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

[wishiwereanurse, BSN, RN]

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?

[Nurse&]

don't he have family member who can talk him into it? The physician or any others hospital professional can rely on the help and/or support of family .This way may be he will agree to cooperate having his family stand his side .This is all i can think of . I am still in school so i really don't know how things work in the real world out there. didn't even know a pt can be allowed for stay up to month without being showered.

[Virgo_RN, BSN, RN]

Has anyone been able to determine the reason for his refusal to shower? Does he feel unsafe doing so?

[wishiwereanurse, BSN, RN]

all i know is i think he's got schizophrenia and he's afraid of water, and he used to take his meds but now when i ask him why he wont take his meds he says they don't do him no good...i've never dealt with someone like this before that's why im asking for help

[Virgo_RN, BSN, RN]

What about alternative methods of hygeine, such as waterless shampoo? Will he use those?

[wishiwereanurse, BSN, RN]

most of the time he gets agitated when approached, CNAs are afraid to go near him, and when offered those waterless shampoos he refuses them. I am glad that he eats, at least. But he's got the same shirt on since 3 weeks ago.

[morte, LPN, LVN]

if he has been declared incompetent...which the "ids conserved" would lead me to believe....the conservator needs to be notified...and meds might be given by force....and the showering done with sedation.....NO BATH

check with social work etc

[racing-mom4, BSN, RN]

But he's got the same shirt on since 3 weeks ago.

"Opps uh oh Sorry I spilled this entire can of strawberry boost down your shirt--silly me--here let me help you change"

That is what I had to do once with an AHLZ pt. I agree sedate him and scrub him. It is not only your job to keep him safe and comfortable but your other patients too, and if he was my room mate I would want to kill him. So dont do it just for his sake but for the sake of the other residents.

[oldladyRN]

This is such a sad situation. It is very common for people with paranoid schizophrenia to have issues involving water touching their skin. It is, as a result, common for patients with paranoid schizophrenia to have terrible hygiene issues.

Where I work, we usually look at it on a case-by-case basis, but three days without a shower is pretty much the limit. During the summer months, or when a female patient is menstruating, three days can smell like three years. We do make every effort to encourage them to make the decision to shower, but we will get a doctor's order if necessary. The doctor's order will state that the patient must shower on XXX date and "cannot refuse". We then restrain if necessary to carry out the order.

It can quickly progress from a simple hygiene issue to a health/infection control issue. The trick is knowing when that line has been crossed. As always, every effort is made to get the patient to make the right decision on their own without having to physically intervene.

[Katnip, RN]

I don't know if you can do this in LTC, but if he has psychiatric issues, talk to your social worker and get him a hearing so he can be forced to shower. And a med panel where he can't refuse his meds. It sounds cruel, but once he's taking his meds, he should come around a bit and be more cooperative.

[woknblues]

You are probably doing this already, but make sure you are documenting all the refusals on his part, and do make sure you are referring for psych evaluation, and documenting. Can someone really go without a shower or bath for 3 months inside a facility?? Color me surprised.

[NY-RN_Kay]

I'm just a student, but I would see if I can get a order for a sedative because this is serious. This must be against infection control. Think of all the things that are brewing on his skin and groves! Yuck! I say speak to charge, administration, DR and see if a sedative can be given to knock him out and scrub, scrub, scrub!!!