1st Clinical ~ Dementia resident

KimberlyRN89, BSN, RN · May 13, 2010

Sometimes residents with dementia get very agitated like this. Once they get to this point I suggest you leave them alone, because they could turn violent. I've been hit a few times & its not fun But you mentioned the nurse gave them something to calm them down. Maybe you should try an hour or so after they've received their meds & again attempt to give them care. If they still refuse- than leave them alone. We have quite a few residents that get like this- they refuse to take showers, change clothes, change their briefs,etc..We know that all we're trying to do is help them, but they cannot comprehend that. They have the right to refuse care,and we have to respect that.

inspired-nurse2b · May 13, 2010

I've had this experience as well working with a patient as a HHA. what i do is usually allow them to express their thoughts which sometimes are harsh but understand what they must be going through at this time in their life, I sit down when I'm talking and not stand over them cause I notice it makes them a little tense and slowly explain things/procedures to them.

rosey2007cna · May 14, 2010

I agree with the PP about walking away when they get this way. I have that residents with dementia really have a hard time with new surroundings and new people. Sometimes you can talk about something completely different and calm them down.

josebeltran88 · May 14, 2010

I work in a lock unit where most resident have some level of dementia, and all are mentally ill. My best advice when confronted with a situation like this is the following; walk away from the patien, but first ensuring that he/she is safe (i.e. wheelchair locked, bed siderails up if applicable, footwear on if resident is ambulatory) or, ask the nurse if a PRN (as necessary sedative) is available to calm the resident. Also, you might want to use the "buddie" system, where you team up with another CNA assigned to your station, and occassionally help each other out with situations like these occur, especially since these patient care scenarios can turn violent and dangerous in an instant.

fuzzywuzzy, CNA · May 14, 2010

Find something else to do for 20 minutes. While you're gone they might forget. When you go back, make sure you act calm and confident, not nervous or stressed. Offer to show them where the bathroom is (not "take them to the bathroom" because they'll just argue that they can do that themself), or ask if they want a snack or a drink. If they're still resistant then just walk away again. Act like it's no skin off your back if they don't want your attentions.

I used to have a lady that was packing her stuff every night. She was not allowed to walk around the room without assistance and us running in to respond to her chair alarm every 2 minutes really ticked her off! And heaven help you if you tried to hurry her off the toilet (to hell with the other residents that were ringing off the hook to go in there!!) or get her to wipe front to back! When her nightly "I'm leaving!" tizzy started I would just take all her stuff out of her closet, drawers, etc and throw it in a big pile on her bed and pull the chair up close and then hand her a bunch of trash bags and let her "pack." That kept her busy long enough for me to get the rest of my work done. Close to the end of my shift she'd get tired and start falling asleep sitting up and that's when I was able to wash her up and get her ready for bed.

CalledtoCare · May 14, 2010

I work in a lock down Alzheimers unit with 50 residents in all different stages of dementia. It requires a lot of team work (like someone above mentioned). DO NOT go in a alone if they are becoming violent. They may seem just fine one minute and the next they may have their legs wrapped around you pinned to the floor (yes has happend!).

I don't know how lucid or "with-it" your pt is, but mine are all pretty far gone. The best thing I can do is to get to know them as best as I can. Some I will leave the covers over and pull up from the bottom so that they stay warm while changing. Some I go in and say good morning and turn the light on about 20-30 minutes before I plan to get them up so they have time to kind of wake up. Some I am just as respectful and quick as I can be because I know if I am talking to them they will start screaming "well, d*** it, get on with it will you!" Some I talk to the whole time because it distracts them from the fact that they are getting care.

Sometimes with someone who is confused and afraid the best thing to do is to kind of get into their world. Let them talk about home if they are homesick. I have one guy who wants me to look for his wife all of the time and will become very upset when I don't, so I just ask a lof of questions about her and we just talk about her while I get done what I need to. Some I don't correct when they call me their daughters name, I just kind of go with it. I don't lie exactly, I just kind of work my way into their reality so that they don't have to be in this real reality where they have no control and cant go home. I just try not to remind them of that fact all of the time by correcting them. Also, anything they can do themselves, let them.

Some of the pts are just so proud, they really don't understand why they are wet. In their minds, they don't pee on themselves, that is humiliating. So tell them (and this is one of the actual lies I tell), wow you must have gotten sweaty last night, you are all wet. Or: wow, that air conditioner vent must have leaked on you, we had better get that fixed. Anything to kind of give them an out where they can think that maybe you didn't notice that they can no longer use the restroom.

Most of all (and I will end my crazy long post with this), they are lashing out because they are confused and scared. Give them dignity, give them compassion, and do not let it get to you. :redpinkhe

CoffeemateCNA · May 14, 2010

I'm in agreement with everyone about having 2 CNAs for cares. But. . .

I wouldn't necessarily have both of them come in at once.

Imagine if 2 people marched into your room and announced they were going to do "XXXX" task on you. It would feel like they were ganging up on you, and you would be more frightened.

Instead, I would have 1 person go in and start cares, and have another aide stand outside the door. After minute or two, he/she can just casually pop in and "see how you guys are doing" and start helping out.

The "new admissions" to the dementia unit are the hardest, especially the ones that are still able to do some of their own cares. Unless a resident has a tendency to wander or is violent, my facility places them on the skilled nursing units for care. Then when it reaches the point that it is no longer enough, or they have behavior issues, then they get moved to the locked dementia unit.

Be supportive of your resident and allow him to express his feelings (if he so desires). He has just lost his independence and is still grieving that loss. It will take some time for him to accept his situation. If you learned about it in class, it sounds like he is teeter-tottering between the "denial" and "anger" stages of the 5 stages of grief and loss.

Ev1987 · May 14, 2010

Delirium, agitation and aggression is commonly associated with dementia.

fuzzywuzzy, CNA · May 14, 2010

You know else helps? Having an older CNA go in there and deal with it. Some of these residents don't want some young person helping them and they act completely different with people closer to their age... maybe someone who could be their kid, but not their grandkid.

freesia29, ASN, RN · May 14, 2010

Thanks for all your great tips! Today is day 2 of 6 for our clinicals. So we shall see what today brings!

I am older...39....so being too young isn't an issue! LOL!

He is new to the home...only 2 weeks....so of course it is understandable that he wants to go home and do everything himself.

I thought also of maybe explaining to him that I am a student and need to practice these skills for an exam...and maybe he can "help" me practice by pretending to be my patient? What do you think of that angle? Do you think that might work?

Thanks and have a great day!

NM nurse to be · May 14, 2010

I think explaining to him you're a student might not be a help. In his mind, he's independent and if he thinks they sent someone to 'practice on him', that might make things worse.

I use a lot of the techniques the other posters have written about. One that I've had a lot of success with is to join them in their world, wherever that might be.

I had one guy who would NOT go to sleep, in his mind he was working and there was trouble with the train. So I figured out I could tell him the bell rang, shift is over. He gave me enough detail I could fudge knowing about his job. If he thought everyone was ok and safe, then he could relax.

One other night, this same guy was SURE he was fishing and had fallen out of the boat. And they were going to leave him like that. He was going on and on about his wet clothes. Turns out his brief was indeed wet. So I changed him, talking about how now he had dry clothes and look the dock shops were closed, it must be quitting time. Now you're dry and clean and we can do the rest tomorrow. And you know what, he agreed and calmed right down :)

Joining them in their world has helped me a lot with agitated, confused residents. I do watch to make sure they aren't agitated and going to slug me, then I wait them out a bit or for the drug to kick in and go back. But most times, you can calm them down if you play along.