Need help with dealing with psychiatric patients post OD

[TaylorBean]

I am a new grad on a 6 month orientation in the ICU. I just started my 4th month and need advise on how to approach the many different psychiatric patients we see when they are medically cleared and waiting to get transferred to inpatient psych unit. I am not familiar with psychiatric nursing and I had an incident the other day where a pt diagnosed with multiple psychiatric disorders was "playing possum " and I could not arouse the pt for many hours. I was unable to obtain neurological assessment and administer meds. I tried stimulating the pt vocally and had to physically lift arm to obtain bp- obtain temp axillary etc. I then turned lights on in room and turned tv on and then the pt awoke all of a sudden in such anger. I don't know if what I did was the right thing but I need advise on how to handle this situation or any type of outburst from psychiatric pts.

[MrChicagoRN, RN]

Who decided he was playing possum? If he had a change in LOC, this needs to be reported and evaluated. Did he respond to physical stimuli, pinch, pressure, scrape sole of foot, etc?

Generally, with the patients you describe, you want to be suportive, non judgmental, but also guarding against limit testing and potential manipulation. Skills that will come in handy with many of your non-psych patients too

[TaylorBean]

There were many clues from my assessments that the pt was indeed pretending. It is hard to explain and I had the same pt the previous day. I did not want to give painful stimulation because of previous physical abuse history, I thought by stimulating physical surroundings would give me a response and I was right. I'm just getting used to being a nurse and it is overwhelming sometimes to respond to a manipulative pt who was trying to staff split me and my preceptor at time. I'm so used to being the person who says yes to everything to do the best/ most I can for my patients and I'm not used to setting limits. It is just sometimes overwhelming but I am learning everyday. Thanks for reply.

[whofan, ADN, BSN, RN]

Psych patient's can be tough. You need to make sure you set boundaries and stick to them. Always report anything out of the ordinary even if you know they are "playing possum" because it is ultimately your license and we all have been wrong at one point or another. Sometimes you have to be firm with the patient and let them know their behavior is unacceptable and why. I have had plenty of experience with psych patients but usually I have the ones who are acting out loudly and obnoxiously rather than the "possum" patients. Good luck to you.