Can anyone explain this?

[Lindasfriend]

Thanks to anyone in advance, who takes time to respond. I am not a nurse, but currently persuading my oldest daughter to become one.

My question:

I have a friend that has been diagnosed with Non-Hodgkins Lymphoma with a tumor in the brain. Diagnosis was 3 months ago and she was told it was inoperable. She was also told that radiation wasn't an option because it was so deep in the tissue.

She was given radical chemotherapy treatments immediately (two rounds) using Methatrexate.

Here is the problem... she is also on Decadron, and it is making her nuts. Three different times now, she has gone ballistic claiming everyone is out to get her. She screams/cusses/yells at the nurses and doctors. I have witnessed this myself, and I do not understand why she is not placed in a psych ward.

She is now coming off another 'episode'... she refused any and all meds, her radiation treatment (they can't give her chemo anymore), and refused her 'surgery' to remove her port. She will not talk to anyone on the medical staff... thinks everyone (including her husband)is involved in some conspiracy to keep her locked in the hospital.

Sorry so long... but this woman is going nuts in a hospital where she has been treated for 3 months with no insurance. WHY WON'T SOMEONE force meds on her??? Her husband has POA, but was told that it means nothing, as long as she is 'competent'.

My 3 yr old neice could tell you SHE IS NOT COMPETENT right now.

I have so much respect for those nurses that continue to take her abuse, that must take strength and dedication.

[EastCoast]

I always say that there is never enough info given when these general questions arise so i will refrain from that statement.

I would venture a guess that you are assuming that the decadron is causing a psychois . But how do you know that her altered mental status is not from the brain tumor. I'm guessing it is because the episodes occur after decadron.

It then becomes a thin line of whether to give decadron to help prevent increased swelling in head or not give decadron and see what happens. It's seem like a real tough situation. Of course i have no answer.

To my knowledge there are no meds to control the paronoia that is created from this psychosis except for the acute treatment when a patient becomes unsafe to themselves or others or stopping the causitive agent.

yelling and being paranoid does not to my knowledge constitute a danger to others and medicating her to make sure she has a treatment seems more worriesome than her husband deciding whether a treatment is of any benefit or in fact asking her when she has her next lucid moment.

Having tenuously answered the inital post would welcome expertise in psychiatric/oncology/ethical nurses....

[renerian, BSN, RN]

I have seen once or twice in oncology clients the problem you speak of with decadron. However, I have seen more of the problem with the progression of the disease.

I know a person here has to be evaluated and deemed incompetent by a psychiatrist, then a judge to deem someone as such. Very hard to do but if she acts as you say, then it should not be hard.

I do not agree with forcing meds either. I sure would not want someone to do it to me. I would need to be restrained if someone tried that with me.

I hope your friend gets better since she is very ill.

renerian

[Lindasfriend]

Thank you so much for your replies.

I, too, hope that she gets better. This is a very frustrating thing to watch, but I am certain more horrifying to be the one actually experiencing it.

I have often thought that it might be a progression of the cancer in the brain, but wishful thinking makes me blame the steroid.

I was frustrated today, because this has been going on for quite a while... she goes in and out of this paranoid state. I just wondered how long the hospital would keep her in a bed when she refused any and all treatment--yet she is paralyzed on one side of her body and will be home alone if discharged. That is the only reason I wanted them to SEDATE her... calm her down and give her a prognosis so she can make an informed decision on whether to continue treatment or not.

I agree, I would not want to have meds forced on me either... but I would want to know if this was it as far as 'quality of life' goes...

Thank you all so much for answering... this is an awesome source of information.