elderly mentally ill with medical problems

dwajr · Mar 9, 2001

you ask

['Can elderly mentally ill patients with medical problems be nursed effectively on medical wards/environment]

Yes, infact if you place a medicaly compromized patient on a psych. unit your asking for trouble! according to A.Maslow if any of the lower level needs are not met then you cannot address any upper level needs! Medical problems tend to be lower level needs, psych. needs are upper level.

Immagine for a moment a 80+ year old lady presenting to a geropsych unit verbalizing she is ready to die. she has been spiting up her food as soon as she swallows it for the last week at the nsg. home. she is mildly confused but still oriented to self and place all of the time. She is a DNR. occcasionally bright affect, but usually has a worried affect.

From a psych. standpoint your may push the Psychiatrist for an anti-depressant. Somewhere inside a gut instinct tells you "maybe the only thing left for this lady to do is to die" maybe this is ok to be ready at her age; and just maybe once the anti-depressants kick in she will find something worth liveing for so you push to find out what hobbies or other intrest she has and try to get her involved.

her one and only chance is to get passed the acute depression before she starves todeath.

she is a DNR.

Now as a psych nurse you have to know from the get go that she is not a medical patient.

Why??

suppose the reason she vomits her food back up after swallowing is because she has an Esophageal stricture.

Suppose the reason she has a worried affect most of the time is because she is afraid and afraid because she doesnt understand whats happening to her, but like everyone else she comes to the conclusion that just because she is 80+ years old it must be time to die.

The DANGER is that the lower level need is unmet. So it really doesn't matter what we do with how she is emotionally handling it she will still die 100% of the time!

Placing Medical patients on Psych. units is a growing problem especially in the elderly.

FIGHT IT WHEN YOU SEE IT!!!!!

Having worked as a Trauma nurse before moving to Psych. I can tell you medical/surgical is an OK place to put psych patients with medical problems! Psych should be reserved for the time all other explanations have been ruled out. which is one reason HCFA is so picky about having the H&P with in 24 hours of admission to any kind of behavioral unit.