What was wrong with my patient??

Nurses General Nursing

Published

Seriously! :uhoh3: We were at a lost at work last night. Pt is A&O X 4. But keep asking where her baby is, she needs a pamper to change baby, and keep pointing and talking to people that's not there. She's even tried to get out of bed a couple of times even though she can't walk. However, she knows phone numbers (and remembers to press 9 to dial out), she knows her name, time, day, where she is, the floor she's on, and her room number! She knows what she's eaten, how much, and even her blood sugars and amounts of insulin. She's a young lady (in her 50's), negative for UTI and no change in her medication regimen! Someone mentioned that she's "faking" but I don't think so but if she is, she's doing an awesome job. I'm a new nurse, but even the seasoned nurses are at a lost for words!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Without knowing her medical history it's impossible to know it can be a psychotic break to a drug reaction to a seizure to to ETOH to drugs in her room to a brain tumor or she needs a nomination for an academy award. Why does she not walk?

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Without knowing her medical history it's impossible to know it can be a psychotic break to a drug reaction to a seizure to to ETOH to drugs in her room to a brain tumor or she needs a nomination for an academy award. Why does she not walk?

She's had an AKA, well over 400 lbs. Not cooperating with therapy. We were thinking possible tumor as well. (or an academy award) She doesn't have TOO much of a significant history. I just didn't want put too much information out on the web.

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Specializes in cardiac, oncology.

Do you work in a hospital? What was she admitted for? Was she on steroids?

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I am a new nurse working in a LTC and most if not all of our residents have major psych issues. Most of them are pretty young also.

We have one resident that can tell you her name, her room nbr, knows the staff names, time of year, season, ect..

But she also yells at the staff because we "stole her baby", she needs to leave because someone has her baby, there are all sorts of animals in her room, she talks to people who we do not see, ect... But other than seeing and hearing things and thinking someone stole her baby she is AOL. It could be a psych problem. I know with women some issues do not show up until mid life.

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Specializes in Developmental Disabilites,.

schizophrenia?

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Specializes in Hospice.

Someone who has a fixed delusion can be like this. Totally alert and oriented, except for the delusion. I took care of a psych pt who had a delusion that Jesus was her boyfriend. It was so bizarre, you could talk to her about anything and it would be totally normal, until you started talking about where she lived and her family.

I work in hospice, and the first thing that popped into my mind from my background is terminal restlessness. It sounds like that is probably not it for this pt, but if she was on hospice that is what I would suspect.

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i was thinking of an undx'd mental illness, delerium, hypoxia, steroid/med reaction, or taking own stash of drugs.

would also be interested in knowing adm dx, along w/other comorbids.

leslie

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Specializes in Med/Surg.

I as well went immediately to a diagnosed/undiagnosed psych issue.

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Specializes in Peds Homecare.

She is not A&O x4, if she is asking for diapers for a non existant child.

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Specializes in ER.

Reminds me of a patient a few months ago, brought into ER with "memory loss".

She kept insisting it was 1979, she described that she was a student on a college vacation in Belgium, (she was in her 50s). and that her daddy was coming to meet her.

What kinda gave it away was that she was always on her cellphone, and they weren't invented in 1979 . . . . : )

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Specializes in I/DD.

The vast majority of my confused patients will answer the "orientation questions" correctly. Don't be fooled by the patient who has figured out what answers we are looking for when we ask these questions. I assess confusion more through conversation with the patient than asking a patient if they know where they are or who the president is.

As far as your patient goes, I agree with everyone else. It could be an underlying psych issue or a disease process that should be looked into. I would consider a weight of >400 lbs, an AKA (severe PVD), and DM pretty serious co-morbidities. Are there any wounds she has that could be the source of infection/sepsis? Is her WBC normal? You're sure there are no new meds that she has started since admission? A top culprit is Ambien. I had a medicine patient who I was told was completely A&O and independent. I went in to assess her and she was out of bed, connected to her IV pole, trying to make it to the nurse's station looking for the bathroom. I checked her history before calling the doctor and realized she had received Ambien 2 hours ago.

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