Nursing interventions for mentally challenged patients

[Blackheartednurse]

i have a mentally retarded patient that I go visit once a week (home health nurse).I'm a fairly new nurse and this is my first developmentally delayed patient....I mainly communicate with the patients caregiver since the patient doesnt understand spoken words nor can she speaks in a way people can understand her. What are some kind of intervention for a patient like this.Like I'm aware that she needs to be encouraged to be independent as much as possible.I also my patient is chair bound,but is able to transfer herself from wheelchair to a toilet seat or on to the couch but cannot walk do to contractures,muscle weakness.Also she had a recent fall due to transferring from wheelchair onto the toilet seat.

[mskate]

Before you get completely flamed by a lot of people - you may want to edit your post so you choose your words better and not refer to a patient as "retarded". Just a friendly suggestion.

[DoGoodThenGo]

i have a mentally retarded patient that I go visit once a week (home health nurse).I'm a fairly new nurse and this is my first developmentally delayed patient....I mainly communicate with the patients caregiver since the patient doesnt understand spoken words nor can she speaks in a way people can understand her. What are some kind of intervention for a patient like this.Like I'm aware that she needs to be encouraged to be independent as much as possible.I also my patient is chair bound,but is able to transfer herself from wheelchair to a toilet seat or on to the couch but cannot walk do to contractures,muscle weakness.Also she had a recent fall due to transferring from wheelchair onto the toilet seat.

You might wish to rethink use of the word "retarded". I say this in the spirit of friendship, not wishing to pick a fight or anything.

[Blackheartednurse]

Well I just go by what the plan of care signed by MD states which is a Diagnosis: Mental Retardation.

[leslie :-D]

is this a new pt for you?

it's difficult in that s/he doesn't understand what is being said to 'her'.

how does the caregiver communicate w/her?

for starters, i'd want to estalish a comfort/trust level with pt.

when you are talking w/the caregiver, make certain pt is involved somehow.

even though it sounds like the bulk of communication will be with the cg, you need to interact with pt as well.

we know that won't be in the form of verbal exchange, but a soft touch, smile, eye contact, non-threatening voice...

are all ways of communicating.

once a comfort level has been attained, she will likely trust you enough where you can accomplish some goals.

you can never go wrong when you take a genuine interest in your pt.

integrity speaks to all ages and capabilities.

leslie

[imintrouble, BSN, RN]

I have a 25 year old daughter with DS. "Retarded" is like nails on a chalkboard to me. I have long since stopped allowing that word to hurt me, but I still prefer mentally disabled when at all possible. I have, out of necessity, made friends with the ugly words.:)

My daughter is pretty high functioning, but I am not uncomfortable with people with severe mental disabilities.

I smile alot.

Speak clearly and use simple words.

Move slow, talk slow.

Make eye contact.

Speak to the pt/client as often as possible, even when the caregiver will answer. Even when you don't think she can understand you.

Good luck.

[chloecatrn]

MR is still the DSM IV diagnosis, so that's what the MD has written. That doesn't make it the appropriate way to refer to the client with whom you are working. Developmentally delayed, or, to use the more preferred "person first" language, person with a developmental delay, are the appropriate ways to refer to your client.

Please, speak to your client. You may not think she understands you, but if her primary caregiver speaks to her and she responds, then she obviously understands. Before performing any care, explain to your client what you're about to do. (i.e.: If she's G-tube fed, explain that you're going to lift her shirt to gain access to her tube, that you're going to open her tube to connect her feeds, etc.) If she requires assistance for feeding, please make sure you identify what she's got to eat, and ask her for her preferences before each bite. It sounds like she's able to communicate in some manner, and before long, you will likely find yourself able to understand her communication efforts.

Good luck.

[nyashan]

"mentally retarded" *smh*

[txredheadnurse, BSN, RN]

I work with this population every day. The developmental delay is not in and of itself something that requires nursing intervention. You gear your teaching to the needs of the client & communicate on a level that is basic and to the point. Actually I tend to do that with all my clients/patients regardless of their cognitive function.

Be sure to include the caregiver in your teaching and ask the caregiver for ideas & input and try to address any concerns they have regarding issues that are important to them. No one knows the DD client better than those dedicated souls who spend every day with them. Remember in home health care you, the nurse, are there for a specific skilled need but the client/patients world does not revolve around their health issues alone. Not everything can be "fixed" by a pill or treatment or nursing intervention. However professional, respectful and empathic care can go a long way towards making a home bound persons life better overall. Allow the DD client/patient the right to try to be as independent as possible and do not shortchange them by not allowing them to participate in their care.

[nursel56]

You mention that you are communicating with a caregiver as opposed to parents and that she lives at a home. She is able to move independently from the chair to the couch to the toilet at this point, but has recently fallen during an attempt to do that. With knowing only those two things she probably falls in the higher functioning area of DD.

Hopefully you have access to a detailed medical history on your patient so you know exactly what her current level of cognitive impairment is. As a rule of thumb, it appears that most of the time people with DD understand more of what is said than less, and their thoughts are more complex than they are able to verbalize. It's really frustrating for them, so when you talk with the caregiver with the patient there, look at her and nod and make eye contact even if you aren't sure she understands.

DD falls into lots of categories so your interventions will be tailored to the specific diagnosis and prognosis. You want to maintain optimum nutrition and mobility, and intervene if there is is evidence of loss of these things such as an increased tendency to fall. You want to make sure she has her range of motion done every day for the contractures, and that she doesn't aspirate food or fluids if she has a po diet.