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
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
When you have someone who is this violent it is required that you have them admitted to a psych unit for a period of medication adjustment. He is a danger to himself and especially to others. You need to speak to his primary physician to get the referral. Administration needs to evaluate him prior to returning to the facility. They have obligations to keep the other residents safe from harm.
Specializes in LTC, home health, critical care, pulmonary nursing.
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.
Ouch. I can relate to being beaten with a towel bar. I work on the unit that all of you would send this resident to. Fun times. I have REALLY quick reflexes.
I got a broken nose once trying to "reorient" a violent pt. In the end he was sent out to the ER yet again and this transferred to a proper facility for his situation . Typically in our area there is nowhere for these people to go . very few facilities LTC that is, are properly equipped to deal with agressive pts.
We can talk med changes all we want but we still can't prescribe them. Where are the phone calls to the doctors for this patients behavior, are we not using a team approach and leaving out a key player? Can we not use physical restaints anymoreeven long enough to provide for his personal care? Where is the families responsibility in all of this?
Specializes in LTC, home health, critical care, pulmonary nursing.
Can we not use physical restaints anymoreeven long enough to provide for his personal care? Where is the families responsibility in all of this?
No, we can't. Totally against the law. And as far as families are concerned, that's why they're in the facility, because the family can't, or won't care for them. What are they supposed to do anyway? Apologize profusely when presented with staff's shiners? Most of them already do that.
kids
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the resperidal may actually be making the situation worse.
from medscape drug reference http://www.medscape.com/druginfo/dosage?drugid=9846&drugname=risperdal+oral&monotype=default&cid=med&src=search