Non-Compliant Alzheimer Patient

[SweetLemon]

So I have this patient who I adore that suffers from alzheimer along with some psychiatric illness who is delusional and choosing not to take her BP medication. She is fixated on the fact that her heart is fine and that when we give her the clonidine and enalapril it only increases her BP.... :banghead:last time I took it her systolic was in the 200s which is not unheard of with this patient but not something I am at all comfortable with considering she could stoke out...

So anyone have any tips as far as getting a patient who is non-compliant with BP medication to take it... I am going to advocate to the Doc in the morning to maybe consider a clonidine transdermal patch but I am wondering if anyone had any tips on how to get the patient to take her meds PO??

[systoly]

There is nothing wrong with giving "Vitamins", or placing meds in apple sauce or pudding ( given all involved parties have been informed and agree). I can understand where some would have a problem with this as it could make one feel as though one were lying to their patient. However, if a person suffering from memory loss or other cognitive impairment was to become soiled and then stated they did not want to take a bath, would we say ok you can stay soiled, because you have the right to refuse? Patient's rights are designed to help and protect and sometimes two different patient's rights are in direct contrast with each other and we must choose to act with the patient's best interest and welfare in mind.

[CathyLew]

I agree with a lot of the above posters. Sounds like you need a family meeting, sit down with the Director of nursing, physician rerprsentative, POA and other family. See what they want done. Many family members are all for *fooling* a patient into taking meds. We see many family do it themselfs.

we are having a hard time with my father who has alzhimers. He was also a Pharmacist for many years. So we can't slip any of his alz meds past him with him not knowing what they are for. It was a bad day when the dr perscribed Aricept for my dad. He just looked and looked at the med card. Then he said "Im just like Ronald Regan" and he turned to my mom, and told her that she should leave him now.

a bit off topic...but back to the OP. you can't force the lady to take her BP meds.... a struggle would just increase her aggitation and her BP. Once your brain is on a runaway track, you can't process the information like informed consent, as it is written to protect patients. deception, if done with consent, and tons of doccumentation, may be the only protection for the patient. Lets face it, anyone who has taken care of a pediatric patient knows you talk and explaine things for that childs level of comprehension. You don't tell them that they need an operation to take an infected organ out of their mouth (Tonsells) and it will probably be the most pain they have had to date, and they could choke on their own blood and die durring the operation, or have a horrible reaction to the anestesia, etc..... you tell them they will go to sleep, wake up all better, and get all the ice cream they want.

the alzhimer patient is gradually turning into a child. A child with an old person's aging body and problems. You can't talk to them like children, and you can't reason with them as adults.

[SuesquatchRN, BSN, RN]

It was a bad day when the dr perscribed Aricept for my dad. He just looked and looked at the med card. Then he said "Im just like Ronald Regan" and he turned to my mom, and told her that she should leave him now.

I'm sorry. That's such a poignant story.

[imaRN08]

regarding the clonidine... has the Dr tried to change clonidine from PO to a weekly patch? I worked with alz for several years and sometimes we would have to change routes of meds. a lot of times they wouldnt even remember the patch. we used to put them on their upper back where they wouldnt see it when they were undressed, or be able to feel/pick at it either. Sometimes I would have to have one of our CNA/CMA (med aide who was alslo a CNA and was able to pass meds) help me with some residents give their PO's to them because she seemed to get along with some residents better than me. maybe thats worth a shot if there is someone like that in your facility

[tewdles, RN]

You must make sure the MPOA understands what is going on and is in agreement with the POC. Clearly this patient is not competent to make choices regarding her care. To allow her to refuse these medications would be similar to allowing a child to decide if they are going to get their insulin injections or some other care which they do not enjoy. If the POA is in agreement with the POC then you crush the meds and put them in some soft food. Or you move to something like a patch. Do not confuse the symptoms of the illness with rational thought.

[Spritenurse1210, BSN, RN]

I have experience with alzheimers and dementia residents. Sometimes you have to be creative. I think you should advocate for the clonidine patch, make sure you clear it through doc and poa of course. If your facility doeant have standing orders to crush or dissolve pills make sure you get one. Try mixing her pills in her favorite ice cream......tell her that you have a surprise for her and hand it to her. Just make sure to document and CYA. Figure out what she likes, and what will work for her.