My Life As A Male Nurse. Caring for the Elderly Patient.
Caring for the Geriatric patient
Caring for the emotionally ill patient, and the staff that cares for them, can be quite challenging on a day to day basis.
Understanding the differences between the multiple causes of mental disorders of the elderly makes caring for them easier.
Working on the new "Geriatric Admissions and Assessment Unit" had its own rewards.
Once in a while an elderly problem patient was able to be returned to their families, after being stabilized by medication and returning to being self reliant and mentally stable once again.
They were not all as lucky.
Bees nest hairdos
1. Old fashioned 'bees nest' hairdos
One day we got an admission of two elderly sisters who were living in their own home by themselves for years.
When one of their family members decided to visit to check up on them, they discovered all was not as it seemed to be. They were living in total squalor in a cluttered and filthy environment, and both totally confused and unkempt.
Obviously personal hygiene was a thing of the past for these two ladies, as well as their memories.
However, their hair was without one strand out of place.
It was really weird.
So, on admission, when the staff had them undressed to bathe them, they asked me to come and see their hair and advise what to do with it.
At first, i thought they might be wearing wigs.
Their hair was in a "bee hive" style hairdo.
When i touched it, it was like touching something made of cardboard, but not as pliable.
In fact, it was a solid mass that was impenetrable.
After some prodding we found that the original hairdo had a hair net around it to keep it in place. Then the net just sort of got lost in the growing hair and apparently sealed in by excessive spraying with hair spray, locking it all in place.
As the hair grew it was entangling itself under the net and hairspray to make a solid matted mass.
We and to call the family member who seemed to be the only spokesperson for the family, to either deal with it themselves, or get written permission to have the staff remove it.
We got the 'written' permission, as i suspected we would.
The matted head pieces were so tightly drawn to the scalp, it was a major operation to remove them.
Gently raising one very small piece of the skull cap at a time, we had to use thin surgical scissors to snip the cap away from the skull.
It literally took an entire day to remove those beehives from their heads.
We had them encased in clear plastic for some time, so everyone could observe this odd phenomenon.
Eventually we had to incinerated them for sanitary purposes.
3. Dealing with insomnia in the elderly
People with Alzheimer's, or other brain malfunctions, all have increased confusion at night with their best clarity in the morning upon waking.
They find it difficult to fall asleep, become restless, and agitated, along with the confusion.
We call this process "sun downing" as this is the time of the day when they are most likely to wander off, fall, or otherwise injury themselves.
We tried a variety of sleeping aides to help them get to sleep, but nothing seemed to work.
The effects of these sleeping aides were random and each patient reacted differently from their usage.
Others types of sleeping aids like (chloral hydrate) that has been around for years, had a cumulative effect.
It would build up in the body, and in a few days hit them all at once, causing the patient to have prolonged sleep periods, that could last for a day or two.
We quickly discarded that one from use in the elderly confused person. Although the prolonged rest periods seemed to be a god send to their families, we did not feel it was healthy or beneficial to the elderly patients.
We had to take into account that medication dosages in the elderly had to be adjusted, just like it must me adjusted for the use by children.
As we age, our metabolism slows down profoundly. The average dosage, for the the average adult, can easily cause overdosing in the elderly.
Believe it or not, most physicians, even today, do not take this into account when ordering medications for their elderly patients. This is a major reason why we as individual consumers should be aware of these facts as well, for when our physician orders medications for us, or our family members.
The team met weekly to discuss treatment and medication effectiveness, etc.. Everyone had input and suggestions.
Being a joker, i said:
"what works for me every time, is 25mg of benadryl (an over the counter antihistamine for allergies) and a shot (one ounce) of whiskey. That always puts me down for the night, and i always wake alert and refreshed."
The team laughed, but the Psychiatrist didn't.
"That may have been said as a joke, but we have tried everything else without much success and i am willing to try anything at this point".
And so, the evening nurse became a pill passer and a bartender.
Lo and behold it really worked.
We became the topic of much controversial conversation, as to whether this was ethical, or not.
So the experimental period was limited to one week. It was very successful. The patients slept well throughout the night and awakened alert and somewhat mentally cleared, due to the extended and uninterrupted sleep period.
Consequences of outside interference
Although this treatment using Benadryl and whiskey worked well It was abandoned after the week trial period was over, due to the unending controversy as to whether we should be allowed to give alcohol to the elderly patient, or not.
There were prissy conservatives (teetotalers) even way back then.
We knew this would never be an accepted treatment for insomnia in the elderly, as there was no major profit to the drug manufacturers.
But, it still works for me when i just can't seem to fall asleep at night.
And as far as i can ascertain, i am still in control of all of my faculties.
Although, we are always the last ones to know when we aren't.
- My Life As A Male Nurse. Part 5. Geriatric nursing: CODE BROWN.
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© 2011 d.william