1. The Evil Roommate Psychosis Case

2. Presentation Mr. P is an 87 year old male Mr. P is an 87 year old male Multiple medical problems Multiple medical problems Concerned his roommate is trying to kill him Concerned his roommate is trying to kill him Upset, worried, refusing to eat because the food is “poisoned” Upset, worried, refusing to eat because the food is “poisoned” More confusion is not present More confusion is not present

3. Ongoing Health Problems Lung disease Lung disease Heart disease Heart disease High blood pressure High blood pressure Constipation Constipation Depressed mood Depressed mood Dementia Dementia Enlarged prostate Enlarged prostate Back pain Back pain

4. More Recent Health Problems Falls Falls Fall recorded 3 days ago Fall recorded 3 days ago Unwitnessed Unwitnessed Found on his bathroom floor Found on his bathroom floor No obvious injury No obvious injury More back pain More back pain Predated fall Predated fall More as needed medication required More as needed medication required

5. Medications Singulair Singulair Metoprolol and Enalapril Metoprolol and Enalapril Colace Colace Zoloft (sertraline) Zoloft (sertraline) Namenda (memantine) Namenda (memantine) Flomax Flomax Ultram and Tylenol (acetaminophen) Ultram and Tylenol (acetaminophen)

6. Assessment Normal vital signs Normal vital signs Laboratory tests all normal Laboratory tests all normal Oxygen saturation level normal Oxygen saturation level normal Has been having regular bowel movements Has been having regular bowel movements No recent mood changes No recent mood changes Pain is noted to be more frequent over the last 2 weeks Pain is noted to be more frequent over the last 2 weeks

7. Nursing Management CNAs endorse distress CNAs endorse distress Removed from areas psychosis more likely to occur Removed from areas psychosis more likely to occur Maintain distance between roommate and resident Maintain distance between roommate and resident Keep very active, even on the evening shift Keep very active, even on the evening shift Ask about particulars of the story to make sure the concern is not partially valid Ask about particulars of the story to make sure the concern is not partially valid

8. Nursing Management Allow him to eat near the nursing station or have family serve him food Allow him to eat near the nursing station or have family serve him food Monitor caloric intake and weight Monitor caloric intake and weight Make sure his hearing is not worsened or amplification devices/aides are used properly Make sure his hearing is not worsened or amplification devices/aides are used properly

9. Medical Management Medical conditions reviewed for likelihood of psychosis: Medical conditions reviewed for likelihood of psychosis: Depression Depression Delirium Delirium Worsened medical condition Worsened medical condition Heart disease, lung disease Heart disease, lung disease Medications Medications Ultram, Namenda Ultram, Namenda Dementia Dementia Head trauma from fall Head trauma from fall

10. Final Determination Likely from the dementia Likely from the dementia Initiated Seroquel 12.5mg at night Initiated Seroquel 12.5mg at night Discussed indication, side effects and course with DPOA and nursing staff Discussed indication, side effects and course with DPOA and nursing staff Nonpharmacologic interventions added to care plan Nonpharmacologic interventions added to care plan Specific intervention information for a care plan derived from the experience of nurses and CNAs Specific intervention information for a care plan derived from the experience of nurses and CNAs Reassessed on a routine basis Reassessed on a routine basis

11. Outcome Delusions about roommate dwindle Delusions about roommate dwindle No further worries about being harmed No further worries about being harmed Returns to room without much ado after one week Returns to room without much ado after one week Loses 4 pounds, but regains same Loses 4 pounds, but regains same It does prove beneficial to have them eat at different tables in the dining area It does prove beneficial to have them eat at different tables in the dining area No significant cognitive down turn noted No significant cognitive down turn noted Seroquel employed for one month, then used as needed for several months before being discontinued Seroquel employed for one month, then used as needed for several months before being discontinued