haldol & parkinsons

[guest114]

Hi, I currently work as an LPN with a very high census on 3-11 (2 units across from one another with 20 patients on each - 40 total with varying acuity), perfect setting for sundowning and all types of psychotic events :) So I float from acute/sub acute rehab to short term and long term units. Now that I am going on 6 years as an LPN, I have sorta gotten down the tricks of the trade in order to adapt quickly, but I still find myself running into the occasional road block or curiousity inducing situations...isn't that what nursing is all about anyway?

So to get straight to the point I have been working for an agency and with this one facility about a year or so and am just getting to the point where I know every unit (all 12) and most patients that have been there, as far as what keeps them quiet and who needs to be dealt with first. Lately we have been getting a lot of new admissions and all with severe behavioral issues. This is something I am not particularly used to as my people are adjusted and we all pretty much have a routine and nice flow.

The new comers have really put a damper on things causing behaviors all around. Some have even passed away. So as the nurse I have to protect the others and my staff. One pt in particular was extremely combative, aggressive, and verbally and physically abusive to staff. He was confused, delusional, and very difficult to control. His main diagnosis was Parkinsons along with the other common diagnoses (ie: dementia, hx of seizures, hypertension, hyperlipidemia, etc...) This man was seen by Psych on 2/21 and the recommendation stated to AVOID haldol ( because of PD daignosis) and use IM Ativan only on STAT basis. Now nobody had addressed this and by the time I came on and did see it, another nurse had given IM HALDOL x2, so when I called the 2/26 MD to request Haldol and explain the situation he was not happy and asked me to check the chart and read to him what psych had said...I can't even say how I felt when I started to say "Avoid Hal..." and I had to explain this was just put in the chart and I wouldn't think anyone would do that and this would be known so once I told him there was an alternative solution he was okay with that and I hung up. But bottom line is the doctor was very anti Haldol as way the Psychiatrist... So now I call back my supervisor who happens to be per diem, both of them...and says now the QUBEX only carries 5MG PO ATIVAN or 0.25 PO XANAX....why she suggested I am not sure because...that is psych's call and really not a valid suggestion, and then why we ONLY carry this 5mg ativan...when I have never seen a pt of mine take a higher dose than 2mg mayyyybee, boggles my mind. I can't even break that in half and get something. So I wasn't about to call the doc back after all that and ask for another order, and it's Psych's deal anyway....so "non-pharmacological interventions" it is.....they stressed this more than I had ever seen, so we ended up not giving him anything and taking turns sitting with him but I had him again tonight and it was even worse and he had to get something and it's a week later STILL with no PRN nothing. Psych said she wants to wait for the Depakote to work...Depakote?! This man is going to hurt one of us, seriously....they are not with these people 8 hours. So I call the MD again and unwilling but desperately ask for Haldol. He says no, and I explain further why we need to medicate this patient. He finally agrees to PO Haldol, but really fought me about it said "I thought we weren't doing the Haldol anymore". I am guessing because it must have severe effects with the PD, and interactions with meds like sinimet but are there other non narcotic alternatives? PO preferably? What are the effect when Haldol is admin to a pt with PD. Is 3-4 times harmful or does it have to be more frequent? Are there some other "non pharmacological interventions" my staff and I may not have tried. We have a heavy census and need to be able to handle these situations quickly or before they even occur. Currenly only standing Psych meds are Remeron 15 @ HS & Depakote 250MG BID. I am not sure the psychological effects of depakene on elderly psychotic, delusional, combative, aggressive, people with PD and Demetia/Alz....I will have to research this one ..

I also have on other who calls out (screams out) HELP ME every second he's not asleep or doesn't have food in his mouth, it's some neurological thing or something I am not exactly sure, TBI maybe...and he is on the NUEDEXTA, Klonopin also and Pysch is telling us it is going to take up to 3 months to see an effect, so we have to hear this yelling all that time until it works IF it works and it makes the other residents upset and agitated because they all have dementia/Alz and other memory diseases and get frightended, defensive, or feel threatened very easily. It can feel like I am juggling sometimes but you get to know what works best to get everything to flow nice I am just curious about some of the meds and interactions with diagnosis if anyone has experience because I have working with these people a lot...

Thanks!!

ALR

[AJJKRN]

Join Medscape for free. They have a nursing area and send you stuff via email specific to nurses. Just read an article on Parkinson's and haldol and other meds the other day that explained the contradiction. I have to go to sleep for work or I'd try and find the article link but I can't guarantee it would work anyways without a membership. Good luck!

[TheCommuter, BSN, RN]

Moved to the Nursing & Patient Medications forum for more replies.

[MunoRN, RN]

I would advocate for better management of the patient's sinemet in relation to their delirium, since sinemet is a known cause of delirium and psychosis.

Keep in mind that sinemet is essentially anti-haldol; sinemet works by acting as a dopamine agonist, while haldol works by acting as a dopamine antagonist. This is why delirium or psychosis is often what limits how much of a sinemet dose someone should take. Rather than giving haldol, it makes much more sense to reduce the sinemet dose, and it may need to be stopped all together.

Benzos should generally be avoided, as it typically only makes the delirium worse.