how do you deal with a patient who...

AllSmiles225 · Jul 11, 2009

Quite frankly I hate to be very blunt..but you are not going to bring this persons memory back. Obviously sounds like the resident is suffering from Alzheimer's or some other form of dementia and there is no rationalizing with a person that suffers from either of those diseases. You have to just try to put your foot down and say I gave you your medicine already PLEASE stop asking me to give it to you and proceed to do whatever you were doing before. You will spend your entire shift trying to explain that you already gave such and such their pills if you don't speak up. I deal with that daily too and its the best advice I can offer..sorry that it's not so helpful.

RheatherN, ASN, RN, EMT-P · Jul 11, 2009

now we cant assume alz's. we need more info, is the pt thinking she needs more meds? or does she really have memory issues? if its either, you could try writing on a white board the times she will recieve and and explanation of why, that may help as a cue. its a start anyhow. and then you need to investigate further as well, maybe she really is having other issues if its not a memory problem. if it is a memory problem, there are many ways you can try and go about helping her.

if you give some more info to us, it may help more.

-H-RN

Keysnurse2008 · Jul 11, 2009

i have a resident who constantly asks for her pain meds even after you've given them to her. our manager stated in a meeting that this res should be given her meds first when you start your med pass. the problem is that you give this res her meds as ordered, and is the first one to recieve meds, but she still chases you asking for her meds. or she says no you didn't give me the right meds. if you explain to her, i gave you the meds that your md prescribed. and you can only get your pain pills q6hr it's not time for your pain pill. she'll say okay, but then a few min later returns and asks for her meds. this res has fallen out of her w/c trying to transfer self into bed at 6p inorder to recieve her evening meds which are given at 8p. if you try to explain that no matter what time she gets into bed she will not recieve her meds until it's 8p, or if you explain to her that no matter if she's in the dr or by the ns her nurse will find her and give her the meds when it's time. i can't seem to get her to understand. any ideas on how to deal with this type of patient?

hmm.....i hate to even say this....but....is she getting adequate pain control? too many times patients, esp the elderly.....are not having their health concerns addressed adequately. if she is still asking for pain meds...after she has gotten them.....then maybe the major problem isnt her memory...but the fact that she isnt getting adequate pain control.

AllSmiles225 · Jul 11, 2009

OP said referenced that the patient was constantly asking for all of his/her meds. Sorry that I assumed it was LTC and therefore the elderly--when you say resident I automatically assume LTC. Sounds like their IS some kind of memory issue going on especially if the patient is trying to transfer him/herself alone when they can not adequately do so.

athena55, BSN, RN · Jul 11, 2009

I agree with NewRN: perhaps you could make up a board with the times of her regularly prescribed meds. Everytime she gets her medication have her sign her name on the large white board. Maybe, if she see's her own signature, it may allieviate her fears that she didn't get her meds

I also agree with Key regarding her pain level.

morte, LPN, LVN · Jul 11, 2009

has anyone just bluntly asked her why she is doing this?

UM Review RN, ASN, RN · Jul 11, 2009

Neuro and psych consults? Pain consult?

Had one resident who was always c/o back pain, had to fight to get her comfortable, months later, we finally got more tests ordered -- she had spinal Ca and a huge mass that was the source of the pain. It broke my heart to look back and think of all the times we had to refuse her medication because the tests she had never showed the mass until a few weeks before the end. :cry:

Lesson learned. The tests are not perfect.

CITCAT · Jul 11, 2009

Well I feel that pain management needs to be adressed can she get a pain patch instead that will maintain theraputic blood level but be aware that in the elderly population metaboism of drug maybe be slower or faster depending upon the drug ,also may I also infur that her pcp needs to be informed of this situation could it be pychological or could it be physiological , Dear nurse lets not be judgemental lets be critical thinkers to help out elders, because one day we :twocents:may be in her position we all get older bless you and just take a deep breath.:redbeathe

MoopleRN · Jul 11, 2009

Dementia? Uncontrolled pain? Both? That's for you to assess and address. I do have the general opinion, however, that LTC patients' pain aren't adequately addressed. I base that opinion on my time as a CNA working day/night shift in a nursing home (and now as an RN on a skilled unit) and seeing how much pain the residents demonstrated when we had to help them with their ADLs.

I remember in particular the RN/DON telling us to ambulate Mrs. X with a hx of arthritis. We had to ambulate her to/from the DR for meals and she'd cry every time because it hurt her so much. When we reported her tears/verbalizations of pain to the RN, we were told "it'll be a lot more painful for her if she doesn't move".

Granted, ambulating/mobility/ROM are important issues that cover several different aspects of patient care but let's be realistic. Mrs. X's arthritis was not going to improve and forcing her (she wouldn't refuse to be assisted to ambulate, she was a grin [read cry] and bear it type) wasn't going to put off what we CNAs could all see coming. Her pain meds weren't adusted accordingly. Sad... and all too often occurring in LTCs.

Daytonite, BSN, RN · Jul 11, 2009

the patient's problem is confusion. giving her medications first only deals with her physical symptoms, but not her disorientation. a person's bewilderment can be trying on you, especially when you have exhausted your interventions for it. logical explanations do not work on someone who is disoriented.

i recommend you do some reading and study about dementia and how to approach the behavior of people who have this.

personally, i would care plan with the rest of the nursing staff a trial of using a "placebo" to be given in between the real pain medication and ok it with the doctor. they could be little white tic tacs or red m&ms, but every time she wanted something she would get one along with a lot of tlc such as "you poor thing i hope this stronger pill helps". the only danger in this is that her need for the real pain medication could get ignored and needs to be monitored closely.

morte, LPN, LVN · Jul 11, 2009

the patient's problem is confusion. giving her medications first only deals with her physical symptoms, but not her disorientation. a person's bewilderment can be trying on you, especially when you have exhausted your interventions for it. logical explanations do not work on someone who is disoriented.
i recommend you do some reading and study about dementia and how to approach the behavior of people who have this.
personally, i would care plan with the rest of the nursing staff a trial of using a "placebo" to be given in between the real pain medication and ok it with the doctor. they could be little white tic tacs or red m&ms, but every time she wanted something she would get one along with a lot of tlc such as "you poor thing i hope this stronger pill helps". the only danger in this is that her need for the real pain medication could get ignored and needs to be monitored closely.

the only part of this that bothers me is that only the pain med appears to be the issue...if she were forgetting every med......