Love night shift....not confused pt's!

Pangea Reunited, ASN, RN · Aug 4, 2015

We use staff, drugs and occasionally restraints. High maintenance patients should also be split up so that one nurse doesn't end up with four of them.

RainMom · Aug 5, 2015

Our managers allow us to keep an additional staff member if we have a higher than normal ratio of confused or total care pts. As long as we can justify keeping extra staff (& don't abuse it), they don't question when it happens. Of course, the extra staff is not always available & you just have to use a lot of teamwork to watch out for each other's problem pts. We also use sitters when we can.

advsmuch08 · Aug 5, 2015

For the confused patients I try to see them first for assessments, med administration, bathing, etc. You don't want to wake them up once they've fallen asleep if you don't have to. Try to round frequently on these patients and emphasis to your aides which patients need to be watched more closely. Use the bed alarms. Once you get to charting, roll your computer to their doorway to keep a close eye on them. Distraction is always helpful. Dim the lights, turn on the radio with soft relaxing music. If you have it, turn on the tv channel with the relaxing scenes of clouds, landscapes and such. Give them some books or magazines to page through. A nice warm bed bath with fresh linens may help.

ArkansasLPN · Aug 7, 2015

Be sure to have your fall precautions in place especially the bed alarm. Depending on the patient's behavior while they are confused, they may need some restraits or even a posey bed. There are also a several medications that may be benefical (ambien, sonata, trazadone, haldol, Ativan, Klonipin, etc). I've had good luck with IM zyprexa. The sooner you get appropriate orders the better your night will be.

And the previous poster made a good point. Reduce any environmental stimuli. However, I have found that turning the TV to a music station with low volume can sometimes help them sleep. If you can't get a restraint order, sometimes laying the bed completely flat and raising the feet only can keep them from climbing over the rail (there are several medical conditions in which this may not be an option).

loriangel14, RN · Aug 7, 2015

Medications and restraints

SubSippi · Aug 7, 2015

Sometimes, you just have to roll the patient's recliner out to the nurse's station and let them hang out with the staff all night. They might be confused as all get out, but I've found they're less likely to act up if they're around a bunch of people, and don't feel like they're being confined to their room.

We had to do this fairly regularly when I worked on the floor, and nobody ever minded. It was much easier than trying to keep them in their room, and those patients were usually pretty hilarious once they weren't so focused on needing to go home, or the always popular, "finding that little girl."

You can also give the old ladies a pile of towels to fold, or find a pair of sneakers and tie them in double knots and ask your patient to untie them for you because you "just can't get it undone." I've never had a patient that wasn't willing to help.

Last, I just want to add that dealing with patients who have dementia is a skill that takes time to develop. Some people have an easier time than others, and I know how exasperating they can be, but you'll get better at it.

stephalina6, BSN, RN · Aug 7, 2015

Thanks everyone. With restraints, our floor manager says we are not allowed to use restraints on our floor. Apparently, a few years ago, a patient died in restraints. I don't know the full story (going to ask someone next time I work) and not sure if the restraints were the sole reason of the death but that's the story. I've had to give Ativan 0.5mg q4hr but sometimes it doesn't even phase them. Same with Haldol IM. I asked a friend that works on another floor and she mentioned the folding of the wash cloths so I thought it was funny to read that again so definitely going to give it a try. We do have sitters available but we can't get one at 12am when the patient starts to get agitated - we have to wait until the next night shift. I love nursing for the teaching and comfort and helping the patient in any way I can.....but these confused patients really take a toll on me. I've been making some serious thoughts about switching to days because during the days there are a lot of distractions - 3 meals, PT, any procedures, visitors, etc. but when I talk to the day shift about how they like it during the day some say they've had moments where they feel like quitting. Here I am talking about how hard it is for me to handle confused patients but I've never been so confused in my life, lol. Switch to days or stay on nights. :cry:

RN_jess · Aug 9, 2015

I feel your pain. Nothing against day shift but sundowners have become my worst enemy (I work evenings). One of the PP's mentioned meds, including ambien and trazodone. I don't know about trazodone but ambien is on the Beer's List and our MDs rarely prescribe it for anybody over the age of 65 due to so many adverse reactions, including worsening agitation. I personally don't like giving any sleepers to my older adult patients unless they have been taking it for years and years. I'll let night shift make the call if they want to give anything like ambien. I'm also cautions with benzos with this population. But haldol and zyprexa? They rock.

odaat · Aug 9, 2015

I feel your pain. Nothing against day shift but sundowners have become my worst enemy (I work evenings). One of the PP's mentioned meds, including ambien and trazodone. I don't know about trazodone but ambien is on the Beer's List and our MDs rarely prescribe it for anybody over the age of 65 due to so many adverse reactions, including worsening agitation. I personally don't like giving any sleepers to my older adult patients unless they have been taking it for years and years. I'll let night shift make the call if they want to give anything like ambien. I'm also cautions with benzos with this population. But haldol and zyprexa? They rock.

I pretty much refuse to ever give ambien to anyone 65 or older again! Every single time I have it has not ended well-IVs torn out, patient running down the hall naked, etc etc. It is a horrible med for that population IMO

loriangel14, RN · Aug 9, 2015

We give lots of Seroquel. It's great.