Published Jun 8, 2003
Hi, I was wondering if anyone here works with LTC residents who have a habit of screaming?
In our facility we have one woman who calls out continually for help that it sounds as though she is being attacked. This looks terrible when new people are in the building visiting others. The doctors seem to think that she is in pain but I disagree. We give her pain medications and it does not help. Also, she has Ativan ordered and it does not help. Instead, if I was to give it to her on evenings, she would be completely zonked not quite 24hrs later, so it's virtually impossible for us to do anything for this woman to keep her from yelling. If you ask her to please tone it down or ask her why she is yelling she will say that she isn't, but will tell you in the next sentence how sore/hoarse her throat feels.
I am at a loss of what we can do with this woman...the screaming is hard to listen to sometimes and her neighboring residents have to listen to her calling out constantly.
Any suggestions besides a soundproof room?
I am certainly familiar with "screamers" in LTC settings. We have lady who is absolutely, totally confused and yells (or used to) all day long at her spouse.
The doctor had prescribed Ativan at first. It helped for awhile until the dementia worsened.
Next, Risperdal was prescribed...it also seemed to help for awhile.
Now she is taking Zoloft - 100mg qhs...and she is doing so much better. She still takes Risperdal also.
Good luck....Oh, we tried all other things- i.e. 1 on 1 interaction, blah, blah, blah.....we all were needing relief....
She is quiet for awhile...until the dementia worsens, anyway.
Thanks for the reply, I was just sitting here trying to recall what other medications she's on. I don't think Risperdal is one of them. I will check tomorrow at work.
we have a screamer too. I have been told she is in pain and that she is hungry, but nothing works.
I work with an ER doc who is positive that half the world's ills could be cured with Haldol. Since it is also an antipsychotic, it might be worth a check.
We have an LTC patient in the hospital right now. She yells "I'm in the bed" or something like that, but she seems to calm down if you talk with her and pet and pat her for a while but different patients and diagnosis, I know.
sometimes Zyprexa works
Haldol also has a very high incidence of EPS. I'd be really hesistant to give it to an elderly patient. I know ER docs love it--I've lost count of how many adolescent psych pts we've had come from ER who wind up with EPS from Haldol. I would think an atypical antipsychotic like Zyprexa or Risperdal would be better, too.
Our psych doc has stopped using risperdal on all of our residents...covering his azz due to the study that recently came out linking a higher incidence of CVA in the elderly using it.Screamers are such a problem-it's an ethical dilema,IMHO.Whose rights take precedence here-the right of the screamer to not be given "unneccessary meds" or the rights of the other residents on the unit? In my experience nothing works well for long-but don't be afraid to try new therapies and approaches.We always ask the doc how long we should give a new med-many do work for a time and as soon as they loose their effectiveness we call him ...It seems to be a phase and they all eventually get through it...Aroma therapy,one to one,tactile stim(baby doll?) pain med,food ,drink,music.,massage(I have found that rubbing the extremities with warm lotion helps for a time-or long enough to keep YOU from jumping out of the window) At least you can feel like you are trying something....
Ok, will try some of these techniques. I think our unit tried giving her a piece of gum once and it worked for about an hour because she was busy chewing. Unfortunately though, even when we're all in the dining room she will call out sometimes. It's not as loud, but she does it anyway.
Her family does not want to find her sedated when they come to visit and have complained numerous times about how "out of it" their mother is. That's from her only having recieved a Tylenol ES on the day before. And oddly enough, this woman tones her calling out down right before a family member arrives. Hmmm.... Family is aware she does it and I'm sure has witnessed it, but what can one do?
I've even had another resident ask me one day (by the screamers room) for a carrot stick and I said, well, I have some in my lunch sack, can you wait until lunch and I'll share one with you and she said "no, I want to stuff it down her throat". It was funny, but it's obvious how much it bothers others. There is a 45 year old man with ALS who is a couple doors down the hall from her and I do not know how he does not go crazy.
Her family does not want to find her sedated when they come to visit and have complained numerous times about how "out of it" their mother is. That's from her only having recieved a Tylenol ES on the day before.>>>>> They just don't get it-obviously she is in some kind of torment...Maybe the family should pay for a private duty 1 to 1 cna for a few hours a day..It sucks for the other residents-it's hard for us to hear this for 8 hours-imagine being an A&O resident and living with it 24/7...I see what this behavior does to other demented residents also...If you have all of your interventions documented then you are covered and a little sedation may be neede-it's no fun to deal with a family like that...Sounds like a team meeting is called for-your DON needs to stand up to them also...
I agree that a team meeting is needed, but there have been many others in the past. Unfortunately this family is very wishy washy about what they want at times. One minute they want things this way, the next minute they want it the other way. Very domineering and hard to deal with at times.
Thanks again for the replies.
Ya gotta love my DON-she has been known to offer problem families a very simple solution "If you are truly unhappy with the care your loved one is receiving here I can give you some information on alternative placement" That ALWAYS works-she only uses it in extreme circumstances-but when she brings out that big gun folks quickly become more reasonable
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