Sometimes you see something that is pretty peculiar, and you wonder, 'Is that SOP here???'

My brother had both knee joints replaced a few days ago. He has been doing fine.

Today, they moved him across the street to a rehab-convalescence place. My sister works at the hospital, so she ran over to see if he was settled in.

He was acting oddly, talking randomly, repeating himself, twitching and fussing, and someone told my sister that they had given him something for pain, which had escalated in the last 24 hrs.

While she was there, a nurse (a real nurse, not a clerical flunky) came in and asked him questions, and he was looking out the window and acting like things were crawling on him, and the nurse asked him if he understood the questions. He said he understood, and he KEPT saying he understood, even when no one asked. Then she had him sign a paper saying that he had understood what she was telling him.

Does this sound right? Give a guy a painkiller that makes him act weird, then ask him questions and have him sign something?

Sue

WRONG have him checked, he may be having a reaction to the "drug"

Mike

Sounds as though he may be having an Allergic reaction to Opiate-based pain meds or possibly too Strong a dose,hence possible Hallucinations,Also it is quite common for many folks to Scratch themselves,for the feeling of something crawling on or under your skin,or tingling nerve sensations,Mainly from Opiate-based pain meds.Talk with your sis to see if they can change his pain med to Non-opiate based such as Demerol & observe the difference,if any!Good Luck with This!

I'm not in medicine, but I would find somewhere else for your brother, or get another doctor's opinion, get another doctor to intervene, etc. This doesn't sound good at all.

Do you think your brother really understood what the nurse was telling him? I guess you're asking because having him sign the paper seems like a way for the hospital to cover its legal liability.

Da Bing

First off, that's NOT an allergic reaction. It probably is a histamine release, which opiates can do, which causes formication (ie, "bugs on the skin" feeling). Honestly, a little benadryl might have fixed it.

Does of the drug was probably too high. Whether he was competent to sign or not is actually a legal question. As long as he's oriented to name/date/circumstance, he's usually considered capable of making decisions.

However, the nurse SHOULD have spoken to someone higher than her before signing. Not technically illegal, but the legitimacy of his understanding is questionable.

Long story short most nursing/rehab facilities suck (probably 80-90% of them in my experiences). I'm not sure where they get their nurses, but I've routinely seen folks lying in soiled diapers to the point of bedsores, people with difficulty breathing getting oxygen by a mask at 2 liters/min (min for a mask should be 8 - essentially the nurse is suffocating them), everyone going on lunch break together and leaving EVERYTHING unattended. I'd sooner euthanize my parents than put them in one.

Very best thing you can do is have someone there as much as possible. The more you're in the way, the more the nurses have to do their jobs, or questions tend to get asked of the supervisor/charge nurse, ie "how come his pain meds are late? Where's his dinner? He pushed the call bell for 30 minutes." Stuff like that gets written up, and that leads to job insecurity.

If that was my loved one, he'd be out of there that very same day.

Your brother needs an effective advocate for his care needs while he's recuperating away from home. Your sister is nearby and actually works in the hospital across the street, that's great - she should raise your brother's condition with his primary care doctor, attending physicians giving care right now or who operated on your brother, the nursing staff at the rehab facility, and focus their attention on it. Many hospitals have drug interaction clinics known by various names, medical consult is one used at the UW Medical Center, they specialize in reviewing patients pre- and post-op for bad drug interactions. Find out if this hospital has one. Ask them (or rather ask the attending physician to prescribe) this type of service to visit your brother. Polite but firm usually does it. Medical consult exists primarily to foster good medical outcomes, and avoiding bad ones, which cost hospitals time and money through lawsuits and complaints.

As to signing a document, I can't speak to that - but it may be important to note that while in a care setting, if your brother is the only person able to sign documents and assist in making his care decisions, the nurse may have pursued the only avenue open to her in seeking his approval for his care, even if he was having a drug interaction. The fact that the nurse kept asking the same questions may be indicative that she was probing a difficult to assess patient for some essential level of coherent decision making, one that indicated he was cognizant of his health status and could make decisions for himself. I don't know your brother's status, if he entered care with a wife or someone else who he designated to make medical decisions for him should be become incapacitated. I can tell you that almost any medical professional would rather seek more care for a patient having difficulty with a medication, even transfer a non-responsive patient back to medical care than continue with them on their post-op service.

As MDinana says though, post-op/rehab facilities can be hit or miss, and pain management is the area that facilities tend to bull through and err on the side of management, on the understanding that a patient with normal vitals and restricted mobility may not tolerate the pain of knee replacement, but the nursing staff can tolerate confusion, twitching and fussing. If the pain management is short term that is. There are fewer physicians in a rehab facility to monitor their reaction to meds and other things. Its often left to what was prescribed on an outpatient basis, and nursing staff. Like I say, I've seen folks try to bull through pain management, its not always good, you need some good caregivers and usually some effective patient advocates with eyeballs on the situation pitching for other alternatives.

Okay, thanks for the info. I'll be going in there today and see what the current situation is.

Since both knees were done at the same time (apparently not the usual), the hospital suggested that he stay there a few more days, but his insurance co/Medicare said he would have to pay the 6X difference in cost, and he can't.

He was given two choices for rehab/convalescence and my sister and I both nixed the other place (bad rep for years).

And I will have Sis talk to his doctor if things haven't improved by today.

Thanks again for all the tips and information. None of us have much actual hospital experience... kind of makes you wonder if that is good or bad, I guess.

Sue

Good luck Susan, and a speedy recovery to your brother.

If you have a few minutes, do a google/bing search on phrases like "caring for a family member during hospitalization", that will lead you to some articles that give tips on working with hospital staff. My mom, dad, wife and brothers and sisters have all received hospitalized care at one point or another sometimes for serious issues, sometimes more routine. You can see the care givers really doing their best most often - but when there's a family member there who can tell when Old Ed isn't responding like hisself, or who knows that certain meds make him nauseous (and he may not be awake to refuse them), it lets them apply alternatives and can lead to better care a speedier recovery. Some folks figure its just keeping the staff on their toes because 'someone is watching', and there has to be some of that, but in fact nurses and doctors are happy to have another set of eyes and ears watching and giving care (family care) to their patients while they are busy with maybe more urgent cases.

I think you have to find out what was being signed for to really answer this question. It could be that permission was needed (a liability waiver?) to change painkilling medication or go on another medication to prevent blood clots for example, but again this is only speculation.

But from what you have described this sounds like a reaction to the pain medication i.e. a reaction to something like dihydrocodeine.

http://www.netdoctor.co.uk/medicines/100000744.html

there could also another possible cause of postoperative confusion, especially after orthopedic surgery.

http://mpatkin.org/surgery_clinical/post_op_confusion.htm

I hope that your brother makes a quick recovery.