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dealing with confused patients

Geriatric   (32,625 Views 31 Comments)
by sprintin08 sprintin08 (New Member) New Member

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DizzyLizzyNurse has 12 years experience and specializes in Peds Medical Floor.

1,024 Posts; 19,529 Profile Views

I think the first time I did this was in my first job in a LTC Facility. A woman in her 80's was concerned about her parents. I was relatively sure they were no longer living. So, I said, "Your parents are taken care of." It calmed her down.

Dave

Just wanted to say be careful! I had an 80 year old resident who wanted me to dial the phone so she could call her mother and I thought she was confused. Turns out her mother was 100 and living in a nursing home in another state!

That nurse was correct. What if you were looking for your spouse/parent and the person you asked told you they were dead? How would you feel? Would you believe them? Or would you think something was seriously wrong and people were lying to you? Or if your child kept telling you that they aren't your child? Or your mother kept telling you she wasn't your mother? (I've had plenty of residents who either thought I was their child or their mother - I just play along.)

I had a resident who used to get combative with personal care until it was her birthday and I wished her a happy birthday. She smiled, relaxed, let me do what I had to do. From then on every day was her birthday!

As long as it keeps them happy and relaxed and you aren't denying them anything, who does it hurt?

We call this "therapeutic fibbing" at my work.

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Davey Do has 35 years experience and specializes in Psych, CD, HH, Admin, LTC, OR, ER, Med Surge.

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Just wanted to say be careful! I had an 80 year old resident who wanted me to dial the phone so she could call her mother and I thought she was confused. Turns out her mother was 100 and living in a nursing home in another state!

And her Mother was "taken care of".

Dave

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Dalzac is a LPN, LVN, RN and specializes in CCU,ICU,ER retired.

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My Grandmother was so confused the last couple of years she was alive. My Aunt (her sister) insisted we reorient her. It drove me crazy because all of Granny's delusions were very pleasant. One day when we walked in she was just sitting there smiling. She said she had the nicest walk down Galvestion beach and the weather was perfect for a picnic. We were in Oklahoma. When my aunt started to ruin granny's perfect day I just had to stop her. What is the point? why ruin their day? If they are happy let them be. Their bodies are failing, their significant others are usually gone, their ckildren are grown. They sit in a tiny little room in a ltc place. They can't have a pet. And here in their mind they went down the beach with their sweetheart in a wonderful day. Are you going to be the one to tell her that Grandpa is dead and has been for 40 yrs! She was 90 yrs old when this happened. I want her last days to be joyous and free.I made my aunt promise to never drag her back to reality if she is happy. It is pointless

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BluegrassRN has 14 years experience.

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I am a night shift nurse, and I live almost 300 miles away from my grandmother, and I don't get there to visit often. Fortunately, my grandmother thinks that I am the night shift nurse for her hall in the nursing home, and once the nurses there realized *I* was a nurse, they started playing along. It's a small town, they know enough about me to be able to tell my grandmother things about my life and my family (pretending to be me, of course). My grandmother also thinks the handyman of the facility is my brother.

Every night she thinks I'm there, taking care of her. Every day, she thinks my brother is there, keeping the place running.

It used to upset my mom, that my grandmother couldn't recognize my brother and I, and she would try to reorient her. Now she understands how much peace and comfort it brings my grandmother. I also pointed out that, they must be taking good care of her, because I don't think my grandmother would let "us" get away with anything but kind and patient care.

Reorienting people like this is disturbing and counter productive. Playing along, redirecting, and reassuring is better for their mental health.

It is funny that, while a few of the nurses may somewhat resemble me, some of the nurses most decidedly do not. Either my grandmother's eyesight is terrible, or she just sees what she wants to see. I'm a very short, round, dark haired, fair-skinned lass of Irish descent. Some of my grandmother's nurses and aides are different races, decades younger or older than me, much taller, and one is a man! The facilities fellow is black, and my brother is white, but it makes no difference to my grandmother, she still thinks he's my brother, and he is such a good man to answer to my brother's name and always spend an extra few minutes with her. I'm so happy to know she feels loved and cared for, and that the staff treat her with such consideration and gentleness.

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14 Posts; 799 Profile Views

I work in a SNF where most of them are confused due to dementia or alzheimers. I practice creative fibbing. I recently had a patient where he was convinced that another resident had a gun and he needed to call the police. I played along and made a pretend phone call. I told him security was at all the exits. It worked and he calmed down. I found that it was more beneficial to these residents to "go along" with what they say rather than trying to re-orient them. I've seen families tell their love one with dementia/alzheimers that "no dad died over ten years ago" then that resident would cry like she just found out for the first time. If they are confused and are trying to do some that would jeopardize their safety, then I re-orient them as best as I can.

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90 Posts; 2,059 Profile Views

I work in LTC and have several confused/dementia patients. One of them is a sweet old lady who once in her bed, does not want to leave her bed for ANYTHING. Yesterday I came in to work and I guess the night shift CNA told her she had to get out of bed because we were having a "surprise party" for her! LOL, she got out of bed and was so surprised and happy to see all of her "guests"!

She frequently requests to call her husband (who is deceased), so I tell her that her husband is with her son (living), and then I let her know that I will call her son and leave a message for the husband. This calms her down considerably.

Another dementia patient was all in a tizzy because someone came into her room and "took pictures of her" (Chest xray technician). In cases like this, I am not sure what to do besides try to reorient and tell her that it was the xray people and the pictures were for her doctor?

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nerdtonurse? is a BSN, RN and specializes in ICU, Telemetry.

3 Articles; 2,043 Posts; 31,791 Profile Views

If it's someone who's temporarily disoriented (waking up after surgery, for example), I reorient. If they've got Alzheimers, dementia, schiophrenia, etc., you're not going to be able to reorient them...besides, think about it this way. If your little fella thinks his dad just came to visit, don't tell him his dad's dead 3 times a shift. It's not going to make your patient better, it's just going to make them worse. There have been many nights where I have been someone's "niece" or "granddaughter" -- and once, I got a really world class fried chicken recipe out of it, since "Nanny" decided it was time to tell me her recipe. I dutifully wrote it down, and made sure the family got a copy, just in case this was "THE" family chicken recipe and she hadn't told anyone else.

Nanny's Recipe:

Wash and dry fryer pieces

Place in a ziploc bag with 1 cup of buttermilk and let sit over night in the fridge.

Next day, take pieces out, salt and pepper to taste, dip in an egg wash (scramble two eggs) and then dredge thru 3 cups of crushed Corn Flakes with 1 cup of crushed stove top stuffing (4 cups total). Bake at 350 until juices run clear.

This really is awesome.

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BluegrassRN has 14 years experience.

1,188 Posts; 21,588 Profile Views

Making this for my thanksgiving bird, instead of turkey. The fam requested fried chicken and I've never done it. Great timing on the recipe; thanks!!!

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NurseCard has 13 years experience as a ADN and specializes in Med/Surge, Psych, LTC, Home Health.

2 Articles; 2,844 Posts; 35,259 Profile Views

Honestly, many times I go along with what they are saying if I can. Many confused patients in nursing homes are not going to get any better, mentally. So trying to re-orient them is pointless; it can just make them angry and even frighten them.

So if Ms. Jones insists from her bed in the nursing home that she needs to go outside and milk the cows and let the cats back in, I may just tell her that I already got all of that done; she can go back to bed for a little while.

A different situation would be, a particular patient that I'm caring for right now, I presume is there for rehabilitation, though whether this particular patient is really going to get any better and be able to go home is up in the air. Anyhoo, he spent three months in acute care after a catastrophic illness and is now with us. He is currently on a Fentanyl patch and routine Xanax and Serax. He gets confused; the other night he just knew he was leaving and going to the riverboat casino. Someone like him, you may want to try to re-orient, as it is probably his meds and his illness making him a little crazy.

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NurseCard has 13 years experience as a ADN and specializes in Med/Surge, Psych, LTC, Home Health.

2 Articles; 2,844 Posts; 35,259 Profile Views

Just wanted to say be careful! I had an 80 year old resident who wanted me to dial the phone so she could call her mother and I thought she was confused. Turns out her mother was 100 and living in a nursing home in another state!

LOL, that reminds me of a comic strip that I saw one time... can't remember exactly which strip.

It involved one salesman saying to another salesman... "okay, if you want to make a sale to the lady down the street, just ask her if her mother is home."

So the next panel shows the suave salesman asking this older lady "Hello ma'am, is your mother home?"

And the last panel shows this very elderly lady at the door "yes... what is it young man?" :lol2:

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Up2nogood RN is a RN and specializes in pulm/cardiology pcu, surgical onc.

860 Posts; 10,971 Profile Views

I've made the mistake before of misjudging my pts confusion (a sweet, tiny lol), instead of dialing the police, I dialed our security office (giving them a heads up 1st) and gave her the phone. When the "police officer" came to her room to take her complaint she wanted to file against us nurses for holding her hostage she threw her telephone at me and whacked me good in the head. Obviously she wasn't that confused. The next day she was sweet as could be with no recollection.

Working years ago in ltc the frequent question besides where are my parent was where are my car keys? Umm your car is in the shop you can pick it up in the morning. I always thought it was fun playing along too when they thought I was a grand daughter or such as they seemed so comforted to actually think their family was there.

My dad did try to reorient my grandfather who had demetia his last year of life.... he thought my mother was an Italian prostitute;) Those were some enertaining conversations to say the least.

Edited by Up2nogood RN

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Mandychelle79 has 2 years experience as a ASN, RN and specializes in Psych.

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I dont call them white lies or fibbing. I call it Jumping realities. One of the first questions I ask a dementia patient is how old are they, because then I know where they are in their life and can make my statements accordingly.

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