Need help with communicating with alzheimer's demetia pt.

[somuch2learn]

Hello, everyone!

I am a 1st semester student nurse. I just had the final exam for the 1st quarter nursing class. I seem to be doing ok with theory part, but my concern is with clinicals.

I have been getting tremendous help with this website, sometimes with coping with stress by reading some humor and reading about how other students are doing and sometimes with helpful information for clinicals, like writing care plan. I love this website!!

I am writing on the thread for the first time, and I actually just registered to this website for a question I have about communication with patient with alzheimer's. I had a 83 year old female patient with alheimer's dementia who seems oriented, appropriate. She is a sweet lady who is the happiest person in the world.... she says she is happy all the time and when asked about her problems she may have, she says she does not have any problem.

I was doing an extensive subjective assessment last week on her on all of the body system. When I asked questions such as "do you require assisstance with walking, turning in bed?" (although I knew she is always on wheel chair, I had to ask these question to fill out SUBJECTIVE ASSESSMENT paper), she says " no, I do not need any help. I can walk from this bed all the way to there." and I asked, "do you use walker?" and she says, "no, I can walk by myself." Later, I asked the CNA if the patient was really able to walk by herself, the CNA told me that she can not walk alone even with a walker. she needs assisstance to walk even with a walker.

I think she thinks she can really walk by herself. She always says she has no problem with anything. should I still put what the patient says under subjective assessment even though she can't??

And under subjective data assessment sheet, I have questions such as "how many times do you urinate, what's the color.." stuff like that. But, obviously she would not remember those when she does not remember how many kid she has. I'd say almost 95% of the subject data can't be from the patient. And even if she answers the rest of the questions, I don't think they are relaiable. In this case when what the patient say is not reliable, should I still document the subjective assessment as the patient says? or should I fill out some that I can see from her..... but that would be an objective data. I am having trouble with this.....

I'd really appreciate any reply from anyone at this point. I asked about this to my instructor but she keeps telling me to dig into the question or give the patient cues when they don't remember... it does not seem to help with this happy patient. HELP!!!!

[Daytonite, BSN, RN]

i don't know what book you can look in to learn this. i learn it through experience. it's not that these patients are lying, but that they are confused and demented. you learned one thing. . .never take anyone's word for granted. . .use your observation skills. had you been able to observe this lady walk you would have discovered that she needed walker assistance, something was wrong with her memory, but she does have a pleasant affect. as time goes on you'll learn how to ask open-ended questions that don't confine you to a specific reply. instead of asking "do you require assistance with walking?" (easy reply of yes or no) you say, "tell me how you got here today," which is more likely to get you a lot more information. how do you come up with these questions? by going home after a day like you've had and lying in bed trying to go to sleep and think about a better way to have done the interview questions. ha! ha! that's how most of us learned. i love watching the tv judges question people. judge judy really is quite skilled and generally leads the liars right up the garden path before she nails them in a lie. believe me, she had to learn how to do this. but, honestly, i couldn't tell you what search words to use to find the rules on the internet.