Transcript Challenging behaviors

Challenging
Behaviors
Agitation…
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Agitation is used to described diverse symptoms such as:
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Irritability
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Restlessness
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Aggression
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Screaming
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Rummaging
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Disinhibition
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Resistance to care
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Wandering
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*Be
specific when reporting concerns.
Urgent evaluation may be required
in some situations.
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Medical Issues
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Abnormal Vital Signs
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Heart rate <50 or >120
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Systolic Blood pressure <90
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Resp rate > 30
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Fever
Other signs of serious underlying condition (i.e. stroke).
Psychiatric Symptoms
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Escalating physically aggressive behavior.
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Danger to self or others (intermittent or persistent).
Plan of Treatment for Problematic
Behavior
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ASK:
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A:
Antecedents
What are the antecedents?
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B:
Behavior
What is the behavior?
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C:
Consequences
What are the consequences?
Some of the causes of problematic
behavior
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Untreated Pain
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Fear
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Frustration
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Confusion
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Inability to Express needs
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Mood disorder
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Discomfort
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Seeking control
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Personal History
General Management guidelines
for persons with challenging
behaviors.
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Address pain and discomfort.
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Minimize sleep disruption.
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Encourage independence.
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Provide activities.
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Involve the patient differently in his or her care.
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Maintain a structured daily routine in calm environment.
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Use different approaches to bathing, feeding and other ADLs.
Examples
Problem:
Poor sleep or overnight wandering
Approach:
Scheduled toileting
Indirect light
Cause:
Reduce noise
Resident may need to void
Review sleep log/daytime routines
Awakened by noise, light, or staff
Staff education
Daytime naps or sedentary during the
day
Example
Problem:
Combative when being bathed
Cause:
Approach:
Reassurance
Flexible bathing method
Anxiety/ Misinterpretation the event
Same sex attendant
Cold or hot
Pain medication prior to bath
Modesty
Movement of joints may cause pain
Example
Problem:
Agitated behavior during the day
Approach:
Pain assessment
Depression screening
Cause:
Pain or depression
Environmental overstimulation
Reaction to an action by family, other
residents or caregivers
Observe for non specific signs of pain
Monitor for what may be contributing
to behavior
Example
Problem:
Inappropriate sexual advances
Cause:
Exaggeration of previous personality
trait
Drive for intimacy and love
Approach:
Separate from people he/she may
have targeted
Encourage loved ones to show
physical affection when appropriate
Educate staff regarding management
Assign care to staff member unlikely to
be targeted
Other Interventions:
Music therapy
Hand massage
Aromatherapy
Exercise