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THE SUNDAY TIMES
Inspected and rated
Outstanding *
0 CareOuality Commission
r'\ INVESTORS Gold� JIN PEOPLE
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100 BEST SMALL COMPANIES
TO WORK FOR
2018
II .
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Rikki LorentiAdmiral Nurse
Physical Health and Dementia, Delirium and Pain
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How important is it to understand pain and infection?
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It is important to identify past & current medical history
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An example paper tell us…
Pain affects the well-being of the person.
Deterioration in physical and cognitive abilities
Reduction in appetite and potential increase of falls
Worsening psychological symptoms.
So what are these “worsening psychological Symptoms”?
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BPSD (Behavioural and Psychological Symptoms of Dementia)
Hitting
Screaming
Kicking
Grabbing things
Throwing things
Verbal aggression
Pacing
Restlessness
Repetitive mannerisms
Complaining
Repetitive questions
Negativism
Hoarding
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Pain TRIGGERS
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RECOGNISING AND ASSESSING PAIN
IN PEOPLE WITH DEMENTIA
The person says they are in pain
You suspect pain Behavioural change of
unknown cause*
Can the person communicate verbally?
Ask them about their pain using a range of terms (e.g. Does it hurt? Is it sore?)
Make a note of any changes you see. Refer to the PAIN prompt as a reminder of some signs to look for.
Make a note of any changes you see. Refer to the PAIN prompt as a reminder of some signs to look for.
Use the Carer Pain Notes to record any pain signs you see, and how these change over time, or after pain medication
A change in behaviour could be a sign of pain. If you suspect a person you are caring for has pain, report
your concerns to your manager or the wider healthcare team.
*Changes in behaviour in patients with dementia can be caused by several different factors, one of which is pain
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How do we know if someone is in pain & can’t self-report?
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Whether you are informally or formally caring, you can see
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So, we can learn from this…
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What can we do?
• Pain
• Infection
• Nutrition
• Constipation
• Hydration
• Sleep
• Medication
• Environment
Pain – can provide a distraction and reduce anxiety
Infection– with associated pain, increased mobility, increase well being
Nutrition – changing environment, activity to stimulate hunger
Constipation – keeping active, promote stimulate hunger for a balanced diet
Hydration – keeping active, ENCOURAGE UP TO 2 LITRES A DAY AND ACT IN HOT WEATHER.
Sleep – active in day, reduce anxiety, calming environment, relaxation. AVOID CAFFEINE AT NIGHT, MAINTAIN STRUCTURE, REPLICATE DAYLIGHT TO AVOID SUNDOWNING
Medication – helping reduce stress and anxiety
Environment – supportive healing environment active/calm
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See wlu,l qou Jee ...( f<_CN 2017)
5upp0,ted by
Don't Discount Delirium rtP.11 • Royal�llege- lf(l'11 of Nursing
Any person can get delirium, but it is more common
when a person is older, has cognitive or sensory
impairment or is very ill. You can make a difference
if you recognise delirium early and escalate it.
Just look for a change in:
AROUSAL
(AWAKENESS)
More sleepy than usual
More alert or active than usual
THINKING
Poor concentration
Slow responses
Seeing things 1- mobility
Hearing things
Sleep problems
Refusing to co-operate
Withdrawn
Change in attihtde
Change in communication
ACT IF YOU SUSPECT DELIRIUM - TELL SOMEONE IMMEDIATELY
August 2017 Public:'rl:ion code: 006 015
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It does not matter if you are an informal or formal carer.CONTINGENCY PLANNING IS KEY
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What is a contingency?
Client Group
Mrs S has a diagnosis of Alzheimer’s. She has also a history of falls and it has been identified recurrent urine infections. She also has a catheter in place
Circumstances
Mrs S struggles to maintain a healthy fluid intake. She forgets to drink and has a tendency to leave them and walk away. She is also prone to infections due to the catheter.
Mrs S will present with increased confusion and agitation and she may hallucinate (the difference being that this will be a rapid increase suggesting delirium rather than her dementia).
What to do/who to contact
On first sign of any “rapid” changes in behaviour as well as physical deterioration (fever) contact the GP. Stress on “first signs” of “rapid deterioration”
Encourage drinks and sit with Mrs S rather than allowing her to self administer fluids
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INFECTION DELIRIUM PAIN
Gain an understanding of what might be the cause the persons infection or pain.
Gain an understanding of what symptoms the person might present with
Put together a contingency plan and share with both family carers and professionals. This should include how the person will present and what the “first signs are”
Talk to the GP about regular medication reviews and whether regular analgesia needs to be introduced (if not already done)
Think prevention: regular fluid intake (increasing in hotter weather), “little and often” diet, structured day with activity to improve sleep and a recognition that any infection could lead to delirium (such as wounds)
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Thank you
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