Difficult Patients plus Haldol IV

29 Dec

How to manage difficult patients is a topic I would just love some advice on. I think on the top of the list of “hard to manage” would be the alcoholics in withdrawal compounded with liver failure and the ensuing metabolic encephalopathy. You know the bright yellow forty five year old with the huge 9 months pregnant looking belly climbing out of bed trying to escape the the non stop lactulose induced diarrhea. These patients are just so sick and their minds are gone! Trying to explain what needs to be done is just not reality. The families are just as difficult to treat often in denial flipping out on the “nurse” as if what is going on is the nurses fault!  Sometimes after having interactions with in denial family members, I just stop and wonder, wow, they really have no idea what is going on, or they just can not handle the reality.  Which of course I am not passing any sort of judgements on these patients or their families, I know it is a sickness.

What about patients who have surgery and do not fare well post operative due to anesthesia under sub optimal conditions to begin with such as lung problems, obesity or heavy drinkers.  I recently experienced a patient who post operative could not be weaned off the ventilator in the PACU, so the patient was intubated for days, sedated the whole time of course and then eventually made the way to the telemetry floor to Nurse Jane. I was exacerbated to say the least about the condition this patient was in. I desperately tried to manage what was labeled as “post operative psychosis/ ICU psychosis.” Of course I validate these diagnosis, but how long can it last? Days? Weeks? I tried to rationalize that the patient was given boat loads of medications and that was the reason for this continued persistent agitation and delirium. I gave the patient nothing for sedation or agitation trying to see if this patient would become orientated. It did not workand I broke my back. I really did break my back as well as the backs of my coworkers who had to constantly help me pull the 300 pound patient back to the middle of the bed instead of half over the side rails.  In between the “F**K yous”, amongst other curses I just wanted to keep the patient off the floor and to stop the patient from pulling out lines and catheters, and then the patient wanted to “box” with me! After 3 shifts of this I broke down. I had to call the attending and I had to give the patient with ATIVAN IV and HALDOL IV.  I felt defeated. I thought for sure when I received this patient from ICU on day 1 the patient would come to some senses if the as needed Haldol and Ativan were given a chance to get out of the patients system.  In the end a psychiatrist was consulted who ordered the Haldol IV around the clock.  Now since I am still a relatively new nurse I was surprised to read this from Pulmonary Roundtables post. I knew that the hospital policy is that all patients receiving IV Haldol need to be on a monitored floor, and that the QTc should be monitored for prolongation.  I was not happy about this ATC Haldol IV orders!






2 Responses to “Difficult Patients plus Haldol IV”

  1. Sean January 21, 2009 at 17:15 #

    In my ICU, we deal with agitation/anxiety/psychosis almost on a daily basis. Some days I pump my patient full of ativan, haldol, and narcotics….and nothing works. It leaves me frustrated, wondering “there has to be a better way!”

    It bothers me so much that I would like to study this topic if/when I do a master’s degree.

    So many questions about it bother me:

    -How can we stop it?
    -How can we better protect the patient?
    -How can we better protect the nurse?
    -At what point does a nurse get to say “I don’t have to take your physical/verbal abuse?”
    -Are these patients legally responsible for threats of violence and violence itself?

    And on and on….it really bugs me! There must be a better way!!!

  2. seejanenurse January 21, 2009 at 21:41 #

    I think it would be an interesting topic because we would all love some answers! 😉

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