Advice on dealing with confused patients - page 2

by SubSippi

3,267 Views | 22 Comments

I work on a tele floor, but lately I have been getting patients whose medical diagnosis is "Alzheimer's, waiting for placement." I'm a new nurse, so I'm not sure how common this is, but what has been happening is that a family... Read More


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    We have an activity table that has stuffed animals that talk or sing little clips also photo albums and magazines, playing cards and as someone else mentioned, wash clothes to fold. Maybe you can suggest to the doctor to prescribe melatonin, because it helps with sundowners. Music therapy if possible when they are winding down. Sometimes they need to go the restroom as well.
    nrsang97, Lev <3, finn55, and 2 others like this.
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    If there's an area where the patient could come to harm, put down a black mat. For example that isolation room or stairwell door. The wanderer will perceive it as a hole in the floor and won't cross it.
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    Hmm, interesting. we use the mats, and all they do is serve to trip up the pt .They're supposed to help them if they fall.Might as well bubble wrap the pt.
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    I have lots of these patients but we have a few things in place to deal with them. We are not a locked unit but the wandering patients have wanderguard bracelets that cuase the doors to lock if they approach them and alarm if they get out.We have aTV and we try to distract with movies and we have an activationist that does activities with them.The worst ones are seen by an MD that specializes in geriatric mental health and he medicates them appropriately.A lot of these patients are waiting for LTC placement.
    All we can do as staff is keep an eye on them as best we can.The most agitated ones will get sitters.
    Lev <3 likes this.
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    A dilemma we deal with is the ones who think they can walk independently, but can't. So they are constantly setting off bed/chair alarms( cause they won't sit still) , causing the whole staff to go running to stop them where they are trying to get up.Sometimes at least 10 pts of 28 are on these alarms( med tele floor)

    Kinda hard taking care of any other pts who might be really sick( ie- on drips ) when we are constantly redirecting those demented pts.

    I wish Dr's would be more proactive in dementia behavior and use the appropriate meds. It's not for convenience, it's for pt safety!Cant exactly mat the whole medical floor....
    Lev <3, finn55, and Esme12 like this.
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    I work on L&D and have COMPLETE respect for y'all on med/surg/tele floors!

    I never have more than 3 labor patients OR maybe 5 couplets (5 moms and their newborns) at a time and none of them are actually sick, let alone demented!

    I can relate to the staffing issues though, a mom in labor should be a 1:1 but we rarely have the staffing at night to allow that!

    Good luck, though!
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    I am a Unit Manager at a LTC facility. I have worked with dementia in one way or another since the beginning on my nursing career 6 years ago. I'll tell you what I have learned works best for me. Keep it personal, speak softly as you can and make your voice as pleasant and as sweet as you can. Be sure you smile widely or look concerned, whatever suits the situation the best. Smiles go a long way. Your initial approach to a confused and/or a combative patient is key. Try to make eye contact with them and keep it, get their attention focused on you if you can and keep it there. Ask them questions about themselves: where did they grow up, what did they do for a living, where and how did they meet their husband or wife, etc. With a pleasantly confused patient, this works 95% of the time. You did well with the towel folding. Usually if you figure out what they did for a living, you can come up with some creative ideas related to that to keep them occupied. A lot of my older folks used to work at a cotton mill in my town. I have loads of clothes and sheets we bring out for them to get their hands on and they will fold alllll day long. If they did something with their hands, find something for them to do that will resemble that feeling in a tactile manner. Something familiar such as this almost always has a calming effect. I had a little woman who was a housewife. I would go into her room and put things out of place, unmake the bed, etc. She would go back in and clean everything up. Just some ideas, hope it helps!
    Lev <3, finn55, and anashenwrath like this.
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    Quote from jrwest
    Hmm, interesting. we use the mats, and all they do is serve to trip up the pt .They're supposed to help them if they fall.Might as well bubble wrap the pt.
    Not the padded floor mats that are used to prevent injury from falling out if bed. Black or dark colored mats like a rug that are used in hospitals or facilities. An advanced dementia patient prone to wandering will likely perceive dark color as a void. It's pretty effective. That way you can save the bubble wrap to keep their fingers busy popping!
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    Cards, dominos, snacks, puzzles, magazines....busy work.
    I've never seen Melatonin work with sun downing....try some trazodone...fewer side effects than Ativan
    nrsang97, Lev <3, and cardiacfreak like this.
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    Quote from dudette10
    For the the dementia wanderer on the tele floor I often work on, we get them comfy at the nurses station with magazines and snacks...a place where there is always at least one nurse or NA available at all times. the responsibility for safety is shared, and it allows the assigned nurse to adequately care for her other patients, too. its too much for one nurse, quite frankly. The patient is bored,bored, bored and isn't getting the stimulation sitting in a private room.
    This is what worked for me in the past when I worked in a Tele Floor as a tech; we were the floor that would get the pt's waiting for placement. Why also works is the activity table like HappyWife suggested, which can be placed over the overbed tray or a "busy" pillow. Both have sensory activities that keep them busy. Now that I work in LTC, I find keeping them busy is key; interaction is a HUGE deal because, think about it-if half of your brain is deteriorating, you can't always control your impulses anymore; and your perception is ANYTHING but normal, how would you feel??? Having a loss of control, no matter how confusing, is going to have some effects of the stages of grief.

    I agree with suggesting trazadone like CapeCodMaid suggested. I would also get a psych consult as well; sometimes they have a great insight in determining if the patients may have underlying depression and/or anxiety, and what would be the safest medication management to use to benefit the patient.

    I hope that with the impending changes of the healthcare delivery system, there will be units specifically for monitoring patients for placement into a LTC.
    Lev <3 likes this.


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