uncooperative resident

TazziRN, RN · Feb 10, 2007

Any idea why she's doing this? If you can figure out the reason, then the fix should be easy.

snowfreeze, BSN, RN · Feb 10, 2007

Request a psych eval for depression. Decline in ADLs for no medical reason, no UTI, no other infection etc.

txspadequeenRN, BSN, RN · Feb 10, 2007

sounds like she wants to leave and is playing the family against the staff...is she there for long or short term. this is one of those things that the social worker needs to get with the family and have everyone (family and staff) on the same page so the goal is completely understood ,then the family needs to sit and talk with this lady. you would not believe how many patients have done this at places i have worked at.. even my own mother while she was doing rehab.. but i stopped that real quick and told her your not leaving until your therapy is complete and you are feeling better, so don't start with the stories.. i at 31 years old got grounded but so what she finished her therapy and now is home.....some times you just have to play the game.....

KellNY, RN · Feb 10, 2007

I was just thinking that, TX.

Depression (r/t being instituationalized?) can lead to loss of appetite. She may be refusing help because she wants to maintain some sort of independance. She may be getting "very mean" because she doesnt want every aspect-from when/how much/what she eats to when/how much she poops being an affair and wants to be left alone.

Try listening to her--see if there's anything that staff or her family could do to make her life there more pleasant. Try to suggest a social work referal.

If I were in a nursing home--even the "nicer" ones I've seen-I'd be depressed and wanting to leave too.

And I'd do anything in my power to do so.

jimthorp · Feb 10, 2007

I'd start with UA C&S and go from there.

banditrn · Feb 10, 2007

I'd start with UA C&S and go from there.

Yep, it surprised me when I first came to LTC how much a UTI can change a person's behavior.

If not that, a psych eval. sounds appropriate.

txspadequeenRN, BSN, RN · Feb 10, 2007

Even a slight UTI can cause a major change in Behavior. It is one of those things you have to see to believe..lol

Yep, it surprised me when I first came to LTC how much a UTI can change a person's behavior.
If not that, a psych eval. sounds appropriate.

nurseofalltrades · Feb 11, 2007

This resident does not have a UTI.. UA C&S were completed twice. Once clean catch and once straight cath. I am leaning more towards the mad at her family for putting her in there. She does play family vs staff.The family comes into see her every evening. As soon as they arrive she becomes the lovely little gramma everybody wishes for. When family isnt around, the eyes turn red and her head starts spinning...LOL (Am kidding just a joke!) I have tried and tried to win her over as has so many other staff members. I think maybe until she realizes she is basically here for the rest of her life(thats sad) she might mellow out. She is only on ativan right now which doesnt do diddly so maybe we could still go the medicinal route. Hate to see her drugged just to be pleasant.......

lpnbecky123 · Nov 20, 2007

I firmly believe that all new residents to a SNF/REHAB/LTC should be given a script for antidepressants for at least the first 3 months, especially if they have never been in this environment. Yes it is depressing to go to "a home" yes it is scary. Caregivers must make the effort to assist the residents in adjusting to this situation. Of course assess for acute conditions But also put yourself in this bed, how would you react to a bunch of strangers telling you you have to get up, eat,, use the toilet, go to activities. * the whole nine yards that goes with life in "the home". Not to mention all the nosy questions we ask them. Stripping them down in the first 24 to do a skin assessment. Asking them when they poop, or if they have problems wetting themselves. Or the looks some staff give to someone when they ask to use the toilet , again. I notice a lot of the time we assume that they are old & feeble & have no idea how to take care of themselves. We need to let them tell us how to take care of them. people forget that these people are somebody's mom, used to work & take care of families. There is always a reason for striking out. It is our job to find out what triggers this behavior. Ok Ok I'm preaching. but things of this nature require futher investigation. Sure she may have a UTI, but she also might be stiff & sore & unable or unwilliing to tell you it hurts to get up. Most of my residents are on pain management, you would not believe the improvements in their abilities & moods. If this isn't enough, we go for the mood, or ask for an antianxiety med to potentiate the effect of the pain management. Don't forget to go up the ladder as far as pain meds.