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Discussion

Nonverbal patients

Hi all, I'm a new nurse training at a LTC facility and have a question about certain patients who are confused, obtunded or not alert and also have contractures. I always introduce myself and explain everything I do, but I'm finding it difficult giving care to some patients whose hands and abdominal area I am unable to reach. For some patients they react when I try, others don't react at all. For some patients I'm unsure if they have contractures but they still didn't budge when I tried to soothe them and explain what I was doing.

When I asked my preceptor how she handles this, she said "well we do what we have to do."

Since I can't tell necessarily what their range of motion is, not being familiar with them yet, and not being able to know when they are in pain, this makes me rather uncomfortable.

How do you go about giving care to these patients that require certain positioning? (Tube feedings, glucose checks, etc etc). Thank you!

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    PAINAD score is the best way to tell. (You can look that up.) You can tell which body parts hurt by their grimaces if you try to move them. Some of it is by assumption. If you're moving their body in unnatural ways then it's going to be uncomfortable so do try to maintain a normal position like if you've got to move a rigid arm try to move the whole thing gently rather than yanking it (of course, just an example.) If you do find their pain score shoots up when moving them try to think about their condition like if they have past history of arthritis or if you're manipulating the gtube there could be a problem with the site, If it's new onset or there is swelling/ bruising somewhere you should investigate, etc. if there's no obvious signs of pain by PAINAD and you're doing the most common sense things, and they are still just ALWAYS rigid then it could be contracture- passive ROM, braces, boots, etc. help with that/ help prevent further damage. Physical and occupational therapy are good resources to help you with those kinds of things. Medications like baclofen can also help with rigidity so you can consult the physician. Warmth, creams, and baths help with joint pain but be extremely careful with any hot packs in this population, they can't tell you if they are getting burned. I usually go with warm blankets instead. Otherwise, just move the rigid limb as little as possible to get the job done. Hope this helps, if not , let me know !

    P.S. I appreciate this question! Some nurses overlook symptoms of discomfort in this population.

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    Thank you! That was very helpful.

    Since there are more than a few patients I work with that I have this issue with, I will definitely look into these suggestions.

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