HOW WOULD YOU about taking care of a patient as the one described.

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    "The patient is a white female who appears her reported age. She neither speaks nor comprehends the spoken word. Sometimes she babbles incoherently for hours on end. She is disoriented about person, place and time. She does; however, seem to recognize her own name. I have worked with her for the past six months, but she still doesn't recognize me.

    "She shows complete disregard for her physical appearance and makes no effort whatsoever to assist in her own care. She must be fed, bathed and clothed by others. Because she is toothless, her food must be pureed; because she is incontinent of both urine and stool, she must be changed and bathed often. Her shirt is generally soiled from almost constant drooling. She does not walk. Her sleep pattern is erratic. Often, she awakens in the middle of the night, and her screaming awakens others.

    "Most of the time she is very friendly and happy. However, several times a day she gets quite agitated without apparent cause. Then she screams loudly until someone comes to comfort her."
    Last edit by betts on Nov 20, '01
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  4. 10 Comments so far...

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    WOW... Sounds like she has a lot going on.Does she understand the written word? You could have ORIENTED BOARDS on her wall such as pictures. Is there a clock there? Can she write? Prehaps she doesn't eat BECAUSE she has no teeth. Get a consult ASAP.Does she not walk because she can't or won't(CONSULT). Is there the possibility of B&B training? Don't know her age but could she be in menapause, or some sort of harmonal imbalance? Prehps her M.D. would prescribe a relaxation/sleeping pill for evenings.Could be a bunch of therepy is in order...Physical, speech,psyc etc. Get a bib for her drooling ..............P.S. Don't know nationality. Is there a cultural difference? Does she have family and friends? Add Social Worker to consults
    Last edit by nur20 on Nov 20, '01
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    sounds like she needs alot of attention. She would be better off with keeping the same caregivers as much as possible to develope some sort of trust and alot of hands on human touch. Not just the touch she receives with her basic care, but like when you talk to her, try placing your hand on her shoulder and look her right in the eyes. I see alot of cna's where I work walk into a room, render care to someone and never open their mouths-EVER to the resident. A mere goodmorning is nice, or how are you? Treating the person the way you would want to be treated is a nice start. Maybe she's not receiving the correct medications to control her behavior. Have that checked out. May I ask, what is her diagnosis? and her age?
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    Are you describing an elderly resident, or a six-month old?
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    Coach Cathy,
    My thoughts exactly. Is this a baby? Sounds like one. Makes me want to go check on my little one to make sure he is all covered up. It is cold up here in Cleveland.
  9. 0
    Sounds like she needs lots of love and reassurance. Was this patient previously abused? Can you tell us more about her age and history? Wish I were there to help. Sounds like a real challenge.
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    A Different Perspective on Aging and Caring
    by Paul E. Ruskin, MD


    I was invited to present a lecture to a class of graduate nurses who were studying the "Psychological Aspects of Aging." I started my lecture with the following case presentation:

    "The patient is a white female who appears her reported age. She neither speaks nor comprehends the spoken word. Sometimes she babbles incoherently for hours on end. She is disoriented about person, place and time. She does, however, seem to recognize her own name. I have worked with her for the past six months, but she still doesn't recognize me.

    "She shows complete disregard for her physical appearance and makes no effort whatsoever to assist in her own care. She must be fed, bathed and clothed by others. Because she is toothless, her food must be pureed; because she is incontinent of both urine and stool, she must be changed and bathed often. Her shirt is generally soiled from almost constant drooling. She does not walk. Her sleep pattern is erratic. Often, she awakens in the middle of the night, and her screaming awakens others.

    "Most of the time she is very friendly and happy. However, several times a day she gets quite agitated without apparent cause. Then she screams loudly until someone comes to comfort her."

    After the case presentation, I asked the nurses how they would
    feel about taking care of a patient as the one described. They used words such as, "frustrated," "hopeless," "depressed," and "annoyed" to describe how they would feel.

    When I stated that I enjoyed taking care of her and that I thought they would too, the class looked at me in disbelief. I then passed around a picture of the patient: my six-month-old daughter. After the laughter had subsided, I asked why it was so much more difficult to care for a ninety-year-old patient, than a six-month-old with identical symptoms.

    We all agreed that it's physically easier to take care of a helpless baby weighing 15 pounds than a helpless adult weighing 100 pounds, but the answer seemed to go deeper than this.
    The infant, we all decided, represents new life, hope, and almost infinite potential. The demented senior citizen, on the other hand, represents the end of life with little potential for growth.

    We need to change our perspective. The aged patient is just as lovable as the child. Those who are ending their lives in the vulnerability of old age deserve the same care and attention as those who are beginning their lives in the vulnerability of infancy.
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    BRAVO,betts !!!!!!!!!!!
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    Human touch, interaction and reassurance is so important whether you are 6 months old or 90 years old, 15 lbs or 100 lbs. They need to know that they are loved!

    Good one betts!
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    Is she constantly drooling due to medication? Is she afraid of the dark? If so, does she have a night light? Is she angry only at certain times of the day? Could it be pain related? If this woman can't make her needs known then I can only imagine how that would make me feel. Terribly lonely and frightened. Sometimes we need to remember to put ourselves in our patients shoes. Then, maybe you can find an answer. It may be a long process of tring different things.


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