LTC Pt - What to do?

[nursesherry]

I work in LTC and have a question about a pt. This man has been in our facility with his wife for about 3 months now. He is A&O during the day and very rational. At night it is a different story. He will focus on a certain ailment and worry himself and the staff sick about it all night. For instance, it may be his arm bothering him. He will lie in the bed and try to figure out what it is for hours. He will call the staff into his room everytime he thinks of a new diagnosis for his arm. Then when he thinks he knows what it is he will call the staff into his room every 10 minutes wanting us to try different things to fix it. This goes on every night. Every night it is a different ailment. He doesn't sleep, he wants to be gotten up and down from his bed to the w/c and back again 3 to 4 times an hour. The day shift nurses don't seem to believe me because he is so different during the day. Last weekend the day shift nurse got a glimpse of this behavior herself. I have been charting the behavior and even got the Doc to write me a xanax order TID. It hasn't touched him. His primary diagnosis is CHF. I read in his history that he was a daily bourbon drinker at home for the past 40 years. Could that be affecting him in some way, not getting his daily bourbon anymore? We have lots of sundowners but I have never seen it to this extent. I hate to keep harping at the doc about this but this man is not getting any rest at night and neither is his wife. He pokes at her with his grabbing stick all night saying wake up and talk to me, I'm bored. Any suggestions? Has anyone else delt with a similar situation?

[Blackcat99]

My mother has alzheimer's and is a "Sundowner." She is more alert during the day. They tried xanax on her and it was not effective either. The doctor tried her on seroquel and now she is up to 250mg every hs.

It worked for Mom. She sleeps fairly well most nights. Once in a while she will still have a restless night but not very often. Good luck;) This guy certainly needs something strong to take-that's for sure.

[EmmaG, RN]

I don't have any suggestions... but this is too cute:

He pokes at her with his grabbing stick all night saying wake up and talk to me, I'm bored.

[EmmaG, RN]

Well... there is one thing.

I've had these prim and proper little old ladies who'd rather die than ever touch a drop of liquor... but they just gotta have their "vitamins" every night before bed.

http://www.eldertonic.com/eldertonic.htm

Works like a charm... just don't open it near an open flame

[CoffeeRTC, BSN, RN]

At first I'm wondering if that is real.

Why not see if he can have his bourbon? We've done it with a few pts and it works wonders. Better than any pill. A look at his meds and an adjustment could help too.

Working 3-11....I see pts like that too. They are total different persons after dinner is done. Frustrating when no one believes you.

[KrissyPRN]

Xanax is probably not the best thing to use for this type of behavior. I would talk to the doctor and let him know that the pt is still having the same type of behavior despite the xanax. I would consider that he could possibly be a sundowner. I highly doubt it is alcohol related or the lack thereof if he has been there for 3 months. Has he been evaluated for possible dementia?

[CHATSDALE]

sundown behavior ahas been well documented for years now but to many people if there is no lab test for it they don't believe it exists

docotors make their rounds during day and, of course, they don't see this behavior. perhaps some amtriptyline or trazodone might be suggested to md

if it works wife and staff will be grateful

[nursesherry]

LOL...didn't think of how that sounded when I wrote it.

[leslie :-D]

during the day, or waking hrs, most people remain distracted.

does he nap a lot during the day?

this would contribute to his wakefulness at noc.

anyway, come bedtime, they are alone w/their thoughts.

i think he would benefit from a psyche eval.

let the pros handle this one.

they would know the meds most apt to work.

i hope he finds peace...

so his wife can sleep. :)

leslie

[chadash]

Wondering....OCD? (NOCD: the nocturnal form:wink2: 0 )

Sundowning is remarkable, but is there any accompanying dementia?

[Neveranurseagain, RN]

When I worked in home health for LTC pts and I would recommend the family talking to the MD about giving him Benadryl 25 to 75 mg every evening. It took the edge off agitation, helped them to sleep but they were not oversedated and could head to the BR with risk of falling. Worked on some pts. but not on others. Also make sure he is getting enough stimulation and exercise during the day.

If Benadryl doesn't work--give it to the staff and wife so they can sleep!!!!!