We have a Winner!

 

First of all, Michael, I wasn’t thinking of a UTI but it is a very good thought.  That’s why I like these public exchanges. 

Hale was one hundred percent correct when he said she was sundowning.  I wasn’t looking for a diagnosis, Dr. Burnside.  The question was what would you do?

There is nothing at all wrong with Cerebral Chaos’s answer.  If I were reading charts, it would bring tears to my eyes.  But I personally would have left off everything up until the AD teaching.  If it is on the flow sheet or the computerized version thereof, it doesn’t pay to restate the normal stuff.  I do like to see the abnormals restated as in, ‘MD notified of 185/102 pressure’ as opposed to ‘MD notified of elevated pressure’.  It simply makes the process of reviewing clinical records easier.

Laurie Soares’ answer  is terrific – absolutely beyond belief.  She gets a flash drive, too.

Gail, I expected nothing less from you. 

So, this week, only, everyone gets a flash drive.  Please email me your address.

But then before you do that….  I have read about 20 charts this week with AD as a primary or secondary diagnosis.  These are the things I have read:

• Taught pt/cg that Alzheimer’s disease is a progressive disease with continuing decline of mental and physical health and ultimately causes death.    (Thank you, Ms. Merry Sunshine!)
• Taught patient to write things down so she doesn’t forget.  (Yes, indeed.  She can’t remember what she had for breakfast but this nurse is going to break through the wall of Alzheimer’s and teach her new behaviors to deal with the old behaviors.)
• Assessed patient’s memory.  Impaired short term, long range memory.  (That really is where it stopped.)
• Taught patient to remove throw rugs and keep a phone close at hand.  (This was taught to a patient who was unable to name the president.)
• Taught patient to take meds on time.  (Taught to a patient in an Assisted Living Facility where medications were administered by staff.)

So guys – I know most of you are in the office doing quality assurance work, directing, consulting and heaven forbid, practicing medicine in Hale’s case.  How do we get from reading about taking meds on time to Laurie Soares’ documentation?  Okay, I’ll settle for less.  But there’s an abyss between the two extremes.

Mona, the answer I was looking for was very, very similar to yours but with one tweak.  By exposing the patient to sunlight and other bright lights during the daytime hours, the circadian rhythm can be reset.  Ask the physician for some Melatonin so that the patient’s chemistry can be assisted back to normal.

There are some terrific resources on Alzheimer’s that I depend on regularly. 

The Alzheimer’s Disease Home Safety Guide

The Alzheimer’s Disease Caregiver’s Guide

Finally, required reading for everyone should be this article from the New York Times about a unique approach to Alzheimer’s Disease. 

Now, send me your address and go buy some chocolate kisses for your patients and your favorite nurse/blogger/consultant.