Geriatric pt on a LTC unit, a week and a half ago was friendly, talkative, semi independent AAO×3. Presents now with severely altered LOC, dyskensia, hallucinations, everything in the book. Clean UA cleanest damn UA I've seen in LTC) , all blood screens negative, (every-freaking-thing) clear neuro, there's nothing.
This pt was in perfect health for 88yo.
The advice I need, is about this:
6 FALLS IN 24 HOURS. I am having to do 1 on 1 with him, and I simply don't have the staff! I tried an activity board, it worked for a bit, Ativan takes the edge off, but isn't lasting, I have tried every distraction method I can think of.
Me, PCP, family and other staff are out of ideas and I can't keep having my poor aides sit with him and get behind on their work, while I do my TX and everything else for the 30 other residents on the unit.
This sounds a lot like serotonin syndrome, an adverse effect of phenothiazines(is he on promethazine?), a severe neuromuscular reaction to an antipsychotic agent or neuroleptic malignant syndrome.
If this was my family member I would insist on a transfer to geri psych.
CoffeeRTC, BSN, RN
3,734 Posts
Any update?