I need advice on a resident who is currently on my floor. I also need a 1-2 part vent about this resident!
Bit of background, I work on a 32 bed unit, mostly LTC and some short-term rehab. We have "Santa Claus" in one of our rooms (named for his white beard). This man's baseline is to be a royal terror. He is not physically abusive, but he often times gets agitated, is EXTREMELY needy, and can at times be verbally abusive. He complains when he can't get a cup of coffee at 2am, when he has his PA on, when his heels hurt, and how he cannot sleep. All of the staff, including myself as the Supervisor RN on 11-7, have been more than accomodating to this man. The trouble is, I can't figure out a way to get him to calm down or quiet down. He is supposedly HOH, and is overly disturbing to the other residents in his room and throughout the floor. He gets very loud and wakes everyone up around him. If I ask him kindly to keep his voice down, he gets worked up. He gets louder.
We have tried so much to get this man stable emotionally/mentally. We've had success with ABHR gel in another hospice resident, and have begun administering that PRN with no effect. He takes Seroquel 25mg QID and q4 PRN. No effect. He gets 0.5 of Ativan at HS. No effect. I am at my wits end with this man. Even my ADON agrees that he is hard to handle. And she usually thinks everyone has a UTI or has to be saved!
Part two of my story and vent deals with a resident across the hall. He is in his 50's, here for rehab secondary to a TMA of the right foot. I heard this man yelling last night, which is not his norm. I go in and hear him cursing like a sailor. He is sick of the guy across the hall, wants to beat him over the head with his cane because he "has no respect for anyone else." He is tired of PT deeming walking down the hall and walking up a few stairs "rehab." He is an A+Ox3 guy who is stuck on a floor of nut jobs and sickies. I really did feel for this guy, he told me he didn't belong here and that he thought he should write to the paper to get them to investigate why someone in his state would be placed at my facility. I had no clue how to respond to him. He apologized and told me it was nothing against me.
So basically Santa Claus is causing an uproar all day every day with his demands and inconsolability, and it's really starting to grind on my other residents. I'm trying to come up with ideas to calm Santa, but I can't think of much else. It's almost impossible to do a 1:1 with him, we don't have that kind of staffing or time. How can I console my A+O gentleman despite the fact that I agree that he doesn't belong in this unit?
I'm not really sure where you're going with this post...
Our current facility is technically locked, you need a code to get out. We have a history of wanderers and residents trying to elope.
He has meals at his set meal times and has been eating better at the set times. He's also been fed between midnight and 4am (me trying to find sandwiches made in the kitchen, or food that he will eat - I even brought him donuts this week).
He hasn't been overdosed on opiates, he has Morphine PRN which has been in limited use for the past 3 months since he has been on hospice, and came in with a Fentanyl Patch 25mcg every 72 hours for pain secondary to cancer and his current wounds.
The last time he went out of the building, he went with his son for a "cancer appointment." I wasn't on that weekend, but what I heard was that he never came back from the appointment. He technically ended up going AMA that weekend. The Social Worker had a funny feeling about him on that Monday, called the house/children's homes numerous times with no answer to try to follow up. She called the Police later to check up on him. His children had dropped him off at the house, and he got as far as getting in the door before either falling, or just sleeping on the floor in urine and feces. His children were nowhere to be found.
I'm pretty positive my work was not going to allow him out on pass after what his children did by leaving him alone. He was accompanied to his new facility by chair car, not even by his kids. It's been freezing here in MA so no one has even been out on the deck in months.
I told this man time and time again that he needed to speak with his children about "getting out of here." His HCP is invoked, and he is unable to make his own healthcare decisions.
I told this man time and time again that he needed to speak with his children about "getting out of here." His HCP is invoked, and he is unable to make his own healthcare decisions.
Is going out for a walk a health care decision?
It's not you - honestly, I don't mean to be hacking at ya.... but it's the system.
An old man separated from his spouse while suffering debilitating conditions - and his kids don't seem to care enough about him. Just abandoned in a nursing home for nurses to care for him like they can do much to alleviate any of the aforementioned issues?
evilolive, BSN, RN
193 Posts
I'm not really sure where you're going with this post...
Our current facility is technically locked, you need a code to get out. We have a history of wanderers and residents trying to elope.
He has meals at his set meal times and has been eating better at the set times. He's also been fed between midnight and 4am (me trying to find sandwiches made in the kitchen, or food that he will eat - I even brought him donuts this week).
He hasn't been overdosed on opiates, he has Morphine PRN which has been in limited use for the past 3 months since he has been on hospice, and came in with a Fentanyl Patch 25mcg every 72 hours for pain secondary to cancer and his current wounds.