Advice re: Psych pt

[UKPedsRN]

Hi everyone,

I am working at a LTC facility and have a patient who was admitted from hospital to our facility with a number of conditions, diabetes, decubitus, history of aspiration pneumonia and schizoprenia (burnt out). Anyway, it took her a couple of days to settle in to her room and routine - to be expected. Her son was not happy about her being tramsfered to us, but he has since come around, and thinks she is recieving excellent care.

I used to be one of her favorite staff, she would often do things for me, that she would not for other staff members, such as recieve her insulin or dressing changes.

However that has all changed and we RN's are all struggling with her behaviour. She screams and shouts, if staff talk to other residents in front of her. She throws things across the room - her dentures, her cups, stuffed toys etc. She has now started screaming out, "I'll kill you" , when people enter her room, or even if she is there alone. She has lashed out a number of times at me. other residents are starting to become afraid of her, and meal times are now also becoming a chore for the staff, and unbearable for other residents.

she was recently assessed by the psychiatrist, but he did not change meds or give us any advice.

There are times when her behaviour appears to be simply controlling and manipulative...

When she is verbally and physically agressive, I lower my voice and tell her that her behaviour is unacceptable. Her response is always to scream arghhhhhhhhhhhhh arghhhhhhhhhhhhh very loudly. I have no psych background, so would love some input here, on how to respond to her. Obviously when she is being disruptive I often remove her to her room. But I am at a loss as to what else I can try with her.

Interestingly, her son has always maintained that she does not have schizoprenia, however her doc says she was daignosed in 1966. The husband said she was born with something, but could not remember.....he has signs of dementia also. A couple of weeks ago her son let it slip that she was diagnosed with manic depression when he was young. She is in her late 70's now.

So, ladies and gentlemen, some ideas on what is going on, and how I can better handle her, would be very much appreciated.

Thanks

[Whispera, MSN, RN]

Is she getting psych meds? Did she get them before and she isn't now? Has she been stable so hasn't taken them for awhile? Changes in life circumstance can bring a relapse...

She could be acting out in response to the change in her life from where she lived before to the LTC facility. That can be a HUGE loss to some. Maybe she feels she has no other choice but to be loud and verbally abusive?

[carolmaccas66, BSN, RN]

Get another psych review. She is definitely unsettled where she is, and may even be exhibiting symptoms of abandonment and the loss of what she had/knew before. She may even be reverting to past behaviours - has she done this before?

Was she on psych meds before? Get them reviewed as well.

She could even be starting to exhibit S&S of some sort of dementia, so I would get a geriatrician/aged care team involved to assess her.