What would you do about a LTC resident like THIS! - page 3

Ok . . . she is a/o and confused at times, and says horrible things to the staff, and is out if control! The other day, I was nothing but nice to her. I took care of her every need, even when she... Read More

  1. by   emily_mom
    I hope to never have to live in a NH. My 4 year old said that she wants to live with me forever, so I'm holding her to it....
  2. by   Peatness
    Mandi. you've gotten some great advice from your peers... Here's my tidbit (big bit ). What works best for me in these situations is to practice empathy to the nth degree. Put yourself into that person's shoes, imagine what it must be like for them day in and day out. They must be so frightened and angry. I learned my greatest nursing lesson before I even began school. My father was diagnosed with terminal cancer and a once strong and independent man required my assisstance 24/7. What was hardest though was when he slowly went into renal failure resulting in him quickly losing his mental functioning. I was assured the dementia was due to his pain meds (not true!) as it was later found that he had no renal fx. Throughout this ordeal I found myself dealing with psychotic episodes where he thought we were all trying to kill him, and became an expert marksman at crushing imaginary spiders that filled his room and competed with the bats for ceiling space...Needless to say it was quite difficult and on many occasions very frustrating. Perhaps it was easier for me because I loved him so much?.. I look at patients in similar situations very differently now. I make an attempt to understand them and their disease. As another member said, I too would be honored to have a nurse like you caring for me or any member of my family. You are obviously very sensitive and caring but you need to learn to not take take things personally so that you can prevent emotional burn-out. Affirm yourself each day and tell yourself what a great job you did. You deserve it! Best Wishes to you, Aniesse
  3. by   Kikumaru
    I believe that most residents in snf's have a case conferencing meeting every month. I think that it is important if family, significant others, etc. participate in these conferences with the providers. If this occurs all minds can assist in finding a common goal in assisting the resident. The goal may conclude with behavioral approaches, legal approaches or any other approach creating a long term gain for either the staff, family and/or resident
  4. by   amanda1229
    We have a resident like that. I can't do much, because I'm an aide so there's no psych consult or med change on my part. But whenever he complains or shouts, I just sit down with him or put my hand on his shoulder and say, "I know, they must have done something horrible to you! What did they do?" I just go along with his "they treat me like a dog" comments. He's constantly shouting this, but when I complain and whine and get worked up along with him, he starts to appreciate me. And since he has dementia, it's not like he's ever going to say, "And Amanda the aide agrees with me!" He calms down for a while, and you say the exact same thing sometime later. I find that when he calms down, he's a very sweet and sad man.
  5. by   jojotoo
    Medicate, medicate, medicate. Not neccessarily sedate her, but perhaps an antipsychotic or something like Aricept.
  6. by   TrudyRN
    Get a different assignment for a while or change your name.

    She needs meds adjusted, Psych consult, perhaps better care or a different type of care.
  7. by   amanda1229
    The bottom line in care for dementia residents is creativity. And, like most others said, not taking their actions personally. My favorite resident has Alzheimer's and is the sweetest person, and always says, "My you look so pretty!" and "My, it's been so long!" with a kiss on the cheek -- so naturally, it breaks my heart on days when she's combative and resists all cares. But you just have to be extremely patient and creative with the way you care for them. My favorite resident, Jane, gets EXTREMELY combative when we Hoyer her out of bed -- I just hold her limbs and say, "Oh, boy, what terrible things are they doing to you? What kind of pain are they putting you in?" And she'll talk on and on about how bad it is, until her mind wanders into something else, and she just calms down.

    I don't think the answer to all demented and combative residents is medication -- I'm not a nurse, but I am the aide who takes care of the resident constantly whereas the nurse doesn't get much observation. As an aide, you realize how to personalize each person's care and dementia is just another roadblock to get around in the process.

    Just link yourself to the resident -- as I mentioned before, if he's a complainer, complain about the staff! Complain that it's too cold where you work, or say things like, "Oh my gosh, you must be freezing! It's always too damn cold in here, isn't it? I'm going to get you a blanket, how many do you want?" They may not be your best friend, but I've found they'll at least answer with, "You're right, I want three!" and agree with you on some front. Repeat this, and soon enough you may be off their hit list! I know you'll get busy at times and you'll have to abbreviate, but once it's comfortable for them and you, it'll just work out much better. Just try it!
  8. by   GeminiTwinRN
    I have to respectfully disagree with the poster who replied that this is "a normal part of aging". No, it is not a normal part of aging. It could be, however, a symptom of some sort of mental degeneration, for lack of a better term. It can also be a symptom of a physiological ailment, and one that needs attention by a trained diagnostician to treat with meds, or a combination therapy.

    My own experience is personal. My grandparents raised me, and my grandfather was an MD. When he began his downspiral into dementia, his actions were similar to what the OP describes. I found that reasoning with him made no headway. Playing into what he described wasn't good either, but it was better than just patting him on the head and telling him what he was seeing/thinking/feeling wasn't real. It *was* real to him. Medications helped him (Aricept for example).

    Risperidal is another good drug for pts such as this, as it aids in the decrease of psychosis, or psychotic symptoms like you describe. The dosing must be carefully monitored, obviously we don't want to put the LOL or LOM into lala land, but we do need some intervention.

    I realize this OP's thread is several years old, but this is a problem that is current with so many of our patient population so I thought it would be worth responding to now.

    Elderly people are often depressed. I know my grandfather, when he had periods of being lucid at times would just sit and cry at his condition. He was a brilliant MD, had delivered over 10,000 lives into this world and yet couldn't use a fork and knife to save his life. I've never forgotten the time he asked me to aid him in ending his life. I'd never cried as hard as I did when he showed me the shopping bag from the shoe store that had a drawstring on it and demonstrated how he could put it over his head and suffocate if only I could help him figure out how to open it up to do so. Can you imagine?

    The elderly population is growing, by leaps and bounds. We must find ways to help these people. We are facing this ever increasing problem, and it seems that we still have a lot of learning and education to do.
  9. by   lpnbecky123
    She sound lonely. she sound like she could be having pain. What kind of activities does she do. did you ever sit down & tell her she hurt your feelings? Maybe she needs to get into a restorative program, maybe she needs to walk a bit. she may be just bored. Does she have any family that visit, I would ask them if this is normal behavior for her.
  10. by   steelcityrn
    Until the resident becomes hostile, your staff needs to set goals, and plan how you all can deal with this person. If this person was to become more of a threat, than just saying hurtful words, then they need placed in a behavior health ward.
  11. by   witchypoo
    can we say psych consult. sounds like she is a trip, couple of anti depressants might help her out too and since she is verbally abusive to other residents maybe a little trip to the local psych center to work on the proper meds just for good measure
  12. by   husker_rn
    I would make sure her behaviors are documented as are all interventions that have been tried...success or failure. THEN I would talk to her physician about alternatives i.e. meds. There are meds for behaviors but that won't be considered until you have shown what does not work. I would go in and take 10-15 minutes with her at the start of your shift. Listen to her and validate feelings. You're going to spend that much time or more with her so you need to decide if you want to do it with a block of time or countless little trips to the room. Good luck. Since I'm in LTC too I certainly sympathize with you.
  13. by   megananne7
    wow, this thread is very old... 2003 anyone?