B and J both have Alzheimer's disease. B walks up behind J in the hall and shouts, "Move along, you're blocking the road. I'll take a stick to you."
J turns around, shakes his fist, and shouts, "I know what you're up to; you're trying to steal my car.". The best action for the nurse to take would be to: a. Reinforce reality by telling B that J can walk in the hall, and telling J that B is not trying to steal his car.
b. Ask the medication nurse to give both patients an as-needed dose of neuroleptic medication.
c. Separate and distract them by directing one to go to the day room and taking the other to the activities area.
d. Step between them, saying "Gentlemen, please quiet down. We do not permit violence here.".
C
Separating and distracting patients from their conflict prevents the escalation of the dispute from verbal to physical acting out. Neither patient loses self-esteem during this intervention, and PRN medication will probably not be necessary (which is desirable given that many anti-agitation drugs have a negative impact on cognition). Both patients appear to be sufficiently cognitively impaired as to make it unrealistic to expect that they will accept the nurse's view of reality, making "reinforce reality" likely to be ineffective in this case. Stepping between two angry, threatening patients is an unsafe action, and trying to reinforce reality during an angry outburst will probably not be successful when the patients are cognitively impaired.
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