annaliz

Hey hope someone can help me.Went to see a patient discharged from hospital diagnosis GI bleed. He has dementia (only 54), denied even vomiting prior to admit and in hospital per hosp. Notes. Went to see him as they ordered HHA. Reason why is because they can't take care of him. He is belligerent, confused, prior to hospital. Drink whole bottle of liqueur daily.He was sent home on only protonix, lactulose, propranolol.He won't take meds by family. His BP was only 100/50 hr 60 so I did not give propranolol. When I was there he wanted to repark his car I tried to redirect but could not. So I took keys from him and of course became escalated. So I ended up giving keys back he got in car turned on ignition , I CALLED COPS. Who came and persuaded him to give up car keys.The mother is scared of him and can't call 911 as she has no concept of it. He has no primary MD. im worried if his clinical condition is unresolved as his BP is low. And no meds to address behavior was on haldol iv in hospital then straight discharge.plus when he is ready to drink again and has no liqueur concerned safety/withdrawals.Any advice as to what do? I told family is he becomes a threat to self or them to call 911.

Hi, So this is huge problem, as you have indicated. And difficult in the field to manage, but no impossible. He can not be taking all meds. I would say, report to physician what the patient is doing, and if you havn't already, notify the primary doctor now that prior to recent hospital admit patient was taking the med and not doing regimen as ordered, non-compliant. chart the physician was notified. The patient who is on a vent doesn't need to have decreased resp drive as he is at higher risk for pneumonia, right? SO, must notify doctor, of non-compliance, of mental and cognitive changes in am, of continues c/o pain with altered mental status. Can suggest to the physician that he be seen by pain medication team while in hospital to create a discharge plan that the patient and family agree to. Family needs education, possibly patient too (although you already seem to know that he is not open to going with the plan), therefore enablers need to be educated to updated pain management system, and your expectations of compliance by all. Who is refilling the prescription? I assume he can not do that himself. As long as all is documented and all providers/specialists made aware, you are ok and just have to chart everything, and monitor respiratory status. Sounds like you know the client pretty well. Be forthright with physician, tell him you suspect dependency issues and discuss if with him your concerns. Ask him, based on my clinical findings and observations, do you feel this is a problem? Do you have knowledge of him being dependent or non-compliant in the past? What have you done about it? What should the plan of care be going forward? Don't doubt your clinical findings, and BIGGEST THING OF ALL :::::: COMMUNICATE!!! Don't hold back. OH, BIGGEST THING OF ALL ::::: DOCUMENT EVERYTHING! education, findings, patient response, family response, physician notification, physician response, collaboration with other nurse and confirm findings documentation, and notification of clinical supervisor. You did right though, good job in a stressful situation, look for resp changes.