Caring for a patient with Dementia; First day of Clinical

[wwilson2]

I am a first semester nursing student and we will just start clinicals next week. We went to the extended care facility today and had a pt. assigned to us. We were supposed to find out what the reason for her admission was (diagnosis) and talk about the pathophysiology and therapeutic care that went a long with it. There were a billion but I would probably say it was dementia.

I walked in the residents room to talk to her. I introduced myself and what I was doing and that I would be taking care of her next week. All she did was the same thing she was doing when I walked in. She was lying down with her arms in a sort of contraction and her hands trembling and making a bunch of weird unintelligible noises. Every once and a while she would say a word but she didn't seem to be "in the room," mentally speaking. I was talking and she didn't even acknowledge I was there. I kind of just froze up and didn't know what to say anymore and told her I would see her next week and left. It was really awkward.

Next week when i go in to see this lady. How would you suggest I approach her and speak? I saw things on giving her easy questions like ones with yes/or no answers, but she didn't even seem to notice I was there.

[CC Wisconsin]

Sometimes all you can do in a long-term care facility with advanced dementia patients is talk TO them, not AT them. You may or may not get a response, but she may warm up to you.

[smurfynursey]

I agree with CC Wisconsin. A patient/resident may not know why you are there, but can sense that they are not alone. It can be challenging, especially if you aren't used to it. Even if you feel like an idiot, you are still talking to a person. I had family that had advanced dementia, and I always appreciated people talking to her :)

It will come and feel more "normal" with time...

[dope a mine]

Sounds like your patient may be in the late stages of dementia. Sometimes all you can do is just offer your company. Even if that means there is not much communication. You have to remember that they are still human and require the same basic needs as all of us. Maybe you can help by repositioning her, cleaning her up, offering her food or water because often times they don't remember to eat or drink.

Read up on dementia before you go back next week and be familiar with the signs and symptoms and try to see if you can spot them in your patient. Make it a learning experience for yourself so you don't think that things are weird or feel awkward.

[HouTx, BSN, MSN, EdD]

Since you can't realistically communicate with her via cognitive means (verbal, written) that doesn't mean that you can't do it through touch and caring. This is the essence of "comfort care". If you have an opportunity to talk to her family members, ask them questions about the person she was before her disease zapped her personality. When caring for unresponsive patients (dementia, head injury, coma, etc) keeping in mind the person they were before.... helps you to relate to them as a human being rather than just a 'patient'.