Tuesday 14 October 2008


One of my nursing colleagues was discussing with me how she'd seen a lady in a care home who was distraught. The lady would often shout out, incoherently. When family were with her, she was settled and fine.

The nurse worked with the home to understand why the behaviour was arising and if there was unmet need.

She worked with the care home to look at if she was hungry or thirsty or needing assistance in mobilising or toileting, addressing practical elements of care.

The nurse sorted out analgesia for her, four times a day, over one week, to see if pain was causing her distress. It wasn't, so she suggest stopping the analgesia and things were neither better nor worse.

She arranged with District Nurses to have blood tests undertaken to exclude common causes of delirium.

She visited when the lady was distraught and told me, "Her blood pressure and respiratory rate and pulse were all normal."

In order to ensure the patient was communicating and not anxious, she'd thought to look for signs of autonomic overactivity consistent with an anxiety state, checking pulse etc.

I'd never have thought of doing that.

Some people are so clever. Very impressed.


Paul said...

Just shows how useful a good diagnosis is...`

Btw, did you find out why she was distraught?

The Shrink said...

In this scenario the diagnosis is helpful purely to appreciate that her behaviour's not through thirst or depression or pain or from being around men, or anxiety or hunger or constipation or an acute confusional state/delirium, or constipation, or from being around strangers, or breathlessness and so on, it's through the cognitive distortions and deficits arising through dementia.

Treatment is therefore informed not solely on her symptoms, but on managing any treatable or curable elemets of her presentation.

Her distress arose through missing family. Photographs, a mobile 'phone for her (that they use to call her, she can't manage it) staff orienting her as to who's coming soon and staff being able to talk about her daughters with her all apparently helped.

She's also needed 0.5mg of lorazepam to reduce distress at times, too.

That's not my name! said...

Don't get me started on Distress!!!!

How comes some MH professionals seem to get the balance between responsiblity, empathy and practical application right whilst others (alot of whom seem to work for the local Trust) get it so damn wrong?

Answers on a postcard to 'Anyone with the capacity to change an organistion for the better, with the staff on board'