Ethical issue regarding antipsychotic

[ksusn]

Hello,

I am a student nurse and I was pulled to work in the ED the other night to be a sitter for a psych pt. The pt has had a history of being very aggressive and claims to have seizures (which were determined to be fake by RN and MD). The pt was very agitated/anxious at the time with security on stand by. The nurse had drawn up olanzapine (antipsychotic) to give IM. The pt asked for antiseizure med and insisted the RN tell him the name of the drug and the drug class in which he was about to receive. The RN told him the correct name of the drug, but told him it was an anti-seizure medication. I understand that if the pt had been violent, he may not have had a choice in whether he recieved the drug or not. However, I feel like it was wrong for the nurse to lie about the medication. Any thoughts on this or how the situation should have been handled? Thanks!

[Davey Do]

A lot of Patients don't want to hear they've been prescribed an antipsychotic such as olanzapine: "I'm not psychotic!" they say, whether they are or aren't.

So I say, "This med is prescribed for racing thoughts and to help with other mental processes". They're more accepting of that.

[blondy2061h, MSN, RN]

Just goes to show the huge stigma mental illness has

[JKL33]

Davey Do said:

A lot of Patients don't want to hear they've been prescribed an antipsychotic such as olanzapine: "I'm not psychotic!" they say, whether they are or aren't.

So I say, "This med is prescribed for racing thoughts and to help with other mental processes". They're more accepting of that.

That is the general form I follow as well. But when, every once in awhile, I'm pressed for the name of the class of medication, I do feel conflicted about that. Seems like an uptick recently with increased use of Haldol for various things, especially...

This is a great discussion.

[umbdude, MSN, APRN]

I also find it unacceptable to put a student nurse on a 1-to-1 with an anxious/agitated patient who is about to get an IM shot.

[brownbook]

umbdude said:

I also find it unacceptable to put a student nurse on a 1-to-1 with an anxious/agitated patient who is about to get an IM shot.

Yeah...do you think! Was she doing clinical with her nursing school? Tooooo many questions about this part of the post.

I hoped, assumed, maybe she was working at that time in the hospital as a CNA or MA. She also happens to be a student nurse so was more attuned to what medications the nurse was giving?

[KelRN215, BSN, RN]

How were the seizures determined to be "fake" by the MD/RN? Was the patient hooked up to continuous EEG monitoring and one of these events captured? That's pretty much the only way to tell though, as others have pointed out, pseudo-seizures are not a result of the patient "faking" a seizure.

I did once have a patient who actually was faking seizures- he had a history of epilepsy and was in juvie. He knew having a prolonged seizure would lead to him being admitted to the hospital, where he had a bed, a private TV, a play station (this was a pediatric hospital). Once he was put on EEG and it was determined that he had viewed faking seizures as a "get out of jail free" card, he was sent back.

Pseudo-seizures are something completely different and indicative of serious psychological stress/mental illness.

[hppygr8ful, ASN, RN, EMT-I]

Scottishtape said:

This.

Edit: I was also thinking maybe it was an off label use, but I'm not finding anything credible, so I removed that portion of my post ?

Actually pseudo seizures are still treated with anticonvulsants and Olanzapine is contraindicated in the presence of any suspected seizure activity/disorder. A far better choice would have been the old 5-2-50 cocktail Haldol/Ativan/Benadryl workers even better and faster when given by mouth.

[ComeTogether, LPN]

"Your sleeping pill is in here" and so your trazodone

"this is a pain pill" also known as tylenol

"your mom isn't here right now" because she died in 1972

I mean, you gotta do what you gotta do. I'm not going to lie if I can help it, but I will phrase my words very carefully whenever I need to, that's what I would want if I were my patients.

[NurseNinja1990]

I'm a psych nurse so I'll jump in on this.

We get multiple aggressive and violent patients a day so here's a few phrases I've used to get them to take their anti-psychotics:

"This helps organize your thoughts"

"This will help with your anxiety"

"You'll feel more calm"

"It will help with the voices"

"You'll be able to get some rest"

"It's for your mental health"

I've seen everything from spitting out the pill, becoming verbally/physically aggressive, to straight up tipping the med cart and beating a nurse for using the word "anti-psychotic". You use your judgment like you would with any other kind of patient with safety of the patients and your staff as your priority.

[CrunchRN, ADN, RN]

Hherrn - you should be a nursing instructor. Great response.

[3peas]

umbdude said:

I also find it unacceptable to put a student nurse on a 1-to-1 with an anxious/agitated patient who is about to get an IM shot.

Absolutely!

[amzyRN]

Take this as a lesson as to what NOT to do as an RN. It is unethical to lie to a patient. As someone mentioned above, the nurse could have said this medicine helps psychogenic seizures. If he was on a psych hold and a risk to himself or others I don't think he had a choice in the matter anyway.