Safety issues with TR patients

[stargatewtchr]

Just came of the worst 3 nights of my nursing career. Terminally restless patient had me in tears. I feel for the patient, but two people were hurt (sprained back and a cracked rib). When do we as a community draw the line between taking care of a patient and protecting ourselves?

[curiousauntie]

Sorry for your awful night. You didn't say if you work in a facility or in home settings, but either way, terminal agitation should be treated as an emergency situation. It may take a few hours to get it under control, but haldol, ativan and morphine have always worked for me. My last patient with TA was at home, with an elderly wife and daughter and son-in-law and we did continuous care for him for about 24 hours to get him under control. Haldol 4 mg q hour til calm, then q 4 hours, Morphine 20 mg q 4 hours and may repeat in 2 hours if sob or pain, (and he was having severe pain and sob, so the dose was warrented) and ativan 1-2 mg q 2-4 hours prn. We had him calm enough after 4 hours of hourly haldol that the family felt they could finally go to bed and get some sleep. We were able to stop the continuious care after another 12 hours or so as he was peaceful as a baby, and remained that way until he died 48 hours later.

I understand that if you are in a nursing facility, using medications like I wrote above may not be possible, but it does work, and usually very well.

[curiousauntie]

And I guess I will also answer your question

We cannot take care of the patient if we are injured, so I would say that we need to protect ourselves...and in an agitation situation, the more you can stay outside of swinging distance, the better off you are! Not to mention, if the restlessness/agitation is being heightened by close contact, that may help to decrease the situation. jmho.