Geropsych important med-surg type info to remember?

[babblingbrook]

I currently work primarily in adolescent psych. However I am considering a move into adult psych. What are important things to remember regarding med-surg type issues? (it's been a few years since I was in school and went straight into working w/ younger people).

My main questions are regarding diabetic pts and pt's c/o chest pain. Also, other than coumarin are there any other meds have to watch closely ( monitor labs frequently, etc).

[casi, ASN, RN]

In gero-psych if you get the patient's who are barely A&Ox1 have severe dementia that the nursing homes can't handle, always remember when they start acting out, before things escalate, that the three primary causes for behavior are pain, need to use the bathroom, and hunger.

Diabetics: I really don't know what questions you have here, but I suggest reviewing your different types of insulin and their onset and peak times. Never hold a long acting insulin. Also review s/sx of hypoglycemia/hyperglycemia. And remember a nice snack that includes a decent amount of protein is one of the nicest things you can do for the night shift nurse

Chest Pain: -First thing is first always look at the patient. Are they clutching their chest, SOB, diaphoretic, what does their skin color look like pale? grey?

-Ask about pain where is it, describe it, have you ever had pain like this before?

-Check vital signs

-If you are in a hospital call a rapid response.

[Moogie]

Casi covered it nicely! She is absolutely spot on to address patient needs before the behaviors start to escalate. In addition to the big three needs: pain, elimination, and hunger, keep in mind that elderly persons with dementia aren't as able to cope with environmental stressors as are younger persons and those without dementia. Noise from a blaring television, discomfort from the room temperature being uncomfortable, or even the change in routines are stressful for persons with dementia and can cause behaviors to escalate.

One of the biggest challenges in my opinion in taking care of cognitively impaired patients with diabetes is that they often don't understand why you're poking and prodding them to do blood glucose checks. All they know is that you're doing something to them that hurts. I remember a doc who ordered QID blood glucose checks on folks with severe Alzheimer's, even on LTC residents whose disease had progressed to the point at which they pretty much stopped eating. I realize that it is important to carefully regulate blood glucose levels but the QUD checks seemed a tad excessive and unnecessary, especially when they upset the resident enough to escalate behaviors.

Also keep in mind that the elderly are more prone to adverse effects from medications as well as drug interactions due to polypharmacy.

I wish you the best as you contemplate this career move!