Re-directing tips needed for Alzheimer's/behavior pts

[bluegeegoo2]

What tricks of the trade do you have for re-directing Alzheimer's or behavior pts? There are 2 in particular on my unit that drive me up the wall! One is so very fixated on "going home" that it seems no amount of attempts at redirecting will work. For instance, last night the 2 were hell-on-wheels. I had 2 skin issues, a fall, and a med pass to take care of. After 11.5 hrs of hearing, "who can help me move my stuff?", and "I want to go home" and watching her pace up and down the halls, go in others peoples' rooms, "pack" some of her stuff and drag it to the nurses' station from 1 res, then the other who wails like a banshee at any attempt at redirection had me pulling my hair out by the time I (mercifully) left. We offered snacks, drinks, turned on the t.v., radio, gave them pain meds, anti-anxiety meds, and sat with them in their rooms and NOTHING WORKED. I am sooooo very frustrated I could scream!!! And, naturally, both are up ad-lib. The lady who was trying to move all night sat RIGHT IN FRONT OF ME FOR HOURS going on about wanting to leave, call the police, etc. She, however, was not violent or any other behavior to warrant a chemical restraint. Any tips on keeping my sanity during such occasions would be GREATLY appreciated!:plsebeg:

[nightmare, RN]

This is a great thread. I think it needs to be a sticky.

Thank you for the idea,this thread is now a sticky.

[linzz]

Yes, I agree that it needs to be a sticky. I have also used the your room is all paid up and you need to use it story. Works quite well most of the time.

I worked as an aide years ago and had a patient that would take things from other residents and not let them go and one of the nurses there would give him one of his own things as a trade to get back the item that he took without permission. Just thought I'd mention this.

[squeakykitty]

Thank you for the idea,this thread is now a sticky.

Thanks, I'm glad it is a sticky, since there are a lot of good ideas here.

[Furwillfly]

I work in a facility with many alzheimer residents and like the other poster said, you need to do labs if this is a sudden or pretty gradual onset. We use behavioral intervenions first, before we medicate. If 3-4 interventions don't work, we medicate. I also deal with those who have mental/pysch disorders. We have a list of 10 rule outs we do.

I worked with a resident with alzheimer's who was a nurse. We put M&M's and med cups on her table and this woman sorted them all into these med cups for 'her patients'. (she wasn't a diabetic) She did this for hours! Find nurse related things. Even though she may not remember, her soul may still know.

I have a resident who continually wants to leave and we just give her bags. The woman has tons of clothes. She tires herself out when she realizes they are put up and she re-packs and tires herself out.

You just need to be creative. Family can help with projects. But their behaviors are usually worse when something is physically wrong.

If you do medicate, you need to use the least medication with the least possible side effects. Most facilities don't like to use some of the meds we use cause it is a charting nightmare.

Our facility accepts those with violent, aggressive, and unpredictable behaviors that are hard to manage. Not many places take them anymore. We have behavior sheets we have fill out on everyone when they first come in, and then periodically after that. To justify the use of the meds we give.

Sometimes its as easy as soft music, to giving them lotion they can rub in their hands, to making them feel useful, or special. I have one resident who doesn't like me for whatever reason, and I brought stuff like 'lotion, perfume, soaps, old gaudy necklaces' and when she takes her meds, she gets to pick one. Sometimes, it's sugar free candy. You can tailor to their needs.

If I can think of anything else, I'll contribute.

[bluegeegoo2, LPN]

Yesterday I called the Dr. of the woman we were giving Ativan, and he rx'd Xanax instead. When I called the daughter w/the update, she said "That's what I always used to give Mom and it worked like a charm". ??????? We've had this lady at our facility for a couple of months now, (she was on the skilled unit when I was), and NEVER, not ONCE did the daughter mention that Xanax worked for her mom. We began using it last evening and her anxiety level has dropped tremendously. She still voices concerns about being "lost", but they only last maybe 1-2 hrs tops and she's off to bed at a reasonable time. I did ask for a lab order, but the NP that works for the Dr.s didn't see cause for labs at this time. The NP is a whole different issue. She didn't order a tx for a man whose u/a came back with

[dbsn00]

I work in a facility with many alzheimer residents and like the other poster said, you need to do labs if this is a sudden or pretty gradual onset. We use behavioral intervenions first, before we medicate. If 3-4 interventions don't work, we medicate. I also deal with those who have mental/pysch disorders. We have a list of 10 rule outs we do.

I worked with a resident with alzheimer's who was a nurse. We put M&M's and med cups on her table and this woman sorted them all into these med cups for 'her patients'. (she wasn't a diabetic) She did this for hours! Find nurse related things. Even though she may not remember, her soul may still know.

I have a resident who continually wants to leave and we just give her bags. The woman has tons of clothes. She tires herself out when she realizes they are put up and she re-packs and tires herself out.

You just need to be creative. Family can help with projects. But their behaviors are usually worse when something is physically wrong.

If you do medicate, you need to use the least medication with the least possible side effects. Most facilities don't like to use some of the meds we use cause it is a charting nightmare.

Our facility accepts those with violent, aggressive, and unpredictable behaviors that are hard to manage. Not many places take them anymore. We have behavior sheets we have fill out on everyone when they first come in, and then periodically after that. To justify the use of the meds we give.

Sometimes its as easy as soft music, to giving them lotion they can rub in their hands, to making them feel useful, or special. I have one resident who doesn't like me for whatever reason, and I brought stuff like 'lotion, perfume, soaps, old gaudy necklaces' and when she takes her meds, she gets to pick one. Sometimes, it's sugar free candy. You can tailor to their needs.

If I can think of anything else, I'll contribute.

I think we work at the same facility (ha ha). I too have several residents who are former nurses, including my former supervisor. I ask them to "help me" with paperwork & I've done the candy in med cups so they can "pass meds". I also "buddy up" with them if they are asking to go home - I tell them I want to go with them, we can wait for the bus together or that we can't leave for at least x amount of hours...usually something will distract them from continuing with the behavior. Most of my "packers" will forget what they are doing by the time they're done packing their belongings (thank God). I always try to find out what the residents did for a living & asking questions can also distract them for awhile. But in night shift...one determined LOL can really mess with your entire night, just pray that you only have to deal with one at a time! If we notice a sudden change in behavior & no interventions are working as the others have said it's wise to do labs & a U/A C&S - UTIs in the elderly cause some major behavior changes.

[Furwillfly]

We have standing orders for UA'S/Labs from our COS. We will usually dip it first, and do vitals before calling MD. Our MD doesn't usually do abo's for

[ktwlpn, LPN]

We have standing orders for UA'S/Labs from our COS. We will usually dip it first, and do vitals before calling MD. Our MD doesn't usually do abo's for

We HAD a protocol for a U/A if we saw a sudden change in behaviors,increased confusion or 2 falls in a 14 day period-turns out that it was cost prohibitive (even though we caught many UTI's) Now our psychiatrist has been told she can recommend U/A's but we have to call the residents physician first and if he concurs then we can obtain the urine.It's the bottom line taking precedence over the well being of the resident here...Especially since we just had the worst survey in the history of the facility and the new admin are running scared for their jobs (as they should be IMHO) If they can control that budget then they think they can save their jobs,I guess....

[Furwillfly]

That's too bad. We can't afford to not do a r/o UA or my staff have the potential risk of getting the c*** beat out of them, or worse another resident. In our eyes this is more important and cost effective than staff time loss or state having to come in for a resident to resident with injury and siting us for not treating or following through. And we got our MD to see it our way..LOL

[MistyDreamer]

One thing we found out on our unit was to monitor the TV programs that were on. A lot of your advanced stages believe that what they are seeing on the screen is real and happening to them. One lady swore her husband who was in the unit with her was cheating on her and kept attacking other female residents. Her TV was being tuned to daytime soaps by CNA's. Once we instigated no TV except by resident request, our agitation and combative behaviors decreased dramatically. The complaining by staff about the policy stopped when they realized they were getting hit less!

[adrienurse, LPN]

What do you make of the recent trend against antipsychotics? There has been research which seems to be getting validated elsewhere that shows at those elders being given these drugs to treat behaviours causes mortality to go up significantly through cardiac problems, but just from the results of falling. Have you seen a decrease in use where you work?

[lookingbeyond, BSN, RN]

One day, I got so tired of hearing a resident tell me, "I want to go home. I want to go home," and it was just such an awful day, I just blurted out, "Well, so do I."

From then on, we were buddies conspiring to get home together.

This might not work for everyone but it worked for me and my dear, dear friend Rosie. (She finally got to "go Home" a few years later.)

That is funny! I'll have to remember that one! LOL