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?

[brithoover]

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.

Don't rethink your nursing career..just maybe rethink your nursing focus! I was in LTC and could not deal with dementia so I moved on to peds!

[ktwlpn, LPN]

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!!!!!

And that's a big problem.Why do hospitals have peds units,neo-natal units etc but not geri units? These people have complex needs and there is just no way a busy med surg nurse can meet them all while juggling the needs of her other patients and we all know that you are seeing sicker folks on the floor then ever before. I think that it is largely the result of unrealistic expectations on the part of the family members.No one wants to face the fact that Alzheimer's is a terminal disease and most dementias are at the very least,life limiting.We in LTC are not always helping the loved ones face the truth-they come in for their weekly,bi-weekly or annual visit and mom is sitting up ,freshly coiffed and dressed,looking plump and they have no idea that she does nothing for herself and it's a daily struggle for the cna's.Palliative care is a dirty word to some of these people-you folks in acute care can jump in any time and show these family members what their loved one is really experiencing in the ER and on the floors,join us in LTC as we attempt to educate them.

[martymoose, BSN, RN]

^^^ you kind of took the words out of my mouth. We should have dementia/geri specific units. Thing is in my place of work, the only specific unit is maternity. Everywhere else can have any pt- cant possibly leave a bed empty for fear of loss of revenue for the ceo . Mass production seems to be the focus now. Years ago my(lol) unit used to be very specific cath lab recovery - we even were able to reserve/save beds for these pts. we were trained to care for these pts . Now and very much to my huge dismay, these pts with art /radial lines are mixed with the confused elderly. And you know what happened to me just a few days ago?? I had a post plasty pt with a radial art. band. I alsio was spending most of my shift trying to keep my confused pt from falling out of the bed/chair/whatever, as we all know I am totally responsible for their safety.And in the time i am fussing with the dementia pt, my other pt called her light -sent her sister out to find the nurse- and I come to a a pillow saturated in blood as her art site was bleeding.THIS IS SO NOT SAFE to mix pts like this. Luckily the pt was ok and not a large blood loss, but what if she hadnt had a fam. member to seek help?All the techs cant answer everylight timely as they are usually watching other confused pts, or 2-3 of the techs are toileting the elderly pts.

I think it also stinks that now our pedsmedical floor now can have reg adult pts mixed in there.IE- drug users, innappropriate confused pts, psych pts,etc. Didn't used to be that way. Would you like your kid in that setting?

[martymoose, BSN, RN]

.Palliative care is a dirty word to some of these people-you folks in acute care can jump in any time and show these family members what their loved one is really experiencing in the ER and on the floors,join us in LTC as we attempt to educate them.

Believe me - we try!! it seems alot of docs dont want to bring it up,; not sure if it's the customer service thing or not.

I sometimes wonder- it seems when we have to do some dirty work, that's when the family leaves and says " oh, we'll go get a cup of coffee or lunch and be back when you are done. They know. They are just glad they dont have to do the dirty or heartbreaking work.

Every so often we DO get a doc who is realistic and tactful.And you don't know how much I want to hug them.

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

Totally agree!!!! I worked long term care for years as an LPN but because of those very expectations that tied our hands, I left! As it turns out, I didn't leave for greener pastures but different pastures because the manure here gets pretty thick!!!!

[ktwlpn, LPN]

It's hard in LTC because many of the docs where I work are "old school" and don't embrace the palliative care concept themselves. Several of ours just become incensed if we bring up the subject.And- if we approach a family and they freak out and go to the doc then he is just as likely to throw us under the bus. I am very careful ,I have learned my lesson.I do always ask if the family wishes to treat the resident in the LTC or send them out and surprisingly a good number will reply" O,I can do that? I thought it was up to you and the doctor" We will soon start educating our folks)and the docs) about end of life issues and the available services (hospice and palliative care) upon admission.I think we'll see a difference,hopefully a decrease in futile care.Many families believe that hospice means their loved one will go to another facility or come back to us and have 1 to 1 cna's round the clock provided by the agency.Some of these same people believe that not putting a feeding tube into a 88 yr old end stage alzheimer's pt is starving them to death-we have our work cut out for us.