I learnt this lesson in geriatrics early on in my medical career:
Beware of opioid use in the elderly
That, and Always check your gloves for holes before manual disimpaction.
This reminder came about last week. I had the rare opportunity of sharing a patient with my fiancee, who's a cardiac surgery ICU nurse.
I saw Mrs. M before her surgery. LOL (Little Old Lady) with type 2 diabetes, admitted for aortic valve surgery. She was as sharp as a tack for someone who was 79 years old. Single, independent. After surgery, I followed her progress and worked on getting her off the insulin drip. That was when she spent a few days in the ICU. As I did my rounds, I told Mrs. M that I knew she was in good hands because she had my fiancee as her nurse, winking at Kris as I said so. She asked about our wedding, so we talked a bit. Despite her having a chest tube in place still.
After I left, apparently pain got the better of her. And she decided to use the PCA (patient controlled anesthesia, a nifty pain medication pump the patient herself controls). And boy, did the Fentanyl take care of the pain: She thought Kristin was her dog, Scruffy, and kept calling her to fetch.
She said that my honey's face was scaring her (how can that be possible??)
She thought the laundry bag in her room (for soiled blankets) was a person riding a horse.
She told her family members that Kristin and I were going to change our wedding date so that she could attend.
She was singing Jingle Bells and Here Comes the Bride (to which my Kristin sang along to, to pacify/humor her. That, in the ICU, must been quite a sight).
And when I came by a few hours later to check on her, she thought I had been drinking. I said I haven't, but if she were to find some beer, to be sure to tell me so that we could share. I got a giggle from another nurse with that.
Anyways. 4 days and a pacemaker placement later, I again saw her in the CV Surgical ICU. I asked her who Scruffy was. She looked at me in puzzlement and asked if I was trying to read her mind. She had no recollection of her antics the other day. And so I told her.
Despite being anemic from 2 surgeries, she blushed a deep hue of violet. And made me promise to relay her apologies to my fiancee.
As I left her room, I turned around and told her new nurse:
"No more Fentanyl for her!"