Need a Nurse's experience for AD Presentation

Daytonite, BSN, RN · Apr 8, 2006

hi, nsnina! so, you want to work in ltc (i read a couple of your other posts). i've gone back and forth to it throughout my career. i've been thinking a bit about your project. i keep coming back to this. within all nursing we have some very basic "hats" that we must wear. we are caregivers, patient advocates, managers of care, teachers of care, etc. so, when we have a patient with ad how does nursing those patients affect those roles as opposed to, say, what we are going to do for a post-op abdominal surgery patient? the nursing care of ad patients is different from other ltc patient in a number of ways. ad requires a lot of our caregiver and manager of care role. to me, it's a lot more mental work on our part rather than physical work. by the way, have you had the opportunity to see or work on an alzheimer's unit? i'm guessing you have not or you probably wouldn't be scratching your head about this.

look at the roles of the nurse. look at the symptoms of ad and what those patients require of the nurse. in an institutional setting how are you as a nurse going to respond in your roles to the ad patient? actually, i think your part of the presentation is simply the nursing actions part of a care plan. i think that if you were doing a nursing care plan for an ad patient, the nursing actions, grouped, would be your part of this presentation.

it is very easy for nurses to become angry and frustrated when having to care for ad patients if they have not had any specialized training concerning their care. ad patients needs are primarily protection within their physical environment and maintenance of their nutrition and physical state. many are still able to be physically active. ad is not often seen as an important nursing specialty. their symptoms are things such as confusion, memory loss, anxiety and restlessness, insomnia, inappropriate social behavior and difficulty speaking. not necessarily exciting nursing. now, incontinence, if it is present. . .there's something we can sink our teeth into--kind of.

here's what i remembered learning when i was oriented to a locked ad unit. first of all, it was staffed with very specially chosen aides. they needed to be what the ad consultant called "turtles"--people who were kind of laid back, weren't in a hurry, could vary from a routine, and very, very, very patient. ad patients do have moments when they are less confused and more cooperative than usual. nurses have to be ready to recognize that and stop what they are doing and immediately take advantage of that period of time to work with that individual patient to accomplish things even if it's something as simple as getting them to eat what they wouldn't eat for breakfast or take the medication they wouldn't take at 9am. so, the nurses also have to know the patient, preferably over a period of time and on a regular basis. nurses have to work with the patient's routine rather than insist that the patient work with the nurse's routine. that is very different from what most nurses practice at their jobs. still, these patients, despite the fact that they can be confused, must have some kind of regular routine attempted even though they may not want to follow it. and that is where the patience of the nursing staff is so important in their care. for many, just being in the same familiar environment is routine enough for them. attention always has to be paid to the safety of their physical environment because these patients are usually wandering all the time and getting into nooks and crannies much like toddlers. physical impediments that might cause falls have to be cleared away. they cannot have access to cleaning supplies or medications that they could ingest. getting my drift here? it kind of seems like babysitting, in a way.

the ad unit in the facility where i worked allowed for the patients to wander to their hearts content. there were alarms on all the doors so we knew immediately if someone "got out". most of the beds were low beds that the patients could literally roll out of without injury although the staff could raise them to a level for us to work comfortably with. bean bag chairs were utilized for patients who became violent or belligerent as it was more difficult for them to get up from them and it redirected their physical energy. there was a kitchenette and dining tables with a fridge stocked with juices and puddings so there was always something immediately available for them to eat if they were looking for food. by the way, their meals were supervised and some were fed since ad patients are notorious for not eating. rooms were kept as clear of clutter as possible. only a few personal items were allowed. wanderers often went in and out of everybody's rooms, picked up things and relocated them elsewhere. so, the staff knew whose stuff belonged to who and had to put things back where they belonged. we had one lady who used to go around collecting everyone's dentures during the night. after she went to sleep, the aide, who learned whose dentures were whose, cleaned and returned them. these patients have visual problems too, so utensils and things they use tend to be a little oversized. the biggie is that you don't reorient these people. you live in their world of confusion or you invite confrontations and violent behavior from these patients--and you don't want that!

here is a link to some information about ad patients. the difficulty of their nursing care is probably not that involved, but it does follow some very basic principles of maintaining and assisting them with their daily needs. again, i would stress that unless nurses understand what is going on with ad people and practice patience in the care of them they are going to become angry and frustrated themselves.

http://www.nia.nih.gov/alzheimers/publications/caregiverguide.htm

hope this gives you some idea as to how to precede with your assignment.

-Midget- · Apr 11, 2006

Daytonite - your post was very informative to me, and some of it made me smile and chuckle. My grandma has profound dementia, and recently went into the hospital and now is in a nursing home. Before that, my grandpa and I cared for her...with the help of a fabolus community health nurse whenver she got a chance to stop by. :) When you mentioned being able to drop something at a moments notice, because she was willing to take pills, change clothes, whatever...that made me smile and nod. My grandpa didn't quite get that, bless his heart, that if she was willing to do something, we better do it quick...before she forgot was said she wanted to! :) There had been many times when I'd be getting lunch or something, and she'd want to go to the bathroom, change clothes, or whatever...and I'd be like "DO IT NOW! DO IT NOW! Quick, before she doesn't want to!" More often than not, I'd have to imediately stop what I was doing and go help her! Or, stop what I was doing and go intervene in a conflict, or redirect her to something else. It was an excelent learning experience...and throughout this process, all the nurses, social workers, etc, have all been very willing to teach me about anything they were doing, or answer any questions I had. They are a true inspiration to me. And you, sir, write some EXCELENT posts...this one being no different!