Confused patient

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  1. This is a discussion on Confused patient in Hospice Nursing, part of Nursing Specialties ... Tell me what kind of intervention or words have helped and what your situation has looked like with...

    by Oct 13, '11
    Tell me what kind of intervention or words have helped and what your situation has looked like with a confused patient that absolutely refuses to give up control of his/her meds. Tomorrow when I visit I will count his meds and see if he is taking them correctly. Family just now called and said that they *think* patient is taking his decadron 4mg 2-3 times a day when it is ordered to take daily. I"m sure he is taking it more because of pain control. We decreased the decadron and increased alprazolam because he has been manic. Working 18 hours a day out in the machine shed, mowing the yard etc. Family has their hands FULL! He is on morphine ER 60 mg BID. And then breakthrough morphine IR 1-2 tabs Q4 hours. When I visit he always declines the need to increase his meds and says that his pain is mild.

    I will talk to the supervisor, but do you advise me to go in and say "this is how its gonna be" ask him if he trusts my and his doctor's judgement? I could see him getting absolutely irate about this and even combative. He is so terribly independent!! The family has hired 24 hour caregivers for him.

    I have offered and pleaded and begged to fill his med boxes weekly for him. He refuses to give up control I believe because he messes around with them. Maybe we could discontinue everything except for comfort and anxiety meds?

    Tell me your experiences!!!
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    by Vtachy1 Oct 13, '11 6:01 pm
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  3. 15 Comments so far...

  4. Oct 13, '11 by
    If he has 24 hour caregivers, can't they control the med boxes and not let him have the meds until the times for which they're prescribed? Might he be experiencing side effects of the decadron that are making him "manic"? What good would it do to take away all meds but comfort...wouldn't he take those as he chose too?

    How about a longer=lasting benzo than xanax?
  5. Oct 13, '11 by
    Maybe Haldol is worth discussing with the MD.
    tewdles likes this.
  6. Oct 13, '11 by
    What Would do you think if I suggest risperdal?
  7. Oct 13, '11 by
    Quote from Whispera
    If he has 24 hour caregivers, can't they control the med boxes and not let him have the meds until the times for which they're prescribed? Might he be experiencing side effects of the decadron that are making him "manic"? What good would it do to take away all meds but comfort...wouldn't he take those as he chose too?

    How about a longer=lasting benzo than xanax?

    I'm thinking now that he must be wanting control of his meds because he is "adjusting" them. As he did confess to me last week, you can't "adjust the decadron! Its not PRN med that can be increased or decreased at every whim.

    I think he will get very angry but we may have to have the caregivers take control of his meds and have me start prefilling his med boxes although he has totally refused this in the past!
  8. Oct 13, '11 by
    I have said to patients 'We have a policy that I assist you in filling your pill boxes', or have just asked to sit with them while they fill them, or have them sit with me while I do it. As soon as someone is confused I start to d/c meds. Anything not absolutely necessary to his comfort. Also this is a time we might talk about a switch to a fentanyl patch for pain instead of pills. Good luck!
  9. Oct 13, '11 by
    Risperdal or Haldol. Either will help although Haldol seems to have a more immediate effect on agitation/mania.
    tewdles and Vtachy1 like this.
  10. Oct 14, '11 by
    Quote from ErinS
    I have said to patients 'We have a policy that I assist you in filling your pill boxes', or have just asked to sit with them while they fill them, or have them sit with me while I do it. As soon as someone is confused I start to d/c meds. Anything not absolutely necessary to his comfort. Also this is a time we might talk about a switch to a fentanyl patch for pain instead of pills. Good luck!

    I have thought of this although his mom had a horrible experience with the fentanyl patch. But its worth a try maybe. If I can somehow convince him.
  11. Oct 14, '11 by
    Fentanyl is extremely expensive and pain doesn't sound like his issue, anyway. Control does.
  12. Oct 14, '11 by
    Haldol is immediately effective and has the potential for some bad side effects that are very uncomfortable. Risperdal or another antipsychotic are less prone to such side effects. However, he's not psychotic, is he?