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75 yr. old patient with severe sleep disorder
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An_248218 posted:
Hello everyone,
I am new here & hope to gather some information about one of my nursing home residents.
She came to live at our long term care facility in June of this year. Initially, she could walk although her gait was very unsteady. She ended up falling 14x's in a period of 3 weeks. But, she was noncompliant as far as using a cane, walker or her call bell. She would just get up & go to the bathroom by herself. Her alarms would go off & we couldn't get there fast enough. Her other symptom was a complete lack of short term memory. She could never remember what she was supposed to do, where her room was etc. She also could not sit still. She would sit for a minute & then be up again walking, walking, walking. She was constantly in everyone's faces asking the same questions over & over & over. As the charge nurse, this was extremely distracting while I was trying to pass out my medications.
Initially when she came she took a few meds & she could sleep at night but did want to get up quite early & get washed & dressed for the day.
She also had this weird disorder called psychogenic polydipsia. She was not a diabetic but could NOT drink enough water. She drank approx. 7 liters a day. And her labs, especially her sodium weren't that worrisome.
Finally she fell & sustained quite a gash across her forehead & stayed in the hospital for a few days. When she came back she was worse & she was yelling all the time.
The medical director, who I have no respect for, decided to send her to a psych unit & taken off all pysch meds & be evaluated. She went for 3 weeks & while there, fell & broke her pelvis.
When she came back, not only was she in pain but now she wasn't sleeping at all & she was yelling 24/7. In 35 years as an LPN I have NEVER seen anything like this. She is absolutely exhausted. She can no longer walk unless she has an assist of 2. She is either in her bed or in the cardiac chair at the nurse's station. This woman has caused such a calamity with her yelling that residents are now threaghtening to leave the facility & go somewhere else.
This woman is the most loveable woman you ever met. She calls you honey, sweetheart, baby & will stretch out her arms for a hug & to tell us she loves us. We can't get angry at her but we are all stressed out by the constant noise. The ONLY time she can sleep is when she is drugged. A few weeks back I spent the worst 3 days over a weekend that I had EVER spent working at this facility in 6 1/2 yrs. Withought proper narcotics for pain & nothing to give her to help with her anxiety & yelling she yelled Fri, Sat. & Sun for & I am NOT KIDDING, 8 straight hours.
The reason I am thinking that she has some weird brain sleep disorder is because she does this calling out of the same words & phrases over & over. Some of her favorites are, "Unbelievable, Unreal, Unemployment, Forget about it, One way or another, temporarily, Dr. Dr. Dr. I want to sleep" & on & on. But, it is like she has a compulsion to talk or yell & really can not stop it.
Last night she was given Risperdal at bed & she slept from 9pm-2am & then she was up yelling till I left at 8am. She does NOT sleep unless drugged. It is breaking my heart. I am hoping someone will recognize these strange symptoms & get back to me. BeachJudy
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Caprice_WebMD_Staff responded:
Hi Judy,

It's clear you really care about this woman and would like to help her. Unfortunately, there is no health expert who posts here on the board who could give you some ideas to explore.

Does she have any family and are they being kept informed of what is going on? Is there any push to have her be seen by specialists in sleep and in dementia? She clearly needs help and I hope she gets it.

I also encourage you to post on our Alzheimer's Community I'm not saying that this is the situation with this woman, but the expert and the community there may have some thoughts on what avenues to pursue.
 
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BeachJudy replied to Caprice_WebMD_Staff's response:
Thank you Caprice, actually the night of the day I made that post here this woman was sent out for a crisis psych evaluation to a clinic. They then sent her to a general hospital where she was admitted. Come to find out she had a chronic subdural hematoma.
This woman was a full code & so many of the staff had begged the powers that be, either supervisors, Asst. director of nurses, Dir. of nurses, medical director (he is the one I probably called the "idiot" in my post. He is horrible, he never pays attention to what we say & he had actually come in a few days earlier, looked at her drugged to sleep & said, "see, there is nothing wrong with her".
I am hoping that this medical director is given a reprimand or is at least warned, whatever. He can't think that what he doesn't "DO" can not get him into trouble.
It is so hard for me to work there full time & care about these residents so much & watch them either deteriorate or die because the MD doesn't want to deal with it.
Well, thank you so much for listening, reading & replying. I will keep working at the job I love & I will keep advocating for these residents.
The only son & daughter-in-law were involved to a point with this woman. The son was extremely passive & his wife was an LPN that spent a lot of time accusing staff of things pertaining to her mother-in-law that didn't always have to do with what was really going on with her.
Sincerely, Judy
 
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Caprice_WebMD_Staff replied to BeachJudy's response:
Dear Judy,

I'm glad that answers are finally being found and I hope she gets the help she needs now.

These residents are very fortunate to have you in their corner. I can imagine how difficult a position you are in and hope that things improve, especially now that this situation has come to light.


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