Dementia

[nurseywifeymommy1]

Patients that shout out almost constantly disrupt an entire group, should first try to be redirected, then medicated? Am I wrong? These patients must be feeling anxious on the inside and in turn sets the others off. A nurse I know says that's "drugging them." I disagree. Any input?

[loriangel14, RN]

I work on a hospital floor that is largely dementia patients. Medication is our life saver.We try to balance controlling their behaviours while keeping them awake enough to function.Redirection rarely works with most of them.

[nurseywifeymommy1]

Exactly how I feel. Today the whole place was upset bc of 1 resident. The residents were yelling at her to be quiet - her nurse would not give her the prn that's on the MAR. It was a miserable day for everyone. I really wanted to walk our. It was non stop from 6-2!! Ugh it's making me rethink my whole career in nursing.

[martymoose, BSN, RN]

how can you redirect someone with dementia??? They forget what you ask 2 minutes later. ughhh.

I hate it when one pt upsets teh lot too- and pt satisfaction scores go down the toilet as a result.

[jacquelyn.]

It's hard stuff. Redirection works only about 50% of the time for me. But I also find medication alone doesn't solve my problem. At my facility if a particular resident is disruptive we try to remove them from a common area or move other residents. Decreased stimulation can help alot. Even just shutting their door so they dont see the hustle of the hallway helps some stay content in their room. But its also about knowing what works for each patient. We try to avoid large group setting for some residents to not provoke them. Its a tough disease. I've been doing it for 3 1/2 years and I'm finally going to try something new. It's exhausting but you'll get to the rewarding part.

[loriangel14, RN]

We can't shut our confused patients in their rooms because we need to be able to see them so they don't hurt themselves.

[ktwlpn, LPN]

You have to try interventions first and document their effectiveness before going for the prn.Often just seeing to their needs immediatly will stop them from escalating to the behavior that you describe.A drink,toileting, something for pain, a blanket or sweater,quiet music and 5 mins of hand holding can work miracles.Also assess your environment.If the noise level is high with staff talking and laughing loudly,alarms ringing and large carts banging around that is going to set the tone for all of the residents and you need to start by making some changes. Q 2 hour toileting,q 2 hour drinks and snacks and soft music will make a big difference.The soft music will also calm the staff down,too.Also an aroma diffuser helps. If you try all available interventions with no effect then you should give the available prn. IMHO to withold it when it is available to that resident is abusive.

[Meriwhen, ASN, BSN, MSN, RN]

It can be very tough to deal with dementia patients. I try to redirect first before resorting to PRNs. It may take a few tries at redirecting, but it should be given a fair trial. If redirection or other interventions have tried and failed to deescalate the patient, document thoroughly and then hit the PRNs.

If you run to medicate without attempting any other interventions, you could set yourself up for potential accusations of using chemical restraint. Yes, there are times that medication is the only answer when dealing with dementia patients--I won't deny that. But that's not EVERY single time...and Joint/other accreditation/human rights agencies tend to agree.

[bestallaround, ADN, CNA, LPN, RN]

Ugh! I hate it when nurses do not give PRNs that the patients clearly need! If the doc didn't want the patient to have the med, they wouldn't have prescribed it! I always give my dementia patients any PRNs they can have. Excuse me, but we are "drugging" all of our patients. It's part of our job.

[ak2190]

I try a non med intervention and if it does not work I give the prn. That's why it's ordered. It's both a safety and environment issue. Other patients have a right to be in a decent environment.

[ktwlpn, LPN]

how can you redirect someone with dementia??? They forget what you ask 2 minutes later. ughhh.

I hate it when one pt upsets teh lot too- and pt satisfaction scores go down the toilet as a result.

Studies have shown that they'll move on to a new thought in about a half an hour (from going home to looking for their purse,maybe-but it's a break) You try to redirect by sitting with or walking beside them and offering prn pain relief, a drink or some cookies or a sandwich and toileting (you'll need to spend a few minutes here-at least 5,10 or 15 if you can spare the time.Ask them to help you and sit with them with a pile of towels to fold and start folding them together or encourage them to talk about whatever it is they are stuck on (and hold hands,keep your arm around their shoulders)if it's looking for mom or dad get them talking about that,if it's home,ask where it is,who lives there,etc.Then segue into talking about the safe place they are now in-with housekeeping and a chef and emphasize that they are never alone.Remind them that their children made the arrangements for them to stay and everything is paid for (if the children are a safe topic) That should get you started-it takes time and practice,it's an art.You will gradually find out through trial and error what works or what escalates the situation. Also,chocolate in your pocket at all times on a dementia unit-it works wonders.Refer to the thread on here for many more tips

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

3 of my 6 assigned patients at the hospital the other night had dementia. I was stuck in the room with one, the CNA was stuck in the room with another, and lucky number 3 was on the floor.....MEDICATE 'EM!!!!!