Wednesday, May 16, 2012

A Dash of Funny

Back to my blog home page:

I ventured upon an interaction today that tickled me, grossed me out a little, and just made me shake my head!

Those of you who work SNF (skilled nursing facilities) know that you always have a few residents in your back pocket who could benefit from therapy when the caseload wanes and you have the opportunity to treat some Med Bs.

Today was the day.

I walked up to Dot who was sitting in a Broda wheelchair.

(By the way, Brodas are great for people with dementia, head injuries, Parkinson's and especially Huntington's Disease.)

Dot had been tearful and anxious every afternoon into the evening. In the long term care world, we call that "sundowning."  In addition, she had become combative when staff attempted to provide care for her, especially when she had to be bathed.

As her OT, my role was to identify a plan of care that would decrease Dot's behaviors and increase the ease with which the caregivers could provide for her. I wrote about this last December (CLICK ME) in Three Tips for Dementia Management.

Today, my intention was to administer the Allen Cognitive Level Scale.

The ACLS is a 3-part lacing task that provides an estimate of a person's cognitive function. Believe me, when I first saw it, I thought, "How in the world could that indicate a person's cognition and functional levels?"  It has proven accurate time and time again!

In addition, I use the Global Deterioration Scale to further confirm my patient's cognitive level. This is a less objective scale, but I find it quite useful when documenting cognition.

I took Dot to her room where there should be no distractions. She shares the room with her husband. Before we could even begin the ACLS, she had begun to direct me, "Ooohhh, what is they-at on my bay-ed?? (a pillow) Can you please move it? Please! Take it off my bay-ed!" I took the pillow off her bed and put in on the chair. And on and on she went for about 10 minutes until she had me move everything around.

Because hindsight is 20/20, I should have stopped right away and taken her out of the room. There was another distraction besides everything in the room, however, and it was in her hand.

She had just been to the beauty shop, and she had a death grip on
 a hairpin.

I decided to forge on (mistake). The ACLS is standardized, so I had to sit on her left side and read from a script. The whole screen is read, demonstrated and cued the same way no matter who I am testing. Every tester should administer it exactly the same way.

 I presented Dot with the ACLS and asked if she had seen anything like this before. Could she see the holes? (part of the standardization of the test).

"Yes, somewhere (to part 1). Yes, I can see the holes."

"Good job," I thought. Now, I'll read the script....

The moment I started to read the script and introduce the running stitch, I lost her. Out flicked the hairpin, and you know where it went?

Just her

"Oh, no, Dot! Not there!" I could just see her punching out her eardrum. Memories of my mom's voice cautioning me not to stick the Q-tip too far into my ear returned full force.

Out she fished the hairpin and in a flash she had it in front of her lips.

"Oh, no, Dot! Not in your mouth!"

Before I could even get the words out, she had blown a hunk of wax right off the hairpin.

And I thought.....only here in long term care in the dementia unit...

I stopped reading the script. To hell with the script. She did not have the focus to complete this screen, which put her at Stage VI on the Global Deterioration Scale (during which: an individual cannot carry a thought long enough to determine a purposeful course of action) -

unless it is to clean out your ear with a hairpin...

I'm confident I will identify some activities to modify that Dot once loved, activities in which she can engage when she becomes anxious. But for today, I waved the white flag.

I surrender, Dot!
Let's try again tomorrow.

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