Don't assume patients aren't taking psych meds
If a psychiatric patient came to your ED acting aggressively with pressured speech, you might conclude that the behavior was caused by failure to take antipsychotic medications. But this is a dangerous assumption. When ED nurses at Beth Israel Deaconess Medical Center in Boston treated a woman with those symptoms, they discovered something surprising.
"At triage, she was uncooperative with a basic exam, so she was brought back to a room," says Dan Nadworny, RN, BSN, CEN, clinical advisor for the ED. The ED nurse insisted on a thorough examination and a core temperature before continuing.
Nurses discovered that the woman, who was wheel-chair-bound due to her diabetic neuropathy, had a heart rate of 120 and a temperature of 102° by temporal artery. When an ED nurse checked a rectal temperature and gave an acetaminophen suppository, the patient was found to have a large decubitus on her coccyx.
"Within two hours, the patient was more coherent and was admitted to the medical service for management," says Nadworny.
If a psychiatric patient came to your ED acting aggressively with pressured speech, you might conclude that the behavior was caused by failure to take antipsychotic medications.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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