Interventions for a Terrified, Disoriented Resident

[SuesquatchRN]

She has been with us for years. She does not know here she is, she is constantly looking for her parents and husband, and she wants to go home. Cries and moans all day. Breaks my heart.

She is on a low dose of an SSRI and Ativan 1 mg QAM, 0.5 QD at 4 pm, and 0.5 a day PRN.

Does anyone have any ideas> When I mention it to the floor nurses they blow it off with, "She's always been like this." Well, maybe she doesn't have to be.

Thanks.

[NurseLoveJoy88, ASN, RN]

Sue I deal with your type resident every day x60. I'm a nurse at an alzheimers alf. I have learned to live in their world. I never try to orient them because it will only fustrate you and the resident. If the sky is green per resident the sky is green. When they get upset I use different methods for differnent residents. Figure out whar her previous hobbies were. They may not have short term mem. But they have long term mem. At times. A lot of my demented friends are on depakote, ativan bid and prn, maybe cymbalta for depression/pain may work. Good luck.

[Morning-glory]

Also, one of the things you could look at it the paradoxical effects of ativan and other psychotropic meds. Ativan can make the elderly more alert and combative. Remeron seems to do a better job at getting them to sleep and lift their mood.

Worth the try, at least to take out the ativan for a day or two and see what happens.

Good luck.

[CapeCodMermaid, RN]

I second the comment about pain. We had a woman who was always pacing, carrying on, and very behavioral. One day I gave her some tylenol. It was amazing...pain is very often under reported and under treated in dementia residents. With all the drugs we try certainly tylenol is benign enough to try.

[*bettie*]

I have a little experience with this type of population, and I agree with the assessments suggested so far. One other med to consider is haldol- limited basis. I also use distraction, simple tasks like folding wash cloths. Possibly she is bored?

:heartbeat

[SlightlyMental_RN]

Have you tried giving her a baby doll to "care for"? When I worked in a nursing home, we had good results with doll therapy. Here's a link to a research study about it:

http://www.nursingtimes.net/nursing-practice-clinical-research/using-dolls-to-alter-behaviour-in-patients-with-dementia/201683.article

[rn/writer, RN]

Sharp group we have here.

I was going to suggest pain meds and the baby doll. Pain in someone who can't tell you about it can easily manifest as anxiety and agitation. They know something is wrong and can't do a darn thing about it.

The baby doll idea has worked with many patients. They know to rock the baby and they comfort themselves in the process. There are some well-meaning folks who protest this as demeaning, but what is more demeaning than being unnecessarily miserable? I'm in the camp that says do whatever works.

You could combine the baby doll therapy with pet therapy and get her a lifelike stuffed animal--a cat maybe. The petting and cuddling can be as soothing to a disoriented adult as it is for a little child.

Thank you, Sue, for caring for your residents beyond the basics. You have definitely found your niche.

P.S. See if you can incorporate some kind of music into her day. Gentle motion, rhythm, and distraction can make a difference for some.

[SuesquatchRN, BSN, RN]

Well, the responsive doc was in today and we upped her Lexapro and started her on Tylenol 500 mg TID.

I tried with a stuffed anima today. Redirecting/explaining/etc really really really are not effective with her.

Thanks so much for your input, everyone. We're going to give the Tylenol and Lexapro a couple of weeks and then re-assess.

[CapeCodMermaid, RN]

About baby dolls...we had 2 very life like dolls on our dementia unit. One woman would go nowhere without her baby. Every day at mealtime, I would have to take the doll to 'change him and feed him'. I would literally have to pick dried food off the doll's face. This lady had a skin tear and wouldn't keep the bandage on so I made a bandage identical to hers and put it on the baby...she kept her bandage on.

The other story...not so much of a happy ending...the demented woman was wailing and crying looking for her baby who she thought was lost. Ah ha! thought I....give her the baby doll. I carefully dressed her ,wrapped her up in a receiving blanket, and brought her in to the woman's room. I said "Oh...I've found your baby" and handed her over to the patient. She looked at it and then at me and then at the doll and finally said in a clear, rational voice "Honey, this baby's face looks like its made of plastic!" I had to leave the room so she wouldn't see me laughing.

[SuesquatchRN, BSN, RN]

She looked at it and then at me and then at the doll and finally said in a clear, rational voice "Honey, this baby's face looks like its made of plastic!" I had to leave the room so she wouldn't see me laughing.

*snort*

[nursejoy1, ASN, RN]

I had a resident who was just like that- cried constantly. Almost everything hnad been tried- even the psych consult and nothing worked. She had order for Lortab 5 and also Ativan 0.5 mg PRN . We tried giving together and she stopped crying, sat up and had almost normal conversations with us. She was like a different woman. I beleive she was in constant pain as well as anxious and the combo allowed her to feel well enough to interact with her world. I don't usually like to give a lot of narcs, but these worked a miracle for her.

[SuesquatchRN, BSN, RN]

Thank you all!

She is not crying. She is smiling. She had one very short episode of teariness this afternoon.

She is usually sobbing when she awakens. This morning she smiled at me and started talking about planning a party. I started dancing and singing and she exclaimed, "Hubba hubba!"

Who knew Tylenol and a little more Lexapro could work such wonders.

Thanks, from me and her.

:)

[Blindsided]

I just wanted to thank everyone here for these posts and for caring enough to help this patient. It's what we do and it's gratifying when it works. I hope she continues to do well. Great going!