She sat in her chair by her bed and talked to me about her life. She was busy, her house was a mess, and she didn’t know if she would be well enough to make Thanksgiving dinner for her family next week. This was her second night here at the hospital “Just because I fell” and she wanted to be home. She was “Sure my heart is fine, they haven’t found anything by now anyway.”
As I took her vital signs I encouraged her to eat her dinner and to “Worry about you. You can’t worry about what you are going to do until you feel better.”
She smiled and relaxed a little at the reminder. She started to eat her dinner and I continued on my rounds.
As I start my shift by assessing my patients, when I go in and out of rooms I continue to engage in ‘small talk.’ By this I let my patients know that I care, that I want to talk to them, they can talk to me and it also gives me a chance to assess their cognitive abilities.
As I left Virginia’s room I was encouraged to have met an elderly (80 something year old) woman without any evidence of confusion or an altered mental state.
The evening continued on and suddenly, around eight-o-clock, Virginia began to seem a bit more confused. She began to insist (kindly but firmly) that she was going home tonight, that her husband would be back to get her. Attempts by me to remind her of our conversation earlier that she would at least be staying in the hospital one more night did no good. She was very insistent but at times re-directable.
Several times over the next few hours we would find Virginia almost out of bed. She needed the help of a walker normally, although she could move quite well all things considered.
We had to put a call bell on her bed that alarmed every time she tried to get out.
She was getting angry, and trying to hit the staff.
She also seemed to have developed a bit of a body tic that could be noticed when she was laying in bed.
When the confusion began to get past the directable stage and I started to notice the tic I gave the Dr. a call and asked him to come out and look at her.
He very nicely arrived and came into assess Virginia. We both were aware that Virgina did partake of an alcoholic drink in the evenings. It was assumed that perhaps she partook of a bit more than she had revealed. The idea of ‘sun downing’ was also discussed and so he prescribed a small dose of IV Ativan.
The Ativan didn’t work. It didn’t seem to change anything and so I called the Dr. again.
He prescribed another dose of Ativan, again small.
I gave it, and it did nothing. Virginia was still climbing out of bed, her alarm kept going off, and she was insisting very strongly that she “Had to go home and where is my husband?
The problem was, however, that after the Ativan, Virginia was not only staying confused, she was also getting weaker and more unsteady on her feet.
By now it was ten at night and I was getting more and more worried that Virginia was going to fall and break a hip because she was getting more and more confused, agitated and now had strong medication in her system.
I had seen this scenario play out many times with dementia patients.
At one point I was two rooms down from Virginia administering medications. I heard her alarm going off and ran quickly to her room, only to find her already to the door, holding onto the door frame tightly because she was so unsteady.
She looked at me with a glazed and confused look and said “Please, I can’t stay here tonight, I have going home! I need to leave, I’m so sorry, why do I feel this way?”
And I looked at her and wanted to cry, because she could not process why she was here, needed to be here and could not go home. And I didn’t want to give her any more medications, but what could I do? She was too unsteady to walk, too agitated to stay in bed and too mentally distressed to relax.
So I helped her back in bed, persuaded her to stay there for about two minutes, and went back to nurses’ station to call the Dr. yet again.
~To be continued~