Pt threw a bedpan...

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What would be your response if a pt threw a bedpan with feces in it at the tech working with you? Pt has bipolar disease but takes medicine. Alert and oriented. Seems to be able to control her actions at other times apologetic afterwards --/- just wondering

Specializes in hospice.
Depends. Is she trying to decrease the behavior or pooping in the house, or increase the behavior of pooping outside? ;-P

Both. Successfully, by the way. :yes:

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Specializes in LTC, assisted living, med-surg, psych.

Not all psychosis is related to schizphrenia or schizoaffective disorder. Bipolar also has its psychotic moments, which can happen at either "pole" of the illness. Not every BP experiences psychosis, of course, but it's fairly common in bipolar 1, and even people with bipolar 2 can have it, especially during a depressive episode.

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Specializes in psych, addictions, hospice, education.

Dementia can lead to psychosis too...

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Most have schizoaffective disorder on my unit. But we have some schizophrenics, paranoid type.

I understand now what you mean when you say that someone being alert and oriented doesn't mean that they are free of any sort of psychosis. However, I'd like to argue that even if someone knows their name, the date, and why they're in the hospital, if they are hearing voices or think we are trying to kill them, this person isn't completely oriented to their situation.

I had a patient recently who was completely oriented, other than the fact that he thought the entire staff was trying to kill him. He was kicking, biting, scratching...we tried everything we could think of to calm him down but eventually had to medicate him and put him in soft restraints because he had kicked someone in the stomach and needed other medical attention fast, which we were unable to give him until he had calmed down.

I just wanted to point that out because there is a real difference between someone being violent due to delusions and/or hallucinations and someone who is being violent just because they're angry or not getting what they want. Both are incredibly frustrating to deal with, but I have no ill will towards the former. I also think that most of us can pretty easily tell the difference.

I'm also curious about your feelings concerning violent patients who are not suffering from psychosis.

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Specializes in Short Term/Skilled.

OK, I clearly used "negative reinforcement" in the wrong context. I do that a lot.... :(

What I meant was, animals, especially Cat's, don't learn from punishment. They learn from positive reinforcement. :-) That is, when you positively reinforce a wanted behavior.... is that right? haha, I get so confused with operant conditioning! It's like negatives and positives in math......ugh!

Anyways, I'm sorry I de-railed the thread, but that is just not OK in my book and I felt the need to speak up. The poster can agree or not agree, but at least I said something.

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Specializes in ER.

I'm pretty sure any dog trainer will tell you that rubbing a dog's nose in feces is counterproductive. It does no good, and may do harm.

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Specializes in Mental Health Nursing.
I understand now what you mean when you say that someone being alert and oriented doesn't mean that they are free of any sort of psychosis. However, I'd like to argue that even if someone knows their name, the date, and why they're in the hospital, if they are hearing voices or think we are trying to kill them, this person isn't completely oriented to their situation.

I had a patient recently who was completely oriented, other than the fact that he thought the entire staff was trying to kill him. He was kicking, biting, scratching...we tried everything we could think of to calm him down but eventually had to medicate him and put him in soft restraints because he had kicked someone in the stomach and needed other medical attention fast, which we were unable to give him until he had calmed down.

I just wanted to point that out because there is a real difference between someone being violent due to delusions and/or hallucinations and someone who is being violent just because they're angry or not getting what they want. Both are incredibly frustrating to deal with, but I have no ill will towards the former. I also think that most of us can pretty easily tell the difference.

I'm also curious about your feelings concerning violent patients who are not suffering from psychosis.

My facility only uses oriented x3 not x4. I know situation is a real thing, but not every facility uses it at this time. Patients who are violent and not suffering from psychosis deserve to be in prison. Remember, axis 1 are the extreme psychotic disorders while axis 2 are personality disorders. Patients who are well aware of right and wrong are subject to the full penalty of the law - and many personality disorder patients know the difference between right and wrong. But remember, bipolar is an axis 1 disorder and can lead to psychosis. The only reason I became defensive of the patient is because 1) I'm a psych nurse lol, and 2) No one was willing to rule out psychosis; everyone just assumed. I'm all for safety of the staff but a lot of these patients end up in the jail system with no way of getting out after they get better. I truly feel for them.

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Specializes in Mental Health Nursing.

I am not a medical nurse, I'll admit that. I did LTC and I did med-surg (only for a month, I hated it). However, my job is not easy. I am a forensic psychiatric nurse. I once had a patient who murdered a man; he came to my facility directly from prison and was crazy as ever. After he started counseling and a solid medication regimen, he got better. Once he got better, he realized what he had done (the murder) and went into a deep depression to the point he attempted to take his own life. My point is, I work with murderers, rapists, and violent offenders, and I can't define them by their criminal offense. Regardless of what they've done, they are patients. And in order for me to successfully do my job, I can never change that train of thought.

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Specializes in Nurse Leader specializing in Labor & Delivery.

What I meant was, animals, especially Cat's, don't learn from punishment. They learn from positive reinforcement. :-) That is, when you positively reinforce a wanted behavior.... is that right?

No. Positive and negative do not refer to if what you're doing is "good" or "bad" - positive and negative refer to either adding a stimulus/intervention/action, or taking one away. So rubbing one's nose in poop is actually a positive, because you're adding an intervention/action.

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Specializes in TCU, Dementia care, nurse manager.

The psych manifestations of physical disease and the physical aspects of psych disease are two of the most fascinating aspects of nursing, in my view. That psych and medical nursing seem so mutually exclusive has always bothered me.

I came across this article on integrating psych and medical "practice." It's not nursing but it does speak to decreasing the separation between the two in healthcare.

MAYO CLINIC EXPERIENCE INTEGRATING BEHAVIORAL HEALTHCARE - Director's Blog - NHMH

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Maybe if the patient were forced to read through all the posts about dog training they'd never do it again.

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Specializes in Short Term/Skilled.
No. Positive and negative do not refer to if what you're doing is "good" or "bad" - positive and negative refer to either adding a stimulus/intervention/action, or taking one away. So rubbing one's nose in poop is actually a positive, because you're adding an intervention/action.

Oh good lord....Thank you for explaining it that way. I don't know WHY this confuses me so much. I remember having a really hard time with it in psych, too. It's a processing thing, i'm sure.

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