What is NICHE Nurses Involved in Care of

What is NICHE? ? • Nurses • Involved in • Care of • Healthsystem • Elderly

Effects of Age Related Changes Diminished reserve and ability to respond to stress Older adults have difficulty managing the stress of hospitalization associated with: • Surgery • • Anesthesia and other medications Medical tests and procedures Physical environment Schedules

Iatrogenesis Definition – from the Greek word, • iatros means healer • iatrogenesis means brought forth by a healer • unintended adverse patient outcome due to simply being a hospitalized patient • not a natural course of disease 36 -58% of older adults suffer iatrogenic illness during hospitalization.

Normal age related changes • Iatrogenesis Lowered reserve and ability to respond to stress • Exaggerated effects of medications • Increased risk of infection • Less aware of the need to drink • Heart less able to deal with stress

Geriatric Delirium

DELIRIUM!! Risk Factors Most common • Dementia • Male gender • Advanced age • Medical illness • Multiple medications Predisposing • Poor functional status • Alcohol abuse • Dementia • Depression • Dehydration • Sensory impairment ** Pathophysiology of delirium is not well understood 6

• Anticholinergics High Risk Medications • Zantac, Procardia, Detrol, Atropine • Narcotics • Sedative hypnotics (benzodiazepines) • Demerol, Morphine, Percocet, Lortab Beers Medications • Ativan, Xanax, Valium, Tranxene, Ambien (CNS depressant) • H 2 Blockers • Zantac, Pepcid, Tagamet • Corticosteroids • Centrally acting antihypertensives • Antiparkinsonian drugs • Prednisone, Decadron, Celestone • Clonidine • Cogentin, Artane, Sinemet, Mirapex, Requip 7

So… What’s the “take-away” message? Delirium is… • Common in hospitalized older adults • A major reason for poor health care outcomes and nursing home placement • Under recognized by doctors and nurses • Preventable and treatable • Potentially life-threatening and needs immediate medical evaluation 8

The C. A. R. E. ™ Channel #60 on Palmetto Health TV’s

DIVERSIONAL ACTIVITY CART *How to use the contents of this cart to REDUCE THE RISK OF DELIRIUM

Purpose of the cart: Geriatric patients are at risk for delirium while they are in the hospital, due to: • Poly-pharmacy • Beers’ (Potentially Inappropriate) Medications • Sleep deprivation • Changes in personal schedule/routine • Un- or under-treated pain • Surgical/procedural stressors and/or anesthesia • Sensory deprivation/restraints/tethers • Boredom &Isolation This cart includes numerous items and activities that may help divert a patient’s attention from some or all of those stressors that often lead to delirium. HELP Volunteers will need access to this cart as well.

Other diversional activity items examples below: Any items you feel might be helpful that are not on the cart, please donate them and notify Donna Wolff via email donna. wolff@palmettohealth. org. üKnitted Shawls üStuffed Animals üDolls üWash Cloths üSlinky üSmall Coloring Books üKoosh Balls üExtra Crayons üPoker chips üDecks of cards (any kind) üAnything to sort or manipulate üPaint by number with water üLarge print books, magazines, Or devotionals üKnitted hats üNew Baseball caps üNew colorful socks to sort üPeg boards üMusic CD’s üExercise bands üSmooth, Small pieces of PVC tubes üSmooth, plastic kitchen utensils (no knives or forks or anything sharp) üPlastic cups üSilk scarves üLap blankets üStacking cones, plastic rings üPuzzles üExtra pencils, pens, paper üBlank greeting cards with Envelopes üSafety scissors (no sharps)

Top of the Cart:

Top of the Cart: • Small basket with: – NICHE program brochure and NICHE coordinator business card attached • Describes programs – Delirium Family Education brochure • Allay fears, suggests ways to help • Patient glasses cleaning wipes – Patients need to be able to see as clearly as possible, – Decreased vision leads to social isolation, confusion, and delirium

FIRST DRAWER:

FIRST DRAWER: Mental Stimulation • “Spring Things”: Reminiscing Picture Pages • Useful to stimulate conversations or promote distraction from unpleasant behaviors • Pencils/Crayons • Large Print Circle-a-Word Puzzles • Large Print Crossword Puzzles • Adult- appropriate Coloring pages • Useful for distraction, mental stimulation • Large Print devotions • Useful for Spiritual needs, calm, prayer, meditation • Printed words to sing-a-long songs • Promotes auditory stimulation, calming, distraction, etc.

SECOND DRAWER

SECOND DRAWER SENSORY STIMULATION • Sound-sensing Light Bar • Flashes lights in response to sound OR can be set to automatically flash a light show üDistraction, involvement, visual stimulation • Busy Apron • Distraction, occupies hands, keeps from pulling at tubes, devices • Pop Tubes • Distraction and interesting noises ü occupies hands, keeps from pulling at tubes, devices,

THIRD DRAWER • Lace and trace shapes with strings • Vegetables and fruits • Tangle – mental stim & busy hands game • Kitchen utensils

THIRD DRAWER • Lace and trace shapes with strings • Vegetables and fruits • Tangle – mental stim & busy hands game • Kitchen utensils

FOURTH DRAWER SENSORY STIMULATION • Plastic cups for sorting game chips, coins, etc. • Colorful plastic chains for sorting • Shoe laces to tie or lace in cardboard, etc.

FOURTH DRAWER SENSORY STIMULATION • Plastic cups for sorting game chips, coins, etc. • Colorful plastic chains for sorting, connecting • Shoe laces to tie or lace in cardboard, etc.

Final thoughts: cleaning and replacing items: Give two or three activity sheets/crayons two or three laces/ soft goods to a patient- unable to clean Hard plastic (wipe-able) items are the property of each unit - clean with cavi-wipes and return to the cart between patient use *Activity aprons, stuffed animals can be washed, please page 352 -1407 to have someone come pick the apron up and bring you a new one. *When you need replacement items for the cart, please email NICHE coordinator donna. wolff@palmettohealth. org