My father (has late moderate stage alzheimer's)was given Zyprexa in hospital to calm his agitated state. He most likely aspirated his own saliva we were told by a nurse. He has aspiration pneumonia. He then was given antibiotics but had to be admitted to the ICU for very low oxygen level. He had to be ventilated but was removed and oxygen level improved and vital signs good, pneumonia is improving so drs. say. HOWEVER, yesterday speech therapist attempted to give applesauce to see if he could swallow and he could not. Later nurse told us he became agitated and pcyh. dr. prescribed haldol (lowest dose) last evening and he was out of it when we visited him this morning and afternoon.
They can't try to have him swallow while he is so out of it from psych med. His primary care dr, pulmonary specialist and psych dr's, all of them keep telling us it's very tricky finding the right med to keep him calm. If he is agitated they give him a drug which knocks him out and keeps him from being able to swallow. He knows all of us and last night was hungry. We don't know what goes on when we are there and why nurses feel they must give him an antipsychotic. It's a vicious cycle and they are so matter of fact about it. In mean time he is not receiving nutrition because they want to see if he can swallow. Maybe tomorrow a naso gastric feeding tube. Any input greatly appreciated.
HAs anyone had this experience with a loved one. It is so frsutrating.
A difficulty with any kind of feeding tube for someone with dementia is the tendency for them to want to pull it out. Even if in a good moment the patient understands why it is there and agrees to it, in a forgetful moment it seems to be something that doesn't belong there so they pull at it. This too often results in them being restrained, either with drugs or physically. Just something to think about, and ask the hospital staff about.
So very sorry you and your Dad are going through this..... It sounds like your father is being over medicated for sure. He may not be able to tolerate the "usual" anti-anxiety drugs at the minimal dose. Perhaps you might say in front of the both the doctors and nurses for the record, " I understand it is difficult to find the best med & dosage for Dad, however I am "Respectfully Requesting" he be given a medication & dosage that would be given a teen who has panic attacks or anxiety on a trial basis". For example, my husband can get super relaxed or fall a sleep when given an aspirin. He and I can at least laugh about it when I tell him "you're such a cheap date".
Applesauce may not have been the best choice to test the swallow or gag reflex with. Its watery & lumpy at the same time, as well as being a rather strong sweet tart flavor. Something with a more neutral flavor with a thick smooth consistencey would be better. Maybe try something he has always enjoyed and is familiar with the expected taste. To thicken, there is a product called "Thick-It" it can be purchased at Walgreen's & many other drug stores. By slowly adding it, it will make any liquid like substance a consistencey that your father may be able to tolerate, even plain water. For nutrition I recommend "Ensure" it is packed with nutrition & calories, it comes in many flavors. It can also be bought in drug stores & supermarkets. I have used this combination of Thick-It and Ensure with very good results. No doubt the hospital staff is aware of these products, but perhaps if you suggest them they may be more proactive in trying it.
I my opinion it would really be best to avoid an NG tube. He may become even more agitated,combative and pull it out. NGs are invasive and very uncomfortable for the person when being fed through the tube. Another option is the Gastic Feeding tube (G Tube). It is invasive too, but much more tolerable for the person. It is a small tube inserted through a small incision into the stomach . The tube is easy to use & keep clean. Many who can't swallow at all due to various illnesses or accidents live their entire lives with a G-Tube. I hope neither tube becomes necessary and your Dad will make a good recovery. Be proactive for your Dad and be the "squeaky wheel". The staff needs to know you will be taking notes on his medications, care and questioning their reasoning for actions taken while you are not there.
Each time my husband was hospitalized I made sure there was a family member with him around the clock. I did it all myself the first time, but got smarter and told the family if it happened again we'd have to take turns. We did. This helps in two ways. First, having a familiar face amidst the chaos of the hospital environment may help calm the dementia patient to the point where no antipsychotic is needed. And it kept me informed about what was going on. It is tough, certainly.