So, I'm all up in the lobby triaging my cotillion of crayzees: Rectal pain post-sex (duhr), sneeze x 1 who wants allegra re-filled, s/p ass-whoopings, drunk-n-falls, cough x 1 year, low abdomen pain x 20 minutes, drop of blood x 1 on toilet paper after wiping who want 4th 1st trimester ultrasound---the usual nighttime crew---when I get an expectation slip.
"Cops are bringing in a male on a psych hold." Oh, sure, bring it on, he'll be in good company. Probably some chronic schizophrenic on crack spazzing out downtown. No big deal. This IS crayzee central after all.
So, la ti da, cops show up with an older dude--frankly I was surprised at how old he was given my pre-conceived notions-- in cuffs who is hollering and carrying on about how we have no right to hold him against his will and whatever else. I immediately put on my nice nurse face (smiling, welcoming, non-threatening) and am all "yo, copper, what's up here?"
Oh, we picked him up at the nursing home, the staff wanted him eval'd psychiatrically for agitation. Uh, from the nursing home by cops? What's he in the nursing home for?
Not sure.
Okay, you got papers?
Yep. [Looks, there's a med list, nothing else]. What's his history?
Not sure, it's not on the papers?
Nope.
Okay, whatever.
I put on my Sherlock Holmes gear, scan the documents and find out that his admit date to the nursing home was the day before. Still no diagnosis listed. No psych meds on the med list, but there are some nebs, inhalers, dig, BP pills, nitros PRN and whatnot. Meanwhile, he's hollering and trying to run like Hell through the front doors.
I have the cop retrieve my patient and hang out while I do my cheerful, smiling nursing assessment as to not have him kick my ass. He was old, but he was a big dude who looked like he'd kicked some ass and taken names in his earlier years.
"Heyyyyy! Let's get your vital signs!!!! How are youuuuu tonight?"
"Well I shouldn't be here! I just left here!"
Vitals: 145/67, P=89, RR=30, Sats 75% on room air. Well, knock me over with a feather. Get in the wheelchair; let's go for a little ride to the 'stab room, dude.
Agitation was relieved with administration of oxygen and other various stabilization tactics designed to allow for the exchange of said oxygen with the blood stream in the alveoli, not that they'd understand that whole concept.
Nursing homes, man. They didn't even check a set of vitals (at least not that I saw) before having the poor old bastard cuffed and hauled in despite him having no psych history and just being just d/c'd after a nearly month-long inpatient stint with...CHF and pneumonia, including a couple weeks on the vent. Dude could have crapped out at any time.
Sunday, August 17, 2008
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6 comments:
Hello Nurse K,
Ouch! Seems like that nursing home is in dire need of a slap-down.
Do you believe nursing homes tend to negligently transfer residents? If so, what would you do to try to minimize that?
Also, do you have any special difficulties or issues dealing with patients who have autism or Asperger Syndrome (AS; it's considered a less severe form of autism)?
Cheers,
Jeff Deutsch
Uh, this post isn't about autism, so I won't go there.
We can't do anything to minimize negligent transfers because they decide how and when the patient is transferred, not us.
In this case, the patient should have minimally gotten his vitals checked and, after it was discovered his sats were low, sent in by EMS after being placed on a nasal cannula or whatever else they had handy to deliver O2 to him. Even though he was yelling, he let us put him on the O2 and check his vitals.
If he was too agitated for vitals or to receive oxygen, he should have been sent in on ALS (ie 9-1-1) ambulance and restrained if necessary, keeping in mind that he had no psych history and agitation was not his norm. His transfer paperwork should have included something like a copy of his recent d/c paperwork from the hospital and anything else they would have thought to be relevant. This transfer sucked major ass and should have never went down how it did.
Normally, I think they transfer people in for stuff they could have handled there, like UTIs, and I suspect most LOLs and LOMs get treated at the NHs for these things.
That poor old guy! Good work!
Ummm- why does that case, like totally not surprise me?
Hi Nurse K,
Well, I know from this and a few previous posts that you've had issues with people's behavior when something was "not quite right" with them. I was just wondering if you believe many of the same things apply to folks with autism and AS.
Wrt what you would do about negligent transfers, I apologize for my apparent miscommunication. I meant what, if anything, would you do as a voter or even a policymaker?
Cheers,
Jeff Deutsch
Underlying pathology which one cannot help that results in abnormal behaviors is really irrelevant to most of the overtly manipulative and abusive behavior for secondary gain that I discuss here.
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