I don't know what to do...

[Pat2012]

On a daily basis myself and my CNAS deal with an ALZ pt who is verbally and physically abusive. She will not let my CNAs near her to change her brief or do HS care, she has slapped people, spit in people's faces, and raises her fists if you try to help. She also cusses you out every time. Now, she is literally taking the pills out of her mouth and throwing them. I've tried putting the pills in applesauce, pudding, hand delivering them into her mouth, and crushing them, and nothing works. My CNAs are getting frustrated because they have to deal with this nightly and then get accused of not doing good care, even when they have re-approached her several times, it doesn't matter. I feel that they should not have to risk getting beat up, just to change a brief. I have expressed my concerns with my supervisor, but she says you just have to re-approach her, and "that's the way she is and has always been." I feel this is an unfair response and doesn't help my team at all. I wanted to send her to geripsych, but my supervisor won't go along with it.... so what I am to do? What would YOU do?

[Dragonmom]

Contact the doc, explain the situation and see what he recommends. He could script something, IM perhaps, or recommend to the family or gaurdian a change in facilities. This pt. is causing harm to themselves by not allowing the cares, and of course harm to the staff.

Good luck.

[NamasteNurse, BSN, RN]

Alzeheimer's pts generally have PRN's for behaviors. Ask your supervisor if you can call the doc for something PRN. Sounds like your facility isn't prepared for this type of patient? I work on an Alzheimer's unit so I have 40 of the residents you describe! Not all are medicated, but we do have the option of calling the doc if necessary. Sounds like something has to change for you, it's not safe for you, the CNA's or the resident.

[Nascar nurse, ASN, RN]

How are the other nurses handling this resident? Do the nurses with years of LTC experience do any better with her?

There is a real talent to dealing with this kind of resident. Some of them really can be re-directed with the right approach but others may need a geropsych unit. I looked at your profile and notice you are a newer nurse. Maybe you can ask someone with more experience to show you the best way to approach this resident. Heck, tell that supervisor (in a non-confrontational manner) "Can you come down and show me the best way to get Mrs xyz to cooperate during a brief change. My way is not working and I'm afraid she will hurt herself". This allows you an opportunity to learn something new OR it shows that supervisor just how difficult the resident is.

Good luck

[alisia1]

I have worked in LTC for 7 years as a nurse, and have been through this so many times. First thing, i would strongly recommend that you NOT advise or recommend the family to another facility. If your supervisor or administator found out that you did, it could cause you trouble down the line, at the very least hard feelings from the higher-ups. Second thing- you have got to document. DOCUMENT, DOCUMENT, DOCUMENT!!! You need to create a paper trail of what is going on, that you and your cna's have offered care, and resident has refused. Also document the result of this refusal, i.e. any new skin break downs, weight loss, abnormal labs. But document them as facts, not saying "resident has an 8lb wieght loss becuase she always refuses her meals and meds". With good documentation from you and your cna's, your supervisor and the other parts of the clinical team will be "forced" to do something- if they don't they would be sorry. Becuase when they have the state surveyors come to your facility and see that nothing was put into place to address those problems the patient had, they could face huge fines and even loose thier medicare benefits. It may take a while to see change, but stay strong and patient, and good luck!!! :)