Hi, I am a new nurse working at a LTC facility. I have one patient who refuses to take her meds. She gets Miralax and I am able to empty 2 capsules into that (Nuedexta and Fenofibrate). Some days she actually drinks it. Her other pills-Lipitor, Zoloft and Januvia-I've tried crushing with applesauce or yogurt. She refuses. I don't know what else to do. She speaks only Russian. And she refuses to let me check her blood sugar or give insulin (the rare moments I'm able to check the BS). How do I get through to this patient? It's very aggravating as we're really not helping her....
May 22, '14
Have you tried speaking to the family? Sometimes when there is a language barrier you can find someone who can communicate with the patient and explain what you are trying to do.Maybe she is afraid or doesn't understand why you need to do things.
May 22, '14
The first question I have is what's the goal of her care? Is she a 90yo DNR? Hopefully over time you've been able to get enough blood sugars and blood pressures to get an idea of how she typically runs. Does each tend to be just a little elevated? Then I would say make sure the ordering physician is aware (as I'm sure you've done) and formulate a plan. Maybe she'd be more agreeable if you just try a BP and accucheck once a week, spaced apart by a couple of days. This helps to keep her from being stressed and perhaps you'll get the info you need more often. Probably the daily attempts followed by refusals has become such a routine for her. I would also talk to her next of kin or POA about it and make sure they know, and reiterate the treatment plan with them. You've already been very creative, but one other thing I would maybe try is spacing them apart and giving them different times of day (a pill in the AM, one with lunch, then with supper or bedtime). Maybe she'd be more likely to take something with supper or at bedtime, or when someone is there visiting her (sometimes family can accomplish things we just can't do). Also, If the BS and BP aren't big issues, pick your medication battles and put your biggest effort into correcting the biggest problem. I'd be most concerned about the Miralax, because constipation would directly impact her quality of life. Also, the Zoloft isn't going to help unless she gets it consistently, so I would put that on a lower priority unless you know you can sneak it to her regularly. Hope that helps!
May 22, '14
Try and communicate with the family and explain to them the issues you are having with the patient, maybe they can be of assistance and help you to gain understanding as to why the patient is refusing. And remember, the pt does have the right to refuse. Education on compliance with med regimen, meds. Etc is important too and this is another reason why the family should be utilized with communication with the patient.
May 23, '14
you asked the right question - how do you get through to her
she already has a Dx of depression, how about isolation and, as mentioned,fear
admissions must have had some idea about communicating with this resident
how does her Dr. communicate with her
involving the family is great if it's available, if not, how about contacting a russian
social club to get some volunteers to visit and get a language board or some
communication tool going
forget about the pills for a minute, this resident needs a "home"
you cannot do this by yourself, activities, admin and people outside the
facility will need to be involved
if a search for other Russian immigrants or Russian speaking individuals comes up
negative, call a Russian consulate (there are 5)
if this resident continues to decline acceptance of Rx and you have established
she's informed, discontinue them
Jun 22, '14
Have you tried pudding? We use snack packs at my ltc and most of my pts will only take it in chocolate. Sometimes I try giving them the whole cup as a 'snack' with the meds crushed in it if they won't accept my hand delivered spoonful. Are you using juice or water for the Miralax? Experiment with different types as Apple or grape may go down better than orange for her. Same for pudding. I had one pt that would only take her meds crushed in butterscotch pudding.
I have another dementia pt who I have to take her meds and lay them out on a tissue in a line and point to each one. If I try to spoon them to her or put them in her hand it doesn't work.
I've had others where I had to put them in their hand then I could spoon them one by one from their hand to their mouth.
Trying to get an idea if how her bg runs may be a bit trickier. Is it possible to catch her in the morning or evening when she Is sleepy and more willing? Can she hold a Lancet and let you guide her to poke herself? Can you non verbally indicate for her to pick a finger and would she be able to understand that?
Just some thoughts. Keep experimenting. Wouldn't hurt to look up some phases in Russian and jot them down on a piece of paper to carry with you.
Jun 23, '14
As many have said. Speak with the family if possible. Along with the good ideas of trying to admin the medication. But, Are you aware that Lipitor and Januvia should not be crushed? You can split Lipitor, but for some reason it is not a good idea to crush it. As for Januvia, it is advised not to split or crush it.
Anyway. Have you ever thought that the reason she doesn't want the crushed pills in applesauce or basically anything is because they taste nasty? Sometimes when it comes to giving medication to the elder it is basically like giving medications to a toddler. You have to come up with some creative way to give it. Maybe find out if there is something she really likes to eat or drink and go from there.
Wish you the best of luck
Jun 23, '14
This repeated refusal and the inability to communicate with the patient need to be adequately addressed in a care conference. The family must be there with the patient (assuming tht she is competent to participate in planning her care).
The issue about a translator needs to be remedied by the facility and the family.
The physician needs to be acutely aware of the problem so that he/she may review the medication POC, the goals for care, and the need for designer drugs.
Jul 4, '14
Talk to your co-workers; find out how they deal with the problem. Try different approaches, something is bound to work some of the time at least...
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