Providing Specialized Care for Residents with Changes in Health
You are the early warning system
Most changes in condition are first noticed during routine care. Report immediately - not at the end of the shift - any sudden confusion, difficulty breathing, chest pain, fever, vomiting, diarrhea, bleeding, decreased urine output, refusal to eat or drink, new skin breakdown, or change in mobility. Describe what you saw, when, and what the resident said.
Dementia and mental health
For a resident with dementia, do not argue or correct. Redirect, reassure, and follow routine. Use short sentences and offer one choice at a time. Keep the environment safe; exit alarms are a care tool, not a punishment. With mental illness, do not take insults personally, set calm limits, and report any statement of self-harm. Acknowledge the feeling behind a delusion rather than debating it.
Chronic and specialized care
For oxygen: post "no smoking," avoid petroleum products, and check ears and cheeks for tubing pressure. For tube feedings, elevate the head of the bed and stop the feeding and report if the resident vomits or has trouble breathing. Empty an ostomy pouch when it is one-third to one-half full. For diabetes, report shakiness, sweating, or confusion and give juice only if ordered.
Emergencies
Seizure: protect the head, do not restrain or put anything in the mouth, time it, and turn the resident on the side afterward. Suspected stroke: note the time symptoms began. CPR: check responsiveness, call for help, and begin compressions.
End of life
Provide comfort care - mouth care, positioning, warmth - and never force food or fluids. Allow family to be present. After death, treat the body with dignity, follow facility policy, and identify the body as required.
Traps
Any answer that waits, ignores, or argues with a resident is wrong.
Rule of thumb
Sudden change means report now; gradual change still gets reported the same shift.