To Orient or Not to Orient?

[sassysteph7]

All,

I work with alot of alzheimer's patients and recently I was taking care of this woman who sundowns pretty bad. Her son called the primary himself and got rid of her prn's so basically the poor woman gets all keyed up every afternoon and it goes on until the late hours of the night. I spoke to the unit manager and she's trying to work on it. This is my question....is it wrong to attempt too orient her and make her understand that she's elderly, her mother has passed away and she's not on cape cod or do I just play along. I usually try and play along but this poor woman just wouldn't let it go. What do most of you do in this situation?

[Simplepleasures]

Reality orientation is a thing of the past and a good thing too. Trying to force them to understand reality is just going to get them and yourself even more frustrated. Distraction with food, song, folding towells, maybe get them to take a walk with you, to sit down with you, ask them if they want to be your buddy,anything, even prayer helps, I started saying a Catholic prayer once with a devout Catholic lady, I had to leave to do the rest of my work, so I taped myself saying the prayer and put the recorder in her room with her and she actually stayed in her bed the rest of the night praying along with the recording. I asked the chaplin the next day to get some religious tapes for her, helped, but not always. Sometimes absolutely nothing works . With no PRNs, its a tough position to be in for sure.

[LiverpoolJane]

I agree with Ingelein - it is absolutely pointless in trying to orientate someone with alzheimers or similar. At the moment we have one LOL who's tormented as she doesn't know where she is or why she is here. At first we weren't sure wether it was acute onset confusion so I did go through the whole business of trying to explain where she was and why - I even wrote it all down on a piece of paper to see if this would help. It was obvious after speaking to friends and neighbours that this had been creeping up on her for years. Now when she approaches me and asks me a question - I go along with her, answering her questions with the answersshe is expecting to hear - to onlookers we are making no sense at all. A social worker was looking on one day and described what I was doing as "entering her bubble" and that made sense - I was attempting to involve myself in her world rather than trying to bring her into mine - a world she could no longer communicate in. She's happy in her own way and it settles her down - and I am not frustrated trying - and failing - to bring her back to reality.

[nightmare, RN]

I agree...Reality orientation just doesn't work in most cases.Speak to her family,did she care for her mother?Was there something she did every evening?Find out a bit of the history and maybe it will help you to calm her down. I once spent the better part of an 11 hour night shift walking up and down with a LOL who just could not be pacified.She had beaten up her husband( also a resident)!and she became more and more agitated and we had nothing to give her.In the end I got her to sit down to drink a cup of tea then I started firing questions at her ,did she have brothers and sisters?what were their names?where did they live etcetc.Believe me it was mentally exhausting but eventually because of the increased input she forgot about the other things on her mind and we managed to get her to go to bed........That was a long night!!!

[CapeCodMermaid, RN]

I agree with all the other posters. Do not try to reorient her...it'll only make her more agitated. Just a question...what is wrong with thinking you're on Cape Cod??? It's a great place to be in reality or in your mind.

[lil' girl, LPN]

Yep I have found that agreeing gets you farther than anything else. BTW why don't you just call her son when she gets uncontrollable and tell him HE has to come and calm her down? We can and do this. Had a lady who used to HIT when she got going, called her family and told them we need you to come and calm "mom" down before she hurts US or herself. After a few episodes of this I expect SON will change his mind about the PRN medication.

[egglady, LPN]

I agree that I would not even try "reality orientation" How horrible it would be to say "you mom has died, and you are old" For that alzheimers resident, who is looking for her mom, it would be like the first moment she found out her mom died. Very traumatic. I usually tell them when they are looking for there mother "I havent seen her, but when I do I will let you know". Obviously I wont be seeing mom since she has been dead 30 years, but it seems to make the resident feel like they are being helped.

[sassysteph7]

Like I said in my original post I usually do play along w/ them. I tried having her sit at the nurses station with me and tell me about her childhood, her career, she just kept trying to get out of the facility. I thought about calling the son however, it was the weekend, and I wasn't sure if the management would get mad at me for doing that. I'm an agency nurse and do not want to burn bridges if you know what I mean.

Oh and there's nothing wrong with Cape Cod-I love it. Thanks for all of your advice. I appreciate it and will no longer worry if agreeing w/them is the wrong thing to do. Let's hope Psych see's her soon and they have a care plan meeting and her her son prn's.

[Simplepleasures]

Family that have unrealistic expectations or ideas about their loved one with dementia/alzheimers make our jobs SO much more difficult.I have called family in the middle of the night to come in and help with thier loved one, sometimes they were very helpful , some got angry, some actually came in, saw what state their loved one was in and OKd a PRN med.Sometimes they just need to see the behavior themselves with their own eyes. Sometimes absolutely NOTHING works and the nurse ends her shift, goes home and takes a PRN herself.:tbsk::beer:

[mandaleigh]

Lots of times family members don't like the drugs used for PRN due to things they may have heard. Why did the son have the MD get rid of all PRN meds?