new grad lpn..how to handle confused pts etc

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if i were to work in a nursing home

1.)how do you handle medication/patient teaching to elderly who are confused, have alzheimers, non verbal? + documenting

2.)what to do when you have 30+ patients, like 2 hours to give meds, drug interactions considering most will have about 5+ different prescriptions, drug calculations, refusals, etc?

asking cause i would like to do the right thing. :saint:

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I would recommend starting out on night shift. There are a lot less meds to pass and things are generally calmer, but not always. Every patient is different and what works on one may or may not work on another. For example, One night I had to tell a confused patient that I was letting her sleep in the guest room at my house since it was too late for her to drive home. That is the only way I could get her to go to bed. Another night I had to convince a patient that if she would get in bed then I would wake her up in 4 hours so that I could also get some sleep. We had to tell her that eveyone was taking turns sleeping every 4 hours. When they have dementia you have to be creative.

Also most confused patients understand if you tell them you are giving them blood pressure medication and vitamins. If you go into too much of an explination then you will just confuse them even more. There are some who are so confused they will not take medications so you have to disguise it. You can crush it (depending on the med) and mix it in ice cream or yogurt.

Drug interactions shoud not be a major issue (hopefully) if the medication has been prescribed to the patient. It should only be on their MAR if it has been prescribed to them by a NP or MD. If they just started on a new med then you need to watch them a little closer to see how they react to the med.

The long term patients who have been there for a long time usually have their own routine and expect to be given meds throughout the day and don't always ask what you are giving them.

It depends on the nursing home that you are working at as to how many patients you will have. Go to medicare.gov and you can look up nursing homes and find out what they are rated by the government. The nursing home I work at is rated 5 stars (highest rating) and that is the reason I applied and was persistant in getting an interview and a job there. You really need to know the type of place you will potentially be working at. Where I work on dayshift the most patients you will have is 24. Most of those are down one hallway and the rest are down the next hall over. One hall has morning meds scheduled at 8am and the other hall has morning meds scheduled at 9am. So that you will have time to get all meds passed on time. However, that may not be the same at other places.

When it comes to patients refusing medications you cant force someone to take it if they don't want to. You can leave and come back later. You could ask another nurse or your supervisor to try to give the meds and that may work. I guess technically you are not allowed to have more than one patients meds pulled at one time so you really should not leave it in your cart to try and give later. State would get you for that, but some nurses do it. But really if you have tried and they will not take it then you have to chart refused and throw away the meds, but its even harder if one of the meds is a scheduled narc. You can't just throw away a narc. You have to waste it with another nurse present so they can sign saying they saw you waste it (and not steal it). That is time consuming but necessary.

In a nursing home setting there are not really a lot of drug calculations that need to be done and most that you have to do are basic and not time consuming.

One more thing. You really need to work somewhere that is going to give you a good orientation. I had 3 weeks of orientation as a new grad in a nursing home. I needed it. That means that there was a nurse there with me at all times (not doing other things). I have heard of a lot of nursing homes that say they are going to give you 2 weeks of orientation but you really only get 2 days. That is terrible. Do your research before taking a job. Good luck! :-)

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I would recommend starting out on night shift. There are a lot less meds to pass and things are generally calmer, but not always. Every patient is different and what works on one may or may not work on another. For example, One night I had to tell a confused patient that I was letting her sleep in the guest room at my house since it was too late for her to drive home. That is the only way I could get her to go to bed. Another night I had to convince a patient that if she would get in bed then I would wake her up in 4 hours so that I could also get some sleep. We had to tell her that eveyone was taking turns sleeping every 4 hours. When they have dementia you have to be creative.

Also most confused patients understand if you tell them you are giving them blood pressure medication and vitamins. If you go into too much of an explination then you will just confuse them even more. There are some who are so confused they will not take medications so you have to disguise it. You can crush it (depending on the med) and mix it in ice cream or yogurt.

Drug interactions shoud not be a major issue (hopefully) if the medication has been prescribed to the patient. It should only be on their MAR if it has been prescribed to them by a NP or MD. If they just started on a new med then you need to watch them a little closer to see how they react to the med.

The long term patients who have been there for a long time usually have their own routine and expect to be given meds throughout the day and don't always ask what you are giving them.

It depends on the nursing home that you are working at as to how many patients you will have. Go to medicare.gov and you can look up nursing homes and find out what they are rated by the government. The nursing home I work at is rated 5 stars (highest rating) and that is the reason I applied and was persistant in getting an interview and a job there. You really need to know the type of place you will potentially be working at. Where I work on dayshift the most patients you will have is 24. Most of those are down one hallway and the rest are down the next hall over. One hall has morning meds scheduled at 8am and the other hall has morning meds scheduled at 9am. So that you will have time to get all meds passed on time. However, that may not be the same at other places.

When it comes to patients refusing medications you cant force someone to take it if they don't want to. You can leave and come back later. You could ask another nurse or your supervisor to try to give the meds and that may work. I guess technically you are not allowed to have more than one patients meds pulled at one time so you really should not leave it in your cart to try and give later. State would get you for that, but some nurses do it. But really if you have tried and they will not take it then you have to chart refused and throw away the meds, but its even harder if one of the meds is a scheduled narc. You can't just throw away a narc. You have to waste it with another nurse present so they can sign saying they saw you waste it (and not steal it). That is time consuming but necessary.

In a nursing home setting there are not really a lot of drug calculations that need to be done and most that you have to do are basic and not time consuming.

One more thing. You really need to work somewhere that is going to give you a good orientation. I had 3 weeks of orientation as a new grad in a nursing home. I needed it. That means that there was a nurse there with me at all times (not doing other things). I have heard of a lot of nursing homes that say they are going to give you 2 weeks of orientation but you really only get 2 days. That is terrible. Do your research before taking a job. Good luck! :-)

thanks. you put my mind at ease. 3 weeks orientation and 24 pts sounds ok. will check that website :loveya:

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