1. I am in awe of you psych nurses!

    We have this 90-something y.o. admitted with phychosis. Her son 'knows' there is a physical/medical cause for this 'atypical' behavior. She is being treated with 10d course of triple IV antibx. for 'possible menengitis' (son refused LP on mom but read about this being a possible reason for altered mental status).

    Her assisted living 'behaviors flow sheet' relieves us of any doubt about the 'suddenness' of the onset (we're talking 8 months).

    Son refuses any/all sedatives without his permission. He is getting plenty of calls. He sometimes sits with her, and his voice calms her for a short time before he finally says, 'ok then, give it'.

    She will have to go to a MHU for med changes just so she can even be placed in an Alzheimer's unit. I am so thankful for those of you who can empathize with/love/care for/advocate for these really needy people! I have a harder time with the son! Everyone else in the hospital, visitors and patients alike are disturbed (oh...the things she says!) by this poor thing, who's change in environment sure can't be helping!

    Anyway......I sure appreciate you wonderful, patient, intellegent, creative, and loving souls!
  2. Visit ceecel.dee profile page

    About ceecel.dee

    Joined: Apr '02; Posts: 968; Likes: 41
    Nurse Educator: love those students!
    Specialty: Med/Surg,ER,L&D,ICU,OR,nrs. educator


  3. by   donmurray
    He's obviously in denial, but how can a lay person, albeit a relative, dictate what treatment someone gets? Surely she should be treated on the basis of what is appropriate for her diagnosis. (Not his!)
  4. by   ceecel.dee
    Our staff agrees totally! Quite frustrating.

    Any input from you psych nurses out there? What would we do without you?
  5. by   Nurse Ratched
    Cecell - that it such a sweet sentiment. I got to read this post after getting home from a particularly horrendous day. Really brightened things - thank you.

    I'm afraid today was not my finest hour in geriatrics/psych. I had to wrestle demented old ladies for blood twice. On the bright side, I won the hardcore match with a severely psychotic CMI frequent flier.

    As for your LOL and her in-denial son, my empathy to you. It's so hard when family members can't or won't see things. If it's clearly documented by the staff from the assisted living that she's been going downhill for several months, one would hope he would accept the fact that she's 90 and probably not going to improve (I'm fairly sure the meningitis incubation period is not 8 months ). You're right - 9/10 times the family will cause you more challenges than the worst sundowning wanderer!

    Still, it's kinda sweet when there's a family member that cares enough to be involved with some of these folks (even if he is severely misinformed.) I'm sure he has no idea that the antibiotics are probably going to give her the craps and a yeast infection to boot...
  6. by   donmurray
    Always look on the bright side of life ..te tum, te tum, te tum te tum te tum! LOL!
  7. by   MollyJ
    When I worked in the ED, one of my nurse friends had a psych nurse friend and her friend said to her, "we DON"T try to reason with these people; we give them DRUGS!" (Might of have been the good old days....)

    Actually, I think the whole medical world is ruled (for better and worse) by family members who insist that some treatments be tried.

    Depending on the outcome, we either call it advocacy or lunacy. (or denial, as Don said).
  8. by   fedupnurse
    Families are so out of control anymore! They read one thing on the internet and they think they are experts. I have also noticed a very VERY strong correlation between the amount of interaction between the family and the patient and how much the family wants done. The less time and farther away the kids are from the nursing home, dementia patient, the more aggreesive care they want done. Thos that are heavily involved generally tend to realize that there is no quality of life whatsoever for most of these elderly patients and tend to be more realistic. Is it the guilt of not being involved or what?
    I have taken to saying to the obnoxious family members who demand we do or don't do certain things "we are trained healthcare professionals and know the best treatments for each particular disease. If you want to use unconvential or nontraditonal measures or methods, I suggest you talk to your family members attending physician and get your family members transferred to another facility, if you can find one, that will cater to your desires for treatment." Of course we document our butts off about what these people say and do to cover our butts.
  9. by   adrienurse
    My problem is with the people who are forever looking for that crooked nursing home they saw on 20/20 or wherever. We are guilty before being proven innocent. It is really draining to constantly have to prove myself and prove that my facility is a good one and that we -- indeed know what we're doing. The worst culprits are the family member that have been out of town or haven't spent time with their family members and suddenly come around and realize that there has been a deterioration. Suddenly it has everything to do with the caregivers have been looking after this person and we have to drop everything and investigate what is most likely just due to the person having a progressive disease. Alzheimer's disease is a progressive disease and is very difficult for people to come to terms with this.

    Just my beef of the day, thanks for listening.
  10. by   thisnurse
    its the "us against them" attitude.
    we get that all of the time and it gets real old real fast. i tell the family member that my job is to monitor the pt and carry out dr orders. if they have a problem with the dr's orders they should talk to the doctor. i dont entertain their bytching or try to reason with them. they are more often than not, not reasonable.
    its not hard to tell the difference between someone who has concerns and someone who just wants to challange the care.
    let them do that with the doc.
  11. by   ceecel.dee
    Yes! Fedupnurse has it exactly right! The more removed a family member is from a vulnerable adult's daily routine or lack there-of, the louder his/her voice is about what has to be done for them. The guilt of the uninvolved 'close' family member!
  12. by   live4today
    May I suggest that you inform the son that it is time for him to call a family meeting (if there are other family members involved), and ask the doctors and social workers to meet with them to discuss alternative treatments/care for his mother based on what he would like to see carried out for his mother.

    The doctors need to be very straightforward with the son about his mother's health; social workers must contribute their assessment of the situation, and her nurse...should also be involved in this round table discussion as a means to reach an agreeable option for your patient's care until her demise occurs.

    Simply present the facts to the son at this meeting of the minds....let the social workers give their input as to options available.......maybe he will simply have to bite the bullet, and take his mother home to die......hiring a private duty nurse for her...round the clock if necessary.

    Including him in this way, allows him to feel part of his mother's care without making him feel as if he is being cut off from the woman who gave birth and a mother's love to him all of his life.
    Letting go is never easy for family members......especially when the one they must let go of is a parent. Healthcare professionals see that mother as a "patient" to be treated with their own expertise...which is all well and good.....BUT.....let's keep in mind that the family (the son in that patient's case) sees their father or mother in the way they use to be, the way they have become, and everything in between since the beginning of the children's lives. We will all have to cross that bridge one day of what to do with our dying parents. Many of you on this thread already have dealt with this situation. Hope this suggestion helps. :kiss
    Last edit by live4today on Jul 12, '02