Advice re. Demanding Resident

[mary761]

I am new to the LTC environment and am working nites as a CNA in a subacute center until I pass my boards. I need some suggestions about dealing with a resident.

My first 2 nights at work, Ms. X rang her call bell every 10-15 minutes the entire shift, requesting help to the BSC so she could move her bowels. Most attempts resulted in nothing; a few times she moved a pea-sized or quarter-sized nugget of soft stool. After about 20 times of answering her call bell (I'm a S-L-O-W learner) I told her she was not moving her bowels and she needed to rest and give her bowels a chance to "move things along" to the point where she could have an actual bowel movement. Her response was to (WARNING: Put your snack down now) dig chunks of stool out of her rectum with her sharp fingernails, ring her call bell every 10-15 minutes, and "show" me that she did indeed need to use to BSC. After these actions, she passed pea-sized and quarter-sized nuggets of stool with frank blood. Needless to say, by the end of the shift I was exhausted.

Last nite, I heard in report that she had been to the hospital for a surgical procedure and was therefore on bedrest for the night. Further, they had cleaned her bowels for the procedure, so she no longer felt constipated. Hallelujah!

10 minutes into my shift, the calls started again. This time, she was calling for the bedpan so she could void. Each attempt resulted in approximately 20 cc of urine. If I did not IMMEDIATELY answer her call bell, she screamed "HELP ME!!! HELP ME!!! I HAVE TO GO SOOOO BAD!!!" at the top of her lungs, waking the other residents. After 4 visits with the bedpan, I put a brief on her and told her she was not voiding enough each time to feel a full bladder. I assured her that the brief would keep her from getting wet if she "accidentally" went, and that I would be back once every hour to check her and put her on the bedpan if she needed to go. This resulted in an even greater acceleration of her demands, claiming that she "couldn't let it go" into a brief, and screaming at me that I "don't know what it's like to be on medicine that makes you have to go so often".

The nurses tell me she has "other things" going on (what, exactly, they won't say) and that there is nothing ordered to calm her down. One nurse helps me with her constant demands, but the others turn a deaf ear or pop their head in long enough to tell her I'll be there as soon as I can (which causes a new round of screaming).

I'm running my @$$ off trying to keep up with her and my other 25 residents, and I'm already dreading work ON ONLY MY 4TH DAY!! Any suggestions?

[Nurse Ratched, RN]

I wanted to let you know I followed your advice and set 1-hr. limits. It has helped a lot. Thanks so much for your replies.

Good for you, Mary :). It's a difficult thing when your co-workers are telling you to "just ignore" someone - yours is a much more practical solution. You have a good heart. Setting limits is a skill that will never go out of style in nursing .

[nycegyrl]

Oh I remember a lady like that. She was a pill. I am not sitting right. Move me here and move me there. Put me on the toilet take me off the toilet. My dress is bunched up. My socks are not in the right place. Ring the call bell to tell you she can't reach the call bell. My hair, my teeth, my socks, my dress. On and on every single day on every shift. It would wear you out. Her family had tolerated her behavior all their life. I don't know how. It was like she was spoiled. Like a little spoiled kid. The nursing home administrator as well as the nursing administrator had to a stop to it. They both sat down and talked with her after talking to her family. She would be adjusted one time. We would come in and redo what she needed one time so she needed to make sure it was what she wanted. After that she would have to wait awhile. But she got onto that. When someone different would walk past her room she would call them in. Whether it be housekeeping or Social Services or Activity director. LOL she was good. But it didn't matter to me as long as someone was pacifying her. I would walk past and see someone, even her roommate, bent over adjusting her socks to the right height on her ankle and I would have to chuckle. She never gave up. It got better. But she never gave up. It is like she would focus on something and obsess about it. And you have to take her seriously at times because she may really have to go to the bathroom again in 10 minutes. I know it must have been uncomfortable for her to be wheel chair bound with arthritic legs that were bunched up and having to wear a leg brace. Not being able to take herself to the bathroom. She didn't even want to roll herself to the dining room. But we would have to encourage her to do so. Good luck with your resident. I never thought it might be a mental problem. It gives me something to think about the next time I encounter someone like her.