Call Light Happy Resident....help please?

[DefmamaNurse]

I'm a Charge LPN at a LTC facility working overnight shifts....I have a particular resident whom is neurotic on the call light all night long. It would be for anything from I need a tissue (when she has a wad of them under her pillow) to using the commode (the commode is a given but every half hour to an hour?? AND in an 8 hour period she would get on commode 8 times and void 2 times).

Here's an example of a night I and a CNA experienced with her.

-Pull the blanket up my shoulder ( is very capable of doing it herself)

-take my blanket off my shoulder (this is 15 minutes later)(again capable of doing it herself)

-I need a drink. (Takes a tiny sip)(5 minutes later)

-My heel is cracking I need lotion on it (half hour later)

- I need the commode. (half hour later)(take her off commode 5 minutes later No void)

-I need a drink (15 minutes later)

-I need the commode (15 minutes later)(wants us to help her up, we do and she whines how it hurts when we do it, AND she is VERY capable of sitting up in bed by herself. Has done it many times.)

- (Pretends to be asleep, we know she pretends because we've stood there watching her and waited)I don't know what I need. Give me a drink of water.(20 minutes later)

-I need my vics vapor rub for my nose. (half hour later)

-I need the commode (Does void but 50cc????? 5 FLIPPING MINUTES LATER!?!?!?)

- Push my pillow back (20 minutes later) (GRRRRRR...she was okay with it a few minutes ago!!!! We know because SHE SAID IT WAS FINE!!!)

(Are we getting the picture yet?)

Now....the CNA and I, we are on our feet the entire night busy doing other tasks and caring for other residents. With the constant puling of the call light it's aggravating and if we are busy with another resident SHE WILL CALL THE FACILITY if you don't answer the light immediately.

We have told her that we have other residents that need our care more so than she (the ones that can't pull lights, the ones that can't tell us they are soiled, the ones that are Extensive assists and require the lift to be transferred to geri chair). We have rounds we must do. Her response? (Very petty of her too.) 'I don't care, I come first.'

Whaaaa?

She does have ativan scheduled twice a day and has ZERO, zilch, nada effect on her whatsoever. She is also on 10 mg oxtcontin BID, 100mcg Fentanyl, tylenol, gabapentin, carvidopa-levidopa, remeron 7.5 mg, tramodol PRN, Ativan PRN (no effect either). She has a UA done every week because we check to see if she has a UTI, and results come back normal.

She is neurotic and gets bent out of shape if things don't go her way.

I've come close to asking her if she is a toddler and wants to be treated as such.

With every request she makes imagine a whimpering sniffling whiny voice with that.

We got her a little pitcher to put cold water in that she can reach and get a drink out of it and it' light, will she use it? NOPE....her reasons...'I can't reach it.' or ' Its warm.' (we just put ice cold water in it too.)

She is all there in her head, and she has been seen being VERY independent for a woman who acts helpless.

She reports to Social Services that she is happy there, yet tells the CNA's and nurses that our work performance is very poopy (I won't use the very naughty word I really want to say) and treats my girls and me like caca.

She has gone as far as to kick me and the CNA, (it's just the two of us on nights) out of her room because we didn't cater to her like she wanted. Just imagine how that went all night.

So.....please help with some ideas that we can incorporate to get her to stop being such a child.

[dishes, BSN, RN]

Has she been assessed by a mental health professional? Does she have a fear of abandonment?

[KatieMI, BSN, MSN, RN]

1). Psych consult ASAP.

2). Convince PCP who cares for her to either reconsider her pain/sedative meds or request consult of someone who is better at that. She is getting pretty much hospice-leve haphazard narc alphabet soup, and the interactions of all that stuff in her are, as things are given, completely unpredictable. She can get any sort of side effects, from agitation to deep sedation, at any point. She might have to be weaned from some of them and her treatment plan MUST be re-arranged. Palliative care and geriatrics are specilaties which do it best.

3). Get together with your boss, ask him/her to call her boss in that "facility" and explain what is going on. Let them know that the patient may call them for trivial or no reason, so they know she was not abandoned for X hours. Tell your boss about your plan in 4)., if she agrees, then go ahead.

4). Speak with the resident. Tell her, as if stating the plain fact, that you are going to be very busy now but you care about her and so you'll visit her room to see if she needs something every, say, 20 min. Get a whiteboard, write down time "right now" and "when you come back" so she can see it. Do that, minute per minute. Ignore calls in between. Make sure that all other nurses and CNAs do the same, and follow the rules you guys set to the point. Usually, in a couple of days patient gets used to that regiment; once it happens, start to add 5 min to the pause between visits. If patient doesn't get it, it usually means some serious medical or mental issue on board.

5). As a last resort, do what you need to do according to your policies if your nursing judgement says that "we cannot provide here the level of care the patient needs" and get things moving in direction of shipping her out.

6). Acess, access, access. And document, document, document!