Hey,
Last week on prac I had an embarrasing scenario happen to me. I was asked by my supervisor to do a chest check on an elderly patient who had dementia and was reportedly very confused. When I went in to see this lady she was trying to walk out of her single room whilst still having her nasal prongs on which were attached to the wall- essentially coming very close to falling over. I managed to get her to sit down in a chair and started my Ax. When I was part way through auscultating my pt stood up and started trying to rush out the door. I tried to calm her down and blocked her path and she started yelling out "Go away! Go away!" at the top of her voice.
A nurse nearby came in to see what was happening and asked the patient if she was trying to go to the bathroom which the pt replied she was. The nurse then guided the pt back into her room and to her bathroom. I felt embarrased that I hadn't asked the patient this simple question but at the time was so flustered with not wanting the pt to walk out the room and trip that I didn't really think clearly. The nurse involved was really nice about the whole thing but I felt like I have lost my credibility in front of her as she had to come in and take over.
Has anyone had similar challenging experiences with pts with dementia?
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I completed a placement in a rehab hospital towards the start of the year, which despite having been set up for people who need a little extra PT and OT intervention before being D/C, was 'home' for a number of induviduals with dementia whom had not yet been able to get into a nursing home. With these patients like yourself I had a couple of misunderstandings ie they were upset/frustrated and I couldn't determine why. When the nurses came in they appeared to be able to tell extactly what the patient required. When I asked the nurse how they did this they just said that they had looked after this induvidual(s) over a number of weeks and had learned to pick up their cues etc, but they also mentioned that it took time to learn these. We cannot read every situation we walk into, we can only do our best and I think you did the right thing in terms of avoiding a potential fall. The best piece of advice I felt this nurse had given me when working with patients with dementia is that they are generally more compliant with routine and people they are most familiar with.
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