Sunday, August 8, 2010

Like Nothing I'd Ever Seen Before

Last Tues night/early Wed morning a patient was admitted...she was in her late 30's...she had a panic attack. She wasn't my patient, but my orientee jumped in to help because this pt's nurse was helping another nurse's pt who was in bad shape. We put the heart monitor on & took vitals...she seemed totally alert & oriented & normal. Since insurance companies don't really like people being admitted with a diagnosis of panic attack, she was admitted with chest pain. Plus she had an abnormal EKG. Regardless, I figured she'd be discharged by the time we got back the next night as most walkie-talkie chest painers usually are.

Well, we end up getting her as our patient on Wednesday night & I was like "Why is she still here?" The report I got was nurse was like "I don't know why she's still here." Doesn't give us much info at all. Not only turns out they had a stress test scheduled for her the next morning, but when we went to assess her at 1930...she is sitting in bed shaking, looking scared to death, but not saying a word....even when we'd speak to her. Weird!! I asked her "What's wrong?" No response. Day nurse had given her a Xanax at 1900 (never told us she did or why she did!!!!) We took her vitals & left to discuss this weirdness.

We came back 10 min later to her vomiting all over the floor. Ok, doubt the Xanax ever really got in her system, so we call the psych MD (yep, psych was on the case) & he orders THORAZINE........old psych med, not really recommended these days, much less IV. So we give that to her & she falls asleep. I think ok...she'll sleep the rest of the night, no problem. Still bugs me though that her behavior was so beyond anything I'd ever seen before.

Nope, 2 hours later she's awake, still silent, but now her arms are all flexed & she's staring at the wall. She can say her name & year, etc when urged to do so, but otherwise silent. Her one arm is all twisted & her legs are doing funky things. She vomited a few more times that night...just green bile as she hadn't had much to eat or drink in the last 5 days. Ok, weird, but she falls asleep again.

I had no idea what to do for her. Us nurses like to fix things & this was not fixable. I even had four very experienced nurses assess her. Like myself...they had never seen anything like that. I said how would I even describe that over the phone to the MD? The charge nurse told me not to call...the pt wasn't in distress & this was something they would have to see with their own eyes. Ok, no prob. Last thing I wanted was to give her something that would just make her sleep during the day when the MD's rounded. They definitely had to see this peculiar behavior with their own eyes.

Now it's 6 am (yay = almost time for me to go home) & she has had no urine output the entire we call her primary doc at 0645 (didn't want to wake him up with this news, so waited until the last minute...figuring he'd order fluids & we could hang them before we left). He tells my orientee (hey ,she needs to get used to calling md's) there is nothing more he can do for this pt, it's all a psych issue & he will not be ordering anything for her. Ummmm...what?? She has no urine output in over 12 hours. We can't give her fluids? Nope, nothing. Did I mention that the psych doctor had signed off? What a mess!

Two minutes later the stress lab is calling for report on her. I told them "ummm, I doubt she will be able to have a stress test today." They said they would still come & get her & if she refused...then she wouldn't have it done. I just don't think they were comprehending just how bizarre this patient was. Oh well, soon enough they would see.

So before we left, we repositioned her in bed as she now had the pillow over her head & her legs sticking out on the side of the bed...not exactly the way I like to leave my patients. She was all sweaty & still not speaking. Gave report to the lucky day nurse & wished her luck. She had seen this patient yesterday as her partner was the pt's nurse. I told her I'll be asking her next week what the doctors had to say regarding the pt's condition...because it was so not normal.

All I can think is that according to her history...she ran out of Celexa & just stopped taking it. I know you aren't supposed to do that with maybe that was causing the reaction we got. I don't know. Maybe the Thorazine just made it worse...with all those twisted arms and weird body positions. It was just very bizarre!!!!!!!!!

I'm curious to see how it all turned out.

I spent another weekend in Orlando. I pricelined it again (I need help!). I got Embassy Suites for $53 a night. Usually it's $123. Good deal, but lousy hotel. I usually like Embassy Suites, but this one was kinda trashy...which somehow got rated a 3.5 stars on Priceline. I have no idea how! It was cloudy & all rainy the entire weekend, so no sun for me. I did see The Other Guys...I found it amusing. Will Ferrell & Marky Mark are funny. If you don't like them, you probably won't like the movie.


Amanda said...

I cant wait to hear what ended up happening with the patient!!!

Cartoon Characters said...

It almost sounds like an extrapyramidal reaction to the thorazine. I have seen it happen in quite a few patients....generally cogentin is given to counter the reactions. It can be mild or severe.
It isn't an "allergic" reaction...just one of the side effects. Happens with the "zine" drugs.