Rant About Meds...

HALDOL scheduled with prn ativan 2mg. q4h prn.

I work on an HIV/Psych unit. My facility, however is not equipped (in my opinion) to handle some of the patients that are admitted because of the ignorance of the medical staff and the lack of locked areas to detain agitated and violent patients.

We just got a new patient who is HIV+ with HIV dementia. She also has Hep C and a Hx of alcoholism, heroin abuse, crack abuse, etc. She was admitted to us after a 3 day hospital stay after her sister called 911 on her because she attacked her with a hammer. When I first met her, she was ok...just kinda roaming the unit, asking for a cigarette repeatedly. Then she started going into other patient's rooms and taking their things into her room. When confronted, she would become agitated....yelling, cursing at, and threatening staff. Her order for agitation you ask? Ativan 1mg PO or IM q6 hours PRN. Oh yeah, like that's going to touch someone who is used to HEROIN, CRACK, and God knows what else!!!! Then she kept trying to get down the elevator. It was a nightmarish day to say the least, and I'm glad I am off today, but I'll have to deal again with her tomorrow.

If she is the same tomorrow, I'm going to set up a meeting with our medical director and see what we can do about getting her some real meds. Either that, or she's going to have to be transferred out to someplace that can deal with her. It's not fair to the staff or to our other patients. Since I am not all that educated on medications for agitation that work for very recent drug abusers, do any of you have any advice as to what I could suggest?

Thanks in advance!

Ativan works wonders!!!

Wow-

Are you working in a LTC facility or a Psych hospital?

If a psych hospital- she should have more meds, to handle her anger & her detox

If you are not in a psych hospital- they should have sent her their for detox & proper psych eval.

Unfortunately, with her dx she has probably not grasped the acceptance of a short life and may still be in the anger stage. She is a threat to others if she went after her own sister in such a violent manner.

Be careful Ali.

I hope all turns out o.k

We have used Haldol & we used to use Thorazine for extreme cases. Pam

I agree with Angela..an in-hospital detox program sounds like a more appropriate setting for her immediate needs.

i didn't know she was in acute withdrawals now.....

also, with the hiv dementia and hx of crack, her nervous system is probably shot and is hypersensitized to anything stimulating.

she needs meds to address the agitated psychosis.

i would get a stat psyche eval asap.

much luck ali.

I work in a long term care facility, not a psych hospital, which I think is the correct place for this woman, at least for now. Unfortunately, she was admitted on a Friday at 4pm, therefore no psych eval was possible until today being that our consultants aren't in on the weekends. She is also on Risperdal, but only 0.5 mg TID. Reading throgh her hospital notes, I saw that they gave her plenty of Haldol and Ativan with not much effect oddly enough. Now with us, she's getting even less than she did in the hospital. Besides safety concerns, I feel very sorry for her. She has to be suffering. Thanks for the advice. I hope that things got straightened out today, while I was off! :)

i have to agree ali.

it is heartbreaking to watch.

i've cared for quite a few full blown aids pts. at the end of their lives.

but the meds used are quite different when the end is near.

i'm sure you'll do right by her ali.

xo

We have a withdrawal protocol that allows po ativan or valium q 1 hour if the patient meets certain criteria. hallucinating, hearing things, temperature heart rate blood pressure increases. however as she is several days out from taking anything she may be out of the actual detox phase. In which case, we sometimes use high dose haldol. Typically 5-10 mg an hour (IV) but once in a while every 5 minutes till quiet. The most I have seen given is about 240 mg in a 24 hour period. believe me i have seen underdosing of patients who are violent and it is not pretty. Not for the patient and certainly not for the nurses. I think haldol in the proper amounts is a great thing. Look up some high dosing information to present to your docs. (im injections work well too, but it is sometimes hard to get to that agitated persons thighs or buttocks. Good luck

We've had good luck with Geodon. IM for severe anxiety and restlessness, p.o. for maintenance. Good luck!

Geodone for anxiety and clonidine for withdrawls. We use this in the E.R.

We've had good luck with Geodon. IM for severe anxiety and restlessness, p.o. for maintenance. Good luck!

I work in a long term care facility, not a psych hospital, which I think is the correct place for this woman, at least for now. Unfortunately, she was admitted on a Friday at 4pm, therefore no psych eval was possible until today being that our consultants aren't in on the weekends. She is also on Risperdal, but only 0.5 mg TID. Reading throgh her hospital notes, I saw that they gave her plenty of Haldol and Ativan with not much effect oddly enough. Now with us, she's getting even less than she did in the hospital. Besides safety concerns, I feel very sorry for her. She has to be suffering. Thanks for the advice. I hope that things got straightened out today, while I was off! :)

From your description she needs to be on at least 2 mg TID of Risperdal.:uhoh21: