The Weekend of... 8-2 to 8-5-19

[Davey Do]

There are some patients you just don't forget, and Bob is one of them.

I have fond memories from last February of preventing a naked Bob from falling off a bedside table to him grabbing my crotch to the point that I could feel my spermatic cord pull my testicles up into my inguinal canal:

Bob presently has the honor of being the first patient in over a decade to have to be put into mechanical restraints on the geriatric psych unit!

You see, while being on a 1:1 status, Bob attempted to do swan dives from his bed onto the floor and needed to be restrained in a 40 minute therapeutic hold to assure his safety. He was then placed in mechanical restraints, received Haldol 5mg/Ativan 1mg IM, and stayed in restraints for the entire four hour time length of the order.

Bob is currently resting quietly on a gurney in the seclusion room after taking the majority of his HS meds from me.

I got the "important" meds down him before he lost steam and began refusing them.

I don't think him not taking meds like his fish oil is going to do much harm, do you?

[CalicoKitty, BSN, MSN, RN]

Yeah.. Sometimes I wonder what the "most important" meds are and how to get them down the Pt's gullet before they refuse. For some patients, I just keep a mental order, sometimes use 2 pill cups - one for the "important", one for the not so critical. On occasion, gotta keep the pain med as a reward for taking the important ones. Really need a flow sheet. Ativan vs Metoprolol vs Potassium. Though, those horse pills are hard to get down in the best of times..

[Davey Do]

On 8/4/2019 at 4:03 AM, CalicoKitty said:

Sometimes I wonder what the "most important" meds are and how to get them down the Pt's gullet before they refuse.

On 8/4/2019 at 2:57 AM, Davey Do said:

Bob attempted to do swan dives from his bed onto the floor

Bob was very impulsive and Friday night, when I went to attempt to give his meds, he spit them out and spilled the cup of water. I immediately retrieved the meds, got a towel, and was stooped down in the process of mopping up the water when Bob grabbed me.

I turned to be face to face with Bob when he started stepping backwards. Fearing we were going to fall, I directed Bob toward a mat on the floor. Sure enough, Bob went down and I landed on top of him.

As I lay there for a moment, regrouping, Bob sang:

[Davey Do]

There is a patient on the women's psych unit, Miralax, who is psychotic and physically aggressive who has sent several staff members to the ER. Miralax is a 1:1 and the doctor's order says that only male staff are allowed to cover her.

Being the only male staff member in the psych division on the 2300 to 0700 portion of two of my three shifts this weekend, I was assigned the duty.

Friday evening, Miralax acted out and required both chemical and mechanical restraints and sent two staff members to the ER. By the time I arrived for my duty, Miralax was asleep in her bed. The two female RNs sat in the hallway, one for patient rounds, the other merely to be at hand should Miralax go off. I sat in the doorway just outside of Miralax's room.

Around 0230 Mandy, the house sup, was making her rounds, chatting with the other two RNs. Miralax arose out of her bed and I immediately stood from my chair. All three RNs saw my move and assumed a stance nearby. I was impressed by their vigilance and told them so later. Miralax merely used the toilet and returned to her bed to sleep.

Around 0500, Miralax again awoke and asked:

Well, I thought about giving her the Yogi Berra reply, but didn't want to push my luck.

[Davey Do]

Miralax refused to take her HS meds Sunday night, which consisted of, among others, Thorazine and Haldol.

When Miralax awoke at 0500, I contacted the charge RN and asked if she'd bring me two of Miralax's PRNs, Zyprexa and Vistaril. I assisted Miralax in making her bed and suggested that she take these meds in order to keep calm. She did as I suggested and we sat down on a ledge in her room and chatted.

Miralax said she wanted to give me 10 million dollars, but I graciously declined, saying that I was financially okay and suggested she give the money to a worthy cause. She said she would and then I asked, "Where'd you get all that money?" "Oh", she said, "I'm on SSD and they send me 130 million dollars every month!"

"Wow!" I replied, "And the government says they're out of money!"

Our conversation went from here to there when Miralax happened to mention that she was born in 1971...

I guess that Zyprexa and Vistaril really knocked her out!

[Davey Do]

I worked the floor on geriatric psych unit Saturday night, as my work wife Eleanor was charge. Nickle the tech and I switched off every two hours making rounds and sitting 1:1 with Bob.

Bob had been med compliant and had received some PRN doses of his Haldol and Ativan, so he slept the majority of the night. He was awake when I took over the 1:1 watch at 0530, so we sat and chatted.

Some of my most favorite people to talk with are diagnosed with schizophrenia, as Bob is. People diagnosed with schizophrenia often use loose association, in that one expressed thought can be connected to another, usually in an esoteric manner.

Bob and I were chatting about this and that and the other thing when I went to look up something on Google for Bob. I said, "Just a minute, Bob, I need to put on my glasses. I've had myopia- nearsightedness- since I was 8 years old. Then, in my 40's, I got hyperopia- farsightedness. Heck, now for all I know, I've just got plain ol' presbyopia!"

Bob asked what presbyopia was and I told him it was the term for failing eyesight due to the aging process. Bob replied, "I've got an uncle who is a Presbyterian minister who's an old guy and he wears glasses!"

"Gee, Bob", I replied...