That's why they call him "The Streak"

donmurray · Jul 18, 2005

An "elephant" thong might appeal to him?

TitaniaSidhe · Jul 18, 2005

1:1 status & confine him to his own room if he refuses to stay clothed also same sex staff to be assigned to monitor him. Yes I know he has rights but so do the rest of the patients on the unit. This is how we handle it when they are acting out in this manner on my unit. Of course some ativan would probably help a wee bit too...

Long Term Care Columnist / Guide · Jul 18, 2005

1:1 status & confine him to his own room if he refuses to stay clothed also same sex staff to be assigned to monitor him. Yes I know he has rights but so do the rest of the patients on the unit. This is how we handle it when they are acting out in this manner on my unit. Of course some ativan would probably help a wee bit too...

You really can't use a chemical restraint in this instance, at least not without a HUGE amount of documentation and 1:1 observation, and the state surveyors will probably still cite you for it (if this is a LTC facility we're talking about here---hospital rules/reg's are slightly more liberal). I've seen nursing-home residents literally beat up on other residents, and our hands were basically tied---we couldn't restrain them, we couldn't medicate them, we couldn't confine them to their rooms, and God forbid we should attempt to evict them, or send them to a gero-psych unit for an evaluation. :angryfire

All we could do was watch the combative resident closely and try to distract them from harming others, and have you ever tried to do this when they're awake 24 hours a day and you have only 2 CNA's and one nurse on noc shift for 50 residents? :uhoh3:

Good luck, Nurse Ratched.....with this kind of behavior issue, you and your facility are going to need it!

SusanJean · Jul 18, 2005

1:1 status & confine him to his own room if he refuses to stay clothed also same sex staff to be assigned to monitor him. Yes I know he has rights but so do the rest of the patients on the unit. This is how we handle it when they are acting out in this manner on my unit. Of course some ativan would probably help a wee bit too...

Ditto on the advice.

Had similar situation, but this one pt thought he (yes, he) was also pg. Fortunately, he "delivered" the "baby" in a private setting (tho the sound-proofing on the walls left a lot to be desired) - all that moaning and groaning followed by the joyful exclamation of "It's a boy!"

Some things just live on (and on and on) in your memory banks. :chuckle :chuckle

And, while it seems to take forever, but the meds will kick in...

SJ

GigLs2u · Jul 20, 2005

In the psychiatric facility I worked this patient would be in intensive care because the behavior is not acceptable. Usually, this unit has less patients than a general psych floor and it is a locked unit. The doctors there knew how to work with these patients well. Frequently, they got them to voluntarily sign into the hospital and go to the PICU to keep them safe since they had been off their medication.

The behavior was immediately addressed and the patient redirected with escort to his room and not left until dressed. If the patient would not go then the other patients were asked to return to their rooms. If these patients asked why then they were asked to give their group member an opportunity to deal with what was going on with him without an audience. If I was not able to get the patient to comply, then the supervisor would meet with the patient. Eventually, the patient would return to his room.

The other bed was kept vacant, not blocked, as long as possible. If there was a roomate, because the unit was full, then there was a psych tech with the patient at all times for observation and redirecting, not restraining.

In most cases the psychiatrist would prescribe ativan for agitation because when they came out naked they would be talking to themselves or others very rapidly. Clinically, their heart rates and B/P were usually elevated which was a concern. It is not good for a person to be tachycardic all the time. In addition, often they would have done things they did not remember prior to coming to the hospital. As you can see there are many safety concerns for such a patient.

I would ask the patient if his mind was racing. If he had been able to sleep and evenutally ask if he would like something to take the edge off. At least 95% of the time they would agree. The medication was explained without too much detail, a medication handout would be given to the patient and then the medication consent signed before adminstration of the medication. The patient would be reminded by me that if his mind was racing again he could take the same medication to take the edge off.

Unfortunately, it takes time for therapuetic blood levels to return. In some cases, the patient needs an acute intervention. It is sad. Some of these patients remember walking around on the unit naked after their blood levels return to therapuetic levels.

Any hints or tips on dealing with the patient who insists on getting naked (and visually traumatizing other patients and staff with said nakedness) while you're waiting for the Lithium/Depakote to kick in?
I swear you can't make this stuff up.

z's playa · Jul 20, 2005

Hey...if you can't beat 'em.....join 'em !

Streeeeaaaaaaaak! :)

Z

Nurse Ratched, RN · Jul 20, 2005

We offered meds before streaking started when pt was clearly increasing agitation. Refused by pt and he wasn't being dangerous - just annoying. Was moved over to a more acute (smaller) psych unit where fewer ppl had to witness the occasional displays and where isolation could be enforced if needed. (This is an inpatient psych unit, mjl - I'm guessing anyone doing that regularly in a nursing home would earn an immediate vacation with us lol.) Fortunately in a nursing home, at least they're usually not young enough to RUN naked - this one was tearing around the place :rolleyes: .

Med levels coming up :).

TitaniaSidhe · Jul 20, 2005

I don't know where anyone got restrait out of what I posted previously...chemical or mechanical? I said a wee bit of ativan if you could get it in him would be helpful for a very manic patient. Unfortunately it is often difficult to get them to take it. In any event I am glad to see your patient's level are coming up, hopefully you all will get some relief from the annoying behavior soon or at least until the next admission.

Nurse Ratched, RN · Jul 20, 2005

a wee bit of ativan if you could get it in him would be helpful for a very manic patient.

Vitamin A - the wonder drug that works wonders :).

PRNMEDS · Jul 23, 2005

I am with TitaniaSidhe on this one. We have had this on several occasions. You have to also consider the other patients rights and safety. Usualy settles down quickly - the Ativan is good, but I find for Manic patients if you get some Haldo flowing (5 -10 mg) each time u give the Ativan - it works a lot better and helps them come out of psychotic state. Good luck

TitaniaSidhe · Jul 24, 2005

indeed haldol & ativan compliment one another quite well & the added plus is you can combine them both in one syringe as there is no precipitate

btw ty for the support I was feeling a wee bit jumped upon for a minute there....lol.