CHF alzhemiers difficulty

[Kerber]

I have 70 yr old hospice patient 6'7 250lbs primary Dx CHF and end stage alzhemiers bi lat pitting edema feet. 02 sats drop often. Very strong man! His confusion is worse takes clothes off won't stay in chair or bed but unsteady. Lives at home with wife. We have been using 1-2 mg Ativan topical and liquid because he spits everything out alone with 5-10 mg morphine for pain and SOA. It hardly touches him. This family tries to sedate him durning day because they are exhausted. He won't keep 02 on either. He's at respite now for 5 days to give family break. He won't eat drink the other day he tried to take off out house and fell down the stairs. Any suggestions on how to deal with this?

[lifelearningrn, BSN, RN]

Have y'all tried haldol and/or Thorazine? Do y'all use a compound pharmacy? If so, they can compound a lotion of haldol, ativan and benadryl that can be applied to the skin that may combat behavior.

[ShesanRN]

We've used both Haldol and ABR (ativan-benadryl-reglan) gel as well as AHBR (ativan-haldol-benadryl-reglan) gel topically with patients like these.

It is very, very challenging for everyone when the larger patients give their family members a run for their money with symptoms like these - good luck!

[toomuchbaloney]

Does the family have a network within this community to assist them with his supervision? Maybe a church or other club which they participated in?

Perhaps they will have to purchase some additional care either during the day or at night.

How often will your agency allow them to access the respite benefit?

[chillin4me]

some pharmacy has compound drugs. for agitation that doesn't respond to anything we do try phenobarbital suppository. And it works wonders.

[PomMom65]

Agitation is a tough one for families. When Haldol or Ativan will not work we go to Thorazine or Phenobarbital.

[dollbaby]

Have you tried Haldol?

[heron, ASN, RN]

What level of sedation will the family tolerate? I once had a hospice pt who was quite strong, and assaultive. His wife would not allow any sedation at all - until he got her in a headlock.

Agree with above suggestions - all things to try, family willing. Are they open to learning to give meds IM or rectally? An initial dose of something like Thorazine, haldol or even Benadryl IM might slow him down enough to let them medicate sl or rectally.

Be patient with them - not only do they have to watch their loved one die ugly, but they will be the ones wrestling with him to medicate.

Why isn't he being considered for GIP level of care? He certainly qualifies.

[Kittypower123, BSN, RN]

Sometimes patients with Alzheimer's have increased agitation with Ativan. Perhaps try Haldol instead rather than in addition to. I've seen Haldol and Seroquel given together work well too. When all else fails, I have seen Thorazine work. Also, that dose of Morphine may not be enough for him. Perhaps a larger dose would help. Dyspnea and pain both feed into anxiety and agitation in this population.