depressed 47yo female

[nanook]

Hi. Im new to this but excited to possibly get some ideas. I work in a state psych hospital adult admissions unit. I have a 47yo female patient with diagnosis of depression with psychosis. She does not feel the need to eat or take meds, as her spirit voices tell her that God will take care of her. She states she is a Christian. When told that Jesus ate after his 40 day fast, and that he also fed his disciples, and the multitudes, she begins to cry and says she is on a different path. She has an indwelling NGT

and receives nutritional supplements and meds via the tube.

She has been tolerating the TID feedings without problem. How-

ever the tube is beginning to irritate her nares and throat. An attempt was made to change the NGT to the other nares, but she has a deviated septem. She has had a tube for about 6 weeks. Had it for a month prior to admission, and has been on the ward for about two weeks. She complained of oral discomfort yesterday, so I encouraged her to use oral swabs, as toothbrushes are too rough. Her skin is very dry. She is a good candidate for a G-tube, as she is essentially healthy. She does have a medication override in effect, and has been taking her meds via NGT since Thursday 9/4/03. She spends her days in her room lying quietly on her bed. She does not attend on-ward groups or really do much of anything. I can't wait til her meds kick in, and would love to figure out how to get her to eat so that she doesn't have to have a G-tube.

A N Y S U G G E S T I O N S W O U L D B E G R E A T L Y

A P P R E C I A T E D.

[gwenith, BSN, RN]

Hmm - what kind of tube are you using? Is it a fine guage or a salem sump?

Have you tried "Mustache taping" the tube?

Is she allowed oral ice??

[nanook]

Hi. She has fine guage tubing inserted (weighted on the distal end). She receives bollus feeds three times a day, via gravity, no pump. I'm not sure what mustache taping is. She is currently taped across the nose. Assume mustache tape is below the nose and maybe crossed over? She could swim in ice

if she would accept it! Hadn't thought to offer her that.

[gwenith, BSN, RN]

Mustache taping is taping the tube to her upper lip it takes it away from the sensiteve nares and makes it more tolerable for the patient. Mustache is a bit of a misnomer as you are actually taping to the cheek.

[laurenkst]

Honey:

Patient's should not have NGT's in for longer than 7-14 days. It

can erode through the septum. If you place a G-Tube in the patient it can be removed at a later date when the patient feels better and is compliant with her medications and eating. Care should focus on what you are doing with the patient now and not wait for a "time when the patient is feeling better". Also: psychotrophic medications and their functions are dependent on

nutrients that must be obtained from the diet or supplemented. Try to remember you are performing a chemical experiment every time you eat or don't eat yourself and that is what is happening with your patient. The drugs won't be effective if her diet isn't nutritionally sound and she will never "feel better".

[sanakruz, ADN]

This woman sounds psychotic.

Why not give IM meds?

In CA after14 days she would be placed on a temporary consevatorship where choices would be made for her. I'm thinking TPN would be in order.

[PMHNP10]

I don't know what capabilities your facility has, but she sounds like a perfect candidate for ECT. Perhaps suggest this to someone at some point.

[athomas91]

an ngt should not be left in that long due to the effects you are speaking of - they need to place a feeding tube (like a neofeed) if this tx needs to be continued.....

[Will Benson]

Nanook,

I would suggest that since this person seems unable to make decisions to provide necessary self care to sustain her life, guardianship might be in order, if it has not already been done. Has anyone considered the use of a PEG tube? This would bypass the oral/nasal route thus eliminating the nasal irritation. However, it might also help to place the patient on an appetite stimulant.

Will Benson

[maureeno]

couple times I have seen Megace be effective

http://www.hivdent.org/drugs/MEGESTEROL.htm

Ativan can help too

>>She spends her days in her room lying quietly on her bed. She does not attend on-ward groups or really do much of anything.

this looks wrong to me....

we'd get her up and lock the door!

[PMHNP10]

Originally posted by maureeno

lock the door!

I'm not sure about your state/city/hospital, but such an action has legal implications. I wouldn't recommend this.

[molecule]

with a rationale and as a part of tx doors can be locked for involuntary pts