Patient refusing meds, combative

Specialties Geriatric

Published

Hello all!

New grad here.... on my first day of orientation at LTC.

Ran across a situation where a patient was very agitated and combative, refused to get up for the day/get dressed/receive peri care (incontinent).

She was also refusing meds. She had a PRN order for xanax, but she wouldnt take it. Of course the CNA's did not want to leave her sitting in messy briefs (she had a roommate, as well as skin breakdown issues).

What should the nurse do in this situation? The nurse who precepted me handled it in a way that I felt very uncomfortable with. What would you do?

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Depends on how long this has been going on. I would first notify the MD on a shift full of non compliance. If it goes on for a day or more then a gero-psych consult is needed because we cannot care for someone we simply cannot care for.

ETA; This is assuming that all normal routes have been taken, 1:1, family involvement etc.

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I sneak the med into ice cream or something the resident likes.

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I sneak the med into ice cream or something the resident likes.

The nurse tried that, and the patient knew what was going on and spit everything out. She was riled up!

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What about an IM med for agitation?

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therapeutic com. techniques? does the pt have a history of non-compliance, or a history of UTI? since they are incontinent they may have UTI, which explains their behavorial changes. If they refuse care, you have to obey them. remember a long term care facility is there "home". if you felt like sleeping in/didnt want to get up you wouldnt want to comply either. chart it under there behavioral sheet, mention it to the charge nurse(in case of UTI/ adverse medication reactions) and try again after a little while to see if there mood has changed.

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Thanks ladies..... I guess the heart of the question is.... Would you force a med on a patient if they were refusing it? (ex. crushing the med and giving it buccal)

I may be fresh and new, but I really feel that is wrong..... I am just worried this situation will happen again and I will be the charge nurse and need to make an executive decision. Eek!

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Specializes in LTC.

I have a patient who is like this. I let her calm down. Then I ask her what flavor ice cream she wants. If she says No to the ice cream. I resort to juice. Apple juice she rarely says no to. I'll crush her xanax and put it in whatever she picks out to eat.

If shes refusing this then you have to call and get an order for PRN haldol IM

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I certainly don't force meds into someone's mouth. Leave and reapproach and when she has forgotten about meds, when nourishments are being given out, crush it very finely and put it into her snack. We have one lady who gets them in her tea - we snag it from the cart before she knows it's come.

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Maybe ask the doctor to write an IM med for agitation and anxiety? Or if the medication is in liquid form, mix it with juice.

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Specializes in Med/Surg and ANCC RN-BC.

Last night at work I had a very combative patient who also refused their medications. At one point we had to call a security code, because I got kicked in the ribs and my nurse got punched in the arm and has scratches all over her arms. Once security came we put on some soft wrist restraints and immediately called the doctor. That way we all had our butts covered. Then he also ordered us to administer haldol to help with the agitation. For 6 hours even with the patient in restraints, they kept trying to get at us and spit at us. So we got an order for ativan. It was crazy. By the end of the shift we had administered 6 mg haldol and 1 mg ativan. it finally worked to calm the patient down to the point where we could start an iv and get a set of vital signs.

Not sure if that helps you answer your question. I would say look at maybe the policies and procedures at your facility. You can also go to the DON to ask them how to handle situations like that.

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Hello all!

New grad here.... on my first day of orientation at LTC.

Ran across a situation where a patient was very agitated and combative, refused to get up for the day/get dressed/receive peri care (incontinent).

She was also refusing meds. She had a PRN order for xanax, but she wouldnt take it. Of course the CNA's did not want to leave her sitting in messy briefs (she had a roommate, as well as skin breakdown issues).

What should the nurse do in this situation? The nurse who precepted me handled it in a way that I felt very uncomfortable with. What would you do?

My first thought is "what did they do that has her so upset?" Usually people don't just start being combative and refusing things for no reason. I realize that as a new grad you may not recognize this, but as an experienced nurse and previously an EMT I have seen too many instances where geri patients are sent out for a mental health eval only to find out that someone in the home has ticked them off. Try to remember that for these patients there is a complete loss of their independence. They must do everything according to someone elses' schedule and the way someone else wants it. They are in control of nothing. Sometimes all they need is someone to recognize that.

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