worry of his wife's condition. I was not informed about his psych history, nor his paranoid, agitated and hostile condition when I went to see the patient, and did not know he would turn on me after welcoming me to the home. Thank goodness he was wheelchair bound and I had some background in psych. If he had been more mobile and stronger, I think we would have been in trouble. The LVN on continuous care was frightened and didn't know what to do. As a team, I think all team members should be informed of psych background and have avenues for back-up if needed. Deborah Greenspan, RN CHPN® [Submitted on: 1/17/2010 by: Deborah Greenspan, RN CHPN® [dgreens1@gmail.com]]
151. Update on Psychiatric Patient and Hospice. Unfortunately, we have run into similar situations. This is an area that needs more exploration from a number of perspectives. I am an PMHHP working with a palliative care team. I would be interested in hearing from any other psychiatric APN’s involved in palliative care. Please email me directly: perleymj@tx.rr.com Mary Jo Perley, PhD, PMHNP-BC Assistant Clinical Professor UTA School of Nursing, Arlington (perley@uta.edu) Instructor, Internal Medicine UNTHSC Texas College of Osteopathic Medicine (mperley@hsc.unt.edu) [Submitted on: 1/17/2010 by: Mary Jo Perley, PhD, PMHNP-BC [perleymj@gmail.com]]
151. Update on Psychiatric Patient and Hospice. I apologize if I do not know all the details of this case as I did not follow the previous notes, but I am outraged at the inappropriate medical care offered to this gentleman. In Minnesota, if someone is a ward of the state, the physicians can draft a letter to the state requesting DNR/DNI and requesting limited treatment. The guardian should be taking into account the wishes of the patient if he is able to express himself (as it sounds like he might be able to do as assessed by the legal dept). However, even if he is full code and continuing on dialysis, there is no reason he couldn't receive better symptom management. I would consider oral dilaudid on a scheduled basis (alternatively fentanyl or metadone) for a renal pt. Perhaps his psych meds could be increased for anxiety instead of use of Ativan (not knowing the meds) and he defineitly should be able to have O2 (no matter the sats), a fan and have a bed where the head can be elevated. I agree that psychiatric pts as well as developmentally disabled individuals often receive terrible end-of-life care as guardians and states are not educated and feel bound by outdated information. These people are subjected to things in the name of providing care that is not related to their disability/worried re the slippery slope. When, in fact they receive worse care by doing INappropriate aggressive care which causes suffering when most reasonable individuals/families in similiar situations would choose comfort /palliative/ hospice care. This is a HUGE area that needs attention in Palliative care. I like the idea of a subspecially of pscyhiatric /palliative NPs. There are not many psychiatrists available and