I had this very pleasantly confused patient last night. He was a fiddler. Fiddled with this line, fiddled with that tube. In and out of bed. I told our telemetry cna to let me know right away if it showed his leads were off because first he would take off his heart monitor and then get out of bed. The bad thing that is he just had surgery and couldn't stand well.
So about the 299 time I went running to his room, (why are they always so far from the desk), he looked up startled, holding his disconnected monitor in his hand and he goes. OK, I am so busted, and he put his hand in the air, I burst out laughing. He was so cute with a real sense of humor. I asked him why he kept taking it off, just trying to stay busy he says laughing, and I'm keeping you busy too huh. Oh Yeah. But in a nice way. Thanks to a bed alarm and the fact I can still run we made it through our 12.5 hours without him landing on his noggin.
We get these very elderly people in that live alone. When they get here we see all this behavior that really sets the alarm bells going off. They seem fairly good during the day, but at night the confusion gets worse and worse. We have learned you can't really do idle chit chat and see how they are really doing. You have to ask questions to assess their cognitive functioning. What year is it. What holiday just passed. Do you know the president. Which is your comb and which is your brush.
Some mild confusion is fairly normal taking people out of their normal routine. In a normal routine even someone who has slight confusion can be perfectly fine. The trouble is with the ones that it isn't safe to return them home alone. Sometimes the family lives far away and don't realize their family member is forgetful. They get skilled at evading questions and family keeps the questions and talk light, maybe each unconsciously hiding from the truth. They aren't confused they will say. She is fine every time I talk to her. Ask her some hard questions I gently say. Ask her what year you were born, who the president is, the steps needed to boil water. It is sad when they slowly realize the person doesn't know.
That doesn't automatically mean a nursing home. Sometimes it is just medications that need to be adjusted, sometimes lab work will be wacky making the mind do funny things. But many times it is the beginning of when role reversals take place.
Anyway, where is all this going. My sweet patient. Living alone. And in danger of hurting himself accidentally. And today trying to get the family to ask the right questions. Because nursing isn't just about dressing your wound or giving you a pill. It is and should be the whole picture. Making sure you have whats best for you..... the patient.