Transcript HELP Volunteer / Delirium Presentation

What is NICHE??
• Nurses
• Involved in
• Care of
• Healthsystem
• Elderly
Effects of Age Related Changes
Diminished reserve and ability to respond to stress
Older adults have difficulty managing the
stress of hospitalization associated with:
• Surgery
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•
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Anesthesia and other medications
Medical tests and procedures
Physical environment
Schedules
Iatrogenesis
Definition – from the Greek word,
•iatros means healer
•iatrogenesis means brought forth by a healer
•unintended adverse patient outcome due to
simply being a hospitalized patient
•not a natural course of disease
36-58% of older adults suffer iatrogenic illness
during hospitalization.
Normal age related changes
Iatrogenesis
• Lowered reserve and ability to respond to stress
• Exaggerated effects of medications
• Increased risk of infection
• Less aware of the need to drink
• Heart less able to deal with stress
Geriatric Delirium
Risk Factors
Most common
• Dementia
• Male gender
• Advanced age
• Medical illness
• Multiple medications
Predisposing
• Poor functional status
• Alcohol abuse
• Dementia
• Depression
• Dehydration
• Sensory impairment
** Pathophysiology of delirium is not well understood
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• Anticholinergics
High Risk Medications
• Zantac, Procardia, Detrol, Atropine
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Narcotics
• Demerol, Morphine, Percocet, Lortab
•
Beers Medications
Sedative hypnotics (benzodiazepines)
• Ativan, Xanax, Valium, Tranxene, Ambien (CNS depressant)
• H2 Blockers
• Zantac, Pepcid, Tagamet
•
Corticosteroids
• Prednisone, Decadron, Celestone
•
Centrally acting antihypertensives
• Clonidine
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Antiparkinsonian drugs
• Cogentin, Artane, Sinemet, Mirapex, Requip
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So… What’s the “take-away” message?
Delirium is…
• Common in hospitalized older adults
• A major reason for poor health care outcomes
and nursing home placement
• Under recognized by doctors and nurses
• Preventable and treatable
• Potentially life-threatening and needs
immediate medical evaluation
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The C.A.R.E.™ Channel
#60 on Palmetto Health TV’s
DIVERSIONAL ACTIVITY CART
*How to use the contents of this cart to
REDUCE THE RISK OF DELIRIUM
Purpose of the cart:
Geriatric patients are at risk for delirium while they are
in the hospital, due to:
•Poly-pharmacy
•Beers’ (Potentially Inappropriate) Medications
•Sleep deprivation
•Changes in personal schedule/routine
•Un- or under-treated pain
•Surgical/procedural stressors and/or anesthesia
•Sensory deprivation/restraints/tethers
•Boredom &Isolation
This cart includes numerous items and activities that
may help divert a patient’s attention from some or all
of those stressors that often lead to delirium.
HELP Volunteers will need access to this cart as well.
Other diversional activity items examples below:
Any items you feel might be helpful that are not on the cart,
please donate them and notify Donna Wolff via
email [email protected].
Knitted Shawls
Stuffed Animals
Dolls
Wash Cloths
Slinky
Small Coloring Books
Koosh Balls
Extra Crayons
Poker chips
Decks of cards (any kind)
Anything to sort or manipulate
Paint by number with water
Large print books, magazines,
Or devotionals
Knitted hats
New Baseball caps
New colorful socks to sort
Peg boards
Music CD’s
Exercise bands
Smooth, Small pieces of PVC tubes
Smooth, plastic kitchen utensils
(no knives or forks or anything sharp)
Plastic cups
Silk scarves
Lap blankets
Stacking cones, plastic rings
Puzzles
Extra pencils, pens, paper
Blank greeting cards with
Envelopes
Safety scissors (no sharps)
Top of the Cart:
Top of the Cart:
• Small basket with:
– NICHE program brochure and NICHE
coordinator business card attached
• Describes programs
– Delirium Family Education brochure
• Allay fears, suggests ways to help
• Patient glasses cleaning wipes
– Patients need to be able to see as clearly as
possible,
– Decreased vision leads to social isolation,
confusion, and delirium
FIRST DRAWER:
FIRST DRAWER:
Mental Stimulation
•“Spring Things”: Reminiscing Picture Pages
•Useful to stimulate conversations or promote
distraction from unpleasant behaviors
•Pencils/Crayons
•Large Print Circle-a-Word Puzzles
•Large Print Crossword Puzzles
•Adult- appropriate Coloring pages
•Useful for distraction, mental stimulation
•Large Print devotions
•Useful for Spiritual needs, calm, prayer, meditation
•Printed words to sing-a-long songs
•Promotes auditory stimulation, calming, distraction, etc.
SECOND DRAWER
SECOND DRAWER
SENSORY STIMULATION
•Sound-sensing Light Bar•Flashes lights in response to sound OR can be
set to automatically flash a light show
Distraction, involvement, visual stimulation
•Busy Apron
•Distraction, occupies hands, keeps from pulling at
tubes, devices
•Pop Tubes
•Distraction and interesting noises
 occupies hands, keeps from pulling at tubes, devices,
THIRD DRAWER
•Lace and trace shapes with strings
•Vegetables and fruits
•Tangle – mental stim & busy hands game
•Kitchen utensils
THIRD DRAWER
•Lace and trace shapes with strings
•Vegetables and fruits
•Tangle – mental stim & busy hands game
•Kitchen utensils
FOURTH DRAWER
SENSORY STIMULATION
•Plastic cups for sorting game chips, coins, etc.
•Colorful plastic chains for sorting
•Shoe laces to tie or lace in cardboard, etc.
FOURTH DRAWER
SENSORY STIMULATION
•Plastic cups for sorting game chips, coins, etc.
•Colorful plastic chains for sorting, connecting
•Shoe laces to tie or lace in cardboard, etc.
Final thoughts:
cleaning and replacing items:
Give two or three activity sheets/crayons
two or three laces/ soft goods to a patient- unable to clean
Hard plastic (wipe-able) items are the property of
each unit
- clean with cavi-wipes and return to the cart between
patient use
*Activity aprons, stuffed animals can be washed, please
page 352-1407 to have someone come pick the apron up
and bring you a new one.
*When you need replacement items for the cart, please
email NICHE coordinator [email protected]