What would you do about a LTC resident like THIS!

Nurses General Nursing

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bagladyrn, RN

2,286 Posts

Specializes in OB.

I've already told my son that when the day comes that I need a nursing home, he'd better warn the staff that I'm going to be the LOL in the geri chair by the nurses station, wide awake all night long (every unit has one) since I've worked my entire career on nights, we KNOW I won't be changing!

duckie

365 Posts

I once had a man that was very much like this person you described. He cursed the staff, hit us, kicked us, you name it, he did it. Every aspect of his care was explained prior to doing it, he FULLY understood, the only one he had fooled was his daughter that said, "Daddy would never treat anyone like this if they were not provoking him." Well that's not what his brothers and sisters said. They said he had always been an abusive alcoholic and this was his normal way of life before entering the facility. Sure, daughter would defend him, she lived over 1000 miles away and saw him 2 days 3 times a year. This very sweet man nearly broke my nose when he used the full force of his fist to slam my head against the wall, nearly breaking my nose and knocked me out, the reason, I was putting lotion on his arm. Some people just will not and in some cases cannot change but others no darned well what they are doing and love every second of it cause they know there is not a darned thing we can do but smile and duck from the punches, I just didn't duck fast enough! Good luck honey but don't take it personally.

emily_mom

1,024 Posts

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....:D

Peatness

22 Posts

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:rolleyes:

Kikumaru

83 Posts

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

amanda1229

73 Posts

Specializes in LTC.

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.

jojotoo, RN

494 Posts

Specializes in Emergency.

Medicate, medicate, medicate. Not neccessarily sedate her, but perhaps an antipsychotic or something like Aricept.

TrudyRN

1,343 Posts

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.

amanda1229

73 Posts

Specializes in LTC.

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!

Specializes in ICU/PCU/Infusion.

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.

lpnbecky123

12 Posts

Specializes in SNF/LTC, ALF, Med surg, from CNA to ADON.

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.

steelcityrn, RN

964 Posts

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.

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