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CoffeeRTC, BSN 19,417 Views

Joined Jan 22, '03. CoffeeRTC is a RN LTC. Posts: 3,733 (24% Liked) Likes: 1,813

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  • Jan 9

    Hi - I'm a Director of Nursing in long term care. Yes, if she is competent she can very well decide to go home. If she is competent, she should also be able to manage figuring out HOW she is getting home and HOW she is going to survive at home.

    She can demand to go all she wants, but she can't demand you or anyone else take her & take care of her. (Sorry, I know this puts you in an awful spot and one she's likely really going to give you a hard time about).

    Some thoughts:
    Is she getting good care where she's at? Or is this frustration about not being taken care of well? Maybe a different facility might be a better fit?

    Does she have the funds to go home with a private care giver 24/7? It is easy enough to buy or rent a hoyer lift for home use.

    Does she just need an outlet to voice her frustrations about being dependent and deep down she really knows she's in the best place to meet her needs?

  • Jan 9

    I'm sorry I can't give you an answer on what to do with the meds but just keep an eye out that she isn't taking those meds in addition to what she is prescribed. My friend is a correctional nurse and she says neurontin is sought after by the inmates. Apparently if you take enough you can catch a buzz. Especially in a drug rehab..some people will do anything to get high.

  • Jan 5

    Quote from CrunchRN
    I WANT to believe something this ridiculous could not be real.
    I am exactly the opposite. I want so bad for this to be a real story.

  • Jan 5

    I can't even...I. Just. Can't.

  • Dec 18 '17

    Convince yourself you're going for the food and then hope they put out a good table.

  • Nov 27 '17

    Well handled, NurseDisneyPrincess!

    Reminds me of a story when I worked in Chemical Dependency Treatment 30 years ago. A Patient said he'd pay any staff member $100 to give him a ride home. Of course no staff member took the Patient up on the offer except the Program Director who said, "I'm holding out for $150". I was shocked and asked him why. He replied, "Anybody who'll pay $100 for a ride home will surely pay $150!"

    The good news is the Patient never got a ride home, completed treatment and had a long sobriety.

  • Nov 27 '17

    I found it useful to be told that the resident had a tape recorder hidden in her nightstand drawer that she activated when she turned the call light on.

  • Nov 14 '17

    Quote from Nursing617
    Resident had an iv catheter to have morphine administered subcutaneously via a butterfly needle on the abdomen. Before the nurse administered the morphine, he mentioned out loud that he had to get the heparin first (referring to the flush). I then witnessed the nurse flush the iv butterfly with the heparin, then the morphine, followed by the heparin flush.
    That sounds like clysis to me. When I worked in a SNF, we would use clysis on some of our older residents who had horrible veins. It's easier on the resident than having to be re-stuck all the time for a blown IV. I don't necessarily see the problem.

  • Nov 7 '17

    Don't suppose there is a local TV station that would be interested in this situation? A little public outcry could go a long way.

  • Oct 13 '17

    she knew, she wanted confirmation.

  • Oct 12 '17

    Sounds to me as if you were just managing her symptoms to provide comfort. I've suctioned hospice patients and given oxygen.

  • Oct 12 '17

    Quote from caliotter3
    I would rather do documentation while I am supposed to be on break, than to waste my personal time by staying after the end of the shift to get it done.
    I agree with you completely. I never could admit it on Allnurses.

    The whole "don't work on your break.....hospitals need to hire more deserve your break, you are working for free ..etc."

    I hate to feel rushed, I hate staying overtime. I feel better, more in control, more relaxed, if I finish things up on my break, better than worry and hurry the whole shift thinking...."I can't leave work late today but I am getting behind on my charting."

  • Oct 12 '17

    I don't know how old you are, but a job that offers state retirement benefits? That's almost unheard of.

  • Oct 10 '17

    Quote from Davey Do
    A lot of Patients don't want to hear they've been prescribed an antipsychotic such as olanzapine: "I'm not psychotic!" they say, whether they are or aren't.

    So I say, "This med is prescribed for racing thoughts and to help with other mental processes". They're more accepting of that.
    Maybe it's just me and the fact that I work in LTC but I can't really think of any scenario where saying "anti-psychotic" would be helpful. Yes, we know that's what it is, but sometimes classifications like that are better left to be used among medical staff, etc.

    I feel like "This pill helps with your mood changes/sadness/anxiety" is perfectly fine.

    Do people really approach patients and discuss their "anti-psychotic" meds?

  • Oct 10 '17

    Quote from ksusn

    I am a student nurse and I was pulled to work in the ED the other night to be a sitter for a psych pt. The pt has had a history of being very aggressive and claims to have seizures (which were determined to be fake by RN and MD). The pt was very agitated/anxious at the time with security on stand by. The nurse had drawn up olanzapine (antipsychotic) to give IM. The pt asked for anti-seizure med and insisted the RN tell him the name of the drug and the drug class in which he was about to receive. The RN told him the correct name of the drug, but told him it was an anti-seizure medication. I understand that if the pt had been violent, he may not have had a choice in whether he received the drug or not. However, I feel like it was wrong for the nurse to lie about the medication. Any thoughts on this or how the situation should have been handled? Thanks!
    The pt has had a history of being very aggressive

    The pt was very agitated/anxious

    I feel like it was wrong for the nurse to lie about the medication.

    The RN told him the correct name of the drug, but told him it was an anti-seizure medication.

    A- "This is Olanzapine, it is an anti-seizure medication."
    B- "This is Olanzapine, it will help stop your seizures."

    Which did the nurse say? Either one helps the patient get the medication he needs to keep him safe. B is also 100% accurate, and meets any definition of "ethical". But, in the heat of the moment, would you really draw an ethical line between these two statements? Is the nurse who was heads up enough to parse his/her words in a potentially dangerous situation really any more ethical than the nurse who is just trying to keep the patient safe?

    Lets look at option C:
    "This is Olanzapine. It is not an anti seizure medication, it is an antipsychotic. Oddly enough, it actually lowers seizure threshold. But, you my friend, are not having seizures. You are having a psychotic episode."

    This is the most truthful answer, and the most likely to cause harm to the patient. Would an ethical nurse choose this?

    • Beneficence - to do good.
    • Non-maleficence - to do no harm.
    • Respect for Autonomy.
    • Fairness.
    • Truthfulness.
    • Justice.

    Sometimes these principles can conflict with one another.
    Even if, in your situation, the nurse chose statement A above, he or she was still maintaining the first 2 principles, despite a sub-optimal choice of semantics.

    Also- remember that there are different theories of ethics. It looks like you are focused on Deontology. "This theory judges the morality of an action based on the action's adherence to rules."

    But, there are other ways to look at this.

    Ethical Relativism- "The theory states that before decisions are made, the context of the decision must be examined."

    Utilitarianism- " The value of the act is determined by its usefulness, with the main emphasis on the outcome or consequences. "

    Feminist Theory- "Feminist theory requires examination of context of the situation in order to come to a moral conclusion."

    Once, while working in the ICU at 0300, I got a call from a nurse on the floor, asking me to come upstairs and pretend to be a doctor. (I am a middle aged man) She said that she had a little old lady with dementia who really needed to take a medication. The nurse had told the patient "The doctor really thinks you should take this medication". The patient said she wanted to hear that straight from the doctor.

    I went up stairs, walked into the room, and said "Mrs Smith, you need to take this medication".

    Regardless of the fact that I did not lie, I deliberately mislead the patient. Did I do the wrong thing?

    I recently had a patient with pseudoseizures as a result of conversion disorder. The doctor was able to stop these seizures by pushing 3 ml of normal saline. This allowed us to accurately diagnose and treat the patient. On a moral scale of 1-10, where do we stand on this?

    Those are my thoughts on this. Now, I am going to ask you the question you asked:

    What do you think would have been the right thing to do with this agitated anxious patient with a history of aggression?