesterol levels within normal limits can decrease
the progression of the disease.
 Lewy Body Dementia
• Lewy Body dementia accounts for approximately 20%
of all cases of dementia, and is caused by the build-up
of abnormal protein deposits called Lewy bodies.
These deposits are often found in the areas of the
brain that are responsible for thinking and
movement.
• In addition to mental decline, people with this form
of dementia develop difficulty controlling body
movements and exhibit signs similar to those seen in
Parkinson’s disease (ie. Shuffling gait, rigidity etc.)
 Lewy Body Dementia
• People with this form of
dementia also tend to
experience hallucinations
and distinct changes in
mental alertness.
 Frontotemporal Dementia
• Frontotemporal dementia is caused by damage to the frontal
and temporal lobes of the brain.
• The frontal lobe is the area of the brain that is responsible
for personality and behavior.
• The temporal lobe is the area of the brain that is responsible
for language.
• As a result, a person suffering from this form of dementia
may exhibit changes in personality and behavior, difficulty
with language or exhibit both.
• This form of dementia accounts for about 5% of all cases of
dementia.
 Frontotemporal Dementia
• Symptoms typically appear at a younger age than in
other forms of dementia. Most cases start between the
ages of 40 and 65 years.
• Unlike other forms of dementia, memory is often
spared until later in the progression of the disease.
• Caring for a person with this form of dementia is
challenging because these patients often say or do
things that are considered socially inappropriate.
People suffering from this form of dementia lack
motivation and energy and do not care about anything.
 The 4 “As” of Dementia
• No matter what form of dementia, people
experience changes that lead to the 4 “A’s”.
• Amnesia
• Aphasia
• Agnosia
• Apraxia
• Patient Care Technician’s that understand the 4 A’s
are able to provide better care for residents.
 Amnesia
• Amnesia is memory loss, and during the early stage of
dementia typically only affects short-term memory. As time
passes and more of the brain is affected by the disease, long-
term memory is affected as well.
• Short-Term Memory Loss may cause patients to behave
strangely and will require frequent reminders and
redirection. A change in the normal routine of a person
experiencing amnesia as well as dementia can cause stress.
• Long-Term Memory Loss can cause a person with dementia
to lose years or entire periods of their life. Some patients are
“trapped” in the past and are unable to understand
references to their current situation.
 Amnesia
• If the caregiver insists that what the person believes to
be true, is not real, the person may lose faith and trust
in the caregiver. Validation therapy is used in instances
like this.
• Validation therapy stresses the importance of
acknowledging the person’s reality. With this technique,
the caregiver would respond to the person within their
own reality. Validation therapy protects the feelings and
beliefs of the person with dementia and assists the
person with retaining a sense of self-worth and dignity.
 Aphasia
• Aphasia is difficulty communicating, and is often
experienced once patients transition to the middle
stage of dementia.
• There are two different forms of aphasia:
expressive, and receptive.
• Expressive aphasia is difficulty using words. A
person experiencing expressive aphasia may use
words that are similar to the person is trying to say,
but is not the correct word. The person may also
group words together that do not make sense.
 Aphasia
• The Patient Care Technician must not mock or laugh at a
patient, and should instead pay attention to the patient’s
mood or body language.
• Receptive aphasia is difficulty understanding words. The
person experiencing this form of aphasia may not respond
appropriately to questions or directions.
• When caring for a patient experiencing this form of aphasia,
a Patient Care Technician may use gestures or hand signals
may help the patient understand what is expected or
desired.
• A change in behavior is often a form of communication from
the resident signaling that their needs have not been met.
 Aphasia
• The Patient Care Technician must allow extra time
to communicate with the resident who has
dementia. Eliminate distractions when possible to
help the patient focus on the conversation. The
Patient Care Technician should always maintain eye
contact and always be cognizant of body language
and vocal tone.
 Agnosia
• Agnosia is difficulty recognizing sensory input, which
could be information received through the eyes, ears,
nose, taste buds, or sense of touch.
• People with dementia who experience agnosia are unable
to recognize potential danger and could harm themselves.
For example they might confuse common household
cleaners as soft drinks. When caring for a person with
agnosia it is important to maintain safety at all times,
cleaners, disinfectants, medications, and personal care
items should be stored in their proper areas, preferably
under lock and key.
 Agnosia
• People with agnosia may not recognize people that they
know which may cause them to become frightened or
frustrated. As a Patient Care Technician, you can help to
decrease the patient’s stress with change of shift
personnel by introducing the new shift to the patient as
well as yourself during each interaction.
• A person with agnosia may not recognize themselves
when they look in the mirror, and may perceive their
reflection as a stranger or intruder lurking in the window.
If this is encountered, placing a towel or blanket over the
mirror can decrease the patient’s stress and alleviate the
perception.
 Apraxia
• Apraxia is difficulty coordinating steps needed to
complete a task. A person experiencing apraxia may have
difficulty getting dressed because they might put their
clothes on in the wrong order, ie. underwear on the
outside of their pants. These patients frequently
experience frustration because of the inability to perform
these tasks and often results in behavior outbursts.
• The Patient Care Technician may be tempted to rush and
complete the task for the patient because it is faster, but
they must remember to allow the patient to do as much
for themselves as they can.
 Apraxia
• In order to facilitate the independence of the resident as
well as complete the task, the Patient Care Technician
should break the task into several smaller steps.
• Hand-over-hand cueing is another technique that can
assist patients to complete their tasks. This simply means
that the Patient Care Technician guides the patient
through the task, by placing their hand on top of theirs to
complete the task.
Behaviors Associated with Dementia
• People with dementia can exhibit a wide range of
behaviors. Some of the behaviors are potentially harmful
for the patient, whereas some are not harmful. The
Patient Care Technician must be aware of the behaviors in
order to determine the risk level.
• Wandering – People with dementia may stray away from
home. This can be dangerous because the person is
confused and/or disoriented. The person might get lost,
step out into the street in front of an oncoming car, or
potentially drown if there is a large body of water nearby.
Behaviors Associated with Dementia
• Because wandering is an exacerbation that cannot be
stopped, most facilities and care centers have developed
ways to allow patients to wander safely. Many facilities
have outside courtyards with secured high fencing which
allows the patient to wander without actually leaving the
property. Most residents that have a tendency to wander
often have a bracelet or alarm device on their person that
signals the staff to their whereabouts or proximity to
facility exits.
Behaviors Associated with Dementia
• Pacing – People suffering from dementia may pace back
and forth. Most often this incidence occurs as a result of a
patient care need that is not being met. A patient may
pace because they are hungry; need to use the bathroom;
in response to noisy, overstimulating environment; or
because they are feeling scared or loss.
• Repetition – Resident who suffer from dementia, may do
the same thing over and over again. This is called
preservation. A resident may for example, repeat the
same phrase over and over again, or complete the same
hand motion or gesture repeatedly.
Behaviors Associated with Dementia
• These behaviors are not typically harmful, but they may
be annoying to other residents or caregivers. These
behaviors may be a sign that the patient is bored.
Distracting the resident by offering to take them on a
walk, or by getting them involved in an activity such as
reading a book or working on a puzzle may help break the
cycle.
• Rummaging – People with dementia might go through
drawers or closets in search of an item that they can never
find or name if asked.
Behaviors Associated with Dementia
• If the patient is found to rummage through other
resident’s belongings then higher surveillance and
security measures should be taken to ensure that the
other resident’s belonging are not taken or damaged. The
patient may be given a drawer with items in it that they
are allowed to rummage through.
• Delusions and Hallucinations – A person with dementia
may lose perception of themselves and belief they are
someone else. Thoughts like this are considered
delusions. If the resident is delusional, do not attempt to
correct them as this may cause anger and frustration.
 Behaviors Associated with Dementia
• Instead of correcting the person, the Patient Care
Technician should redirect the conversation.
Hallucinations are common in dementia and are when a
patient sees, hears, or tastes, or smells something that is
not there. If a patient is hallucinating, reassure the
patient, then gently redirect the patient’s attention to
something else.
• Agitation – Patients with dementia often become very
upset and excited. When a person with dementia is
agitated, he may pace, shout or strike out at caregivers or
other residents. People with dementia often lose their
communication skills and may use behavior as a means of
communication.
Behaviors Associated with Dementia
• Catastrophic Reactions – Some patient’s suffering from
dementia may over-react or have an extreme reaction
that would normally cause someone with a healthy
mental status minimal stress. An example is if a patient
begins to yell and scream, or cry if you attempt to give
them a bath. Catastrophic reactions often occur when a
patient feels threatened or overwhelmed.
• Sundowning – This is worsening of a patient’s behavior in
the late afternoons and evening. An example is a patient
that may have been pleasant throughout the day become
more and more agitated typically around 6pm or later.
Behaviors Associated with Dementia
• Patient’s experiencing sundowning may have difficulty
sleeping and become restless or confused in the evening
hours. There is no scientific reason why sundowning
behavior occurs, and is often thought to be a result of
fatigue. Ensuring quiet and rest during the day may help in
reducing patient fatigue, and thus reduce sundowning.
Another theory is that sundowning occurs because the
person cannot see well in the evening hours when the sun
goes down and their perception changes. Turning on lights
early before evening hours may decrease the incidence of
sundowning.
Behaviors Associated with Dementia
• Inappropriate sexual behaviors – A person suffering from
dementia may attempt to get into bed with another
resident who is not their spouse. Patients may even
masturbate or undress in public areas. These incidents
occur because the resident is disoriented and confused to
person, place, and time. Patient Care Technicians must
take measures to stop inappropriate sexual behaviors
especially if the patient is making unwelcome sexual
advances towards another person. Gently lead the patient
back to his/her room and redirect the patient’s attention
by introducing another activity.
Behaviors Associated with Dementia
• OBRA specifically states that a resident of a long-term care
facility must be allowed to fulfill his/her sexual needs with
another consenting resident, however, another resident
suffering from dementia is not able to give that consent.
Therefore the patient care technician has the
responsibility to protect all the residents of the facility
from unwelcome sexual advances. This includes patients
who are married, and both are suffering from dementia.
Managing Behaviors Associated with Dementia

• When caring for a patient suffering from dementia, who is

demonstrating a particular behavior, the Patient Care
Technician must use their observation skills to answer the
following questions:
• What is the behavior being exhibited?
• Whom is the behavior associated with?
• When does the behavior occur?
• Where does the behavior occur?
• Why is the behavior occurring?
Managing Behaviors Associated with Dementia

• Typically the patient exhibits various behaviors as a means

of communicating needs that are not being met.
Addressing the patient’s need typically will resolve the
behavior episode. Tone of voice and approach can also
affect how the resident behaves. The patient care
technician should always be cognizant of the tone of
voice, language, and non-verbal cues exhibited to the
patient as the patient may be sensitive to these and in
their confused state their perception is skewed.
Managing Behaviors Associated with Dementia
• Some situations that may cause dementia related
behaviors include, but are not limited to:
• The resident is in a room that is either too large, or too
small.
• The resident is in a room that is overstimulating (ie.
cluttered, noisy, or decorated in abstract or distracting
wallpaper or fabrics).
• The resident is in a new or unfamiliar place.
• The resident is asked to complete a task that is new,
complicated or has too many steps.
Meeting the Needs of Residents Suffering from
Dementia
• Speak clearly, in a calm tone of voice.
• Remind the resident at each step what they need to do
next.
• Use hand gestures in addition to spoken instructions.
• Plan for the procedure in advance.
• Keep to a regular schedule.
• When assisting with bathing, playing music that the
patient enjoys or singing a favorite song to the patient
might decrease anxiety the patient may feel.
Meeting the Needs of Residents Suffering from
Dementia
• Prepare the shower or tub room in advance and ensure
that all supplies needed are available.
• Use a bath blanket or towel, to ensure patient privacy and
decrease feelings of being exposed.
• Some patient’s suffering from dementia have difficulty
dressing and often would prefer to wear the same outfit
everyday if allowed. Limiting the number of outfits the
patient has to chose from and requesting that the family
purchase several identical outfits may decrease the
patient’s anxiety during dressing.
Meeting the Needs of Residents Suffering from
Dementia
• Clothing should not have multiple fastenings, and should
be simple and easy for the patient to put on and remove,
especially during toileting.
• When assisting a patient with dementia, a quiet eating
place with limited food choices may assist the patient
with being able to focus on eating. The patient care
technician may have to prompt the patient to eat
throughout the entire meal, and monitor to ensure that
the patient is not packing food in the cheeks which would
increase the patient’s risk of aspiration.
Meeting the Needs of Residents Suffering from
Dementia
• Use of a cup with a straw or secured lid may increase
patient fluid intake.
• If the patient cannot focus enough to eat a prepared meal,
finger foods such as sandwiches, fruit or vegetable cup.
Patients in advanced stages of dementia eventually lose
the ability to eat independently and often forget how to
use the tongue to push food back to the back of the
mouth to swallow. In this instance, a special syringe may
be used to deliver food to the back of the mouth so the
patient can swallow.
Meeting the Needs of Residents Suffering from
Dementia
• A patient suffering from dementia may forget where the
restroom is or fail to recognize the toilet. Sometimes
residents experience incontinence because they are
unable to remove their clothing in time. The Patient Care
Technician can complete routine toileting times and assist
the resident with clothing to decrease incontinent
episodes. If a resident who typically does not experience
incontinence starts having increased episodes, report the
incidents to the nurse, their may be an underlying disease
process or condition occurring.
 Meeting the Emotional Needs of Residents
Suffering from Dementia
• Reminiscence therapy is encouraged in patient’s suffering
from dementia to allow them the ability to share
experiences from the past with others. Talking about the
past can divert the patient’s attention, and increase self
esteem. When completed in a group setting, this also
allows the patient the opportunity to socialize with other
residents.
• Activity therapy is used to help patient’s exercise their
mind and body. Even though patient’s with dementia are
confused, the can still become bored.
Meeting the Needs of Residents Suffering from
Dementia
• Activities are important to a resident’s well-being and are
often displayed on a calendar in a central area, as well in
patient’s rooms for the entire month. Patient’s may enjoy
creative, intellectual, social, or physical activities.
• Music therapy can be very beneficial to people suffering
from dementia, as research has shown that when we
listen to music that we enjoy, our heart and respiratory
rates slow, and blood pressure decreases. Music can often
calm agitated patients.
Meeting the Needs of Residents Suffering from
Dementia
• Pet therapy such as dogs or cats can have many benefits
for people with dementia. The facility may participate in a
visiting pet program, in which volunteers with specially
trained and cleared animals visit the facility on a routine
basis. The facility may opt to adopt a pet for the facility or
each unit that the residents participate in caring for. The
resident may receive pleasure from watching the animal,
stroking their fur, or having them sit in their lap. These
activities can be calming to the resident and decrease the
episodes of disruptive behavior.
 Caring for Residents with
Late Stage Dementia
• In the final stage of dementia, the patient loses the ability
to sit or walk independently. Immobility increases the
resident’s risk for pressure ulcers and skin breakdown, as
well as contractures and pneumonia.
• The patient loses the ability to swallow, affecting the
ability to eat or drink. At this time the family may consider
placement of a feeding tube or if the patient has an
advanced directive that prohibits placement, palliative
care measures may need to be considered and
implemented. Families require support during this time.
 Mental Health
• Mental health is the absence of mental illness.
One of the main components of mental health
is a state of emotional balance. Mental health
is characterized by the ability of people to
make adjustments to maintain a state of
emotional balance.
• Stress, which results from any change from a
normal routine affects a person’s ability to
maintain a state of balance.
 Mental Health
• Stress can be physical, mental, or emotional.
Stress that is not managed properly can affect a
person’s physical health, as well as his/her mental
health. Each individual has a limit to the amount
of stress that he/she can effectively deal with at
any given time. Most people are able to achieve
and maintain emotional balance, however those
suffering from mental health conditions may
require medication, counseling, or support groups
to help regain emotional balance.
 Coping Mechanisms
• Overtime people develop knowledge regarding
actions or things that help them to regain their
emotional balance in times of stress. These
conscious and deliberate actions of dealing
with stress are called coping mechanisms.
• Most people rely on positive coping
mechanisms such as exercise, prayer,
meditation, socializing, or engaging in a hobby
to restore emotional balance.
 Coping Mechanisms
• Other people may utilized negative and less
effective coping mechanisms, and seek short-
term relief through behaviors such as nail
biting, pacing, overeating, abstaining from
eating, smoking or drug and/or alcohol abuse.
These behaviors may initially assist the
patient to regain emotional balance, but
overtime place the person at risk for serious
physical, mental and emotional problems.
 Defense Mechanisms
• Defense mechanisms are methods of dealing
with stress that just occur. They are the
body’s way of attempting to return the
person to a state of emotional balance. These
mechanisms are a way of the body protecting
the person from traumatic events, and often
the person is unaware. Common defense
mechanisms include the following:
 Defense Mechanisms
• Compensation – which means to make up for a
loss by “filling in” or “substituting” something
else. An example is a person who is lonely
overeats. Overeating is a substitution for the lack
of affection.
• Conversion – which means “to change”. A person
who is experiencing an emotional problem may
develop a physical anomaly or physical problem
to avoid participating in a particular activity.
 Defense Mechanisms
• Denial – is refusing to believe something that is true,
especially if the reality is unpleasant. An example is a
person whose baby has been diagnosed with cancer, the
patient may believe the doctor has made the wrong
diagnosis.
• Displacement – is shifting emotion from one person to
another who is less threatening. An example is a resident
who is placed in a nursing home by a family member
who becomes angry with the staff instead of expressing
their anger or frustration with the family member.
 Defense Mechanisms
• Projection – is when a person blames someone else
for their own unacceptable or uncomfortable actions
or feelings.
• Rationalization – is when a person makes excuses or
creates acceptable reasons for poor behaviors or
actions.
• Regression – this means to return back to a former
state; and example is an adolescent child exhibiting
behaviors of a pre-school child such as bedwetting
or finger sucking.
 Defense Mechanisms
• Repression or suppression – is the refusal to
remember or acknowledge a painful or
frightening memory.
 Causes and Treatments of
Mental Illness
• Some mental illnesses are hereditary, and
others are a result of chemical imbalances in
the brain. An imbalance of neurotransmitters
in the brain can lead to the formation of
some mental illnesses. Some mental illnesses
can be caused by a patient’s environment.
 Causes and Treatments of
Mental Illness
• Thanks to advances in medicine, most mental
illnesses can successfully be managed with
medications, psychiatric counseling, or a
combination of both. The word psychiatric
comes from the Greek words psyche which
means the soul, and iatreia which means
healing.
 Causes and Treatments of
Mental Illness
• A psychiatrist is a medical doctor that is trained in
diagnosing and treating mental illness. These
physicians are allowed to prescribe medications to
treat mental illnesses.
• A psychologist is a health professional with extensive
education and training that allows them to provide
counseling services to assist people with mental
illnesses. They are not medical physicians, and
cannot prescribe medication.
 Causes and Treatments of
Mental Illness
• People who suffer from mental illness are at
high risk for suicide so diagnosis and
treatment of mental illness is a high priority.
People who suffer from mental illness are
also at risk for potentially harming others,
which is additional justification for rapid
diagnosis and treatment.
 Types of Mental Illness
• There are several different types of mental
illnesses including anxiety disorders, mood
disorders, schizophrenia, substance abuse
disorders, and eating disorders. The patient
care technician must remain aware that two
patients with the same diagnosis may not
exhibit the same symptoms.
 Anxiety Disorders
• Anxiety is a feeling of uneasiness, dread,
apprehension, or worry. Anxiety is a normal
emotion that is a response to situations
perceived to be threatening to a person’s life,
body, lifestyle, values, or family. A certain
level of anxiety is normal and may lead to
positive actions in a bad or potentially
dangerous situation.
 Anxiety Disorders
• Too much anxiety however, or prolonged periods
of anxiety can make it difficult for people to
function or cope with everyday situations. Anxiety
can cause physical symptoms such as restlessness,
fatigue, changes in appetite, sleeplessness, and
increased heart rate and/or blood pressure.
People experiencing anxiety may also be irritable
and have difficulty processing thoughts.
 Anxiety Disorders
• Some people have periods of anxiety that
continue to build until they can no longer
function. Anxiety may be present in some
mental illness, whereas in others it is the chief
symptom.
• Common anxiety disorders include: panic
disorder; obsessive-compulsive disorder;
phobias; and post-traumatic stress disorder.
 Panic Disorder
• Panic is defined as a sudden and overwhelming
fright. A person with panic disorder has terrifying
episodes or “panic attacks”, during which they
experience feelings of extreme anxiety and/or
intense fear. If a person is experiencing a “panic
attack”, they often exhibit physical signs including
chest or abdominal pain, elevated pulse,
shortness of breath, and/or dizziness.
 Panic Disorder
• These signs and symptoms are often mistaken for
a myocardial infarction or other severe physical
illness. Even though the signs and symptoms may
not be life threatening, they are perceived as such
by the patient. Use a low and calm voice when
speaking with the patient, suggest that the person
take slow deep breaths, and encourage the
patient to focus on you. Reassure the patient that
they are safe and you are there to assist them.
Obsessive-Compulsive Disorder (OCD)
• This is an anxiety disorder that causes a person
to suffer intensely from recurrent unwanted
thoughts or obsessions. These obsessions are
usually associated with rituals that the person
cannot control known as compulsions. Examples
of rituals include repetitive handwashing, or
counting. These actions are repeated over and
over again in belief that they will make the
obsessive thoughts go away.
Obsessive-Compulsive Disorder (OCD)
• Failure to perform the ritual increases the
person’s anxiety level. Then this disorder is
severe, OCD can take over a person’s life.
• The person may be unable to perform tasks
that are associated with normal daily
activities because of the obsessions and
compulsions.
 Phobias
• A phobia is an excessive, abnormal fear of an
object or situation. Phobias can be severely
disabling for the person affected by them.
The person will do anything to avoid the
object or situation they are afraid of. There
are three main groups of phobias: simple
phobias; social phobias; and agoraphobia.
 Phobias
• Simple phobias are the most common type of
phobia. People who experience simple
phobias are abnormally afraid of a specific
object or thing (ie. Insects, dogs, cats, water,
etc.).
• Social phobias involve a fear of being
humiliated or embarrassed in front of other
people.
 Phobias
• Agoraphobia is the fear of places and
situations that might cause panic,
helplessness, or embarrassment. The person
fears being trapped or being in a place were
help is not readily available.
Post-Traumatic Stress Disorder (PTSD)
• This is an anxiety disorder that occurs after a person
experiences an overwhelming traumatic event such
as military combat, natural disaster, serious injury,
criminal assault, rape, or death of another person.
Patients that experience PTSD, can have flashbacks,
or vivid memories of the event, panic attacks,
nightmares, depression, and increased anxiety. The
symptoms can be so severe as they impeded the
person being able to function normally in society.
 Mood Disorders
• Mood disorders affect how a person feels
emotionally and can manifest as physical
symptoms. Two prevalent mood disorders
are depression, and bipolar disorder.
 Depression
• Depression ranges in seriousness from mild,
temporary episodes of sadness to severe,
persistent depression. Throughout life there are
many different events that can cause temporary
feelings of intense sadness and hopelessness.
People who have good mental health, this
intense sadness goes away over time.
Occasionally medication may be required to
assist the person through this troubling time.
 Depression
• People who experience intense feelings of
sadness or hopelessness that do not go away
are considered to suffer from clinical
depression. Clinical depression is one of the
most common mental illnesses. There is
research that suggests a family history of
clinical depression increases the chances that
people will develop clinical depression.
 Depression
• Women typically experience clinical
depression about twice as often as men, and
this condition is the most treated among
elderly.
• There are several factors that lead to the
development of clinical depression,
including:
 Depression
• Chemical imbalances in the brain.
• Low self-esteem and poor coping skills.
• Hormonal changes, such as those that affect
women during pregnancy, menstruation,
childbirth, and menopause.
• Medications may also affect mood.
 Depression
• People suffering from depression may sleep too
much, or not enough. They may be restless or
irritable, and may become angry or defensive.
Physical complaints of pain or digestive disorders are
common and prompt treatment is needed to help
these patients return to a productive and enjoyable
life. The incident of depression increases with age, so
the Patient Care Technician must be aware of the s/s
in order to notify the nurse so that prompt diagnosis
and treatment is made.
 Bipolar Disorder (Manic Depression)
• This is a mental health disorder that causes
mood swings where the patient experiences
episodes of excessive happiness and excitement
that may cause the person to engage in
impulsive or reckless behavior (mania),
followed by periods of depression. Most
researchers believe that bipolar disorder is
caused by a chemical imbalance in the brain
that affects the person’s mood.
 Bipolar Disorder (Manic Depression)
• A person with bipolar disorder may have
mood swings several times throughout a day,
or less frequently, with days or even weeks
passing between episodes. Bipolar disorder
can be a difficult condition to recognize and
properly diagnose, especially if the mood
swings are spaced out.
 Schizophrenia
• This is a mental health disorder that is very
disabling and often is hereditary. Some
researchers believe their may be a genetic
connection to the development of the disorder.
As with other mental disorders, schizophrenia
can range from mild to severe. A person with
severe schizophrenia that is untreated may
pose a threat to themselves or others.
 Schizophrenia
• People with schizophrenia have difficulty determining
what is real and imaginary. These patients often
suffer from delusions and may also experience
hallucinations. There speech and mental process may
become disrupted and they may switch from one
topic to another during conversation or make up new
words or patterns of speech. As a result, the patient
may say or do strange things making it difficult for
them to function in social situations.
Substance Abuse Disorders and Addiction
• Substance abuse disorders are conditions
that involve the excessive or inappropriate
use of medications, legal or illegal, alcohol, or
inhalants. Some people suffering from this
condition may abuse more than one
substance. People who suffer from this
condition can develop physical and
emotional dependence on the substance(s).
Substance Abuse Disorders and Addiction
• When this occurs the person must have this
substance in order to function, and if the
substance is unavailable may experience physical
symptoms such as tremors and delirium, as well
as emotional symptoms such as anxiety and
paranoia.
• Addiction is a physical need of a substance that
results in withdrawal signs and symptoms if the
substance is withheld.
Substance Abuse Disorders and Addiction
• Withdrawal is an emotional and physical
reaction that occurs when use of the addictive
substance is discontinued.
• Alcohol is one of the most frequent substances
abused by people. Older people who suffer
from substance abuse are often able to hide
the problem because they live alone or do not
socialize with people on a regular basis.
Substance Abuse Disorders and Addiction
• Withdrawal is a medical emergency, and the Patient Care Technician should
report any of the following signs and symptoms to the nurse immediately:
• Body tremors
• Mental status and mood changes
• Delirium
• Hallucinations
• Restlessness
• Anxiety and fear
• Insomnia
• Nausea and vomiting
• Diaphoresis
• Heart palpitations and tachycardia
• Seizures
Substance Abuse Disorders and Addiction
• Patients and residents who suffer from substance
abuse disorders may attempt to seek the
substance they are abusing even after admission
to a health care facility. A visitor may bring the
desired substance to the person, or the patient
may seek a staff members help in obtaining the
substance. The patient care technician should
never agree to these types of requests, and the
incident should be reported to the nurse.
Substance Abuse Disorders and Addiction
• If it is suspected that a visitor is supplying the patient
with abusive substances the information must be
reported to the nurse immediately. The Patient Care
Technician must be alert to signs that suggest that the
patient is continuing to abuse the substance, such as
changes in the patient’s behavior or mental status, or
the smell of alcohol or certain street drugs such as
marijuana. Importing the observations is important for
the protection of the patient as well as the other
patient’s and staff of the facility.
 Eating Disorders
• There are various types of eating disorders.
Two of the most frequent are anorexia nervosa
and bulimia nervosa. No matter what disorder,
all eating disorders have serious and
potentially fatal changes in eating behavior.
• Eating disorders cause many physical
problems, including kidney failure and serious
heart problems that can lead to death.
 Eating Disorders
• People with eating disorders cannot voluntarily
control their impulses and need treatment to
assist them with eating normally again.
• Eating disorders often start during adolescence
or early adulthood. Women are at a higher risk
for developing an eating disorder. Many people
who suffer from depression or anxiety disorders
also suffer from eating disorders.
 Anorexia Nervosa
• People who suffer from this condition see
themselves as being overweight, even though they
are excessively thin. Anorexia or loss of appetite is
an integral part of this disease as the person simply
will not eat. These patients often skip meals,
dispose of food without eating to provide the
appearance of eating adequately, and exercise
excessively. These patients severely reduce their
caloric intake and monitor everything they eat.
 Bulimia Nervosa
• People suffering from this condition regularly
eat huge amounts of food called binging and
then induce vomiting or use laxatives to rid the
body of the excessive food before it is digested,
which is called purging. A person with bulimia
nervosa is often of normal weight for their age
and height. In spite of this, the person suffering
from this condition is also obsessed with their
weight and believe they are overweight.
 Binge Eating Disorders
• A person with this disorder eats large
amounts of food but does not purge. The
need to continue eating is excessive and may
lead to obesity. Weight related health
disorders such as cardiovascular disease,
diabetes, and hypertension usually develop
as a result of the excessive weight gain.
Caring for a Person with Mental Illness
• Listening and observing skills are very important
when caring for patients with mental illness. In some
situations, the patient care technician’s observations
may lead to the diagnosis of a condition.
• Medications called antipsychotics are often used to
treat patients with certain forms of mental illness.
These medications may have side effects that make
the patient feel excessively sleepy, dizzy or lethargic,
which places the patient at a higher risk for accidents.
Caring for a Person with Mental Illness
• Mental illness may affect a person’s ability to eat,
sleep, or manage activities of daily living including
grooming and hygiene. Patient’s who suffer from
mental illness will have different levels of
assistance needed with there ADLs depending on
the severity of their disease. The Patient Care
Technician should continue to foster the patient’s
independence by allowing the patient to provide
as much of their self-care as possible.