What would you do about a LTC resident like THIS!

Tweety, BSN, RN · Feb 22, 2003

She's confused and demented. She won't be satisfied.

You guys need to have a unified approach in dealing with her. Set limits, encouraging appropriate behavior.

Good luck.

itsme · Feb 22, 2003

If she is a threat to herself or to others, cant the nurse ED her? (emergency detention). That is what we do when a res. actually becomes a threat. Is she on any PRN meds, maybe some xanax or ativan for her agitation? Maybe a social service consult?

nursedawn67, LPN · Feb 22, 2003

Originally posted by itsme
If she is a threat to herself or to others, cant the nurse ED her? (emergency detention). That is what we do when a res. actually becomes a threat. Is she on any PRN meds, maybe some xanax or ativan for her agitation? Maybe a social service consult?

Most definantely a social service consult..maybe get a Psych consult and get some meds on board to ease the temper down some. When residents that seem "with it" to me talk to me like that I ignore them, or say "I'm sorry you feel that way"

Aussienurse2 · Feb 22, 2003

You just have to remember that this lady has lost her inhibitions, she has no control over what she is saying. It's a natural part of aging for some people. Have you thought about what it must be like to be, in effect, drunk for the rest of your days? Please don't think I'm attacking you personaly I'm just trying to give you a different perspective. You can't take these things personaly, if you do you'll go mad, just keep thinking " She can't help it". I think you may also find that the families of the other residents know that what she is saying is untrue and you can explain to them that this is just the way dementia is rearing it's ugly head in her. Aging really sucks.

CraftyLPN · Feb 22, 2003

Originally posted by greer128
Most definantely a social service consult..maybe get a Psych consult and get some meds on board to ease the temper down some. When residents that seem "with it" to me talk to me like that I ignore them, or say "I'm sorry you feel that way"

DEfinitely sounds like a plan to me... When I worked @LTC.. we had a fellow.. if you said or did something wrong(in his eyes) he would go after you.. I remember a time when a fellow nurse and I had to lock ourselves in the med room because he was "gonna beat the sh!t out of us", and came up to nurses st and trying to getinto med room, pounding, kicking on the door.

He was finally sent to psych hosp after last episode bcuz he was violent w/ another nurse

Furball · Feb 22, 2003

Definitely a psych or neuro consult.

emily_mom · Feb 22, 2003

Since consults are pretty much out of your job realm, just love her. Think about how difficult it is to be trapped in a world that doesn't understand you. Think about what it would be like to be trapped. My grandma has dementia and do just that. Once you understand the pathology of this, it is easier to be compassionate. People with dementia have very few advocates. Just be kind to her...even when she treats you like crap. That may be you someday.

Kristy

mchospicern · Feb 22, 2003

I once took care of a woman who was nasty, not to that degree, but was pretty brutally verbally abusive. She seldom had visitors, but one day I caught her neice coming for a (very brief) visit. The neice told me this lady had been nasty her whole life. She was just a miserable person. I guess there are some people who are sweet to the bone, and some who are just bitter. According to the neice, she just didn't have any other mechanism for getting through life other than being abrasive, and as she aged, she just got more bitter. She was the kind of person who freely told people they were "too fat", "lazy", "stupid". Her mind was sharp as a tack, she managed her own finances, even her own medications at bedside. What do you do with a resident like this? The same as you'd do for any resident: provide the highest standard of care, protect her dignity, don't take it personally, encourage her to verbalize and provide reflection. Consider spiritual distress, and perhaps a chaplain could be of some benefit. Last but not least, consider pain as an etiology.

Agnus · Feb 22, 2003

This has GOT to be really hard on you.

I don't know if telling this story will be of any help but maybe you can gleen something from it.

We had a patent who had a serious brain injury. She kept yelling out.

One day she was doing this and a visitor (to another patient) came storming down the hall stood in from of the screamer's door and say, "are you going to do something about this." She had been yelling "Help" etc.

She had SERIOUS short term memory loss and did not remember that you just responded to her call. She did not want anything but was having anxiety and had been medicated for it.

The meds just were not working real well at the time. She was very rational and quiet when you talked with her. But the second you turned and left she's start again.

Anyway this visitor walks right into the patient's room. Well I follow her. She is standing looking at the patient and the patient is rolled on her side and doen't see this person. The patient is not making a sound.

I ask, "who are you?" She replies that she is a visitor from down the hall. I signal her to come away from the patient's bed.

Now I am debating that privacy issue vs this visitor saying we are ignoring a patient. I very quietly tell this visitor that this patient has very serious brain damage and she has no control over this.

She then respectfully, sheepishly (and seeming to understand) says, "Oh, I'm sorry and leaves."

I refrained at that time, due to her response, from saying that she was not allowed to just walk in to any patient's room without thier consent or consent of a gardian, that I would have to ask her to leave. She was violating the privacy of this patient and that she could not just walk in on anyone she pleased. Nor did I ask her to think about how she would feel if some stranger did this to her or someone she loved.

If she had responded differently I would have.

Later I find out this visitor is a medical professional. So she even KNEW better than to just go in a patient's room.

I violated privacy by giving this info. But I had to weigh out the consequences of not doing this. If I had not she would probably spread the word that we ignored patients, she would become demanding thinking that we were ignoring her mother (whom she was visiting) She might lodge complaints but worst of all our reputation would be scarred and this woman would believe we were negletful and worry about her mom.

Often visitors do not understand but once they do they respond appropriately.

It is VERY embarrasing when you have someone like this.

As a CNA there is not a lot you can do. Maybe you can say, "she can't help it." But maybe you could talk to the nurse or adiministration and ask that they talk to family and visitors and educate them.

Anagray, BSN · Feb 22, 2003

While I don't have any constructive offers on what to do with this woman, I can only offer my sympathy and understanding to you.

It definitely hurts when people say horrible things to you after u have been working so hard to make them happy, but like the others said, she is sick. Her mental capacity is gone and for many of us this is the kind of future we will have when we get to be her age.

I only hope that if i am like her, I will have some like you taking care of me.

I think one of the things that need to be done is to put this patient in a private room ( if u have one) because her roommate is obviously suffering.

kimberle · Feb 22, 2003

I'm just wondering if the social worker can, of course, do an evaluation including seeing if the doctor feels a psychiatric consult is appropriate. But I would also speak to the social worker about how disruptive this resident is to the whole facility and see if there's any family to help get involved. In this case, I would keep the family updated, so if something did happen to a nurse or another resident (another resident or resident's family can report it as verbal abuse and/or hostile environment to live in and take action legally) they would have been informed of this behavior prior. In our facility, our social worker would go through the whole medical/psychological work-up with the doctor, then approach the family/resident in a meeting and inform them that the resident could be asked to leave/find another facility if she/he continues to be abusive/disruptive. Even if there's a psychiatric or medical reason or if that it "just how she is" for the behavior it needs to be addressed/taken care of involving the social worker, physician. resident and/or family if she has any.:)