Advice please

[NoahscoopsRN]

I'm a new RN working in LTC 11-7, 4 nights per week I work Alzh unit (weekend rotation) and 2 nights a week I work Medical/Psych with a lot of skilled pt's. (Rotating schedule). My question is in regards to Nurses working with Alz patients. When is it appropriate to medicate a pt with a PRN (for example, resistive to care, wandering etc)? I ask this because I have been told (and have refused in certain instances) to "just give them something" when they get out of hand or are up in the middle of the night. Usually if they are resitive to care (and in this unit a majority of them can be) I usually tell the aides to leave them be, and try again in about 30 min. If it is their shower day and I am hearing them scream in the shower (and I mean SCREAM) or become combative or say continuously "no!" I have, in the past, told the aides to just stop, change them if necassary, and put them back to bed. I have gotten strange looks from the day nurse when I tell them, so and so didn't get their shower because they were screaming, worked up and combative and I just rather not put them (the pt) through that. Am I wrong? When is enough enough? Or if someone is up wandering in the middle of the night like the case I had the other evening. This woman was simply walking around the unit. No behavior issues whatsoever, she was pleasant, I gave her a snack and something to drink etc. I did end up giving her something about 2:45am just because I did want her to get some sleep however, I know other nurses (with this same pt) that the minute she begins wandering they medicate her with trazadone. Is it just me? I don't see the need for it, she isn't doing anything wrong. I try to think to myself, can she simply just not be tired? Don't people wake up in the middle of the night? hungry? thirsty? Why do they need to be medicated. Maybe I'm crazy, I just don't get it! Don't get me wrong, if someone is out of control and is a danger to themself or staff I will and have medicated, but for simple everyday things like being up in the middle of the night I just don't see the need for it. Advice please? I appreciate it.

[followyourbliss]

Hi Everyone,

As a LTC nurse in Alzheimers myself I am quite frequently approached by RCA/CNA to " give them something" to

a) calm down, B) be more "manageable" C) staff don't have the skills, patience, time to use alternate methods etc.

For me the issue of PRN meds, be it narcotic, anti-psychotic or both raises issue of assessment; what is the underlying reason for the behavior. I certainly agree that there is a time, place, and need for prn meds. I strongly feel that they have been greatly misused, misunderstood; that the side effects are not often considered when residents are getting these. For me, I look at ambulation,fall risks, and cognition- to me I have experienced more hassles, falls, and over sedation that has it's drawbacks.

I agree that creating flexibility around aggression and behavior challenges are key. Who likes to be "managed" and I personally see many dementia/AZ patients amp up because staff are trying to exert their wishes/ will upon them and things turn sour.

Sometimes I feel as though we are trying to undue something that is progressive and has it's own path and challenging pathology; that perhaps we need more night staff to provide the "right" kind of care....meaning that nocturnal wandering, insomnia, disturbed sleep cycles etc sometimes cannot be "fixed" no matter what we try to do.

At the facility I work at the night nurses and care aid's have quite the time most nights; falls, wandering, aggression etc because staff are trying to get them all back to bed. It is a frustrating situation that I personally have been in, including the baths! I feel a great bed bath or sponge bath ,whatever we can accomplish is what we can do. If someone has trauma around bathing-albeit- being raised up in a bath chair- up an over into a bathtub....we look at showers and alternatives.

Well guys, I suppose the heart of the matter for me is staffing, priorities, and education.

We have to have enough staff to provide safe & competent care, we need staff that are educated in Dementia and employ that, we need staff that care and have the energy to invest, and management that support and endorse us!!! Big wish list for Santa!

Thanks for reading everyone,

Followyourbliss

[NoahscoopsRN]

Suz, there are a few patients that they get up in the morning, no they don't shower them in the middle of the night. I would have a serious problem with that.

[NoahscoopsRN]

@ Dixie,

I couldn't agree more! I would probably be swinging at someone if they tried to shower me at 5:30 in the morning too! I just don't see the sense in it. This facility is like nothing I have seen before (perhaps im a bit naive), they just don't seem to care. The facility is big on trazadone (BIG, that's all you see in the med carts) I just don't see the sense in medicating someone if they are not doing anything wrong or are not out of control. And i've said this to other staff, "don't you get hungry in the middle of the night?" "aren't there nights where you just can't sleep?" It's the same for them.