What do you think?

[TamIam]

I am interested to hear what others think about this situation.

A male patient is admitted after an impulsive OD ingestion of an antidepressant, following what he percieved as rejection from his physician. The patient has a history of being admitted several times in the past. He claims to have a neurogenic bladder, and this may be true, as he is reported to self-cath at home. He was admitted with a diagnosis of Suicidal Ideation, and has been diagnosed in the past with Personality Disorder. At the time admission, the patient acted out, throwing his belongings at staff or nearby. He calmed down and was admitted, slept well, and had a calm day. He was offered a catheter several times during the day, but said he was fine, that he didn't need it. When the Psych Dr. came that evening, the patient demanded to be discharged, sit ting down in the nurses station and refusing to move until he did. He was not discharged, however. He then began demanding a catheter, which was supplied. However, he is accustomed to using a rigid straight cath, and was provided with a flexible rubber catheter. He became angered, saying he couldn't use this one. His bladder was palpated, and was not distended. (The nurse did not provide the patient with a firm catheter because, during a previous admission, he had inserted a firm female catheter [which he had impulsively grabbed from the nurses hands] in so far it had to be surgically removed. He also had a past history of pulling an indwelling cath out when he was angry.)The patient yelled that he would "piss all over the furniture" and was encouraged to use the bathroom. He then voided in the bathroom and provided a urine specimen. He then went to sleep. The next morning, he awoke and met with the doctor, who discharged him. The patient said he was "Fine. Ready to go." There were no complaints at that time about urinary discomfort. After discharge, the patient called the facility and reported that his nurse had a bad attitude, refused to discuss the rules of the unit during his admission, and failed to supply him with the materials he needed for his condition. The Unit Director has questioned the staff RN in this case, and feels that the nurse should have arranged for the patient to be cath'd. It was clarified that the rules of the unit had been reviewed at the time of admission. The staff RN feels that the patient was being manipulative and was not in true crisis, as did not have a distended bladder and was able to void immediately after the event in question. The RN also feels that the patient is splitting and transfering, being pathological in his behaviors, concurrent with his diagnosis of Personality Disorder. The Unit Director requested that Axis II no longer be considered in treatment, because "it leads to judgement."

What do you think?

[Morgan314]

I hope this patient follows up with outpatient psychiatric services.

[Psychaprn]

I wouldn't work where a pt. was trusted more than my word, I'd be blamed for the pt.'s behavior(Was there an MD order to cath. the pt.?). I feel the nurse was condescended to when it was said personality diagnoses caused "judgements". What role did the MD play? Maybe the nurse should have called the MD for consultation about the patient's cath. and behavior.