violent alzheimer's....

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I'm an rpn in a ltc facility...last month, i think it was, we admitted an alzheimer's res who is very violent when it comes to anything to do with personal care. from the first night we've had him, there have been staff injury incident reports made out because of him. he's ok if you leave him alone....but once you try to change his brief, wash him...basically touch him, he gets very agitated and aggressive. he came from home, was on no meds. now, all he's on is risperidone OD and ativan PRN. he's only on .5mg ativan--he started out on 1mg, but that literally knocked him out for days...but the 0.5 barely touches him! it makes him unsteady on his feet...so then we have to worry about him falling..but it doesn't make him any less violent.

now, it's come to the point where pretty much all the staff is afraid of him. The only ones who aren't are the administrators...the ones at the desks who keep telling us we should be doing 1 on 1 care with him..when it can take us 6 or 7 ppl to change him! I hate using that many people, but he's strong and he's really going to hurt someone one of these days. So far he's only been violent with staff with one exception, where he struck out at (but didn't hit) another res.

He's only getting changed once or twice a day....and i feel terrible for that but the HCA's just can't do anything with him without getting hurt. so far his skin hasn't broken down but i know it's only a matter of time. Any suggestions on how to better handle a res like this? or how to better get the attention of the 'head honchos' of the facility....i really feel this isn't the place he should be....he should be in a geri psych ward i think, because we just don't have the staffing to deal with him...any suggestions would be really appreciated! thanks a lot, sorry this is so long

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Alzheimer's are such an unpredictable bunch when they are violent. The families don't want them heavely druged ,but the meds take a day or two to build up in the system to and up with th desired effect. How often can you give the ativan .5 ?

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IT sounds to me like he needs a different med- Seroquel or something similar maybe? The best thing you can do is document extensively, then take the documentation over a week or so to your administrator and hit 'em where they really care about- the pocketbook. Let them know that you are worried about your facility, that it is clear from the documentation that the resident is known to be a threat, and that it is only a matter of time before he seriously injures an employee or another resident and that the facility would be liable.

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Wow! Reading your posting it reminds me of something that I could have written myself, more than once. I know exactly how you feel, calling all your staff to help perform cares for one resident, wondering if you are actually ensuring that needs are met or committing boderline abuse. In my case(s) we did end up with both staff and other residents hurt. It's just as Lori said in the previous posting, document, document, document- get the rest of the staff behind you on this from nurses to support staff (including dietary, housekeeping, anyone who has had difficulty with the resident)-demand an meeting to discuss problems, or an inservice for staff on how to handle this type of resident if they are not used to dealing with violence. As soon as the facility sees that it is not in their interest to pay 5-6 staff members to care for one resident or if someone (hopefully this doesn't happen) gets hurt, they will change their tune. Be sure to enlist the help of the resident's physician (if you have in house they should know the situation, or if they are seen at a clinic insist they come to the facility), family (if you have a good relationship with them) see if they will assist with cares, try different approaches (I'm sure you've tried a million). Definitely inquire about different medications. Hopefully there is an Alz unit with an open bed that will be ready to take this resident when your admin comes to their senses. Best of luck to both you and your resident.

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I work in an acute care hospital, but I have refused to touch patients like this when they are very combative. I will give them IV meds (where I can stand a foot away from the patient and use a distal port) and perform care that does not involve direct contact, but I don't get paid enough to be injured. If the meds and restraints (we aren't allowed to use the hard restraints) are not effective in protecting my safety and the doctor and family don't want to give more sedatives or stronger restraints, then I don't put myself at risk any further. This may sound cold, but I would rather his/her skin break down from laying in waste than have my teeth knocked out. They are at the end of life (and at that point with end stage ALZ, the sooner the better), and I'm still a viable member of society. I will do what I can SAFELY with what I am given but I'm not a martyr and I'm going to protect myself and my health first- otherwise my other patients won't have a nurse.

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You make a good point undecided, but couldn't you get in trouble for neglect if you let a patient go without changing or cleaning them?

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Specializes in ICU, step down, dialysis.

Would someone like this qualify to be admitted to a gero-psych unit, to get this behavior under more control, then return to you?

I'm an rpn in a ltc facility...last month, i think it was, we admitted an alzheimer's res who is very violent when it comes to anything to do with personal care. from the first night we've had him, there have been staff injury incident reports made out because of him. he's ok if you leave him alone....but once you try to change his brief, wash him...basically touch him, he gets very agitated and aggressive. he came from home, was on no meds. now, all he's on is risperidone OD and ativan PRN. he's only on .5mg ativan--he started out on 1mg, but that literally knocked him out for days...but the 0.5 barely touches him! it makes him unsteady on his feet...so then we have to worry about him falling..but it doesn't make him any less violent.

now, it's come to the point where pretty much all the staff is afraid of him. The only ones who aren't are the administrators...the ones at the desks who keep telling us we should be doing 1 on 1 care with him..when it can take us 6 or 7 ppl to change him! I hate using that many people, but he's strong and he's really going to hurt someone one of these days. So far he's only been violent with staff with one exception, where he struck out at (but didn't hit) another res.

He's only getting changed once or twice a day....and i feel terrible for that but the HCA's just can't do anything with him without getting hurt. so far his skin hasn't broken down but i know it's only a matter of time. Any suggestions on how to better handle a res like this? or how to better get the attention of the 'head honchos' of the facility....i really feel this isn't the place he should be....he should be in a geri psych ward i think, because we just don't have the staffing to deal with him...any suggestions would be really appreciated! thanks a lot, sorry this is so long

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Specializes in Geriatrics/Alzheimer's.

I work as a Care Coodinator/LPN in our Memory Care Unit, when a resident gets to the point where they are violent, where staff, and/or residents are in danger of becoming injured, we immediately contact their MD and inform them of their behaviors and request an order for a gero-psych evaluation. We have done this before and it has been very successful.

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I work in an acute care hospital, but I have refused to touch patients like this when they are very combative. I will give them IV meds (where I can stand a foot away from the patient and use a distal port) and perform care that does not involve direct contact, but I don't get paid enough to be injured. If the meds and restraints (we aren't allowed to use the hard restraints) are not effective in protecting my safety and the doctor and family don't want to give more sedatives or stronger restraints, then I don't put myself at risk any further. This may sound cold, but I would rather his/her skin break down from laying in waste than have my teeth knocked out. They are at the end of life (and at that point with end stage ALZ, the sooner the better), and I'm still a viable member of society. I will do what I can SAFELY with what I am given but I'm not a martyr and I'm going to protect myself and my health first- otherwise my other patients won't have a nurse.

This would never happen in a LTC facility. First the man would probably pull his IV out. Second we would never be able to restrain like that. Then you have to look at the neglect issues. Just because they might be dx with end stage alz....I've taken care of a pt like that for a few yrs. So neglecting them like that....boy I could just see the bed sores!

Soooo what do you do? The other posters are on tract. Document..every shift and occurance. Speak with family...find out what calms him. Get psych involved and supply them with the documentation. Have your DON come and observe you when care is being provided and he is out of control. When you can get to clean him, try to do it fast and thorough. Use a good barrier cream.

There are more ideas on another thread here about "Forcing a resident to change"

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Specializes in Nursing assistant.

I don't Know drugs, but I would think ativan is not the one for this guy. You said a larger dose knocks him out, and a lighter dose has no effect. That would say to me that the ativan has no positive effect in changing behavoir. Passing out would sort of be the cutoff point in the test for effectiveness.

Is this true: alzheimers has damaged portions of his brain that would inhibit these behavoirs, or preceive what is actually happening in his environment? Would psyche drugs used for pt who have similar mental illness be appropriate for this? Just wondering.

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Specializes in Gerontology, Med surg, Home Health.

can you spell section 12? if he hits you, another resident could be next. we need to care for our residents but we shouldn't be putting ourselves at risk in the process. and ativan is not the drug of choice for demented residents...risperdal or zyprexa work well.

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a med change is in order. Also, when I worked ltc, we had a special unit for violent pt. They were staffed better and the pt's medications were adjusted here. They usually returned to us "all tuned up" after a 3-4 week stay at the behavioral-psych unit. Do you have anything like this available to you?

another thought...Does it make a difference what time of day you approach this guy? Maybe he has severe sun-downers and changing him in the early evening sets him off?

Also...document, document, document. and then document somemore. document how many cna's/staff it takes to change him, what his response it...be specific, including foul language quotes-don't just say "resident was combative with cares" say "resident swung his fist and struck cna, resident kicked cna as she tried to assist res from soiled attends"

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