So I had this older lady who was hospitalized for pneumonia. All evening she was very pleasant and even offered chocolate each time I went in to see her. It was mentioned to me at the beginning of the shift that the night before she had gotten out of hand and I thought this lady is so sweet I wonder what they are talking about. Well at 6am I found out. She was screaming down the hall that if someone doesn't get her water right now there is going to be a dead patient. I go in the room and her eyes are red and puffy and she starts screaming at me saying I am a horrible nurse and I neglect her and this is a horrible hospital. When I asked her why she was so upset and what she needed she started screaming how she hasn't had a bowel movement in 2 days and I don't care because I'm not calling the doctor. (The night before I did give her something)
I wanted to tell her the reason she isn't going as frequently is bc she won't get her butt out of bed! She refuses to get up to a commode or a chair. But I wasn't going to fight. She yelled for us to get her fixed up in bed so we pulled her up in bed and I laid the blanket on her and she said "this is how you're gonna leave me, you aren't even gonna make it nice." Omg! I wanted to just tell that lady to cut the crap bc she was just out of control but I know we are supposed to be cordial with the patients.
Has anyone ever told a patient to just cut the crap and stop being nasty?
I also wonder if she has some home meds that were abruptly discontinued. Over the years, I have discovered that many elderly ladies take meds "for their nerves". If they get admitted to hospital and these meds are suddenly stopped, they can go into withdrawl.
Conversly, meds can trigger behaviors, too. Benzos are notorious for being disinhibiting. Paradoxical reactions are more common than we think - I'm always verrrry ginger about giving them, especially if it's a new order and especially to elders. They're also a total no-no if you suspect delirium.
I'm also thinking delirium or some form of dementia. And none of us were there so we have no idea. But I honestly could tell you crazy stories of what differing meds can do to patients. I won't simply because of hipaa and I would never want anyone from work recognize me. But know that we see patients at their absolute worst, most vulnerable. Does that give them the right to abuse you? No. But keep in mind mental status patients especially in the elderly indicate something else is going on.
Investigate all other causes first. Then just deal as pleasantly as possible with the patient, but firmly. Always try to put yourself in their shoes. Constipation can be extremely uncomfortable. And there could be another cause for it as well.
People can be delirious AND A,Ox4. As well as doing that ridiculous "delirium screen" with 10 and 5 score while being totally sure that they receive the worst care ever known to humankind and that their loved ones dead for the last 10 years just got out for some coffee.
A LOL should be sound asleep at 6 AM. Sleep hygiene is your best friend #1 here. Turn off everything that blinks, emits lights and otherwise disrupts melatonin production. Ask family to bring eye mask and ear plugs if your unit has a policy of keeping lights on during the nighttime. Ask the patient what she usually do to sleep better, and do whatever you can to provide as much routine as possible. If nothing else, get an order for Ambien AFTER you ruled out obvious reasons. Constipation and such need to be found, investigated and addressed while patient is at his personal "normal", not during acute delirium attack.
People who tend to sundown have to be at the top of your high risk list. Delirium is a "hyper -energy consumptive" condition for the brain in particular and for body in general. AMI, hypertensive urgencies, strokes, falls (with intracranial bleed and broken bones) and other things which will make you stay well past your shift happen quite often in delirious patients, so by preventing delirium you really make that proverbial "difference" in patient's life as well as in your own's.
She may also be on new meds for the pneumonia which may be causing a reaction. Let's also not forget the possibility of nightmares. As has been said, she may have woken up and couldn't figure out where she was or where the glass of water was that she knows where they are at home.
Approach her quietly and calmly and try not to show any frustration. Get her comfortable and situated how she wants to be. But speak and act in a calm manner. This goes a long ways towards calming her. Also, assess for pain and her breathing.
Also the fact that you were told in report that she had acted up the night before should have made you think when this started or before whether there was something else going on
This thread could be combined with the "Your job is to make me happy" thread. We all have the pain-in-the-***-all-the-time patients, as well as the suddenly-pain-in-the-*** patients. Thank Gawd for the nice patients, and even the ones who are in-between.
I have less patience for this because I'm in ICU. I went here because I love the gtts and the management of a critically ill patient. However, when they've gotten a bit better from their OD, ETOH poisoning, skipping dialysis, etc they act entitled and are demanding.
There are people who do the same thing every time they come in and it's so annoying. Never mind the fact that the same nurses you're giving a hard time to devoted hours to saving your life when you couldn't speak for yourself....but wait, I can't tell them that quite like that, can I ? haha
I get the OP and it is frustrating. I'm dealing with a patient like that at the moment except she's confused/oriented in almost equal measure so it's difficult to score her behavior/neuro. She's not an ICU pt, "knows" everything, and screams when she doesn't get her way (which, a few minutes ago was a beer), which keeps the other 2 pts (who aren't ICU pts either) awake and asking what's going on?
Specializes in Psych, Addictions, SOL (Student of Life).
I see a lot of nurses recommending Ambien for a LOL who can't sleep. Ambien is a very bad choice for the elderly as they commonly experience paradoxical reactions to it. At the SNF where I worked we usually started with 5 mg melatonin, if that didn't work we titrated 25 to 50 mg Trazadone, if neither of those worked we used Restoril which seems to work better in the elderly population. I actually detest Ambien and think it's possibly the worst drug ever invented and possibly proof of the existence of Satan himself. My who family is made up of Nurses, physician's, lawyers and law enforcement personally and we all have shared stories of the things normal rational people with no history of mental illness or criminality do under the influence of this drug.
Specializes in Float Pool - A Little Bit of Everything.
Unfortunately, this sounds like the majority of my patients in the hospital. I will say I never talked down to a patient. But I have for example been in situations where I had to ask a patient to stop calling me a particular word or to stop trying to punch me in the face. This was kind of common practice in the Trauma ER I worked in. I have had times where people got so out of hand we just had to excuse ourselves from the room so that all parties could take a breather. Sometimes it is the nature of the beast. I just would never say anything to en-flame an already bad or possibly hostile situation with a patient. One of our triage nurses did just that once, a few seconds later a patient had her up against the wall by her neck and beat the holy hell out of her.
We all have the pain-in-the-***-all-the-time patients, as well as the suddenly-pain-in-the-*** patients. Thank Gawd for the nice patients, and even the ones who are in-between.
heron, ASN, RN
4,647 Posts
Conversly, meds can trigger behaviors, too. Benzos are notorious for being disinhibiting. Paradoxical reactions are more common than we think - I'm always verrrry ginger about giving them, especially if it's a new order and especially to elders. They're also a total no-no if you suspect delirium.