I'm a pretty logical person, so I become absolutely at a loss when I have a disoriented patient who wants to do something that isn't possible. I haven't started working in the ICU as an RN yet because I just passed my boards this week, but here were some situations I encountered during my ICU externship last year where I didn't really know what to do:
Lady with breast cancer with mets to the lungs had SIADH. She had a foley in, and 2 chest tubes that pulled out 5L fluid the previous day, was on fluid restriction, and had Na in the 120s. She was a very sweet woman and didn't have hallucinations or anything blatant like that, but her behavior came off as being sort of hysterical at times and ranting & raving. She kept begging me to take out her foley because it was bothering her. But since her major issue was with fluids and Is & Os monitoring would be extremely important, I don't think that would have been a possible option. Also, with Na in the 120s...staff usually don't do the demands of patients who are not likely to be in their right minds. Except that she was technically A&Ox3. And she kept screaming about how she knew her rights, and she knew that she was allowed to refuse treatment if she wanted to and she wanted her chest tube & foley out right now!!! So, I didn't know what to do (and it wouldn't have been my judgment to make anyhow, I was just the student. But also the person who had to talk to this woman face to face for the longest period of time...). I mean, she does have the right to refuse treatment of course...but...what do I say to her? "Sorry, we think you're batty so you no longer have the right to refuse treatment"? I tried explaining why they were necessary, and offered her the morphine that she was prescribed if she had pain, but she didn't care about the explanations and didn't want the morphine. I tried giving her a backrub, distracting her by getting her to tell me stories, and those measures worked for short periods of time. She would get into a story and forget about the chest tube and foley for a while. And sometimes she'd fall asleep. But then she'd suddenly remember that she didn't like them again and start screaming again. *sigh* I was so worn out by the end of that day. What would you all have done?
Example 2: Recently extubated COPD patient was definitely disoriented. Kept insisting that I "check her mail" that was "right over there! Don't you see it!! WHY WONT YOU CHECK MY MAIL??". She got really aggravated with me because I wouldn't let her climb out of bed to go to the bathroom (fall precautions, had a foley in). I tried explaining to her that she had a catheter sitting in her bladder, and that she wasn't supposed to climb out of bed yet, but she was to confused to understand. So she was all like "help me put on my shoes so I can go to the bathroom" and "why are you aggravating me????" when I tried to keep her from climbing out of bed. *sigh* another tiring day. I tried combing her hair, distracting her, etc etc. but it didn't work for more than 2 minutes. What do you do with patients who are constantly trying to climb out of bed and picking at their lines and get really mad at you for trying to stop them from doing that? Do you just suck it up when they yell at you to "shut up" and "leave me alone" and keep at it? I mean...you can't very well just let them get out of bed or pull out their IV right? So what do you do?
Advice would be extremely appreciated.
Newbie ICU nurse