Caring for status post hip fx with Alzheimers

txspadequeenRN, BSN, RN · Aug 25, 2005

Have you tried moving this patient closer to the nurses station then placing her in a mid-low bed with an alarm or even a alarm pad. Is she combative all the time or just since she came back from the hospital. She may need to have some pain issues addressed, but if she has always been this way she may need some med managment for her behaviors. You may want to try some ativan gel 30 min prior to transfers, then put her (at first) in a Gerri chair for more comfort (if she has pain issues- unrelieved). Any transfer from facility to facility can cause alzheimers patients to go off the wall for a week or so... Her behavior may eventually improve once she adjusts...good luck

We had an Alzheimers patient fall and break her hip last week and she came back last night. She had been on a low bed before. We are supposed to get her up for meals and it is very difficult to do from on the floor. She is also combative and tried pulling out my hair and pinching me. Later she tried to bite me We wanted to put her in a higher bed to make transferring easier on her and us. Our don was totally against this but the doc said I could put her in one. The don called him and told him she didn't want this. How do we make the transfer safer for her and her fx and also keep all our hair on our heads.:)

Daytonite, BSN, RN · Aug 28, 2005

I'm assuming you don't have the very low beds that also can be electrically raised as high as a regular hospital bed when needed. You ought to mention to the DON that such beds are available and perhaps they could rent one for the acute part of this patient's care. We had a number of fall risk patients in these kinds of beds. The best they can do is roll out of them when they are in their lowest position. The beds can also be disabled from hidden (from the patient) controls so they cannot be raised.

I'm stumped on an easy way to get this lady up off the mattress. I have seen some aides put two bath blankets under patients from head to toe and then take up four positions and physically lift them into a position somewhat like a sling chair and then, in unison, move the patient to a chair. Do you have a chair lift (like on a scale) you could use to help you get this lady up?

Have you tried putting mitts on her hands, or does she rip them off quickly. Getting slugged with one of those Posey mitts doesn't hurt too bad. Also, I'd do a 1 - 2 - 3 and make sure everyone knew their role when working with this lady with one of the main focuses being that everyone keep an eye on her hands and stop her immediately from effectively hitting anyone.

Don't you love nursing?

meownsmile, BSN, RN · Sep 16, 2005

First, determining what kind of repair this lady has is important. Did she have a pinning, or did they have to do a total arthroplasty? That will make the difference on how this lady is transfered. If it was a pinning, you will be fine with anything suggested to keep yourself and her safe.

If it was an arthroplasty though, you will want to make sure you do not let her legs cross or knees scrunch together when you transfer her. Keep the abductor pillow between her legs when you transfer to prevent dislocating the hip prostesis.

A pinning will not be sent back with a abductor pillow, an arthroplasty will. At least at my hospital we use them.

dinkymouse · Sep 16, 2005

She went back to the hospital last week her hip had popped out. She needed surgery. No one knows when it popped out and they all thought she was being witchy when she screamed in pain. I know she was fine Sunday when I left and Wedensday morning she was screaming in pain. She had a scheduled appt with her ortho doc and he called and said it was out and they would have to do surgery.

JentheRN05, RN · Sep 16, 2005

Although it wasn't me that posted, I really appreciate the post. I'm about to start work on a ortho/neuro unit. This is likely something I will come across. I had no idea they had ativan in a GEL! That's awesome for alzheimers patients. My grandmother has alzheimers, she's already been through the initial combative stage, she's comfortably numb most of the time. But in either case, I really appreciate this information!

THANKS

P_RN, ADN, RN · Sep 22, 2005

The solution is going to depend on what positions her doctor will allow. Since you say it popped out, I assume that it was at least a unipolar ?(just the femoral part?) How low do your hoyer lifts go? I'll have to think more about this. Was she ambulatory prior to the fracture?