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Yes Score (ii) Date Show individual a monthly calendar and ask to point out two dates medications with weight loss side effect best bonnispaz 15ml. Repeat for animals medicine woman dr quinn purchase 15ml bonnispaz, colours medicine vicodin generic 15ml bonnispaz, and towns 3 (8-10 Items) Fruits Animals Colours Towns 2 (5-7) 1 (1-4) Score 3 treatment syphilis trusted bonnispaz 15ml. Feeling States (a) Subjective Inform the individual that you would like to talk with him/her about how he/she has been feeling in the last week. When asking the following questions, it may be necessary to preface with probes. Score 0 if answers given are not shown Score (b) Depression Suspect depression if the individual expresses "no" to (iii) and (v) and "yes" to (i) (ii) (iv) and (vi). Reprinted with permission of Pam Dawson, Consultant and Director, Dawson Geront-Abilities Consulting. Groaning is characterized by louder than usual inarticulate involuntary sounds, often abruptly beginning and ending. Loud groaning is characterized by louder than usual inarticulate involuntary sounds, often abruptly beginning and ending. The person is trying to escape by yanking or wrenching him or herself free, or shoving you away. The behaviour stops during the period of interaction with no indication that the person is at all distressed. Frown Facial expression Smiling, or inexpressive Relaxed Facial grimacing Body Language Tense. Frequencies: 0 ­ never 1 ­ once per shift 2 ­ twice per shift 3 ­ several times per shift 4 ­ constantly Please circle the number that corresponds to the frequency on your shift. Up at night 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 Developed by: Geriatric Consultation Team, Henderson Site, Hamilton Health Sciences, 1995. Pace, aimless wandering 1 Inappropriate dress, disrobing 1 Spitting (include at meals) 1 Cursing or verbal aggression 1 Constant unwarranted request attention or help 1 Repetitive sentences/questions 1 Hitting (including self) 1 Kicking 1 Grabbing onto people 1 Pushing 1 Throwing things 1 Strange noises (weird laughter or crying) 1 Screaming 1 Biting 1 Scratching 1 Trying to get to a different place. Caregiving Strategies for Older Adults with Delirium, Dementia and Depression Appendix T: Care Strategies for Dementia Early-Stage Manifestations and Behavioural Interventions Manifestations Impaired recall of recent events Behavioural Interventions Use reminders (notes, single-day calendars, cues) Talk with the client about recent events Avoid stressful situations Do not ask for more than the client can do Keep the environment, schedule, routine the same Maintain normal mealtime routine Have items in the same place and in view 174 Impaired functioning, especially complex tasks Gradual withdrawal from activities Lowered tolerance of new ideas and changes in routine Difficulty finding words Anticipate what the client is trying to say Provide word or respond to thought/feeling Be tolerant and respond like it is the first time stated or heard Assess safety of driving and other desired activities Allow performance of skills as long as safe Accompany on walks Provide safe and secure walking area Ignore inconsistencies Help to maintain consistency by keeping needed items in view and maintaining routines Keep items in the same place and in view Find things and replace or hand to the client without focusing on the forgetfulness Maintain familiar social, physical, mental, and work activities Repetitive statements Decreased judgment and reasoning Becoming lost Inconsistency in ordinary tasks of daily living Increasing tendency to misplace things Narrowing of interest Living in the past Self-centred thoughts; restlessness or apathy Preoccupation with physical functions Focus on the client and listen Allow pacing or sleeping Assist in maintaining normal physical functions (basic and instrumental activities of daily living) Nursing Best Practice Guideline Intermediate-Stage Manifestations and Environmental Interventions Manifestations Increased forgetfulness (meals, medications, people, self) Behavioural Interventions Place food where client can see and reach it Hand medications to client Remove mirrors Put things away as desired; do not expect client to put them away Provide a chest of drawers for hoarding or rummaging Keep needed objects in sight/reach Do for the client what he or she cannot, but allow the client to do as much as possible Provide assistive equipment: shower stool, elevated seat Close and perhaps lock doors on stairways and rooms that the client should not access Fence the yard Place cues to help recognize rooms or objects Avoid physical and chemical restraints while providing areas for wandering and resting Have non-shiny floors without contrasting colours or patterns. Caregiving Strategies for Older Adults with Delirium, Dementia and Depression Appendix U: Drugs That Can Cause Symptoms of Depression Antihypertensives Reserpine Methyldopa Propranolol Clonidine Hydralazine Guanethidine Analgesics Narcotic Morphine Codeine Meperidine Pentazocine Propoxyphene Non-narcotics Indomethacin Antiparkinsonism Drugs Levodopa Steroids Corticosteroids Estrogen Psychotropic Agents 176 Antimicrobials Sulfonamides Isoniazid Sedatives Barbiturates Benzodiazepines Meprobamate Antipsychotics Chlorpromazine Haloperidol Thiothixene Hypnotics Chloral hydrate Benzodiazepines Flurazepam Others Cimetidine Cancer chemotherapeutic agents Alcohol Cardiovascular Preparations Digitalis Diuretics Lidocaine Hypoglycemic Agents References: Kane, R. Nursing Best Practice Guideline Appendix V: Indications for the Selection of an Appropriate Psychological Therapy Primary Objectives 1. Symptom removal Examples Cognitive-Behavioural and Interpersonal Psychotherapy Case management; Cognitive-Behavioural, psychoeducational, occupational, marital or family therapy Maintenance therapy (Cognitive-Behavioural, interpersonal, other) Marital, family, cognitive, interpersonal, brief dynamic, and other therapy 2. Correction of "causal" psychological problems with secondary symptom resolution 5. Increased adherence to medication Clinical case management, specific Cognitive-Behavioural, or other psycheducational techniques or packages Occupational, marital, family interpersonal, cognitive therapy, other therapies focused on specific problems 6. Caregiving Strategies for Older Adults with Delirium, Dementia and Depression Appendix W: Outline of Key Factors in Continuing Treatment for Depression Assess Response (week 6) Worse Not improved Somewhat improved Clearly improved 178 Referral to specialist mental health services Monitor Weekly Monitor bi-weekly Continue acute treatment phase Check compliance Adjust dosage Add medication Refer for psychological therapy Continuation phase Check compliance Review medication Consider referral for psychological therapy Continue current treatment for 6 more weeks Assess Response (week 12) If relapse (within current treatment) Relapse prevention Psychological therapy for underlying issues Life skills Lifestyles Not improved Monitor biweekly for 6 weeks) Partially improved Complete remission Continuation of treatment Further 3-6 months for first episode For up to to 3 years for recurrent episode6 Check for associated conditions & compliance. Augment or change treatment(s) If not improved consider referral Adjust dosage Add medication Change medication Refer for psychological therapy While on antidepressants monitor, on average, monthly Reprinted with permission: National Advisory Committee on Health and Disability (1996). Guidelines for the treatment and management of depression by primary healthcare professionals. Nursing Best Practice Guideline Appendix X: Detection of Depression Monitor For each client receiving the Detection of Major Depression protocol, the nurse/physician should complete the Detection of Depression Monitor on at least a weekly basis throughout the depression detection program. For each patient receiving the intervention, please keep a record of the changes observed in his or her client records. Criteria Key Y - Yes/met criteria N - No/criteria not met J - Justified Variation/patient not included in the monitor (Note why patient is not Included) Please place the appropriate key next to the two outcomes for each assessment period 179 Patient Record For At Risk Individual Outcome 1: Patient record reveals that depression screen was completed. Outcome 2: Patient record reveals that further psychiatric evaluation was ordered as needed. Comments: Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 1: Week 2: Week 3: Week 4: Week 5: Week 6: Week 7: Week 8: Reprinted with Permission: Piven, M. Evidence-Based Protocol: Detection of depression in the cognitively intact older adult.

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