Monitoring Changes of Condition

Outline:
I. Introduction A. Early identification of problems B. Definition of change of condition and monitoring C. Example of change in condition D. Observing for changes in condition E. Checkpoint: Question II. Probable Causes and What to Observe Related to Change in Condition in Residents A. Medication effect, side effect, adverse reaction, interaction B. Urinary tract infection (UTI) 1. Cause, symptoms, prevention, treatment C. Conditions that may increase the risk for falls D. Conditions that may trigger delirium E. Changes in disease process F. Pain and other forms of distress G. Checkpoint: Questions III. Establishing a Baseline A. Move-in evaluation B. Reports from family C. Direct assessments conducted by care community D. Getting to know the resident IV. Determining a Change in Condition A. Physical, mental or emotional changes 1. Observation: head, mouth, chest, arms, hand, abdomen, urinary output, legs and feet, skin 2. Pressure injuries B. Social changes in condition C. Determining a change in condition D. Learning Engagement Activity: Video - General recommendations E. Checkpoint: Questions V. What to Do When a Change in Condition Is Noted A. Learning how to determine what to report and what happens to reported concerns B. Tools and tips for reporting and recording 1. SBAR 2. INTERACT C. Follow community’s policy and procedures D. Hospice E. When to call 911 F. Reporting to family/responsible party G. Checkpoint: Questions VI. Summary and Conclusion VII. Final Exam (post-test)

Joanne Rader, RN, MN, has worked  as a nurse in the field of long term care for more than 40 years. She graduated from University of Maryland, School of Nursing in 1968, with a BSN and from Oregon Health and Science University in 1979 with a Master's in Psychiatric-Mental Health Nursing.  As a nurse clinical specialist, she worked to reduce the use of physical restraints, inappropriate psychoactive medications, and defensive, self-protective behaviors during bathing for persons with dementia. She was on the faculty of the Oregon Health Science University (OHSU), School of Nursing for 20 years and published numerous articles and books addressing the emotional needs and behavioral symptoms of persons with dementia and co-authored and produced manuals and videos on individualized wheelchair seating for older adults. In 1996, 2002 and 2008, her books, Individualized Dementia Care: Creative, Compassionate Approaches and Bathing Without a Battle,  won  AJN Book of the Year Awards. She is a founding member of the Pioneer Network, an organization working to change the culture of aging in America. Currently, she works as an independent consultant and babysitter for grandchildren.

Cynthia McDaniel MSN RN, is a nurse and administrative consultant in long term care. She is the CEO of ElderWise Inc, a senior living consulting and education group. Cynthia has worked as a nurse consultant for the States of Oregon and Washington,  a geriatric care manager, a regional director of clinical operations for a senior living company, and an assistant professor at Oregon Health & Science University School of Nursing. Her research in assisted living focused on the characteristics of residents in assisted living communities and the role of the nurse in assisted living. Cynthia holds a Master's of Science in Nursing from Gonzaga University in nursing education. She is a Fellow of the Sigma Theta Tau/John A. Hartford Foundation Geriatric Nursing Leadership Academy.