Change in mental status

essarge · Sep 6, 2003

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Nrs. LaLa-Land · Sep 6, 2003

Labs that are off like Low K+ etc..can cause altered mental status. Sometimes when older people get infections their first S+S is a change in Mental status. Their problems dont manifest the same as younger people all the time.

Long Term Care Columnist / Guide · Sep 6, 2003

You can see my post on the EMS-with-an-attitude thread to find out how *I* feel about this issue. LTC staff typically are VERY in tune with their residents and know right away when one is behaving differently. UTIs, infections, dehydration and electrolyte imbalances are extremely common in the frail elderly, and even with normal VS and no fever, they can be very sick, and the only outward sign is a change in their baseline mental status. The staff doesn't send a resident to the hospital just because they need a "vacation" from him or her. Please don't judge LTC nurses so harshly. Their job is hard enough without being looked down upon by nurses in other fields.

CoffeeRTC, BSN, RN · Sep 6, 2003

Wellll I just had to respond. I work in a LTC center and do know my residents. Just because they have a dx of Alz or dementia doesn't mean they shouldn't be treated. Yes, they are mostly confused, but even the slightest bit of agitation or increase in confusion, delrium, or change in eating/ sleeping patterns could indicate alt labs, anemia, infection, hypoxemia...... the list can go on. In my LTC we try to get to the bottom of these issues first, some times we need to send to the ER for labs, because our lab service is just M-F and no eve pick ups. Trust me we are not looking for a vacation... most often it is the family and doc who want to send the res out for the extensive work ups..

Here's an idea... if the dumping is such a problem in your hosp. It might help to talk to the facility or LTCs where this happens the most and discuss this issue....

bubble · Sep 6, 2003

I work in LTC also and we do not send out our res. to get a vac. from them--tho that is a thought. It has already been said that they can have normal vs and still have loc. we do labs. and ect. and place on doctor's board to eval and tx. and most of the time for the very noncompliantand aggres. they are sent to Psych. ward for two or three weeks. The families do insist on sending their loved one to the hosp. and the doctors comply with their wishes! DNR status---well families do not fully understand and / or change their mind when they see a change in family member.I have encountered issue with Hosp. nurses and doctors reguarding DNR ---HEY I agree DNR does not mean --Do not tx.------BUBBLE

Mazzi · Sep 6, 2003

I am a hospice nurse and work within LTC facilities. All the nurses I work with would never send out a Pt. just to take a vacation. These residents are family and they greive just like family. There is a fine line between old and frail and the dying prosess. I find the LTC staff are deathly afraid to have a resident DIE in their facility d/t Medicare and Medicaid Reviews and rules. It is sad to me that a person has to die in a cold/ sterile environment because the government mandates certain regutation. Yet I know this has come about because some LTC has been abusive. Bottom line is .... Good nurses, aides, EMT, any medical person need to work together to make our elderly safe, cared for and loved.

aimeee, BSN, RN · Sep 7, 2003

I once had a resident who just looked "different" to me. She did not speak at all so she couldn't tell me anything about her condition, but her respiratory rate was up to 44 and she was restless. Her pulse ox was fine, lungs clear. No temp. She had an anxious, doting family so the Dr. said I could send her for eval. Turns out she had urosepsis.

essarge · Sep 7, 2003

Please don't think that I am stereo typing all LTC nursing staff. I stated in my post that SOME do this. And yes, I know that there are some (most) very caring people in this field.

I do however know of several cases that the patient was admitted with "altered mental status" per Dr order, and when all was said and done there really wasn't anything wrong except that they were agitated because of the change in environment by the admission. By the time an evaluation was done, the bed was gone and they had to wait to find another one for several weeks. This is mostly from the state hospital and one particular nursing facility in this area.

I do respect LTC nurses very much. It's just a few that I find this happens with and I was just asking if anyone else had dealt with anything like I posted.

RNonsense · Sep 7, 2003

I was just asking if anyone else had dealt with anything like I posted.

Um, no.

angelbear · Sep 7, 2003

Essarge, Yes I do think that this happens but no it is not that common. The population I now work with is profoundly mentally retarded. For the most part they cannot speak for themselves. At leaste not in a way that most people would understand. When we send one of our residents out to the hospital one of our staff always go along. We work with them day in and day out we KNOW them. Often times it is just something about the way they look or act that shows us something is wrong. We would never send one out just to get a vacation for ourselves as generally one of us is at the hosp around the clock with them anyway. But I do not believe you are alone I do think that it does happen admitted or not. So dont feel bad for asking.

wjeff · Sep 7, 2003

I do not understand this ltc verse hospital thing.What do hospitals staff expect that the ltc only send pts who have an extremely high temp or residents that are totally unresponsive.PLEASE,PLEASE keep in mind that ltcs do not at none i know have equipment to perform x-rays,mri,or other tests which are needed to care for their pts appropriately.Trust me when i say sending 1 pt to the hospital is no vacation. By the way work for an agency so i work hositals and ltcs.No i do not prefer ltc nursing over hospital.I enjoy nursing where ever.Take a minute in ponder if pts did not come to the hospital,no matter where they come from.