Providing Specialized Care for Residents with Changed Conditions and End-of-Life Care
Recognizing changes
Residents with chronic illnesses can change quickly. Observe and report changes in breathing, mental status, pain, skin, appetite, urine output, and mobility. For diabetes, report signs of low blood sugar such as sweating, shakiness, or confusion, and high blood sugar such as excessive thirst or frequent urination. For heart failure, report weight gain, swelling, or shortness of breath. For COPD, report increased difficulty breathing. After surgery, encourage coughing and deep breathing as ordered, splint incisions, and report bleeding or fever. Any sudden change in condition is reported to the nurse promptly.
Dementia and specialized needs
With dementia, do not argue with delusions or hallucinations. Validate feelings, redirect gently, and maintain safety. For catheters, ostomies, oxygen, and feeding tubes, follow the care plan and report problems such as redness, leakage, or dislodgement.
End-of-life care
Hospice and palliative care focus on comfort, dignity, and quality of life. Provide pain relief as delegated, mouth care, skin care, repositioning, and emotional support. Signs of dying may include cool extremities, mottling, decreased urine, irregular breathing, withdrawal, and confusion. Do not force food or fluids. Support the family and respect cultural and religious practices.
Traps and rule of thumb
Do not dismiss a complaint as “just old age.” Do not promise that a resident will recover. After death, provide postmortem care with dignity and follow facility policy about tubes and family viewing. Rule: any sudden change in breathing, mental status, pain, or skin is reported now. Example: a resident with dementia insists on going home; validate the feeling, redirect to a safe activity, and report the change.