I work long term care, and we recently had a patient return from the hospital on palliative care (family did not want to pay for hospice until medicaid kicked in... also would not pay/consider having a patient sitter to stay with the patient in her final days ) Anyway... when she came back, her lungs sounded horrible and she had an O2 sat of 88% on 4LPM by NC. MD aware, family wanted her in LTC, so we kept her. She would shift between 90-95% on 4LPM. Gradually, she began to wake up and was very agitated. She would repeatedly remove her NC and try to climb out of bed (bed low, floor mat). Called the MD and he ordered ativan. Problem was though, that we couldnt get it until about 7 hours later, because pharmacy only delivers 2x a day. Of course, borrowing was not acceptable in this scenario. I told the MD that we had haldol, phentergen and benadryl available if he wished to use those instead. Eventually, he decided to go with 1x dose 25mg benadryl... but he was irritated about doing so, since he "needed a reason to prescribe" and she wasnt sneezing. He kept asking me "is she a danger to herself or others?".... Which really made me think. Danger to others? Certainly not. Danger to herself? Possibly. By removing her NC and allowing her O2 to drop, she is unknowingly a danger to herself (since she was so confused with demenia, she was not aware of the consequences of her actions).
Would you consider a dementia patient who removes life-sustaining O2 a "danger to self"?
) Anyway... when she came back, her lungs sounded horrible and she had an O2 sat of 88% on 4LPM by NC. MD aware, family wanted her in LTC, so we kept her. She would shift between 90-95% on 4LPM. Gradually, she began to wake up and was very agitated. She would repeatedly remove her NC and try to climb out of bed (bed low, floor mat). Called the MD and he ordered ativan. Problem was though, that we couldnt get it until about 7 hours later, because pharmacy only delivers 2x a day. Of course, borrowing was not acceptable in this scenario. I told the MD that we had haldol, phentergen and benadryl available if he wished to use those instead. Eventually, he decided to go with 1x dose 25mg benadryl... but he was irritated about doing so, since he "needed a reason to prescribe" and she wasnt sneezing. He kept asking me "is she a danger to herself or others?".... Which really made me think. Danger to others? Certainly not. Danger to herself? Possibly. By removing her NC and allowing her O2 to drop, she is unknowingly a danger to herself (since she was so confused with demenia, she was not aware of the consequences of her actions).