Wild in the Halls

There is a not-so-well-known, not-so-good movie called Wild in the Streets for which the play on words for the title is from. In the land of that movie, my day definitely would not have happened since the elderly were shunted off into communes, but since we don't really live there, feel free to continue reading about the craziness that has been Wednesday.

Wednesday starts for our purposes when the evening nursing shift came on at 7pm. In 12 hours, Mr. L will cause enough disturbance that there will be 15 different nurses notes written about his exploits. He will be found wandering in the hallway carrying a sheet and/or the room's courtesy curtain. He will dismantle 2 bedchecks, take the bolts off a geri chair, and also climb out of a geri chair with the tray attached without a scratch.
His mini-mental scores are stable, at the very lowest regions of the Moderate Cognitive Impairment range. He has been speaking very tangentially, somewhat in nursery rhymes, and has identified our president as "Muhammad." He has been very emotional and has yelled at the PT several times this week, today he was pleasant with me for 25/30 minutes while he petted his dog (not a real dog). Mr. L decided to take a walk while I was present, and I barely had time to throw a walker in front of him and couldn't get to the gait belt... had to walk side by side with my arm around his waist to keep him on his feet. He has been in this fugue of confusion since his most recent surgery- he has no history of dementia. Hopefully someone can figure out a cause and reverse this process.

Ms I is 96 and has advanced dementia with the delightful combination of severely decreased vision (macular degeneration) and decreased hearing. She is disturbed by visual hallucinations and is terribly frightened of being left alone. She has been in a geri chair by the nurses station for the better part of 2 days so that she has 'company.' She started sundowning today really badly, calling out in a cat voice about being left alone during shift change. Her new roommate has had cancer and uses a kerchief to cover her head. Roommate said to me that Ms I thought she was a man when she took off her hat, but roommate was perplexed, since Ms I wears a wig and/or kerchief too. Roommate told nurses at some point last night "either give her a tranquilizer or give me one."

New admit today... (I forget her name, I did 5 evals this afternoon and hers was the last at 415) we'll call her Mrs T who also has dementia but is oriented, sees Ms I in the hallway and during those 5 minutes that they were around each other Mrs T got at least 75% more confused. I did the home safety cards with her yesterday, she had some interesting responses. She could spot some of the simple stuff, but when I asked, "Should she take this medicine that expired 10 years ago?" she didn't really know. This lady has been in acute care and thought that she was going home for the past 3 days... hope that she adjusts ok to the SNF floor. She may have to adjust to placement, but we'll hope for the best.

Twice I had to intercept the same pt. in the hallway this morning... once he was pushing a chair out in the hallway ("to get it out of the way") without his oxygen when he should be wearing 4 liters. He has no diagnosed cognitive impairments but lacks insight into his deficits and consequences. We barely made it back to his room without falling, and he made a grab for the curtain and I thought we were going down for sure then. 20 minutes later, I walk by and he hands me a "sputum sample" on a piece of gauze. The nurses didn't want it, I certainly didn't want it... BLEH.

Bad enough to have seriously cognitively impaired patients that require constant supervision for everything... adding in those who are just overly demanding or lacking in insight has made it hard to get much done. Did manage to discharge a couple of patients today, which is fortunate, because this has been a difficult week for the nursing staff and for meaningful therapy interactions. I have some time off, followed by some more time off soon, so hopefully everything will be on the upswing.

On a totally random note, I consider myself pretty "with it" in terms of technology, in fact, I am the resident computer dork of the rehab staff. (Fun fact- I had my first website when I was 15 and still remember random pieces of HTML code) I have a facebook account and utilize other internet technologies with ease, but I am having major difficulty figuring out OT Connections. I can't seem to join groups and am not finding other people that I know are on there. Perplexing. Also, I do continue to have issues making the cut links work well on this blog, but I am working to fix that since it makes my main page look all weird.

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