Hospitalization and Alzheimer's Disease : Protecting Tubes and Dressings

by National Institute on Aging

(Page 3 of 3)

Reduce the number of tubes as quickly as possible while considering patient safety. Make remaining tubes as unobtrusive as possible. Nasogastric Tubes (of small diameter): Tape to the side of the face, place tube behind patient's ear and fasten to shoulder area of the gown with a safety pin.

Central Venous Pressure lines: Can remain under the gown with a point of departure through the sleeve. Peripheral Intravenous Line: 1. Can be wrapped in bandage gauze to prevent access or, 2. Can be place high on dominant arm. Dress patient in long sleeve gown with cuff (like an O.R. gown), run tubing up the arm and out the neck of the gown. Foley Catheters: Should be run directly from the area of insertion to the end of the bed to prevent accidental pulling by the patient. Patient should wear undergarments to minimize access to the catheter.

Foley Catheter in Men: Should be taped to the abdomen. Picks at Dressing: Consult with your occupational therapist to develop hand splints (like those used for patients with burns or rheumatoid arthritis) that maintain alignment and mobility but eliminate the pincer grasp, thus eliminating the ability to pick at the dressing.

What Do I Do When...? Tips For Working With Behaviors

General Guidelines

• Think of behaviors (no matter how unusual) as communication signals from the patient that there is a problem or unmet need. Try to figure out that signal.
• Remain calm.
• Protect the patient both physically and from embarrassment.
• Offer reassurance and appropriate assistance.

Changes In Sleep Patterns

Possible Causes:

• Medications
• Pain
• Not enough activity during the day
• Can't find the bathroom
• Too hot or too cold
• May be hungry

Possible Strategies:

• Review medications for possible side effect of restlessness.
• Evaluate your patient for pain and treat if needed.
• Provide nightlights to aid the patient in finding the bathroom. Make sure the pathway is clear and well lit.
• Attend to toilet needs right before bedtime.
• Continue the patient's at-home bedtime routine as much as possible.
• Limit beverages containing caffeine in the afternoon and evening.
• If the patient wakes up at night, let him walk around (in sight) or sit at the nursing station until he is tired.

Confusion

Possible Causes:

• Unfamiliar environment
• Medications
• Environment too noisy
• Unfamiliar or difficult task
• Unable to understand directions

Possible Strategies:

• Identify any potential dangers in the environment.
• Use pictures (symbols) instead of written signs to assist the patient with locating his room and bathroom.
• Decrease noise level if possible by avoiding paging systems and buzzing call lights.
• Place the patient's name in large block letters on the door to his room.
• Review medications for side effect of confusion.
• Simplify tasks. Break them down into smaller steps.
• Simplify communication. Use short sentences and avoid lengthy explanations.
• Ask the family member/caregiver about the comfort strategies used at home.

Wandering

Possible Causes:

• Patient is stressed and anxious
• Lifestyle related-previous work role or habits
• Looking for security
• Pain
• Searching for something familiar

Possible Strategies:

• Ask the caregiver where and when the patient usually wanders. Find out what strategies have worked at home.
• Place the patient in a room that is convenient for you to keep a watchful eye on and that is away from stairs or elevator.
• Keep the patient's suitcase, street shoes and street clothes out of sight.
• Assess the patient for pain and treat if needed.
• Plan walks with the patient.
• Use distractions such as a snack or music.
• Take time to talk with the patient.
• Offer a simple, meaningful activity.

Catastrophic Reactions: Patient feels overwhelmed and overreacts to a situation

Possible Causes:

• Fatigue
• Environment is too stimulating
• Patient is asked too many questions at a time
• Too many strangers in a noisy, crowded atmosphere
• Patient is asked to perform a task beyond his abilities
• Fails at a simple task
• Encounters irritable, impatient staff

Possible Strategies:

• Remain calm.
• Use a low tone of voice.
• Do not argue with the patient.
• Try the activity or task again later.
• Refrain from forcing or restraining the patient.
• Offer reassurance and try distraction.
• Move the patient to a quieter area.
• Simplify the task for the patient.
• Build in rest periods.
• Simplify communication.
• Be aware of your own body language and what it is saying.

Preventing Catastrophic Reactions

• Maintain a simple, structured, secure environment.
• Follow routines and schedules.
• Limit choices - choose between two items instead of five or six.
• Introduce new treatments slowly.
• Give step by step directions.

Disruptive Vocalizations: Calling out or screaming

Possible Causes:

• Fear
• Pain
• Loneliness
• Self-stimulation

Possible Strategies:

• Offer the patient reassurance.
• Place the patient where he can see a nurse.
• Spend time with the patient.
• Assess the patient for pain.
• Provide a range of textures in the environment for stimulation.

About the Author

www.nia.nih.gov
NIA, one of the 27 Institutes and Centers of NIH, leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. In 1974, Congress granted authority to form NIA to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people.