agressive patients

leslie :-D · Aug 19, 2008

I see haldol used way to much, and in one case a nurse gave it to a patient and he was knocked out for days until he passed away, did the haldol kill him ? I don't know but I think it helped him along, if ya know what I mean. So what do you do when a patient is agitated, agressive, and possible combative.

i suspect the pt who was knocked out from the haldol, had an underlying infection, severe renal insufficiency or some other pathologic etiology.

and so, to answer your question, the first thing you want to do is r/o any disease process, which would contribute to ms changes.

this includes checking for constipation as well.

and, whether it's haldol or ativan, a combative/distressed pt needs a med to calm him down until etiologies can be established.

leslie

TopazLover, BSN, RN · Aug 19, 2008

Most people who are aggressive are trying to tell you something. You heard his message. He did not want to be there. Sometimes a call to the NH will give you some cues that will help give care. If he had dementia remember a lie is not a lie if it is used for comfort. Reality orientation will just confuse him more. Nights in new surroundings are hard for all of us. With confusion and dementia it can be catastrophic.

One of the professors from USC used to call Haldol "vitamin H". He felt it was used to often it the wrong situations. I have seen small amounts used to help "glue" a psyche together, a little. In large amounts it will sedate just as you described and decrease lung function so pneumonia can take over.

Too often nurses get orders for medications just to "medicate" the nurse. When we don't know what to do it is easier to get an order to calm someone down than study why the behavior is happening.

I always start by looking for a UTI or constipation in any older, sick person. Are they wet? What about HALT- Hungry, Angry, Lonely, Tired?

Most older people have "earned pain" with time. Could be arthritis, previous medical problems, emotional losses. All studies show we under medicate older people. This can be due to fear of over medicating, lack of complaints by the patient, or their fear of medications, just to list a few.

NH residents in hospital will always be challenging for us. They have lost the care givers they depend upon. These care givers know what to do to make the person more comfortable. Take a deep breath and pat yourself on the back that you intervened to get a less sedating medication that allowed him to get some rest. :yeah:

DaMale Nurse · Aug 19, 2008

I work in a pscy facility. Some times you don't have a choice but to medicate. But I usually try to avoid it if I can talk to the pt and see what's going on right at that moment. In terms of meds I prefer a prn of 1/4 to 1/2 there normal dose of an anti-psychotic. ie. someone who takes 10mg of Haldol TID I would want 5mg of Haldol prn. For someone without a anti-psycotic or who are on a large dose of that anti-psycotic(say 900mg of seroqul QID) I would prefere ativan, valium, or a second anti-psycotic like zyprexa, ablifiy, or klonopin in about 1/2 of normal bid dose. I always medicate to calm, not knock out, execpt of course for the extremely manic patient who hasen't slept in 72 or more hours.

CoffeeRTC, BSN, RN · Aug 20, 2008

Please, Please..if you have a few minutes, call the nursing home and see what he is like there. Maybe they can give you some info or pointers on what will calm him. Sometimes it could be a simple...turn the lights down or put the TV on at night.

Haldol will stay in an elderly person's system for a while. It is aweful to give and will cause so many more problems. I'd rather see ativan used.