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Tips on dealing with the demented patient in the ER

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We've all been there: you get an ambulance call that EMS is bringing in an elderly patient who had a ground level fall and now their leg is shortened and externally rotated. Oh and by the way, they have dementia.

Tips on dealing with the demented patient in the ER

Ugh...could your night get any worse? Here are some tips for dealing with the patients who are demented:

1. Enlist family support if at all possible. Make sure the nursing home or facility has sent a current next of kin notification and try to get the NH to call the family as they already have a working relationship with them.

2. Provide the patient with their hearing aid and/or glasses or dentures. It is difficult enough to deal with someone who is confused and even more so to try and understand them when they can't hear or see you or answer back because they don't have their dentures in place.

3. Try to keep the interruptions and interactions to as few people as possible. Ensure consistency of caregivers in the ER if at all possible.

4. The ER is a loud and bright place. When you are done with your assessment, try turning off the overhead lights but ensure that a directional light remains on just not directed at the pts face.

5. Confused people have pain. Treat their pain and yes, with narcotics.

6. Keep them close to the nurses station if possible to ensure adequate eyes on them. Some pts will not be aware that they are seriously ill or injured and might try to climb over the bedrails. Keep them in sight.

Reference:

Cohen-Mansfield, 2000

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267 Likes, 12 Followers, 124 Articles, 184,121 Visitors, and 20,386 Posts.

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7. Screen for delirium and then watch for delirium developing. Delirium superimposed on dementia can affect up to 89% of hospitalisations and, more often than not, it remains undiagnosed (Fick, et al., 2002, p. 1723). Delirium is a medical emergency. Delirium is characterised by sudden onset, fluctuating course, inattention and disorganised thinking and/or altered level of consciousness (Lyons, Grimley, Sydnor, 2009, p. 41).

EBP: cognitive functioning tests should be routinely administered to older people admitted to hospital (Royal College of Psychiatrists, 2006, p. 3; 2005 p 10). Delirium can then be confirmed using the empirically validated Confusion Assessment Method (CAM) (Inouye, 2003).

Some resources:

1. Anything by Inouye, SK

2. Fick, DM, Agostini, JV,Inouye, SK, 2002, Delirium superimposed on dementia: a systematic review, J Am Geriatr Soc., 2002 Oct, 50(10): 1723-32

3. Fick, DM & Mion, LC, 2008, Delirium superimposed on dementia, Amer Jnl Nursing,Jan 2008, 108(1): 52-60

4. Inouye, SK, 2003, The Confusion Assessment Method (CAM): Training Manual and Coding Guide, New Haven, Yale University School of Medicine

5. Lyons, DL, Grimley, SM, Sydnor, L, 2009, Delirium and dementia: double trouble, LPN,2009 March April, 5(2): 38-44

6. Royal College of Psychiatrists, 2006, Prevention, diagnosis and management of delirium in older people, Concise Guidance to Good Practice 6, National Guideline,June 2006, London

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2-3mg versed IM and send them to the scanner.

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Of course if available get a current copy of their medication list....something new may be triggering adverse reactions as well

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Most demented patient come from the nursing homes. These patients are often guarded from having to deal with the treatment from the nursing home. We as nurses have to try to comfort them which may help in decreasing there anxiety level.

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haldol increases death rate amongst the elderly. haldol should not be used to treat dementia.

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This happened to me.. Why can't we give Haldol?

This is why Cebuana, You should also curb the Demerol as well

Increased Mortality in Elderly Patients with Dementia-Related Psychosis

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of seventeen placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients of between 1.6 to 1.7 times the risk of death in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. Haldol Injection is not approved for the treatment of patients with dementia-related psychosis

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