Need Help With VS

[greatan]

Can anyone help. This is my first clinical experience in LTC. We have to do vitals on our pt every clinical. Just one problem. How can you stay focused to listen (and actually hear) apical, radial pulses and do bp with dementia pts. My pt usually is moving around a lot and saying it hurts whenever I take a bp or the pulse is so faint I can't hear it. Either way I get distracted from the pt's reaction to the vitals I am taking I cannot hear anything. Please help!! P.S. No it doesn't hurt her, she has Alzheimer's and is always completely aware of everything around here. Her reaction with my instructor was the same way. Any help would be appreciated.

[Daytonite, BSN, RN]

the trick to working with alzheimer's patients is to distract them when they are in a mood to allow you to distract them. when i worked in a nursing home that had an alzheimer's unit, a primary rule of working with the patients in the alzheimer's unit was that we did things by the patients schedule, not by ours. consequently, these patients were sometimes up eating breakfast at 1am or getting dressed to go to church at 9pm on thursday night.

you get a pulse by letting them allow you to hold their hand and wrist while talking with them. what you are really doing is taking their pulse and respirations while looking at a clock on the wall to watch the time. the blood pressure is a little trickier. you need to try to get them to cooperate with you. but, if they won't have any of it, then you don't get a blood pressure that day. it's not worth arguing and getting the patient agitated. if the patient is up and moving, they have a blood pressure.

[greatan]

Thank you, Daytonite. I thought there was something wrong that I was doing. I glad to know there is a certain way to deal with these pts. My only problem is that my instructor is asking for these vs at postconference and I truly need the experience of doing these skills. Your answer helped explain to me why exactly my pt is up and out of bed at 5am, when everyone else is still in bed. It is also hard to do vs because she sleeps most of the time and waking her up too much gets her agitated. I just want to make sure my skills are honed before moving on to the next clinical site.

[Daytonite, BSN, RN]

Ask the staff what they do to get the patient's vital signs. I found that with the Alzheimer's patients there were often certain CNAs who were able to get the patients to do things for them that others of us could not. That's just the way it works with this population of patients. The criteria for any CNA or nurse to work in the Alzheimer's Unit was that they had to be "turtles". In other words, extremely patient, laid back, kind and able to allow the patients to do their thing. I'm not saying that we weren't constantly trying to figure out how to get our tasks accomplished with these patients! But, it was a great challenge to work at their level and have to constantly modify our routines.

[Megsd, BSN, RN]

If you need the experience of doing the skills and your particular patient is uncooperative, in addition to the recommendations Daytonite mentioned, I'd let your instructor know the difficulties you're having (if she doesn't know already) and see if there are other patients (ones your classmates have, or ones students are not working with) that need vitals taken that you can try, who might be a little more cooperative.

[sissyboo]

Always make sure it is quiet! Shut the door, turn off tv or radios. Some Alzheimers patients could be distracted with something for a few minutes and you could get their VS.

[minnytangles]

I always move my head to the beat (heart), or tap my foot to stay on count! also -practice, practice, practice. Practice on yourself or someone you are comfortable with untill you get the hang of it. Also try taking a newborn heart rate- they are really tricky in the 120's!!!! Also you can take them for 15 sec. and multiply by 4: this may be containdicated for some situations. -Good Luck

[locolorenzo22, BSN, RN]

A good trick I've picked up so far is to take the pulse while inflating, pump up to 40 past where you stop feeling it, slip on steth QUICK, then watch the dial. When it starts bouncing, the sounds usually start around 2-4 mm past there, then you get the rhythm.....

Distraction is a powerful tool, a little tv, or a good picture can keep attention for a few minutes....Dementia pts are tough to deal with, but don't lose your focus!

[JaxiaKiley]

Thanks for asking this question -- this is good information!

[lovingtheunloved, ASN, RN]

the trick to working with alzheimer's patients is to distract them when they are in a mood to allow you to distract them. when i worked in a nursing home that had an alzheimer's unit, a primary rule of working with the patients in the alzheimer's unit was that we did things by the patients schedule, not by ours. consequently, these patients were sometimes up eating breakfast at 1am or getting dressed to go to church at 9pm on thursday night.

you get a pulse by letting them allow you to hold their hand and wrist while talking with them. what you are really doing is taking their pulse and respirations while looking at a clock on the wall to watch the time. the blood pressure is a little trickier. you need to try to get them to cooperate with you. but, if they won't have any of it, then you don't get a blood pressure that day. it's not worth arguing and getting the patient agitated. if the patient is up and moving, they have a blood pressure.

will you come work with me?