Friday, February 04, 2005

Your Truth: Frequent Call Light Scenario

Since I got so much positive feedback about providing scenarios for discussion, I am posting another one. Again, this is a hypothetical scenario based on a mix of experiences. I want to hear your thoughts and then later will tell you what I would do / have done in similar circumstances.

Ms. Pearl has been pressing her call light every 10 minutes starting around 11:30pm. The first time you answer it, she tells you that she is too hot. She asks you to pull her blankets off, but they are already down. “No, pull them off my feet.” You see they are barely draped over the soles of her feet, but as she has asked, you pull them all the way off. You take her temperature, concerned she may have a fever, but her temperature is normal. Ten minutes later, you answer her light and she tells you she’s still hot and wants you to pull off all of her clothing. Though you discourage it and suggest using the fan instead, she says the fan hasn’t been helping and insists. You remove her clothes, leaving her half naked with just her diaper on. Ten minutes later, she is still hot. You unfasten her diaper, so that it hangs loosely against her body and turn on the fan. Ten minutes later, she is still hot, you run a cool rag over her entire body. Ten minutes later, she tells you she is freezing. You cover her in her blankets. Ten minutes later, she is just right, but her ears and her hands are too hot. You walk in and see the nurse’s aid has already added a pile of about a dozen blankets on top of her. You put cool rags on her ears and offer her ice packs for her hands. You decide that perhaps she is lonely and offer to sit at her bedside while you do your charting. She says, “That would be lovely.” But each time you put your pen to paper, one of her pillows needs adjusting. You try to start conversation by acknowledging, “Ms. Pearl, you seem kind of anxious with so many discomforts.” She denies feeling anxious.

What do you do?

Here are some options to get you started. I am not suggesting any of these is ideal, but just throwing some ideas out there:

-Give her Ativan for her anxious behavior even though she denies feeling anxious.
-Set limits – tell her to make a list of her needs and that you will address all of her issues once per hour
-Continue to sit in her room to do your charting so you can get up every few minutes to make changes as she requests them
-Give her a sleeping pill so she can fall asleep, knowing the elderly can get confused if they stay awake all night
-Continue trying to get her to talk about what may be bothering her psychologically that is manifesting in these physical complaints
-Look in her chart to see if she has a thyroid problem that may make her susceptible to temperature changes and suggest they restart her thyroid hormones for comfort though they probably discontinued them when they put her on the palliative care service

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