Independent by day, dependent at NOC

[fangirl]

So, there's this patient who during the day is completely and totally independent. Showers self, feeds self, dresses self, walks unassisted, you get the picture. But, at 7pm, they change gears and demand staff to do all ADL'S for them. They will hit the call light to ask you to hold the cup and give them a drink. Demand you walk to the bathroom with them and hold their hand, demand you pull their brief down and pull it up. They will also demand for staff to turn them over in bed. Resident is below 150 pounds and is perfectly capable of turning themselves over. No amputations or fractures and no recent falls. I just don't understand what to make of this, other than that the patient wants attention. Staff has tried everything from encouragement and praise to just doing it all for them. Any ideas?

[Been there,done that, ASN, RN]

It's time to call for a patient care conference. All disciplines need to come together on this. Especially the attending physician.

There is a psych issue that needs to be addressed. It could be sundowner's syndrome.

Best of luck to the staff and your patient. Let us know how it's going.

[heron, ASN, RN]

It's time to call for a patient care conference. All disciplines need to come together on this. Especially the attending physician.

There is a psych issue that needs to be addressed. It could be sundowner's syndrome.

Best of luck to the staff and your patient. Let us know how it's going.

Yup.

Where is this happening - acute or long term care?

How long has it been going on? How often does it happen?

Look at medications, especially psych, pain and

sleeping meds, as well as med changes. Elders can be tricky to medicate, especially sundowning elders. (Any good psychiatrist would say the same thing, I think.)

"First, do no harm" - I think the priority is to avoid doing any more avoidable damage.

[calivianya, BSN, RN]

What time does family visit?

I have seen very anxious or attention-seeking patients suddenly become helpless when their family members leave. Day shift reports patient is doing great all day, low maintenance, very independent. Family walks out the door, and patient is instantly on the call bell every fifteen minutes.

Sundowners certainly do this, but A&Os do too. The most common groups of A&Os who do this for me are either COPDers/sleep apnea people who went to sleep one night and woke up in the hospital on the ventilator, or the rare cardiac arrests with no/minimal deficits. Both are 100% convinced that if they go to sleep they are absolutely going to arrest again, be it cardiac or respiratory, and if they are alone at the time, no one's going to catch it in time and they are going to die for real.

The sundowners are harder to fix, but I usually just call for something for anxiety for the A&O ones. They need some time to mentally work through what happened to them before they can get control of their anxiety, but we can help them out pharmacologically until then.