Need help figuring out what happened to this guy!?!? - page 3

Ok at the end of my shift something very strange happened with my patient. My patient was a young guy who had been an alcoholic for quite some time. Was admitted with DT's and pancreatitis. He has... Read More

  1. by   Kim O'Therapy
    I had thought about him ignoring you also. I'm a student and would appreciate someone explaining the arm above the head thing. Thanks.
  2. by   EmmaG
    Quote from Kim O'Therapy
    I had thought about him ignoring you also. I'm a student and would appreciate someone explaining the arm above the head thing. Thanks.
    One way to tell if someone is faking unresponsiveness. Hold their arm up over their head and let go. It's amazing how their arm will fall to the side
  3. by   GrumpyRN63
    I'm suspicios he may have been ignoring you,maybe some visitors slipping him something, nice to run a tox screen to rule that out
  4. by   Daytonite
    I worked for many years on medical units and had lots of alcoholics in various stages of liver disease as a result of it. Alcoholics are without a doubt a most interesting group of people to work with. On one hand they can be the very sensitive and caring people and on the other vicious and devious. My first thoughts in reading your post was that he probably had some build up of acetone in his system which would account for the confusion and somnolence. Or, it could have just been him pulling a little wool over your eyes since alkies are well known for having psych and behavior issues, including manipulative behaviors. I would look into his medical record and see what else is going on with his liver. The liver is a funny thing and cirrhosis can manifest itself in a number of different ways. Devoted alcoholics at the end of their drinking days who have cirrhosis can have manifestations that are behavioral in nature. It's sad to see, but they chose the lifestyle and we're left to deal with the results of it when they are hospitalized. You have to understand that maintaining a life of continual drinking involves psychological and psychiatric "fooling" of the self and others around them to justify doing it. With these patients, stopping drinking doesn't stop their treatment. Many require long-term psychiatric and psychological intervention as well.

    Next time try waving an ammonia capsule under his nose. No one can ignore smelling one of those and reacting to it!
    Last edit by Daytonite on Dec 9, '07
  5. by   Bugaloo
    I agree with the other nurses. Sounds as if his ammonia levels are off, or kidney failure. Also, when their liver function is screwed up, they will act like this. I would have called the doc too, so do not feel stupid. You did the right thing.

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