I want this pt showered...and a bunch of other questions...

[wishiwereanurse]

We have a resident who hasn't showered in months. He stinks so bad, at one point the smell saturated all the way from his room, down the hallway, to the nurses' station. He also hasn't been taking his medications, he refuses them. I cannot stand it anymore..someone has to do something about this man's hygiene. I don't have him most of the time but when I do, I am really bothered. The psych hospital was asking me to do a skin assessment on him, but he gets really agitated when we get near him. He told me to go to hell and stop bothering him tonight so I just backed down. He is "lds conserved"...what does that mean? CNAs have tried to lure him into the shower room with snacks, we've given him IM haldol, it's like it had no effect on him...he's growing crusts on his hair, and his roomate is complaining because of the smell. What can we do for this man?

[wishiwereanurse, BSN, RN]

Went to work today but I did not work with this man today. I can only count in my fingers how many times I've worked with him, but I passed by his hall and got a wiff, and still, he is status quo. I swear, my workplace is so weird, this one man was praying with his rosary and his nurse labeled this as a "behavior".

I don't know why they don't get him sedated so he can get scrubbed up and clean and get his skin integrity checked out (SunnyAndrsn's story is like....yikes!). Most of the time he's just lying in bed and the only time he gets up is when he goes to the bathroom or during meals. We did get an order for an IM haldol but after we restrained him and gave him the shot, he got more aggressive. Someone did suggest the IM geodon, it wasn't me, it was another nurse...why they did not get the order for that is beyond me.

The facility is trying to transfer this man to a psych unit in a nearby hospital, i spoke to the nurse over there and she asked me why it seems like nobody is being a patient advocate. The CNAs are also concerned, not just for the patient but also for the roomate. We are amazed that the roomate hasn't been complaining, but family will be visiting the roomate tomorrow and I can just imagine the family having a fit bec of the smell. The CNAs are willing to team up and scrub the man just as long as we get him sedated enough that he wouldnt be combative in the shower room (he's a pretty big guy). Of course it is occuring to us that not doing anything is neglect.

[wishiwereanurse, BSN, RN]

i said the roomate hasnt been complaining bec they transfered him to another room,with a new roomate..

[nurseeB]

We had a patient that didn't want to shower and he smelled really bad. The LPN I was working with told him that if we didn't make sure he was cleaned appropriately it could be looked at as neglect. It worked...the man came out smelling like roses

[leslie :-D]

aw, this story could be one of many pts i've cared for in hospice.

usually, homeless schizophrenics who just break your heart.

i find most of these folks know how sick they are, as they suddenly stop 'dialoging' with their 'buddies' as soon as you enter their room.

with one pt, i could tell that his 'buddies' were giving him a hard time as i talked to the pt.

they must've told him "don't listen to her" as pt would respond "don't worry, i got it" to his 'buddies/voices'.

one day i got really ticked off at these 'buddies' and started yelling at them:

"IF YOU HAVE A PROBLEM, TALK TO ME AND NOT TO JOHN. I AM ONLY TRYING TO HELP YOUR FRIEND. NOW LET ME DO MY DARNED JOB AND KEEP YOUR MOUTHS QUIET!!!"

well, i tell you, 'john' looked at me, studying me carefully, as if:

a- i had totally lost my cookies, or

b- maybe i did understand what john was experiencing.

with that, i quietly promised john that i wouldn't pressure him to take a weekly shower, but that i needed to clean him up now...and that i wouldn't bother him for at least a couple of weeks.

i made verbal contracts with him, which were reasonable and as unintrusive to extent possible.

bottom line: he/they ended up trusting me and allowed me to do what i needed to do.

fascinating yet devastating disease process....

leslie

[Cindy-san]

Question, would/do these types of pts do better with those cleaning wipeys as opposed to an actual shower? I imagine they drink at some point, so the minimal wetness of those cloths might not not be as terrifying?

[Scrubby]

In the OR we quite often have intellectually disabled patients come in to have their teeth scaled and cleaned, and sometimes even just removed because they are rotten. It's quite heartbreaking that they get to the point where they have to be anaesthetised just for dental hygiene but if anyone tries to clean their teeth these patients will become aggressive and probably hurt themselves or someone else. I get so annoyed because often they come into theatre and go berserk (they have no idea what's going on and they are terrified) and it ends up with a bunch of people restraining them and an IM injection. I don't understand why they just give them a pre med to sedate them as much as possible instead of us staff being put at risk of an injury.

But back to your problem I agree that something needs to be done about patient because of the potential for skin breakdowns etc and the potential for litigation. However, the staff also need to be protected from possible violence so that probably means he has to be sedated heavily.

[leslie :-D]

as w/any mental illness, i do think the key to success, is earning their trust.

as i've stated, we've had many pts who refuse or are unable to adequately keep themselves clean...

and just would not trust anyone.

then along came a Godsend of a tech, who was blessed with many gifts and established meaningful rapports w/these type pts.

as with most pts, these pts need to know they're in control.

a big part of compliance, imo, is babysteps, being truthful (which means never, ever trick/deceive them) and involving them in the process every step of the way.

sit them on a shower chair, keeping them covered at all times.

let them feel the water on their leg/arm, so they know what to anticipate.

do not ever, ever spray their face.

when it's time to wash their hair, give them a washcloth to hold over their eyes and keep shower nozzle only on their head.

explain to them, what you're doing/washing, encouraging them ea step of the way.

go as quickly as possible, yet making it therapeutic.

when it's over, dry them completely and dress them quickly.

when they recall the (positive) experience they had, they just may not be as resistant the next time around.

even though are techs are the ones who do the showers/baths, i often will do it myself, if i need to see their skin, or, are known to be labile.

but before any of this transpires, the pt is going to have to trust you in the first place.

if all else fails, then chemical sedation may be necessary, but certainly not on a weekly basis.

finally, document your proverbial behind off, at all attempts to intervene and subsequent refusals.

they're a tough bunch, and decidedly, for good reason.

leslie

[wishiwereanurse, BSN, RN]

sorry I haven't been in AN.com for a long time so I haven't updated but now I'm back and I remembered this (looking through my old posts).

So anyway...

What happened to the man was we got him psych referral and got him some IM Haldol which is a once-a-month shot, the drug started working about some two weeks after it was given to him...it was my day off when they gave him a shower, haircut, nails done, changed everything from beddings to clothes. So the next day I came back to work I seriously did not recognize the man...I thought he was a new admit...CNAs told me it took three of them to get him squeaky-clean.

The man then remained on the facility, he would eat his meals and take his showers and let nurses give him the shot, he rarely talks to me when I visit but he used to wave at me when I work at his hall...

and then one night some months ago, he slid on the floor, cracked his head open and passed away.

Thanks to everyone who gave responses to my inquiries, I learned so much from this experience.

[lamazeteacher]

WOW!

I've never known a fall like that, to cause such disastrous injury.

Perhaps his journey became complete when he accomplished his goal to be socially acceptable.

Good job.

[boggle, ASN, RN]

Thanks for the update. Glad to know he got the needed care.