Question

1. Describe the impact of acquired brain injury in Canada. Include a minimum of 3 details with supporting information. 

2. Identify 5 immediate signs or symptoms of a head injury. 

3. Give a definition of mild, moderate, and severe brain injury, outlining the criteria for determining the difference in severity. 

Mild _______ 

Moderate _______  

Severe _______ 

Answer 1

Ans

Acquired brain injury may include ischemic stroke and lead to the damage to the brain

The area which undergoes in ischemia then function of the that area is effected

If temporal lobe is effected then it lead to memory loss

If occipit lobe is effected then vision is effected

If parital system is effected then balance is disturb

Ans-2

Headache

Fever

Disturb consciousness

Disturbed mental acquity

May increase ICP

ANS-3

If only injury occur no damage to brain parenchyma then it is mild

If drain paranchyma damage but there is no disturbance in daily living activity then it is moderate

If brain function and daiily activity is severly effected then it is sever injury

Answer 2

Date : - can be classified ed Broin injury nito troumatic of non Traumatic brain injury is because of accadents, falls, Concession whereas in traumatic causes like stroke, aneurysm causes on traumatic brain busy ОТ Accouleding to stats 1,60000 Canadiens will experience brain injury each year It s the serious cause of disability in 4syo age group inpuiduels. It predispose's an induid wel to early onset dementie later Substance abrese and mental illness. It cause huge stress to carefwers physically in finanually - Scanned with -Geescanner

Date : _ * Immed ake san ay symptors of Head injury i loss of consuousness. 2) Headache 3) Nousee & vomiting 41 fatigive /Drowsiness s Speech problems 3 Brin ligury based on severity iamn Amnesia Consciousnes Ara (gasjoko come scale | 13-15 mild 0-30 min noderte I 9-12 21-27 days 730m Severe 3-8 » 7dog > zy hey Scanned with CamScanner

Answer 3

1. Cognitive impairment can disrupt the person’s ability to participate in their ADL’s. List three examples of specific difficulties with ADL’s that could arise, and then provide one action the PSW could implement to support and assist the client to promote autonomy and dignity with the task. (6 marks)

i) ADL task: 

One task that may be disrupted with cognitive impairment may be bathing.

PSW support: 

The PSW should provide for safety in bathing making sure that proper safety measures are in place, as well as privacy.  Though they may not be cognitively aware, the client’s right to privacy should still be maintained. 

 ii) ADL task: 

Another ADL task that could be affected by a cognitive impairment is getting dressed.

PSW support:  

As a support worker it is our job to help the client do as much for themselves as possible.  A client with a cognitive impairment may have trouble getting dressed or finding the proper clothes.  The best way to start is to give few options for clothing.  Being presented with a closet full of clothes may be overwhelming for them.  After they have picked the clothes, if they are capable, allow them to take their time to get dressed and do not rush them.  They may just need a little more time than others.  Help in any way they need.

iii) ADL task:  

A client’s ability to eat may also be affected.

PSW support:

A PSW may be required to feed a client with a cognitive (or other) impairment.  I believe it helps their dignity if we do not allow the food to run down their face, but keep the face as clean as possible while they are eating.  If they can eat by themselves, but maybe have trouble swallowing, we can allow them to choose foods they like and then prepare the food in a better way, such as cutting it into smaller pieces or even making it into a puree.  Making sure there is water with the meal will also help swallowing.  It may simply be that they just forget to eat.  In that case we can just give them a gentle reminder.

 

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2. Mr. Heron is a 78-year-old client of the agency you are employed with. He lives in a retirement home but is supported by your agency two mornings each week. He has been a client of yours for a month. Mr. Heron’s forgetfulness is progressing slowly, but he remains a person with precise ideas and preferences regarding how things should be done. Mr. Heron’s occupation was a high school principal. He held that position for over thirty years. He is married and has two adult children and five grandchildren. Three times in the last two weeks when you have visited Mr. Heron you have found him hovering near the elevator in his building. He has appeared slightly agitated and has not been fully dressed. Today you find him in the same location wearing a suit jacket with no shirt underneath, and he seems particularly upset. He says to you, “The train is leaving and I’ve got to be on it or I will be late for school.”

a. How might Mr. Heron’s personality and past experiences influence the behaviour you witness today? (2 marks)

            Most likely Mr. Heron took the train to the school where he was principal, which is why he also is dressed in a suit jacket.  He had to be at the school at a certain time every day.  He is remembering those things because it was his habit and routine for over thirty years.  His personality is coming through that he was a person who liked to be on time and prepared.  Though he is forgetting the present time, he is remembering the past.

b. What actions or verbal direction might you do or suggest in order to make Mr. Heron more comfortable? (2 marks)

            I would gently guide Mr. Heron back to his room.  If he did not want to go, I would point out that is forgot to put on a shirt under his jacket.  If he is comfortable in his suit, I would allow him to stay dressed in the suit.  I would talk to him to find out why he is agitated and if it is because he thinks he is late to be somewhere.  I would gently explain to him that he does not need be anywhere today.  I would talk in a calm, gentle voice and not argue with him.  I would also try to do some activities with him to distract him from his agitation.

3. Why is depression often mistaken for dementia? (1 mark)

            People with dementia may experience changes in mood as well as in behavior.  Both depression and dementia can cause forgetfulness and confusion.  Some of the symptoms can look very familiar.  Also, many people who have dementia also suffer from depression.

 

 

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4. Using the three stages of dementia, explain how you would support your client with their meal times and eating in each of the stages. (3 marks)

Mild Stage:

            The client might need a reminder to eat or to take medication with their meal.  For the most part, at this point, the client should still be able to feed themselves, though they may need help making the food or maybe just having it cut to smaller pieces depending on if they are also suffering from other issues.  They may have just very mild problems with coordination, and may need special utensils to help with that.  It is a good idea for the client to have a clock to refer to in order to know the time and keep a routine.  Help them to stay focused and not get distracted during meals.  They may also refer to the clock as well as a dosette to know which medications to take at which meal.

Moderate Stage:

            At the moderate stage, clients may have dulled senses and be unable to tell if food it too hot.  As support workers we should make sure the food we are serving if a good temperature, not something that can burn. If they have to choose their food, we should only allow them to pick between two choices.  Expect them to eat well on some meals, and hardly anything at other meals.  They will need help feeding at this stage, though if they are able, just guide their utensils.  Because of short term memory loss, they may become distracted during meals, so you may have to remind them that they are still eating and other activities can wait until they are finished.  It is a good idea to have their taste preferences written down before they reach this stage so that it can be referred to.  They may have trouble expressing if they dislike the food but it may come out in other ways including aggression or restlessness or rude table manners.  Just continue to be kind, respectful and patient.

Severe Stage:

            In the severe stage a dementia patient will be totally dependent on others for feeding.  They will need to be hand or spoon fed by the support worker.  They may have trouble swallowing, so it is very important at this stage to watch for signs of choking and aspiration.  They will be unable to sit on their own so their bed will need to be adjusted to a high fowler’s position for feedings.  This position should be maintained after meals as well until the risk of the food coming back up has passed.  It is also a good idea to have fewer small meals and snacks than to try to have 3 large meals a day.

 

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5. A client you are assigned by your home care agency has been diagnosed with Alzheimer’s Disease – Stage 2. List five safety concerns you would have in the client’s home. (5 marks)

i)          One safety concern is mobility.  The client at this stage may have issues with moving around and we should check if they have grab bars in their home at crucial areas, especially around stairs.  Loose rugs and tripping hazards should also be removed.

ii)         Another safety hazard could be stoves or other heating sources.  The client may try to use a stove and then forget it is on, creating a fire risk.  It is a good idea to unplug stoves and disable heating sources if the client is left alone.

iii)        As sad as it is, another safety concern is “stranger danger.”  As they are forgetting who people are, they may let strangers into the house thinking that maybe the person knows them.  It is important that safety measures are put in place to protect the client as well as the support workers who come to work for them.  (For instance, my grandma is only left completely alone to sleep. One of her children will come to lock her door around 6pm.  The grandchildren know we cannot visit her after this time.)

iv)        Electrical outlets should have covers over them.  The client may forget what they are for and end up putting things inside the outlet or plugging things in that they should not, or might forget about.

v)         Another safety hazard could be chemicals in the house.  These should be locked up in a cupboard, so that the client could not accidentally ingest them thinking they are food or drink.

 

6. Mrs. Green is a client of your agency. She has been diagnosed with multi-infarct (vascular) dementia. She has been assessed to be in the first stage and is only mildly forgetful the majority of the time. She is most comfortable when she gets the answers she needs, although she may forget them in a short period of time. Today she asks you, “Have you seen my daughter? I haven’t seen her in a very long time.” You know that Mrs. Green’s daughter visits on a regular basis but you are unsure as to when she was last in. (5 marks)

i) What is dementia?  

            Dementia is, “a general term that describes the progressive loss of brain functions, which include cognitive and social functions.  It is not a single disease but a group of illnesses that involve memory, behaviour, learning, and communication.  Dementia is categorized as being either a mild or major neurocognitive disorder, depending on its symptoms.” (Wilk, 2022, p. 1140)¹

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ii) What is meant by multi-infarct dementia?

            Multi-infarct dementia is also known as vascular dementia and, “is caused by chronic, reduced blood flow to the brain – usually as a result of a stroke or a series of strokes.” (Wilk, 2022, p. 899) ¹  It “results in a subtle, progressive decline in memory and cognitive functioning.” (Wilk, 2022, p. 900)¹

iii) How might Mrs. Green’s forgetfulness interfere with her safety needs?

            While Mrs. Green has only been assessed at the first stage, there could still be some interferences with her safety.  If she hurts herself in some way, she may forget emergency or family numbers to call for help.  She may get lost on her way to visit people, stores or the doctor’s office, either by forgetting where she was going or the way to get there.

iv) Considering effective communication techniques, how would you respond to Mrs.Green?

            I would inform Mrs. Green that her daughter visits her on a regular basis.  I would them suggest that she keep a book near her entrance for visitors to sign and put the dates and times that they came to visit her, so that anytime she wants to know when someone was there last, she can simply look in the book.

v) Explain how this approach would be helpful.

            Mrs. Green is most comfortable when she gets the answers she needs.  In this case, I do not have the exact answer of when her daughter visited last, but I do know that she visits regularly, so that is the best answer I can give.  The book idea came from my grandmother.  She always used to have a sign in book whenever we had special events and now that she is 97 and starting to forget a lot, the visitor book became a great tool to use so she could just look at it and see who was there and when, even if she didn’t remember.

 

 

7.   When a resident is cognitively impaired, does it really matter whether he/she is attractively dressed? Are we just trying to make an impression on visitors and other residents? If the confused resident doesn’t know or care how he/she is dressed, why should we? It’s not bothering him/her. (2 marks)

            The important thing to remember here is DIPPS.  Dignity is worthy of respect.  We should dress them in such a way as it shows we respect them, so dressing them in pajamas all day long does not help.  We should dress them for the day.  This may also help them distinguish between day and night.  We should look at pictures they have of their dressing style beforehand so we can know how they liked to be dressed, and how they carried themselves.  They may even be able to still pick out which clothes they would prefer.  This covers independence and preference.   I personally think a lot depends on what the person was like before they became cognitively impaired.  For instance, I would hate to think that someone was dressing me in frilly dresses and make-up when I dress nothing like that now.  There is nothing wrong with dressing comfortably.  Lastly, we also need to consider safety.  Even though the person may have loved walking around in high heels, at this point, that would most likely be a bad idea, as it presents a very real tripping hazard. 

 

8. You have been assigned a client with a diagnosis of schizophrenia. At the time of their in-home assessment, the client was well controlled on medication and had excellent outside support from social work and family who live in the area. Desiring to be prepared for any change that could potentially occur from non-compliance with their medication regime, what are three signs that you would take note of that your client may be in mental health crisis? (3 marks)

            There are so many signs that a person could be in a mental health crisis, although sometimes the signs (especially in the case of suicidal thoughts or intentions) may not be obvious to those around.  Some of the more obvious signs include seeing hallucinations or hearing voices, difficulty with common everyday tasks (ADLs), and substance abuse.

 

9. “The elderly are not at risk of committing suicide.” Do you agree or disagree?

I strongly disagree with the comment that the elderly are not at risk of committing suicide. The elderly have seen more people in their lives pass away, often including spouses or close family members and friends.  The older a person becomes, the more death they see.   Death alone can bring a person to become sad or depressed, but losing a support system of loved ones and friends can leave the person with no one to talk to.  This can lead to depression and thoughts of ending one’s life.  Maybe it is not the death of a person, but death of themselves as they knew it.  As people age, they can no longer do the things they could at a younger age.  They may also lose their memories and sometimes that is all they have left.  As people age, they can develop aches and pains that they never experienced before.  Constant pain is a huge source of depression and hurt.  All these reasons and more give the elderly much more reason to become depressed and begin to think of suicide.  They may also feel they are becoming a burden to their family and committing suicide will relieve their family of the burden.

 

 

 

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10. Define: (4 marks)

i) Affective disorder:

“Affective disorders are illnesses that affect the way you think and feel. The symptoms may be quite severe. In most cases, they won't go away on their own. The most common affective disorders are depression and bipolar disorder.” ² 

Give one example:

One example is bipolar disorder.

ii) Anxiety disorder:

“Anxiety disorders are a group of mental health disorders whose main symptom is extreme anxiety, with fears and worries so disproportionate to the situation as to affect normal functioning.” (Wilk, 2022, p. 866)³

Give one example:

One example of an anxiety disorder is PTSD, which stands for post-traumatic stress disorder.  This happens after a person has experienced a traumatic event that causes them future stress when people, things, or situatiopns remind them of the event, either consciously or subconsciously.