Med question?

[GretaRN]

Hi,

Have been in assist. living for 3 months now...love it...but one resident is on trazadone, she has moderate anxiety, is 70 year old w/picks disease. In the past she would wake around 6am and be anxious (packing things etc.) I believe she was on trazadone 25mg in am and hs. she also had 25mg prn q8hrs. In the last month they have increased traz. 25mg am, 50 at 5pm and 50 at 11pm. We provide daily documentation for the md since the increase. within the last week she hasn't been going to sleep until 3 or 4 in the am. waking around 7 or 8am. This morn she was very un-coordinated and putting glass into cereal bowl. I held the morning dose of traz. She seemed more coordinated after lunch and actually sat for an hour and a half watching movie...but legs and feet were moving... Previous to this med increase, the poor woman didn't even know what to do when handed meds (she puts them in cereal bowl-I was testing to see what she would do) . She frequently has things in her mouth: papers, bingo chips; she also has a hard time following simplist of directions... so we really have to keep an eye on her. She also eats and 5 minutes later is hungry because she doesn't remember eating...I feel holding traz. was the correct thing to do, I also checked on side effects of traz and she seems to have them also.

Any advice out there? Thanks for the support.

[ghillbert, MSN, NP]

The only advice I can suggest is discussing your concerns with her physician.

[GretaRN]

thanks, I don't get to see her physician I only work part time, eves and every other weekend days,,, but will discuss w/unit manager who does communicate with him.

[SuesquatchRN, BSN, RN]

Greta, make a really clear note and make sure to pass it along in report. And put it on the MD's rounding sheet or whtever you use.

[mamamerlee, LPN]

I don't know where you are, but my MIL has picks' and had started to put EVERYTHING in her mouth. We had to move her to a special unit where there is NOTHING on any surface to pick up and chew on. Also, she had lost a lot of weight, so they started to give her bigger portions, and finger food that she could carry, as well as shakes. They have adjusted her meds, as well.

You will eventually need to get her somewhere so she can be safe. My MIL had a latex glove, a small baggie and someone else's bottom dentures in her mouth all at the same time. This new unit is in an excellent facility, family-owned, very caring.

The meds are not the only answer.

[Psqrd]

Anytime a medication is held, document observations and notify physician.

Not notifying the physician of a held medication can get you in trouble.

P2

[Havin' A Party!, ASN, RN]

Yup, have the MD informed and follow through. If her status is deviating from baseline, she'll likely be sent out.

Could be the Traz or something else (infection, etc.).

[SuesquatchRN, BSN, RN]

And Greta, the first thing we do when anyone is wonky is dip the urine. A UTI that has us uncomfortable can really whackado and old person.

Seriously, any deviation from baseline is, "Dip her." You know the old saying, "When you hear hoofbeats think horses, not zebras"? In geriatrics, a UTI is the horse.