patients with Alzheimer's

I have had to treat a number of pts with Alzheimer’s which can be quite challenging at times, especially if you are trying to do a subjective examination with them. When I’ve asked some of them if they are in any pain they have told me about a chronic pain issue rather than what they are in hospital for and they aren’t actually aware that they have the injury that has bought them into hospital. When I went to see a pt last week, I had read her notes and noticed in the admission form that she was from a low care hostel. When I started asking about social history, she told me that she lived with her parents in a 3 storey house and had 6 children. I asked her a few other questions but knew I was going to have to call the hostel to get the relevant information I needed. When I was about to start my objective examination the patients daughter came in, so I took the opportunity to ask her the questions I needed answering, and I found out that the pt was actually a high care pt in a low care facility due to lack of places in high care facilities and the pts mobility had recently deteriorated as she had been hospitalized after a fall for 3 weeks a couple of weeks beforehand. The daughter gave me a very good social history about the pt as she was a nurse herself. I also phoned the hostel just to confirm what exactly the pt’s mobility was and the assistance level the pt needed as my supervisor said the daughter may have been a bit biased in her evaluation of the pts mobility and assistance needed.
So when going to see pts who have dementia I’ve tried to gather how orientated they are to time, person and place and then I’ve continued on with the S/E as with all other pts and if it is a first Rx session I’ve sought clarification from the facility at which the pt lives with regards to mobility, falls etc. When asking about things such as pain, cough, dizziness, nausea and other symptoms I’ve taken the pts word for what they say but known that it may not be entirely accurate and then relied more on watching for symptoms, reading body language and continually asking about symptoms throughout the treatment session. I had my gerontology placement at a low and a high care facility so I was lucky enough to get insight into how the facilities run and what sought of residents are at the different care levels. This has helped me in my understanding of what the pt’s I’m now seeing on my placement have to be able to do from day to day and the level of assistance they are usually given and I feel confident and comfortable treating pts with dementia.