LTC Screamers - page 2

Hi, I was wondering if anyone here works with LTC residents who have a habit of screaming? In our facility we have one woman who calls out continually for help that it sounds as though she is... Read More

  1. by   nursedawn67
    I have found some yell/call out just out of sheer habit. And no matter how many interventions tried nothing stops the yelling/calling out.
  2. by   ktwlpn
    I have found some yell/call out just out of sheer habit. And no matter how many interventions tried nothing stops the yelling/calling out. >>>>>>>>>>>.Especially since the most effective measures would be considered abusive-like a rubber band around the wrist-snapped briskly every time they yell out....:chuckle ........One of my gals called out all afternoon today-when I went over to her for about the 19th time she asked me very innocently" What the hell do you want?
  3. by   CashewLPN
    um... on my usual floor, we have 1 screamer, 1 attacking wanderer, and, 1 'cry and moan' person...

    each, will respond to verbal stimuli, some stop, some dont... we seperate the attacking wanderer, often to a geri chair with table (we have an order for that prn) and, then, put into the dimmed dayroom, (which then, he gets quiet) (and, he spits out meds... so the PO .5mg of ativan, mind you this guy weighs easy 125 KILO's easy... well.. it doesnt work)
    the yeller, we bribe with cheese doodles... if he's chewing, he cant scream... (yay) its worth the yellow mess...(he is also, vest restrained (with order) to the chair... as he likes to get up and fall... ALOT)
    the moan/cryer has bad mental retardation... She can speak regularly and let us know what she wants, but occasionally she wants things we just cant give her...like, she wants her roommate out of the room permantantly( another woman w/ M.R. who is the floor 'baby'... cute and giggles all the time) or, her favorite, turn off the street lamp (even with the light blocking curtains closed)... we tell her no, that we cannot do that, and, she cries/moans all night... 'hon, why are ya crying?' 'Turn out the street light.. aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa aaaaaaaaaaaaaaaaaaaaaaaah. Now! aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa aaah. '
    not an urgent cry... just a I want my way now cry...
    we keep her door closed, which she seems to like, and she hopefully sleeps....

    what do we do... we do our best...
    --Barbara
  4. by   FutureRNMichael
    Maybe it would help if you had the family talk with the resident?
  5. by   MandyInMS
    What works for one doesn't work for another..usually takes a while to regulate meds for each person for the best results..you mentioned that Ativan zonked her for almost 24 hrs...what mg? maybe trying lowest dose 0.5 mg q 6-8 hrs...just enough to calm her but not 'zonk' her..we have a geri-psych floor that is wonderful...they try diff meds / doses until they find what works...maybe you could suggest sending her to one of those units where she could be monitored closely and find the effective med relief........I can see myself in my 80's (if I live that long) being what I call a 'tortured soul'..screaming, yelling, fighting, totally out of my mind....I'd just hope and pray somebody would help me.As many diff meds that are out there SOMETHING will help..just takes a little time and effort to find the right one...best of luck hun (((hugzzzz)))
  6. by   gizzy76
    Didn't want to revive this thread seeing as it's been a few weeks since the last post...but....

    the issue of this woman was brought up by a concerned staff member today and we had a candid talk about treatments or what can be done for this woman.

    The main issue at hand today was...her disruptiveness...and how it affects the residents who "live" around her.
    We have a 45 year old gentleman with ALS who is practically across the hall from her and today he refused his exercises because he was all worked up over her screaming constantly and calling for "help".

    What do you all have for suggestion of how we can give the OTHER residents some peace and quiet???? We are desperate for some advice!

    What has worked for some of you?
  7. by   adrienurse
    Okay, I work with people with dementia for a living.

    Having the people available to lavish the so called screamer with love and attention 24/7 would wipe the occurance off the face of the earth, but we all know that's not a viable option.

    Sedatives like ativan do nothing but dope people out of their tree and cause falls. They are a better treatment for staff then for the patients.

    Antipsychotics are good, and contrary to popular opinion, i believe quite essential when dealing with agiatated behavior (ding ding ding -- see footnote). Allows the demented mind to focus and have a sense of calm. Most signs of agitation are caused by fear and sense of unease. Some popular ones are Seroquel/Quetiapine (my personal favorite, but can cause hypotension), olanzapine/zyprexia and risperidal. I am not a fan of risperidol, cause of its parkinsonian-type side effects. Very rare, but I have seen it cause tardive dyskenesia (which is not good at all). Contrary to what you would think, putting the person on ever increasing doses of antipsychotics rarely diminishes the problem. Lord if I had a nickel for every time we get a transfer that is on humungus doses of risperidol....... Small doses actually work better, and it is wiser just to switch to a different drug if you find the one you're using is not working. Haldol is a dinosaur drug and is just NOT used in nursing homes any more. Should not, should not be used (+++EPSs)

    Some of these behaviours are self stimulating (ie person is suffering from lack of stimulation and so entertains self with screaming). Behavior modification does work, but is dependent on consistency and staff co-operation (whiches is rarer than rare these days).

    FOOTNOTE:
    Please for the love of god, investigate for physiological causes of agitation prior to committing to a long term Rx treatment. Rule out pain as a cause. Rule out any other sources of irritation and negative stimulants that would likely cause screaming.
  8. by   ktwlpn
    DO check her urine and try some extra strength tylenol.HOw are her teeth?..I have not seen seroquels effectiveness yet-our psych doc just recently stopped all of our risperdal which was very effective for most of our residents.We have a unit that uses a lot of depakote and has good results with it (with close monitoring of labs) Have you heard of Snoezelen? It's a sound and tactile stim thing-do a search on the net for activities for alzheimer's residents.I may not have the spelling correct on it...It may be worth a try....If other a and o residents and their families get involved and approach the DON her and the doc are going to have to go back to the family of this resident and something will have to be done...The other resident can always call the ombudsman-they have rights,too...Is the screamer ambulatory? If not independently have you tried a merry walker? They also have some kind of glider rocker that the resident can bounce around in-sometimes they just need to move and we have to find away for them to do it safely....Have you tried a mattress on the floor or bean bag chair for her?
  9. by   GAstudent
    I also work in LTC, and I am a CNA. We have a few screamers. One of them is a man who yells all hours of the day. We have pt and family complain of him all the time but there is nothing that I can give him for it (that is up to the docs and nurses). Most of the pts buy hear plugs. Sometimes For him the nurses give him meds and he sometimes gets quite but not always. I have started taking him milk and changing his position. Believe it or not it works with him.

    We have a lady who yells all day and we can't keep her quite at all. I've tried and her family does not want her out in the hall or up in her chair, they want her in her bed. We can't do anything with her.
  10. by   adrienurse
    Now I need some input-we have a pee-er on the unit.She is in a private room due to some of her strange habits-she will not use a bedside commode(used it for storage and peed on the floor) She will not go out to the bathroom across the hall(but she knows where the dining room is and what it is for)She is a rummaging hoarder...Any ideas? She just squats and pees in the corner of the room-and does it smell!
    Maybe she cannot recognize the commode as a toilet? Is her path to the toilet obstructed? I would look into whether she has a UTI. From my experience, people usually pee in inappropriate places because they cannot fing the toilet. Posting signs and pictures all over the place can help. What also can help is if the person is physically taken to the toilet every 2 hours while awake and especially after meals. Also more frequently after a diuretic is given.

    Also, learn to spot cues that the person needs to go to the toilet, eg. gulling at clothes, stripping, and calling out are common ones.
  11. by   ktwlpn
    Originally posted by adrienurse
    Maybe she cannot recognize the commode as a toilet? Is her path to the toilet obstructed? I would look into whether she has a UTI. From my experience, people usually pee in inappropriate places because they cannot fing the toilet. Posting signs and pictures all over the place can help. What also can help is if the person is physically taken to the toilet every 2 hours while awake and especially after meals. Also more frequently after a diuretic is given.

    Also, learn to spot cues that the person needs to go to the toilet, eg. gulling at clothes, stripping, and calling out are common ones.
    This gal was given a bed side commode-she put her shoes in it and climbed up on the sink to pee.....We try to get her to go regularly but often she just refuses-I have seen her go to the bathroom on her own in the proper place.Go figure-she is inconsistent.It is usually during the night that she hits the floor.Sometimes she will go in the trash can-often she moves the bed-pees-and then pushes the bed back over it....Or just squats wherever.She has had a UTI in the past yr and we just checked her a few days ago.She probably has one now but treatment in the past did not effect her habits.She is too strange..She used to throw things out of her window and pee in the radiator until they closed it off....

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