Another True Clinical Story

Maximizing Function Competency

Mr. D. was 73 years old. He had been admitted to the geriatric unit of a hospital where I was a clinical instructor for nursing students in their medical-surgical nursing rotation. Mr. D. had multiple medical problems and his care was complicated by his mild dementia. The hospital environment was unfamiliar to him and it had multiple stimuli. Mr. D. became agitated easily.

One afternoon, Mr. D. was quite agitated. An IV push medication was ordered, to be administered through the IV lock in his forearm. The medication was supposed to be injected slowly over 5 minutes. Administering it more rapidly would likely cause Mr. D.ís blood pressure to drop dangerously low. Drawing of a syringe

The nursing student and I prepared for the procedure. She was very apprehensive. This procedure required that Mr. D. hold his arm still for 5 minutes. But Mr. D. was agitated and restless, waving his arms, and moving frequently in his bed. He was not combative, but he had the potential to become so. What should the student do in order to administer the IV push medication safely?

Here are my instructions to the student: "This morning, we discovered that is difficult to engage Mr. D. in a sustained conversation. He kept wandering off topic and a few times he said something about a farm. So I suggest that you use mental imagery of a farm. Sit down so you are not towering above him. Position yourself so that you can reach his arm and can also look him directly in the eyes. Speak in a quiet, calm voice. Create the mental image of a farm and engage him in it. Once he is calmer, then hold his arm gently but firmly while you administer the medication. Take him mentally to the farm and continue the imagery for the full 5 minutes until you have administered the medication. Meanwhile, keep watching for the physiological changes that would indicate his blood pressure is plummeting. Iíll be in the room if you need assistance."

Can you imagine what happened? 

An agitated Mr. D. became quiet and engaged as the student spun out the verbal description of a farm. 

Drawing of a red barn with a silo
Drawing of a cow Drawing of a goat                        
Occasionally, she would ask him a simple question about the color of a tractor or the sound of an animal to keep him fully engaged. The student administered the medication over the 5 minutes without difficulty. 

After she measured his blood pressure and we left the room, the student was awestruck at what she had been able to do. She had become so caught up in creating the image for Mr. D. that she had forgotten her own fear. Her quiet voice, calm manner, eye contact at his level, and vivid mental imagery of a scene that was important to Mr. D. had enabled her to avoid a problem behavior and give safe, compassionate care.

To hear this story narrated by the author, use this audio link. Drawing of poultry

Narrated by L. Felver, Ph.D., R.N.

Maximizing Function Competency Learning Activities

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