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
Hello, I'm new here and this situation I can really relate to! We have residents like this frequently and send them (if possible) to a geri-psyche unit. If this is not an option, the doctors in my area will generally prescribe namenda. excelon and depakote sprinkles then use haldol with the ativan as a prn. We have excellent results with this combination, however remember all residents are different and tolerate meds differently. Hopes this helps
A person with alzheimers has no idea what they are doing or why they are doing it, because of the plaques and slow shrinkage of their brain. I was surprised how much the brain will shrink! Can you imagine how that can effect the behavior of a person with alzheimer's. It is brain damage. How frightening to go through the memory loss and one day not know who you are, or who everyone is around you. No wonder some alzheimer's patients become violent. A very scary disease.
A person with alzheimers has no idea what they are doing or why they are doing it, because of the plaques and slow shrinkage of their brain. I was surprised how much the brain will shrink! Can you imagine how that can effect the behavior of a person with alzheimer's. It is brain damage. How frightening to go through the memory loss and one day not know who you are, or who everyone is around you. No wonder some alzheimer's patients become violent. A very scary disease.
So true, HannasMom, I have tried to imagine what it must be like, and it seems to me it would be TERRIFYING, and so sad. Thanks for your explanation of what alzheimers does to the brain. Still a question, do psych drugs that you would find helpful with patients with paranoia (for instance) be effective with a dementia pt with paranoia symptoms, or is it much more complex?
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.
Absolutely. We just lost my FIL to AD that manifested very much like paranoid schizophrenia. He was HORRIBLE to be around. In the morning of the day passed, I was attempting to give him a bath and he was taking swings at me the entire time. And amazingly enough, he hadn't eaten in weeks and hadn't had a sip of water in 4 days, but he was strong as a horse. But I digress....
Zyprexa or Seroquel PLUS and SSRI while keeping the Ativan PRN is what calmed FIL enough to be (barely) tolerable. A med change is definitely in order for this patient you mention. But honestly, the Zyprexa is what really made the difference.
My grandmother also has AD and Haldol is working really well for her, but she is more "sweetly" delusional where as FIL was aggressive, combative and having very bizarre hallucinations.
I'd recommend a med change for your patient, unless the Risperdal was just started.
Absolutely. We just lost my FIL to AD that manifested very much like paranoid schizophrenia. He was HORRIBLE to be around. In the morning of the day passed, I was attempting to give him a bath and he was taking swings at me the entire time. And amazingly enough, he hadn't eaten in weeks and hadn't had a sip of water in 4 days, but he was strong as a horse. But I digress....
Zyprexa or Seroquel PLUS and SSRI while keeping the Ativan PRN is what calmed FIL enough to be (barely) tolerable. A med change is definitely in order for this patient you mention. But honestly, the Zyprexa is what really made the difference.
My grandmother also has AD and Haldol is working really well for her, but she is more "sweetly" delusional where as FIL was aggressive, combative and having very bizarre hallucinations.
I'd recommend a med change for your patient, unless the Risperdal was just started.
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),
Don't count on it! The ECF I worked in had a seperate dementia unit. We had a patient that swung at anyone (residents, staff, family) in arm's reach. His family had been caring for him at home until he was too violent for them to deal with. Staff was getting hit several times a day and it required an additional person in the solarium just to keep other residents away from him. To change his diaper required 5 people! This scenario is what staff decided worked best/safest after trying the gentle teaching BS, redirection, etc. 2 people had to walk up behind to secure his arms and help him stand up. They would walk him to his room, where 2 more aides would lower his pants and keep him from kicking the 5th person who was responsible for the actual "changing" part of the ordeal. These were experienced dementia aides who could have a miraculous effect on patients other units couldn't manage. The NM of the unit was continually fussing at her staff to use their gentle teaching, telling them that they were just approaching him wrong. Refused to send him out to geri-psych for evaluation. After a few weeks, she thought she'd try her luck. Squatted down to make eye contact, softly spoke his name, moved a couple feet closer and WHAM! he sent her sliding across the linolium with a solid right hook. He left the very next day for a psych eval.
amazing that she thought she could approach him like that.
Yeah, we all got the biggest kick out of it. She thought that we were all doing it wrong. She tried doing it what she thought would be "the right way" and got a black eye to show for it
Don't count on it! The ECF I worked in had a seperate dementia unit. We had a patient that swung at anyone (residents, staff, family) in arm's reach. His family had been caring for him at home until he was too violent for them to deal with. Staff was getting hit several times a day and it required an additional person in the solarium just to keep other residents away from him. To change his diaper required 5 people! This scenario is what staff decided worked best/safest after trying the gentle teaching BS, redirection, etc. 2 people had to walk up behind to secure his arms and help him stand up. They would walk him to his room, where 2 more aides would lower his pants and keep him from kicking the 5th person who was responsible for the actual "changing" part of the ordeal. These were experienced dementia aides who could have a miraculous effect on patients other units couldn't manage. The NM of the unit was continually fussing at her staff to use their gentle teaching, telling them that they were just approaching him wrong. Refused to send him out to geri-psych for evaluation. After a few weeks, she thought she'd try her luck. Squatted down to make eye contact, softly spoke his name, moved a couple feet closer and WHAM! he sent her sliding across the linolium with a solid right hook. He left the very next day for a psych eval.
I just loved this story! not that I wanted the nice NM to take a right hook, but......
Wow this is an interesting topic. I don't work in a nursing home but it sometimes feels like I do because many of my patients in the hospital are elderly and suffer from alzheimers. It's hard to know what to do for these patients to keep yourself safe and to keep from giving them something that will really knock them out.
We actually just have had a lot of news coverage in the last few days about a nursing home patient here in my city with alzheimers, who beat his roommate with a towel bar. Both men had alzheimers and the guy hit with the towel bar died a few days later. Very sad story.
Wow this is an interesting topic. I don't work in a nursing home but it sometimes feels like I do because many of my patients in the hospital are elderly and suffer from alzheimers. It's hard to know what to do for these patients to keep yourself safe and to keep from giving them something that will really knock them out.
We actually just have had a lot of news coverage in the last few days about a nursing home patient here in my city with alzheimers, who beat his roommate with a towel bar. Both men had alzheimers and the guy hit with the towel bar died a few days later. Very sad story.
That is such a good point, and a problem I have seen in an alzheimers unit. Some of these patients are not only violent, but also quick and stealth-like and a real threat to other patients. Had one who would put dinner ware (thankfully plastic) in his pants to pull out on his roomy later. Always had to check that fellow pants! What a job.
I empathize with your situation. I strongly agree with some of the posts that see the resident as a person first and behavior second. We in the LTC sector deal with this every day. The first thing we do is rule out some kind of delirium. If no underlying illness can be found to cause this behavior, we then send them for a geriatric psych consult. They are the experts, and will look at all the meds and their interactions and provide appropriate meds to stabilize them. Here in Canada, we also utilize something called PIECES training. This training allows the health professiona to look at the physical, intellectual, emotional, capabilities, environment and spiritual aspect of each resident when dealing with behaviors. It looks at the person as a whole and examines effective methods to deal with each behavior. We have had some great success with it.. Here is the website www.piecescanada.com for some info....not sure if you have anything comparable in the states. Good luck.
Miss Terri
2 Posts
Hello, I'm new here and this situation I can really relate to! We have residents like this frequently and send them (if possible) to a geri-psyche unit. If this is not an option, the doctors in my area will generally prescribe namenda. excelon and depakote sprinkles then use haldol with the ativan as a prn. We have excellent results with this combination, however remember all residents are different and tolerate meds differently. Hopes this helps