THE SUNDAY TIMES

Inspected and rated

Outstanding *

0 CareOuality Commission

r'\ INVESTORS Gold� JIN PEOPLE

:;..-..;

100 BEST SMALL COMPANIES

TO WORK FOR

2018

II .

Copyright SweetTree

Rikki LorentiAdmiral Nurse

Physical Health and Dementia, Delirium and Pain

Copyright SweetTree

How important is it to understand pain and infection?

Copyright SweetTree

•

f P · · D roent1a· Under .. Treatment o . a1n in e

Assessment is Key·- - · -·- - -· · . -·- Potential und

. eruse of nursing home . analgesics forresidents . recogniz d sectional stud

with dementi . e Pain in

Y a. A cross-

' na\n

nts o,"'

. \ c.of\"\\'>one

u\t\\'> e

· a on f\"\

t ae'1'ent\

\n�\uenc.e o

!-=· SweetTree - " Home Care ServicesCopyright SweetTree

It is important to identify past & current medical history

•

•

•

•

•

•

•

•

•

Copyright SweetTree

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”?

Copyright SweetTree

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

Copyright SweetTree

Pain TRIGGERS

Copyright SweetTree

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

!-=· SweetTree Home Care Services Copyright SweetTree

How do we know if someone is in pain & can’t self-report?

Copyright SweetTree

Whether you are informally or formally caring, you can see

Copyright SweetTree

So, we can learn from this…

Copyright SweetTree

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

Copyright SweetTree

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

!-=· SweetTree Home Care Services Copyright SweetTree

It does not matter if you are an informal or formal carer.CONTINGENCY PLANNING IS KEY

Copyright SweetTree

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

Copyright SweetTree

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)

Copyright SweetTree

Thank you

Copyright SweetTree