Confused out of control dementia pts

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Specializes in PCCN.

I was looking at an old "ad" for thorazine. why was it ok back then to treat these pts, but not now? We get blamed for them falling. They pull out their iv, foley, feeding tube, etc. they punch, kick and bite and scream att the top of their lungs. And we get blamed for their behavior. Bed alarm my butt- yep, i get a brief warning they are getting up just in time for me to get to their room to see them fall.

Things must have been better in the old days- when this stuff wasn't allowed.

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I dunno. I've been in LTC for the last 17+ years. I like what I'm seeing now with the change. Granted, most of my residents/ patients are more rehab than LTC, but I'm still dealing with dementia.

I haven't been bit or pinched in quite a few years, the falls and injuries from the restraints have gone down since we got rid of the side rails, posey vest restraints, wheel chair restraints etc. Those vest restraints and hand restraints were horrible...can't tell you how many times I found someone all tied up and a mess.

When was the last time I saw an Alz pt all curled up in the fetal postion with without hand, knee contractures and bed sores??? years!

How about the patient that is soooo snowed they are drooling, need fed, changed etc?

Dose reductions are what kills me now. We finally get a med regime that works and some consultant wants to dose reduce. We aren't even using that much med to begin with. .25 of Ativan is a spit.

Now..it is different in acute setting, I do understand that. If the hospitals would devote some extra money to get extra staff or sitters or the low beds and use some of the techniques that we use in LTC, the agitation, agressiveness, feelings of being out of control etc could be reduced. I know it is easy to give the pill to snow them then do the hand restraints etc so they aren't pulling out the ivs, tubes etc, but in the long run..its just setting them back. Instead..look at why they really need the treatments...its it really necessary?

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Specializes in PCCN.

seems we cant retrain anyone. family members dont want their person tied up, yet they do nothing to assist in keeping them safe. Im just really tired of not having any control, yet being at blame.

oh, they are this way becaue they are 99 years old with severe dementia, and someone decides to cath them, or put pacers in, etc etc. nice- art line with confused, unretrained pts. while i hope none of the other pts bleed out because i had to it 1;1 with the confused uncontrollable ones.

This angers me to no end. I wish I could have some thorazine!!!!!

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Specializes in PCCN.

ooops restrain

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Wow! I'd love a copy of that Thorazine ad for my medroom...

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seems we cant retrain anyone. family members dont want their person tied up, yet they do nothing to assist in keeping them safe. Im just really tired of not having any control, yet being at blame. oh, they are this way becaue they are 99 years old with severe dementia, and someone decides to cath them, or put pacers in, etc etc. nice- art line with confused, unretrained pts. while i hope none of the other pts bleed out because i had to it 1;1 with the confused uncontrollable ones. This angers me to no end. I wish I could have some thorazine!!!!!
My doctor came in for rounds and I looked him in the eyes and said, "you need to write an Ativan script for mrs. Dementia patient OR me... I'll accept either" ... He wrote it (for her, not me lol)
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Yes, in the acute care..you need something. Most often..pain meds work better than the psych ones (unless you are using enough of it)

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I used to joke at the last place I worked about giving the staff ativan. It makes sense to me because they were afraid to overmedicate the patient.

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