I am at the end of my first year of a three year program. we are currently on the med-surg floor. last week I had a schizophrenic patient who was on zyprexa 5mg and Ativan 2mg. yes, that was it. she is ESRD and uncontrolled hypertension, COPD etc, etc. everything was going fine. fine as in she wasn't out of control. she was doing a lot of muttering under her breath and talking about how her family was trying to kill her, etc. but she was responsive to me, but kept asking for her dilaudid which was due around 10. the nurse wanted me to hold all her blood pressure meds because she was scheduled for dialysis. so i did. gave her zyprexa which she wouldn't take without ativan prn so she got it around 0930. turned out dialysis was running behind and they weren't going to get to her till early afternoon. so the nurse wanted me to give the BP meds, told me to hold off on the dilaudid because she just got the ativan. (do you usually need to wait between these 2 meds?)
so anyway. i go to give her bp meds. she refuses to take them because she wasn't getting her dilaudid. i told her that she would be getting it, but had to wait a bit longer and I explained why. she went into a tirade calling me a whore, telling me to get the f*** out of her room. i sat down and tried to talk to her about why she needed her bp meds and further explain about the dilaudid. she kept repeating over and over that i tricked her, calling me other names and telling me to get out while spit was flying out of her mouth. i told her okay, but i would be back to check on her in a little while. i left the room and wanted to cry. not because she said all that stuff to me, but because i felt truly dumbfounded as to how i should have handled the situation.
later when i was able to give the dilaudid, she said something about how you just need to be mean to people sometimes and asked if we could be friends again. and she started crying when i was pushing the med. i asked if it was hurting her, she said no and pointed to her head and said it hurt inside.
i left the hospital that day feeling really confused. i don't know if i handled things right or how i should have responded to her. i love psych and do want to work in it eventually. i just want to hear anyone elses thoughts about it. what would you have said/done?
Specializes in Med.Surg, Oncology, Psych.,Telemetry,CCU.
I agree with Charlie. Always have an escape route. No. 1 priority - when pt's act out is Safety. Pt became manipulative and angry (could be a no. of reasons). Being a med. surg. unit you were focused on the physiological tasks, i.e. bp meds, comfort, get pt to dialysis, do everything right while someone else (preceptor) is watching ........Remember, you cannot debate any issue with a non-rational person. Just let them talk it out (or throw it out) and keep your distance. If this were a psych. unit - you may have had the time to develop pt's trust (and even then it may not happen).
Don't beat yourself up. Your frustration stems from your desire to help the person, and you just need more time with these types of pt's to understand the dynamics. I worked geriatric psych. for 4.5 years. I saw alot, but I haven't seen it all...
readysetgo
24 Posts
I agree with Charlie. Always have an escape route. No. 1 priority - when pt's act out is Safety. Pt became manipulative and angry (could be a no. of reasons). Being a med. surg. unit you were focused on the physiological tasks, i.e. bp meds, comfort, get pt to dialysis, do everything right while someone else (preceptor) is watching ........Remember, you cannot debate any issue with a non-rational person. Just let them talk it out (or throw it out) and keep your distance. If this were a psych. unit - you may have had the time to develop pt's trust (and even then it may not happen).
Don't beat yourself up. Your frustration stems from your desire to help the person, and you just need more time with these types of pt's to understand the dynamics. I worked geriatric psych. for 4.5 years. I saw alot, but I haven't seen it all...
This was a learning experience..