Impaired verbal communication.

CVA
Dementia
Said “what” after physical therapist continuously repeated her name
Primary nurse reported hearing her say “yes” and “no”
Moans when in pain
Closes her eyes when someone is looking at her.


Impaired communication r/t cognitive impairment

Cognitive impairment is any disorder that impairs cognitive functioning. It may affect the ability to use and understand language. The total loss of speech, impaired articulation, or the inability to find or name words may develop. It can also alter the ability to send, receive, or comprehend messages. When an individual experiences a decrease, delayed, or absent ability to receive process, transmit and use a system of symbols. Communication is impaired. According to Carpenito impaired communication is thestate in which an individual experiences or is at high risk to experience difficulty exchanging thoughts, ideas, desires, wants, or needs with others
Ms. CR had dementia and a history of CVA. Brain damage due to both of the diseases can impair communication. Pt. doesn’t verbalize her wishes and desires. She is able to articulate simple words, however really does so.
Pt. will use alternative method of communication WIMC.

1.Assess mental status
2. Assess developmental level.
3.. Assess pts. anxiety level
4.Establish Rapport
5.Maintain therapeutic
communication
5a. Using silence
5b. Using touch
5c. paraphrasing
5d. Offering self
5e. Listen attentively to pt.
5f. Offer support to pt. and caregiver
6. Identify alternative method of communication.
7. Refer pt. to speech therapy.

1. It reveals the clients general cerebral function. The functions it includes are intellectual and emotional.
(Kozier pg 642)
2. According to Erickson the developmental stage is adulthood and the task at this time is generativity VS stagnation. Those that achieve generativity are creative, productive, and concerned for others. Those that are in stagnation are self indulgence, self concern, with lack of interests and commitments.
(Kozier pg 353)
3. A person with mild anxiety can learn to alter lifestyle habits, more severe anxiety can be paralyzing. Pts. experiencing anxiety may be worried and therefore unable to focus on complete essential self care activities.
(Brunner pg 116)
4. It is an understanding between two people. It allows the client to have control over the communication, the purpose, subject matter, and pacing. It is an appropriate approach to gain information. It is a process of establishing good will and trust.
( Kozier pg 183 & 186)
5. It promotes understanding and can help establish a constructive relationship between the nurse and the client.
(Kozier pg 467)
5a.Allows the pt. to put thoughts together.
(Kozier pg 469)
5b. Providing appropriate touch reinforces caring feelings.
(Kozier pg 469)
5c.This conveys that the nurse has listened and understood the client’s basic message and also offers client’s a clearer idea what they have said.( Kozier pg 469)
5d. Suggesting your presence will allow you to understand the pt. without making any demands. (#6, 469)
5e. Allows you to pay attention to the total message, both verbal and nonverbal. It allows you to absorb both the content and the feelings the person is conveying. You listen to the pts. needs. It encourages pt. to communicate
(Kozier pg 468)
5f. It enhances exploration of feelings and let the clients and their caregivers know that the nurse acknowledge their feelings.
(Kozier pg 1089)
6. To determine how the pt. best receive messages i.e. by listening, looking, through touch, or an interpreter. It is often helpful to use alternative communication strategies such as word boards, pictures, or paper pencil.
(Kozier pg 479)
7. Speech therapy would be able to do their own assessment and establish a system of communication.
(Brunner pg 612)

1. Patient is alert and responds to her name. I was unable to establish orientation to time and place due to patient’s inability to communicate.
2. I assessed developmental to be older adult. Developmental task is integrity vs. despair. Pt. appears to be in despair. She understands simple statements and is able to articulate at least some words. (she said “what” after physical therapist continuously repeated her name) however, it appears she doesn’t want to communicate her wishes and doesn’t wish to respond to questions in other way.
3. Pt sees to be angry and wishes to be left alone. Was unable to assess emotional further due to lack of verbal communication.
4. I attempted to establish rapport by using therapeutic communication, however patient refused to communicate with me. It appears I was able to improve rapport on a second day. Patient closed her eyes as soon as she saw hospital stuff looking at her, however she kept her eyes opened when I was with her alone with curtain closed
5. I maintained therapeutic communication.
5a. I asked the pt how she is feeling and waited for response. She didn’t answer so I started asking more direct questions, such as “Does anything hurt you”
5b. I touched pt’s arm when talking to her. She didn’t pull her arm away when I touched her.
5c. Pt wasn’t talking to me, however I reacted to her actions by asking her questions about reason she does this. For example when she pulled her nasal cannula, I asked her if it feels uncomfortable and then expected nasal cannula and noticed it was too tight.
5d. I let her know that I am there for her in case she needs anything and every time I was leaving I reminded her that if she needs me, she can use a call bell.
5e. patient did not use verbal communication, however I paid close attention to nonverbal communication. I told the pt. I was going to feed her, she turned away and closed her eyes. This message showed me she doesn’t want to eat.
5f. I offered support and tried to explore feelings by asking about physical therapist, she seemed to be angry at him, I acknowledged her feelings and said that is must be hard to have people always telling you what to do and when.
6. I asked patient to squeeze my hand for “yes” and squeeze my hand twice for “no”.
7. I talked to the primary nurse about referral to speech therapy.
Goal not met. patient didn’t attempted to communicate with me, however the progress was present and if more time was given, I would be able to improve the communication further.

1. I was unable to determine orientation, however due to dementia; patient might not be oriented to time and place.
2. patient’s lack of desire to communicate is a barrier to communication.
3. anger is a barrier to communication and teaching. Anger has to be resolved prior to teaching alternative methods of communication.
4. rapport improved slightly, however it wasn’t improved enough for patient to open up enough to talk to me or even use alternative methods of communication in order to make her wishes known. If more time was given to establish rapport, I might’ve gotten her to respond to my questions.
5. Therapeutic communication techniques were not as successful as I hoped they would be, however they did help to establish rapport and improved communication.
5a. patient didn’t speak to me, however she became more relaxed, and did not get frustrated.
5. patient did not seem to react to touch. she did however resisted when people whom she never seen before would touch her.
5c. pt. became more calm and didn’t pretend to be sleeping as long as I was the only person in the room or the curtain was closed and she didn’t see anyone other then me.
5d. pt. did not ask me for help or used the call bell.
5e. I was able to understand when the pt. needs help and when she wants to be left alone by closely monitoring her nonverbal messages. This helped me to show the patient that I can help her whenever she needs it, yet I was not trying to invade her personal space.
Patient was more relaxed after she saw that I’m only there to help
5f. patient turned away from me and pretended to be asleep when I started acknowledging her feelings. She seemed to be upset. Although she got upset, I don’t think she was upset about me asking her about it but rather she was upset because she remembered about the way she was treated.
6. this intervention was not successful, how ever if I had more time to establish rapport, she would be more likely to communicate.
7. nursed stated that she will refer the patient to speech therapy. It is unclear how well the patient can articulate verbal message. However it could be the case since patient has a history of CVA.