We just got a 65 year old man with sudden onset dementia. This man, Bless his heart, does not have many brain cells left.
He is unable to understand any directions. When he is incont. it is taking 4-5 people to provide ANY hygiene on him. He is on one to one staff, we try talking him through it, we have shown him pictures, we have used only one or two staff members to assist him. It took over one hour of discussion with him just to get his wet pj's off and then he still would not let us take his attends. We tried letting him put new attends/clothing on and he puts them on over his wet things
I hate this but how do you provide even basic care for this man without some physical interventions? Chemical interventions at this point have proven to have an undesirable affect on him. He is very new to our unit and our docs are VERY slow on helping us.
When we do get the attends off we have been unable to provide much pericare and he hasn't had a shower/bathe since admission (4 days) as we would have to force him into the shower or bath:crying2:
I am at a loss PLEASE HELP!!! When does it become patient abuse to provide basic care???? BECAUSE RIGHT NOW IT FEELS LIKE PATIENT ABUSE!!!
Specializes in Gerontology, Med surg, Home Health.
Well, not to stereotype, but in Massachusetts we wouldn't be allowed to give IM Zyprexa. The sad truth is that people like this man don't belong in a long term care facility. He sounds more psychotic than demented. Unfortunately, it is reality that we constantly have to do with people like this and our hands are tied (figuratively of course or it would be considered a restraint) by regulations.
The reality is that most people in LTC have psych problems as well as physical ones. And until reimbursement rates permit staffing adequate to deal with this they will continue to suffer from loneliness and increased fear and confusion.
Also, has he been screened for a UTI? I had a pt on our floor in her 80's and she was so wild it took all of us to just change a brief and wash her -- that classic stiuation of a little 90 pound woman that was beating the crap out of all of us.
I managed to get a cath, got some urine, and it looked like muddy river water. She had a major UTI, had gram + cocci in the blood, and after levaquin and seroquel, she went back to being "just" demented, as opposed to demented and dangerouos to self and others.
Well, not to stereotype, but in Massachusetts we wouldn't be allowed to give IM Zyprexa. The sad truth is that people like this man don't belong in a long term care facility. He sounds more psychotic than demented. Unfortunately, it is reality that we constantly have to do with people like this and our hands are tied (figuratively of course or it would be considered a restraint) by regulations.
my concern as well, about the dx being potentially incorrect.....i was thinking of poisoning of some sort, not sure that that would make any diff now......and, if he is genuinely psychotic why cant we tx it that way?
In regards to Alzheimers patients I noticed they have good days and bad ones. I was working yesterday and my patient refused to eat , he ate in the dining room. So checked in on him several times to see if he would agree to eating in his room , he finally agreed to it . So I got another assistant to help me get him into his wheelchair he refused again!!!!! He stated that he could get himself in the wheelchair he sat and thought about it for 40 mins everytime I tried to help he got mad. So finally we got a male nurse and he got him in that chair in 2 mins flat!!!!!!!!!!!
I think that you have to look at the problem from a different angle.
I have some experience with what you're describing as homeless men (filthy with everything you can imagine- lice, feces, nails thick with fungus, communicable diseases, elephantism from filiarisis etc)
They come kicking and screaming only because where I live we don;t allow homeless to sleep outdoors and if they have Alzheimers or are elderly, the SW sends them to us.
We have to provide care despite their refusals. We have to pput them in a closed unit ( and they have broken doors and windows trying to get out)
Despite it all - we provide care by multiple caregivers and use meds as per the psychiatrist (who is very conservative and responsible). We NEVER use physical restraints as they are counterproductive.
In time most of them realize that we only want for their good- providing square meals and warm beds in attractive rooms, showers and recreational activities etc.
The key is consistancy and warmth. A human responds to good old fashioned TLC. It takes time and patience so hang in there.
Don't view the harsh methods necessary in the beginning as cruelty- Tough Love is sometimes necessary until things calm down.
BECAUSE RIGHT NOW IT FEELS LIKE PATIENT ABUSE!!!
CapeCodMermaid, RN
6,092 Posts
Well, not to stereotype, but in Massachusetts we wouldn't be allowed to give IM Zyprexa. The sad truth is that people like this man don't belong in a long term care facility. He sounds more psychotic than demented. Unfortunately, it is reality that we constantly have to do with people like this and our hands are tied (figuratively of course or it would be considered a restraint) by regulations.