Frustrating patient care situation

[hookyarnandblanket]

I care for a patient with dementia who often clenches her hands in a contracted position when we try doing nail care or wash her hands before and after eating as well as during her bath time. Her hands are not totally contracted all the time and it is definitely voluntary contraction. She is still able to occasionally feed herself finger foods but fights us when we try to clean her hands.

The problem is that no matter what we do to clean her hands well, they still smell terribly. We've tried softly scented lotions, scented hand soaps, everything. I don't think we could get her to sit with her hands in a basin of soapy water. Does anyone have any tricks to getting that smell out of her hands?

[Leonardsmom,LPN]

One of the things you could try, if she will allow you that I have done with stroke patients, or those whose hands are contracted, is that I use a wash cloth that has been lightly powdered and place that into their hand. Just regular powder will work, the same type that you might use on your heavier set women under their breasts or abdominal folds. The powder will help to absorb the moisture that is gathering there. If at all possible try to wash and dry her hands as best as possible first. Massaging her hands might help her to relax so that you can take care of things easier, or try other things that may help her relax. One patient that I use to take care of would get upset anytime we would go to change her, another would scream in the shower. With both of them I found that they liked music, singing in particular... so I would sing songs that were familiar to them. Most of the time they would stop screaming and would calm down, more often than not they would start singing with me and I was able to complete the task that needed to be done with very little trauma.

Also try to do this at a time in which you don't have to rush, so that you can do things slowly. Unfortunately sometimes when we have multiple patients that we are trying to take care of we can become more focused on completing the task so that we can get to the next patient and try to meet their needs. Those with dementia don't always know or understand what is going on, and when we come through, to them which might seem like a freight train their anxiety and fear will increase. Not saying that you are doing this, but sometimes we need to slow down and might not even realize it.

[mvm2]

Barb H gave some great advice. Especially love the music idea it might just relax her enough to allow you to do what you need to do. And the powder as well might really help

Just also want to point out that with you mentioning that she is doing this voluntary that you don't have the impression that she is doing this on purpose just to make things difficult on you. In some situations she might indeed be able to relax her muscles and be able to use her hands, and you may think that if she can relax her hands while doing this then she should be able to relax when I am trying to wash her hands. But it might be that this is an uncomfortable feeling for her and that will make her tense up. I have a client that does not like to be touched unnecessarily. You don't just pat her hand or touch her shoulders or knees. It makes her feel very uncomfortable. So maybe it is uncomfortable for her to have someone touching her hands and then it becomes really an involuntary thing because if her body starts to tense up she can not relax her hands.

Also you never know maybe in the past she got hurt by someone tring to pry her hands open and now she feels tense and scared about getting hurt again.