A gentle approach to dementia...

bellehill, RN · Apr 24, 2003

nursemouse...I think the way to deal with confused patients depends on the level of confusion. If they are confused and agressive, never hesitate to use restraints and get security involved if needed until they calm down. If the patient is simply confused and not agressive; ask the family to sit with them, move the patient out to the nurse's station to sit in view of everyone, give them something to do (folding towels, magazines, puzzles). A lot of times restraints will only make the situation worse and agitate the patient. Just try to keep them calm and make sure they feel safe. :)

Jenny P · Apr 24, 2003

What type of facility are you talking about? Bellehill gave a good answer for a pt. in an acute care facility; but I think the approach would be different for a LTC facility.

BrandyBSN · Apr 24, 2003

haldol? just kidding....

TV (nick at nite really seems to help), family members at the bedside, and songs from their time... also calendars and clocks to keep them as oriented as possible.

howie122832 · Apr 24, 2003

All of the above, but I really found the folding of towels or socks in a basket worked really well to occupy their time. We had an alzheimers patient that was very loud and combative if she wasn't otherwise occupied, so we got a laundry basket full of socks and towels and told her that she needed to "do" the childrens laundry, and she would sit there and mate the socks and fold the towels. When she was finfished, we would un-do everything she had done and she would start over again!... she also like to color, do childrens puzzles, blocks, etc... Good luck with your presentation!

howie122832 · Apr 24, 2003

All of the above, but I really found the folding of towels or socks in a basket worked really well to occupy their time. We had an alzheimers patient that was very loud and combative if she wasn't otherwise occupied, so we got a laundry basket full of socks and towels and told her that she needed to "do" the childrens laundry, and she would sit there and mate the socks and fold the towels. When she was finfished, we would un-do everything she had done and she would start over again!... she also like to color, do childrens puzzles, blocks, etc... Good luck with your presentation!

ktwlpn, LPN · Apr 25, 2003

Originally posted by nursemouse
OK, truth-in-posting: I'm preparing a presentation for relatively new nurses on dementia. I wanted to include input from the allnurse experts on creative ways that you deal with confused patients, particularly in this restraint-free current atmosphere. Any input would be GREATLY appreciated!!! :kiss Thanks! Nursemouse:D

I have found that therapeutic touch,a calm approach and a potty break and FOOD work wonders in LTC....One of the major factors I see that staff is responsible for that contributes to agitating the dementia residents on my unit is loud noise...If you can keep things calm around them you see a difference-age appropriate music is good but not too loud...Laughing and joking in a loud way can really upset and make a resident escalate-so can talking to them loudly and in a condescending tone.Also-if you have someone unable to safely ambulate independently an inexpensive and often very effective method to keep them safe is a low chair-we got maintenance to actually cut down the legs of some of our chair-at and angle with the front slightly higher-like a low Adirondack chair-very comfortable.Not considered a restraint because our friends can get up but these chairs slow them down so that you can get there and walk with them....Doll babies,folding,washing and wiping can all work-you just have to know your resident.But THE KEY is realizing (and teaching the significant others) that THERE IS NO PILL TO FIX THIS-and the best we can do is keep them safe,fed and as clean as possible-and maintaining as high a level of function for as long as possible........Can't MAKE them do anything....If they want to walk-walk with them.Crawl? Do the same-and give them a safe area to move in....I absolutely love getting to know my residents and trying to determine what causes their behaviors and finding ways to manage them-

ktwlpn, LPN · Apr 25, 2003

Originally posted by nursemouse
OK, truth-in-posting: I'm preparing a presentation for relatively new nurses on dementia. I wanted to include input from the allnurse experts on creative ways that you deal with confused patients, particularly in this restraint-free current atmosphere. Any input would be GREATLY appreciated!!! :kiss Thanks! Nursemouse:D

I have found that therapeutic touch,a calm approach and a potty break and FOOD work wonders in LTC....One of the major factors I see that staff is responsible for that contributes to agitating the dementia residents on my unit is loud noise...If you can keep things calm around them you see a difference-age appropriate music is good but not too loud...Laughing and joking in a loud way can really upset and make a resident escalate-so can talking to them loudly and in a condescending tone.Also-if you have someone unable to safely ambulate independently an inexpensive and often very effective method to keep them safe is a low chair-we got maintenance to actually cut down the legs of some of our chair-at and angle with the front slightly higher-like a low Adirondack chair-very comfortable.Not considered a restraint because our friends can get up but these chairs slow them down so that you can get there and walk with them....Doll babies,folding,washing and wiping can all work-you just have to know your resident.But THE KEY is realizing (and teaching the significant others) that THERE IS NO PILL TO FIX THIS-and the best we can do is keep them safe,fed and as clean as possible-and maintaining as high a level of function for as long as possible........Can't MAKE them do anything....If they want to walk-walk with them.Crawl? Do the same-and give them a safe area to move in....I absolutely love getting to know my residents and trying to determine what causes their behaviors and finding ways to manage them-

gwenith, BSN, RN · Apr 25, 2003

Please! Include the concept of diminished processing. All too often i have seen my colleagues approach a confused patient (whether post head injury alzhiemers or Korsakoff's it doesn't matter) one will stand one side and the other will stand the other side and talk to them. Then they wonder why the patient errupts violently! Basic priciple - with pts who have reduced capacity to process information the more information given the less they are able to process and the more likely the violent outcome.

The Ranchos Los Amigos Scale - levels of cognitive functioning does give a good assessement of cognitive state and in some texts also has interventions appropriate to each state. Althoough this scale was originally designed for post head trauma victims it should be applicable - at least in some instace to the patient with deteriorating mental function.

I have heard where reality reorientation combined with aromatherapy has had a significant impact unpon aggression and behaviour.

gwenith, BSN, RN · Apr 25, 2003

Please! Include the concept of diminished processing. All too often i have seen my colleagues approach a confused patient (whether post head injury alzhiemers or Korsakoff's it doesn't matter) one will stand one side and the other will stand the other side and talk to them. Then they wonder why the patient errupts violently! Basic priciple - with pts who have reduced capacity to process information the more information given the less they are able to process and the more likely the violent outcome.

The Ranchos Los Amigos Scale - levels of cognitive functioning does give a good assessement of cognitive state and in some texts also has interventions appropriate to each state. Althoough this scale was originally designed for post head trauma victims it should be applicable - at least in some instace to the patient with deteriorating mental function.

I have heard where reality reorientation combined with aromatherapy has had a significant impact unpon aggression and behaviour.

Rapheal · Apr 25, 2003

I greet them with a big smile everytime I am in the room. I also try to redirect them if I can. I will question them about something they were talking about before such as "So you lived in Memphis for how long? or "What did you and Ellen like to do, remember you told me you and Ellen liked to play bridge" and so on. Good luck on your presentation!!

Rapheal · Apr 25, 2003

I greet them with a big smile everytime I am in the room. I also try to redirect them if I can. I will question them about something they were talking about before such as "So you lived in Memphis for how long? or "What did you and Ellen like to do, remember you told me you and Ellen liked to play bridge" and so on. Good luck on your presentation!!