How much do you know?
•Quickest tool and best used to flag individuals for further follow up
•Identifies cognitive impairment
•Remembering words and drawing clock
Mini Cog
Patient loses job due to deficits from stroke, how would you therapeutically communicate with this patient?
How does this make you feel?
If your patient is taking antidepressants or has suspected depression, what should you alway assess for?
Suicidal ideation
Patient with dementia reports seeing her deceased parents, what should you do?
Ask her if she misses her mother, or tell me more about your mother?
If your patient is use to a routine and you are following this routine at the nursing home-- how can you ensure that your patient still gets meals and medications on time?
Call the kitchen and request meals around their schedule, provide meals/meds around their schedule.
A decline in patient's cognition tends to have a direct correlation with
Depression
You are in the middle of an encounter with an agitated patient who has the potential to become violent, what should you do?
Reman calm, remove other patients from danger, keep the patient talking, give the patient space, do not turn your back, make sure you have an exit.
Fixed beliefs that are false and cannot be corrected through logical discussion
Delusions
What type of patient would benefit more from an adult daycare?
Dementia
Normal age related changes that can affect a patient's progression in rehab:
muscle atrophy, decreased bone mass, sub q fat loss, decreased flexibility
How would you give a patient with cognitive impairment instructions?
Give simple instructions, one at a time.
If a patient attempts to grab hold of you during an agitated encounter, how should you remove their hand?
Rotate away from the thumb of the patient's hand.
You notice that your patient is giving away belongings and find medications hoarded in her bedside table, what do you suspect this patient planning?
To commit suicide by means of overdose.
How can you make a patient feel more at home in assisted living facility?
Bring familiar items from home.
You are trying to facilitate and improve bowel and bladder function, what is the best intervention:
Adherence to a schedule
Your patient is hallucinating that snakes are crawling around the room, what would be the best action?
Remain calm, remove patient to a calm enivornment.
A patient is acting out sexually, performing inappropriate actions at the nurses station. What is the most common reason for this action?
The patient is touch starved and desiring the need for human connection.
What are some signs and symptoms of depression?
decreased appetite, anhedonia, non-compliance etc.
Priority goal for rehab
promote highest level of functioning.
What is the difference between palliative vs. hospice care?
Palliative care, we will still manage the patient's symptoms. Hospice we have shifted care to faciliate a peaceful dying process.
You are trying to finish your initial assessment of a patient and notice that they are tense and uncooperative; what can you do to facilitate this experience?
Gain trust, try to get the patient to open up. Ask about them about their interests.
remove stressors, behavior is temporary and once the underlying reason for the delirium is addressed, the behavior will stop. Maintain quite environment, limit # of vistors during episodes of delirium. Goal is to provide a stress free environment for the older adult
What is considered a restraint?
Physical restraints, chemical restraints.
Ask about need for additonal resources, patient may not be able to afford food.
Signs and symptoms of impending death:
bowel bladder incontinence, altered LOC, decreased pulses, pallor, mottling