Confused patient

Specialties Hospice

Published

Specializes in BNAT instructor, ICU, Hospice,triage.

Tell me what kind of intervention or words have helped and what your situation has looked like with a confused patient that absolutely refuses to give up control of his/her meds. Tomorrow when I visit I will count his meds and see if he is taking them correctly. Family just now called and said that they *think* patient is taking his decadron 4mg 2-3 times a day when it is ordered to take daily. I"m sure he is taking it more because of pain control. We decreased the decadron and increased alprazolam because he has been manic. Working 18 hours a day out in the machine shed, mowing the yard etc. :uhoh3: Family has their hands FULL! He is on morphine ER 60 mg BID. And then breakthrough morphine IR 1-2 tabs Q4 hours. When I visit he always declines the need to increase his meds and says that his pain is mild.

I will talk to the supervisor, but do you advise me to go in and say "this is how its gonna be" ask him if he trusts my and his doctor's judgement? I could see him getting absolutely irate about this and even combative. He is so terribly independent!! The family has hired 24 hour caregivers for him.

I have offered and pleaded and begged to fill his med boxes weekly for him. He refuses to give up control I believe because he messes around with them. Maybe we could discontinue everything except for comfort and anxiety meds?

Tell me your experiences!!!

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Specializes in psych, addictions, hospice, education.

If he has 24 hour caregivers, can't they control the med boxes and not let him have the meds until the times for which they're prescribed? Might he be experiencing side effects of the decadron that are making him "manic"? What good would it do to take away all meds but comfort...wouldn't he take those as he chose too?

How about a longer=lasting benzo than xanax?

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Maybe Haldol is worth discussing with the MD.

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Specializes in BNAT instructor, ICU, Hospice,triage.

What Would do you think if I suggest risperdal?

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Specializes in BNAT instructor, ICU, Hospice,triage.
If he has 24 hour caregivers, can't they control the med boxes and not let him have the meds until the times for which they're prescribed? Might he be experiencing side effects of the decadron that are making him "manic"? What good would it do to take away all meds but comfort...wouldn't he take those as he chose too?

How about a longer=lasting benzo than xanax?

I'm thinking now that he must be wanting control of his meds because he is "adjusting" them. As he did confess to me last week, you can't "adjust the decadron! Its not PRN med that can be increased or decreased at every whim.

I think he will get very angry but we may have to have the caregivers take control of his meds and have me start prefilling his med boxes although he has totally refused this in the past!

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Specializes in Hospice.

I have said to patients 'We have a policy that I assist you in filling your pill boxes', or have just asked to sit with them while they fill them, or have them sit with me while I do it. As soon as someone is confused I start to d/c meds. Anything not absolutely necessary to his comfort. Also this is a time we might talk about a switch to a fentanyl patch for pain instead of pills. Good luck!

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Risperdal or Haldol. Either will help although Haldol seems to have a more immediate effect on agitation/mania.

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Specializes in BNAT instructor, ICU, Hospice,triage.
I have said to patients 'We have a policy that I assist you in filling your pill boxes', or have just asked to sit with them while they fill them, or have them sit with me while I do it. As soon as someone is confused I start to d/c meds. Anything not absolutely necessary to his comfort. Also this is a time we might talk about a switch to a fentanyl patch for pain instead of pills. Good luck!

I have thought of this although his mom had a horrible experience with the fentanyl patch. But its worth a try maybe. If I can somehow convince him.

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Fentanyl is extremely expensive and pain doesn't sound like his issue, anyway. Control does.

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Specializes in psych, addictions, hospice, education.

Haldol is immediately effective and has the potential for some bad side effects that are very uncomfortable. Risperdal or another antipsychotic are less prone to such side effects. However, he's not psychotic, is he?

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Specializes in Pulmonary, Cardiac.

Risperdal is not generally covered by hospice. Haldol is, with less side effects. I had a pt like this, I delivered meds weekly, I filled the pill box, and I had to explain that if he ran out before the week was over, I wouldnt be a le to refill ( the scheduled meds)

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We cover risperidone and haldol, also the more expensive ones such as Seroquel and the bank-breaker Zyprexa. Haldol just works quickly and efficiently.

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