G'day,
Definately an interesting patient set this week! The patient about whom this blog is about is a 66yr old female with an admit diagnosis of R sided pneumonia. Her very relevant background Hx includes Schizo-Afflictive disorder. I was lucky enough to be given this, oh how shall I say....hmm "charming" lady for an assessment this wk. She was admitted the previous evening, had been refusing any treatment - namely 02 therapy - with Sp02 dropping to 57%. However some marvellous nurse had finally managed to get her to accept sometime before my visit. I was a little anxious reading her notes.....and readied myself a bit like I was preparing for combat. It was a pleasant surprise that she was quite calm and was able to reasonably answer my questions, even have a feel of chest expansion and auscultate a few ant aspects of her chest. Then all of a sudden the storm clouds rolled in. She became very angry and yelling for us to leave (perhaps a few insults thrown in for good measure...). So realizing the time had expired on our meter, I(we) retreated. Returning later on I met with the same resistance. There was no way I could even get her to position herself so a bit of drainage might occur. Patient very febrile and lotsa secretions. Tried later on - no way! The next day I was asked to do an induced sputum. I think the farthest I got was setting it all up. I attempted 5 times that day - obviously going to settle for even clearance from a cough without the induced sputum method.
I will spare you all my different ways of approaching this situation, but it is a little frustrating obviously from a communication point of view but also due to the fact that she could really use some physio! What I have noticed about this lady is that she is generally very calm and compliant (sort of) for the first 3-5 min that you are in the room and then it is like a button is pushed and she goes off. I guess this is the first Schizo disorder I have had to interact with in such a way and therefore do not know if there are any 'tricks' for dealing with these individuals. As I will likely be seeing her again this coming week, if anyone has had experience and could offer me an tips that would be great.
Subscribe to:
Post Comments (Atom)
2 comments:
I had a patient with bipolar last placement, she was highly emotional and anxious. Turns out her psych meds had been altered to that which she was taking pre-admission, the Drs were very reluctant to sign off on the level of meds that she requested as they believed it was an unusually high dose and highly irregular! The patient then produced from her draw the dose she had been previously prescribed and finally the Drs were convinced and the psych team were called in. She was given the new dose level and her experience within the hospital was more pleasant for all involved. Maybe check the psych meds and if there are any changes could be a possible cause of your troubles. All other thoughts I am sure you have already tried, good luck!
Certainly a very interesting patient drawing in lots of skills,not just traditional physio stuff! The fact she was so "medically" unwell was probably impacting significantly on her schizophrenia and she was probably so much worse than usual. Fevers, other meds etc (and of course lack of the old o2 to the brain!) can all affect psychiatric disorders and cause imbalance and the resulting behaviours you mentioned. You may (hopefully) find her much improved after 3 more days of antibiotics, normal temp etc. I don't think there's much more you can do other than you have tried already...being calm, steady, unaggressive and non- challenging...! It will be interesting to see what happens..good luck!!
Post a Comment