[Furwillfly]

We have standing orders for UA'S/Labs from our COS. We will usually dip it first, and do vitals before calling MD. Our MD doesn't usually do abo's for <100,000 either, unless they are having s/s; ie: fever, behaviors, etc. If we don't medicate, we keep an eye on them.

[ktwlpn]

Originally Posted by Furwillfly

We have standing orders for UA'S/Labs from our COS. We will usually dip it first, and do vitals before calling MD. Our MD doesn't usually do abo's for <100,000 either, unless they are having s/s; ie: fever, behaviors, etc. If we don't medicate, we keep an eye on them.

We HAD a protocol for a U/A if we saw a sudden change in behaviors,increased confusion or 2 falls in a 14 day period-turns out that it was cost prohibitive (even though we caught many UTI's) Now our psychiatrist has been told she can recommend U/A's but we have to call the residents physician first and if he concurs then we can obtain the urine.It's the bottom line taking precedence over the well being of the resident here...Especially since we just had the worst survey in the history of the facility and the new admin are running scared for their jobs (as they should be IMHO) If they can control that budget then they think they can save their jobs,I guess....

[Furwillfly]

That's too bad. We can't afford to not do a r/o UA or my staff have the potential risk of getting the c*** beat out of them, or worse another resident. In our eyes this is more important and cost effective than staff time loss or state having to come in for a resident to resident with injury and siting us for not treating or following through. And we got our MD to see it our way..LOL

[MistyDreamer]

One thing we found out on our unit was to monitor the TV programs that were on. A lot of your advanced stages believe that what they are seeing on the screen is real and happening to them. One lady swore her husband who was in the unit with her was cheating on her and kept attacking other female residents. Her TV was being tuned to daytime soaps by CNA's. Once we instigated no TV except by resident request, our agitation and combative behaviors decreased dramatically. The complaining by staff about the policy stopped when they realized they were getting hit less!

[adrienurse]

What do you make of the recent trend against antipsychotics? There has been research which seems to be getting validated elsewhere that shows at those elders being given these drugs to treat behaviours causes mortality to go up significantly through cardiac problems, but just from the results of falling. Have you seen a decrease in use where you work?

[lookingbeyond]

Originally Posted by Angie O'Plasty, RN

One day, I got so tired of hearing a resident tell me, "I want to go home. I want to go home," and it was just such an awful day, I just blurted out, "Well, so do I."

From then on, we were buddies conspiring to get home together.

This might not work for everyone but it worked for me and my dear, dear friend Rosie. (She finally got to "go Home" a few years later.)

That is funny! I'll have to remember that one! LOL

[lookingbeyond]

Originally Posted by bluegeegoo2

For me or the resident? Just kidding. The one who wants to go home was a server for most of her life, and the other was a noc nurse for a long, long time. She doesn't remember being a nurse, though. I've had the former fold towels and such, but she was very fixated on "home" last night. I've never seen her that excited for that long before. She is a sundowner and will usually settle in by 2230. I guess they will just have nocs like that. I feel bad, though, because she was obviously very agitated and there was nothing I could do to help her. She even has a steno pad her daughter brought her filled with info on where she is, why she's there, etc. She kept saying, "Well, I just don't believe THAT" and on and on. Well, it's a new day, and a new opportunity to try again!

I can sooo relate. I hope your next time with her is smoother?

[achot chavi]

I can empathize and here are some tips= not necessarily a quick fix but we put in a snoezelen sensory room (if you don't know know it is- google it) and it really helps. also we got neighborhood volunteers to take patients for walks. humor is always good and last but not least- take a day off and pamper yourself. Alzheimers patients require the patience of a saint. there are many new strides in treatements- pills and vaccine etc- so hopefully our generation will not suffer- try empathizing- remember these patients die twice- first their personality then their body goes. they need our tlc more than ever

[sweetmagnolia1439]

As a nurse who works with Alzheimer's and dementia patients, I've found that redirecting works 'part' of the time. Most of the time, Ive found that you just have to try and enter "their world". Agree with them, talk to them about anything they say and it calms them down. If you agree and talk to them from their perspective....it leaves no room for arguments, etc. Of course, I'm not saying this works ALL the time, but in the vast majority of cases I've encountered, it does. Try it...it's fun to 'role play' with them and it makes them feel as if they know exactly what they are referring to. If "Bob" isn't coming back for 8 hours, tell them he is coming back in a "little while". They don't understand the difference in 8 hours and 'a little while', but it makes them feel better. That's what it's all about....keeping them safe and making them feel secure and knowledgeable.. REMEMBER....Alzheimer's pts. and severe dementia pts. CAN NOT BE REORIENTED! You have to enter 'their world' in order to better understand them.......don't try to make them enter 'our world' as it's a lost cause and only causes more frustration and anxiety for them. Trust me...it WORKS!!

[nurse_clown]

Originally Posted by MistyDreamer

One thing we found out on our unit was to monitor the TV programs that were on. A lot of your advanced stages believe that what they are seeing on the screen is real and happening to them. One lady swore her husband who was in the unit with her was cheating on her and kept attacking other female residents. Her TV was being tuned to daytime soaps by CNA's. Once we instigated no TV except by resident request, our agitation and combative behaviors decreased dramatically. The complaining by staff about the policy stopped when they realized they were getting hit less!

Do you have any suggestions for more appropriate shows they could watch? I wonder if keeping a liabrary of DVD's would help the ones that don't sleep at night very well. We have one resident in particular who watches tv a lot. We've also had a recent increase in new tv's over the last little while. The residents don't really know how to use them. Or would music be more appropriate at night time?