laynicrn

Yes, the patient has significant death issues with spiritual/emotional issues that she refuses to even consider. Won't go into specifics, but there was a major event approx 40 years ago that she refuses to talk about, refuses to even identify. As she has become more agitated, we have attempted to address it in many, many different ways, including the entire family participating. I've never seen a case like this before either. Will keep you posted. But it is a very sad case. Just needed to get it off my chest.

Yes, I meant for the title to read that way. Give a patient 10 mg versed, 15 mg haldol, 4 mg dilaudid, 4 mg ativan in two hours and they are still not only awake, but throwing things, hitting, screaming, trying to get up and walk around, pulling hair, you name it. That much medication and you could harvest my organs and I wouldn't know about it. And yes, this was all with MD approval, who at first couldn't believe she was still awake after the first dose of versed and haldol (5 mg each IV). If not for her terminal agitation, this patient would probably have been totally active and possibly passed on by now. She is in pain, but the fear and anger she has about dying is keeping her here. Today has been a hard day. We finally got a pump with Versed at 1 mg/hr with 1 mg/hr prn clinician bolus, plus dilaudid and haldol IVP. We will see how it goes overnight, but anticipate her to be awake tomorrow, still ****** of and ready to arm wrestle. Never seen anything like it, have even stumped the nurses I work with who have been doing hospice since the dawn of time. If not for HIPPA, I would try to figure out a way to video it just for educational purposes.

I have both home and facility patients. Last Monday I had 14 patients, as of today I have 11. I have two facilities with 3 patients in one and two patients in another, not even half my case load. It really depends on the facility and the DON and attending physician. At one facility, the MD will pretty much give me carte blanche when it come to most orders for our patients. I mean, I can't schedule 60 mg of Roxanal hourly without talking to her, but I can get 20 mg no problem. I can write for seroquel, haldol, ABH gel, you name it and she will sign it, no problem. At the other facility, I have to leave a communication note in the MD's box with what I think the patient needs then wait until the doctor or the NP happens to read it and write me a communication note back. Field work is soooo much better, especially if your MD's are easy-going, you know what they will let you do, etc. Case load really depends on the acuity of the patients though.