JABSOM Department of Geriatrics Mrs FI CC Combative behaviors during bathing care Mrs F is a 7 6 yo F with hx of Alzheimers dementia HTN who has been living at ID: 660367
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Slide1
PROJECT ECHO:Behaviors Associated with Dementia
JABSOM Department of GeriatricsSlide2
Mrs. F.I
CC: Combative behaviors during bathing care
Mrs
. F is a
7
6 yo
F with hx of
Alzheimer’s
dementia, HTN
,
who
has been
living at
a Nusing
Home
with her
husband
for the last
3 years.
She often refuses to take bath/shower and she also refused to have bed bath.
Despite behavior interventions by NH sta
ff, she continues to refuse to bathe.
Staff noticed she occasionally has odors due to lack of bathing.Slide3
Mrs. F.I
Meds: Zoloft,
Trazodone, Lisinopril, Metoprolol
Social
: No EtoH, no
smoking
, no illicit drug use
Her functional
status
Cognitively
interactive
.
Able
to stand, transfer and walk with
walker
,
needs supervision
.
Needs assistance for bathing, lower trunk dressing, needs supervision for grooming,
walking. Slide4
Physical Exam
BP 100/76, HR 86, RR 20, afebrile Weight:
120
lbs
, Height:
5’2
ENT
:
moist
oral mucosa, ill-fitting dentures
Chest, lungs:
unremarkable
CVS:
RRR, no Murmur
Abdomen:
Soft, no tnederness
Ext: Low muscle bulk, trace
edema
Skin:
Dry skin, no rash
Neurologic
: Nonfocal
.
Sensory intactSlide5
MMSE and Depression
MMSE: 14/30Geriatric Depression Scale (GDS)
4
/
15 (not depressed)Slide6
Bathing for elderly patients with Dementia
Before bathing careGathering bathing supplies.
Making
the room comfortable.
Placing
soap, shampoo and other supplies within reach.
Monitoring
water temperature.
http
://www.alz.org/care/alzheimers-dementia-bathing.asp#ixzz4doS2CDqsSlide7
BathingGive the person choices.
Fill the tub with 2 to 3 inches of water. Be sure the person has a role.Be aware that the person may perceive bathing to be threatening.Always protect the person's dignity and privacy
.
Have a familiar person of the same sex help, if that is more comfortable.
Read more:
http://www.alz.org/care/alzheimers-dementia-bathing.asp#ixzz4doSQ4zNwSlide8
BathingSet a regular time for bathing.
Be gentle.Simplify the bathing process.Coach the person through each step.Use other cues to remind the person what to do.
Use a tub bench or bath chair.
"Sponge bathe" as an alternative.
Individualized careSlide9
InterventionsNH staff set up “Date Night” with her husband complete with a “couple dinner table” and encouraged her to bathe prior to the date.
Her attending physician wrote a “You need to take a bath” prescription and RN shows it to her before her bath.Play her favorite music during bathtime.Slide10
COMMENTS?
QUESTIONS?
OTHER CASES?