Which diagnosis?

psychRN27 · Jan 31, 2014

In my just over a year inpatient acute psych, couple years mainly geri psych with some rehab (love rehab facilities), and many years as a social worker in the community... I would say the most serious risk for injury is somebody with dementia.... then acute psychosis (schizoaffective of schizophrenia) I got my knee twisted assisting a very large patient to his bed for an IM as he was walking into others holding a chair over his head... figured that was reason enough... I've heard of another unit having nurses seriously injured when a psychotic patient got his hands on pens... and I've been popped a few times in geri psych... now why this APRN who had that unit in the facility refused to d/c the timolol when the pt got violent every time anybody went near her eyes is besides me... her BP was consistenly 140s over 90s... if you are that worried about the Glaucoma of a 94 year old... order some Diamox and monitor lytes... geez....

And the drama... it takes experience in dealing with personality disorders to minimize that. Its mostly borderline personality disorder. Dealing with them is like an art... some do better with 2 or 3 1 min check ins... some need 1 5-10 min session a shift on reframing or some other skill. Limit setting and consistency are important! (limit setting/consistency RE the rules of unit... its another art if you have 2 people with BPD and they notice you spent a few more minutes on another patient than they got)

Mandychelle79, ASN, RN · Jan 31, 2014

Mood disorder,nos who admitted to acting out just to get the drugs that the pt wanted

TerpGal02, ASN · Feb 4, 2014

I would say the addicts with antisocial pd have been the most dangerous for us. Then the psychosis. Dementia pts can be quite violent as well, but we don't take just straight dementia at our facility so we don't see too many of them.

302queen · Feb 7, 2014

psychosis patients and the invol holds tend to be the most problems for us.

Kay28 · Feb 7, 2014

Personality disorder patients seem to cause the most chaos on our unit

taydian · Feb 8, 2014

substance abusers with personality disorders are by far the worst forme. Can't stand those guys. Nothing but grief all day. I'll take an aggressive psychotic over a manipulating addict any day.

Umberlee · Feb 9, 2014

I personally have had the hardest time with developmentally delayed or brain-injured patients. Borderlines are tough all around, so are manics, so are schizoaffectives...but the DD/BI are like behavioral patients that you can't get through to or redirect.

rnhooch · Feb 10, 2014

I have the toughest time with the psychotic patients. Still learning how to deal with them. Borderlines can be trying also. I am great at setting boundaries with them it is the staff splitting they do that is hard to deal with. Communication between staff is key for continuity of care with borderlines.

pinkiepieRN · Feb 13, 2014

I don't work psych anymore, but I do work in a nursing home and we see our fair share of co-occuring psych disorders. I gotta say that it's the TBIs that cause the most trouble and the end stage dementia. Re-direction is impossible and medication only goes so far!

nurse lala, BSN, RN · Mar 1, 2014

Addicts: alcohol, prescription and illicit, make up the most trouble. Personality disorders, such as antisocial and narcissistic, often accompany addiction, at least the folks that make it to the psych unit, right?

The next difficult group are the personality disordered staff (ha! got you there!). But really, a staff member with inappropriate behavior can single handedly escalate an individual and a unit.

JuliRN · Mar 2, 2014

Definitely acute psychosis. Those patients we have admitted who are using spice/K2/bath salts/and even meth can become extremely psychotic and destructive. A lot of these patients don't seem to respond well to antipsychotics for the first day or so either.